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Resource Networks:

An alternative to clinical supervision

By Roger Gilbert M.A.  D Hyp (dist.) MBSCH

This article is concerned with “clinical supervision”, the practice whereby a therapist sees a supervisor to talk about clients. It is not about supervision in the sense of “tutorial”, that is to say a meeting when a student meets with a tutor for the purposes of tuition.

[In this article, I use the word “therapist” to cover therapists of all descriptions including counsellors. For convenience, I shall speak of supervisors, therapists, and clients in the male gender to avoid having to write s/he etc. For the avoidance of doubt, I believe that male and female supervisors, therapists and clients are all equally competent!]

Supervision essay
Roger Gilbert

Roger Gilbert is a full member of the BSCH having passed the diploma course with distinction in 1998.

He completed the Practitioner Diploma in 2004.
He
became an NLP Practitioner in 1989 and was awarded a Master Practitioner certificate in 1992.

He has a certificate in counselling skills. He has been in

practice since 1993 and from 1993 to 2000 was a member of a university counselling service.

He has been a solicitor since 1982.



The move towards clinical supervision

In the last couple of years, the question of clinical supervision has cropped upwith increasing regularity in BSCH literature. The BSCH now puts on a course in Clinical Hypnosis Supervision so that members can learn to become clinicalsupervisors, and the BSCH has recently appointed a Clinical Supervision Officer.

It does not seem unreasonable to infer that it will not be long before it isproposed that all BSCH members must undergo regular clinical supervision.

I am surprised that the BSCH is heading in this direction, because, as far as I am aware, there has been no debate on whether clinical supervision is something that members want, or whether it is in any event something of benefit to members.

The argument in favour of clinical supervision is that it is part of good practice. However, I have had extensive experience of clinical supervision and have thought about it carefully over 13 years of practice. The conclusion I have come to is that clinical supervision – whether compulsory or voluntary - is a model of practice which members should reject.

Resource networks – a better way forward

I am all for increasing the general standards of therapists, and passionate about developing my own skills, and my view is that the most effective model is is for members to set up their own resource networks of fellow therapists so that they can obtain and offer support as and when needed. It also happens to be cheaper than clinical supervision.

I can speak from experience because in January 2001 I set up my own resource network of therapists and NLP practitioners, and we have met once a month ever since to discuss clients, personal issues, practice issues, courses, to share ideas, and generally to encourage each other. Over the same period I have also had regular meetings with an NLP trainer for the same purpose.

 

This may sound like clinical supervision, but it is quite different in character. It is like the difference between doing an evening class because you enjoy it, and doing an evening class because your employers require you to.

I call it “resourcing” to reflect that therapists are pro-actively creating and using a resource for themselves. It also has the following benefits for members:

1. It is free.
2. It is very easy to set up.
3. Therapists only meet up as often as they want to.
4. There is complete flexibility of format.
5. All therapists have equality of voice.
6. Therapists benefit from being a resource for others.
7. Therapists use it to get the help they want, rather than to hear what someone else thinks they need.

My discussions with other therapists indicate that this is precisely the type of support that they value.

Good practice

This model of practice is in line with the assumptions which I believe underlie good practice, namely that: -

1. I, as therapist, have all the resources and abilities I need to help my client to change;
2. My client has all the resources he needs to make the changes he wants to make (including the ability to ask for help);
3. My client knows more about his life than I do;
4. My client is perfectly able to decide for himself whether he needs help and is gaining benefit from seeing me;
5. The best way to help my client is to focus on strengths and achievements and solutions, rather than problems;
6. One of the aims of therapy is to help my client to become more able to make his own decisions about his life - which I can best do if I am communicating beliefs 1 to 5.

Having thought about this long and hard I do not see how good practice could be underpinned by any other assumptions1. For example, if you as a therapist believe that you are better able than your client to decide whether he needs your help (something which I have more or less heard stated explicitly by some therapists) you and your client are in trouble.

