Clinical Supervision

Walking alongside emerging psychologists in training is a joy. It is a unique privilege, one that requires humility, disciplined reflection, and a versatile and robust fund of knowledge. Training and education are building blocks of our growing profession. Without question, providing clinical supervision to predoctoral interns and allied professionals has deepened my understanding of the art and science of psychotherapy. The inherent reciprocity of clinical supervision yields many, many gifts. 

I am a better person.
I am a better educator.
I am a better counseling psychologist.

At the culmination of my predoctoral internship, the universe created a pathway for me to remain in college student mental health. Before the completion of my first year as a Staff Psychologist, I was promoted to an administrative role, Assistant Director of Training Programs, at Duke University CAPS. Funny how life unfolds: There, I was able to jointly oversee a predoctoral internship program in which I trained as a student. Balancing my time between clinical services (individual and group psychotherapy) and training and education resulted in unapparelled opportunities for growth. Program oversight taught me valuable lessons in the arena of institutional bureaucracy. I helped to conceptualize and implement a robust 12-month training program for an APA-Accredited predoctoral internship for 3 students. I independently coordinated the clinical program for 2 MSW students. Working on a multidisciplinary team of talented professionals created an atmosphere of earnest vulnerability and innovation.  Moreover, one of my favorite experiences as the ADT was participating in a 1-year advanced clinical supervision certificate program at the world-renowned Smith College School for Social Work in Northampton, MA. My understanding of and love for psychoanalytic and psychodynamic theories was nurtured, reimagined, and solidified. 

After several years as the ADT, I advanced as the Director of Training Programs and Assistant Director of Duke University CAPS. Serving in these capacities increased my administrative influence for the training program and agency, respectively. Though the dual roles were sometimes challenging, I remain thankful for knowledge acquisition and the extensive and intimate training of bright psychologists and social workers. 

So, what do I value in clinical supervision? I'll outline a few pillars:

Curiosity and Self-interrogation. As “fellow travelers” (Yalom, 2017), psychologists cocreate a “holding environment” (Winnicott, 1953) with those whom we help and guide. Our clients, brave in their own right, entrust us to master the art of displaying curiosity. We help “fellow travelers," or clients, cultivate a greater capacity to introspect, discover, confront, and reconcile parts of themselves that need attention. An effective psychologist is refined in their ability to honor cultural humility in a way that engenders intimacy and shared vulnerability. This task, I would argue, is rightfully facilitated by way of self-interrogation. Psychologists and allied practitioners are ethically charged with pursuing continuing education opportunities that, ideally, provoke thought, learning, and an honest accounting of personal choices and behaviors. Undoubtedly, practitioners must wrestle with personal matters that substantiate one fact: We are all human. An ideal trainee holds in mind the importance of curiosity and self-interrogation, both as it pertains to those we serve and ourselves.

Mutuality and Intersubjectivity. My supervisory style is experiential and relational. This dovetails nicely with how I approach psychotherapy. What helps you to feel connected to other people? What comes to mind when you imagine yourself as an “instrument of change”? What is your understanding of countertransference and how, if at all, do you use that information therapeutically? In clinical supervision, inordinate focus can be given to client welfare; this partly makes sense given the context and our professional charge. However, the “I-Thou” relationship (Buber, 1958) must remain an ongoing topic of discussion. My experience suggests that it is extremely easy to obfuscate, evade, or dismiss how practitioners, especially those in training, bring themselves to bear on their work as healers. As such, my value and ethic is to support trainees in repositioning themselves as someone who is with clients, as opposed to someone who “does stuff to” clients. 

Criticality and Nuance. Ecological variables, history, and systems organize society and thus remain interrelated with our experience of the world. Often, ahistorical or post-positivistic ideologies dismiss subjectivity and the role of our environments. Resultantly, people are more inclined to denounce having an “agenda,” which is otherwise seen as biased or improper. I resolutely disagree with this sentiment. My socialization as a scholar-activist-practitioner informs much of what I do, including the critical consumption of knowledge. This conviction is not value-neutral, and neither is objectivity. My “agenda” is premised on a liberatory epistemology and praxis. I have no qualms about “outing” myself, or publicly owning what some describe as a “feminist sensibility.” Our historical moment, both beautiful and horrific, tasks me with promoting mental health resources for everyone. I have many privileges because someone is marginalized. I have vulnerabilities that are created or exacerbated by our systems, our laws, and social traditions—so, too, do our clients.

In clinical supervision, I invite trainees to think aloud about what they know, how they know it, and who benefits (or not) from said knowledge. Also made clear is the idea that, if we are to make our society more equitable for everyone, I may be required to give up a few privileges. This is different, in my mind, from a zero-sum game. Rather, the statement propels an individual to think about how they amass unearned benefits, including psychic freedom and attention. It’s tempting to critique others as more privileged power hoarders who need to relinquish control or ownership of a resource. Externalizing, in this case, is a form of defense and absolves a person from taking action in real time.

Theoretical Parsimony. Having previously served as the Director of Training Programs at Duke University CAPS, I spent a substantial amount of time teaching a wide variety of theoretical orientations. In fact, creating didactics and other activities to expose psychology interns and MSW students to the wonders of theory was a preferred pastime. Developing a robust regimen of theoretical study, along with regular lessons with interns, radically changed my understanding of the art of psychotherapy. A significant portion of my doctoral training emphasized evidence-based schools of thought, namely, Cognitive-Behavior Therapy and other third-wave modalities. With further study, however, I eventually came to realize that CBT does not have a monopoly on empirical support, despite popular belief. Psychodynamic and Interpersonal Process theories are informed by rigorous study and observation. Additionally, randomly-controlled, quantitatively-grounded approaches to psychological inquiry are tools to make sense of phenomena, not the sole methods. There are multiple ways of knowing, of learning. I provide this brief overview to underscore the usefulness of taking seriously the task of familiarizing oneself with foundational knowledge and theoretical precepts. Facility with respect to theoretical propositions is garnered when the focus is singular, as opposed to a compulsory positioning of oneself as “integrative” or “eclectic.” I provide technical guidance and support in helping a counselor-in-training carefully catalyze experiential strategies, employ immediacy interventions, explore latent and manifest functions, and monitor transferential reactions.    

Openness to Feedback. With respect and compassion, feedback is an authoritative tool in clinical supervision. Germane to feedback is the conscientious use of power and timeliness. I believe in highlighting a person’s strengths, as well as foregrounding areas of growth, in clinical supervision. It’s possible to effectively use strengths and resiliencies to bridge growth edges. This approach increases the likelihood of a trainee feeling safe, understood, and ultimately willing to take risks in psychotherapy. As a trainee, I grew most when high expectations were commensurate with high support. Cocreating this learning environment with junior-level providers is a priority. Ultimately, a supervisee should expect to be challenged, remain accountable, display curiosity, and welcome (appropriate) laughter. Finally, I view feedback, positive or constructive, as ongoing and symbiotic. This ethic will help us monitor shifting power dynamics, among other relational factors.

“Supervision is an opportunity to bring someone back to their own mind, to show them how good they can be."

– Nancy Kline