The assumptions listed above apply equally where the person asking for help is atherapist who would like help in working with a client - in which case substitute the words “the therapist” for “my client”.

Of course there are times when I, as a therapist, feel the need to discuss a client with a third party – perhaps because I seem to be running out of ideas, or perhaps because some ethical issue has cropped up. The ability I have to be aware of this need is one of the resources I have as a therapist.

However, in my experience, I can go for weeks without needing to discuss any cases with someone else. This is not because I am complacent in my attitude, but because the work I am doing is plainly going well from my own perception and from the information I am getting from my clients.

The case against clinical supervision

Before we can consider the case against clinical supervision, we need to consider what it is and the case put forward in its favour.

What is the case for clinical supervision?

Clinical supervision is the process whereby a counsellor or therapist meets a “supervisor” to discuss his or her cases. This might be a one to one meeting between supervisor and supervisee, or it might be a group supervision where up to five or six people meet with the supervisor and each in turn discusses his or her cases.

For some schools of therapy clinical supervision is voluntary – as is currently the case for members of the BSCH. However, for some schools of therapy, particularly those deriving from or influenced by psychoanalysis, individual supervision is compulsory.

The psychoanalytical roots of clinical supervision are evident in the BSCH course which covers such subjects as “the psychodynamics of supervision”, “transference” and “counter-transference” which are all terms from the psychoanalytical approach to therapy. However, many modern approaches to therapy do not find the ideas of psychoanalysis helpful and I find it surprising

Over the years, I have heard a number of arguments put forward in support of clinical supervision, such as:

1.
Other schools of therapy believe that clinical supervision is a necessary part of ethical practice;
2.
Having regular clinical supervision will make us more “professional”.
3.
A therapist needs regular clinical supervision to ensure that he keeps his own “stuff” separate from his client’s “stuff”.
4.
A therapist needs regular clinical supervision to deal with the stress of practice.
5.
Newly qualified members of the society have asked for it.

All of these arguments for clinical supervision spring from a certain point of viewof the therapy or counselling process and one which I reject entirely.

The case against clinical supervision

My objections to supervision are twofold: firstly, that the term supervision is awholly inappropriate label for the process for which it is used; secondly, that the assumptions underlying the term “supervision” are contrary to the assumptions which underlie good practice.

An inappropriate label

The term “supervision” (and the cognate terms “supervisor” and “supervisee”) is an entirely inappropriate label for what goes on under the guise of clinical supervision2.

In my dictionary, the verb “to supervise” is defined to mean “oversee, superintend execution or performance of (thing), movements or work of (person)”.

What actually happens in clinical supervision is this.

A therapist tells his supervisor (or his supervision group) about a client and about what the therapist believes has happened in the therapy process. Obviously this is a subjective account, based on minimal experience of the client3, and moulded by the therapist’s experiences, theories and beliefs about therapy and the client. Frequently, the therapist is giving an account of a therapy session or events which happened several days or weeks earlier, when recollection has faded.

The supervisor or group listens to this one-sided subjective account and discusses it with the therapist. They try to fit what the therapist has described into their own experience and/or theories about therapy and, on the basis of a five or ten minute presentation, suggest theories about the client, whom they have never met, and suggest ways forward for the therapist.

Subsequently, the therapist may or may not ever see the client ever again. If he does, it may well be several weeks later, when the therapist is again working on his own, and, if he is doing his job properly, will use his judgment in the session as to what he should do – which may be the opposite of what his supervisor recommended.

To suggest that the therapist is being “supervised” by the supervisor or by his supervision group is a delusion. It is no more supervision than if a teacher were to say that hearing an account of last month’s history class is tantamount to supervising tomorrow’s!

Since supervision is a delusion, it is time to dispose of the concept and look around for a model that is, to use a fashionable phrase, fit for purpose.

The assumptions underlying clinical supervision


If there is one thing which therapists should be aware of, it is the power of words and the unconscious associations they carry with them.

My second objection to the terms “supervision” is that to label someone a “supervisor” carries with it explicit and implicit assumptions that the supervisor is more skilled or experienced than the therapist, and knows or ought to know better than the therapist being supervised what is happening in the relationship between therapist and client and is in a position to judge or assess the therapist’s work.

This is not fanciful: I have met people who have told me with an air of superiority: “I don’t see clients any more – I supervise other therapists”. The implication being that they are practising on a higher level than the lowly therapist. This belief is perhaps inevitable where the supervisor has perhaps been in practice longer than the supervisee, and has attended a course on supervision4. Needless to say I do not agree with this belief.

Nor is the use of the term “supervision” with these associations accidental: clinical supervision was introduced by Freud specifically to ensure that his disciples practised psychoanalysis strictly as he developed it5.

This may no longer be the supposed objective of clinical supervision. Nevertheless, to place people in the role of supervisors is to set up a belief that their job is to “supervise” the therapist and make sure that he does the right thing with his clients. This is not a useful belief: firstly because, for the reasons I have explained they are not in fact supervising the therapist; and secondly, no matter how long they have been in practice, and no matter what courses they have attended, any opinion the supposed supervisors form on what the therapist should do with any particular client is based on hearsay. The person who can form the best view of what is required in the therapy session is in fact the person delivering it.

Placing a therapist in the role of “supervisee” is equally pernicious. It is fundamentally disempowering, because, it moves him from the frame: “what is my opinion on how to proceed with this client?” to “what is my supervisor tellingme to do?”

It does not take much thought to realise that the process of clinical supervision runs counter to the assumptions underlying good practice which I have set out above.

Other professions

It is worthwhile at this point considering the practice of other professions such as barristers, solicitors, doctors, accountants, surveyors, and insurance brokers.

None of them are required to undergo a process equivalent to clinical supervision6. As appropriately qualified professionals, they are assumed to be competent and expected to take responsibility for their work7.

I have been a solicitor for 24 years. I have never been required to have supervision to discuss my files. I am expected to take responsibility for my work – which includes taking responsibility for consulting others when needed.

The advantage of resource networks over clinical supervision

The “resourcing” model of professional growth is fundamentally different from both the model of clinical supervision, as can be seen in the following contrastive analysis:

Resourcing

Supervision         

Is free

Therapist has to pay         

Therapist is pro-active

Therapist is reactive       

Recognises equality of voice  

Sets up “expert” who has the answers  

Puts the therapist in charge of his own development

Undermines the autonomy of the therapist         

Assumes that the therapist knows best how he can help the client

Therapist is not a resource for others    

Encourages the therapist to take responsibility for his therapeutic decisions    

Encourages the therapist to look to someone else for the right answer              

Summary

It is not difficult to see that all the supposed arguments in favour of clinical supervision fall away.

Argument for supervision

Answer         

1. Other schools of therapy claim that clinical supervision is a necessary part of ethical practice

The fact that some therapists operate a flawed model is no reason for members of the BSCH to do so.    

2. Having regular clinical supervision makes therapists more professional

It does not: it undermines the therapist.     

3. A therapist needs regular clinical supervision to keep hisown “stuff” separate from his client’s “stuff”

No he does not – any more than a practitioner in any other profession needs supervision for such purposes. 

4. A therapist needs regular clinical supervision to deal with the
stress of practice.

The Ericksonian approach, which focuses on the client’s strengths and achievements and producing successful outcomes for the client, is far less stressful for the therapist than approaches which focus on problems. As a therapist you have all the skills to deal with stress.

5. Newly qualified therapists have
asked for supervision

You have all the resources you need to help your clients. The only way you will learn
now is by using them. Rather than look to
someone else to supervise you, have confidence, take responsibility and set up
your own resource network!         

Conclusion

Consideration of the process and of supervision and the assumptions underlying good practice show that the supervision model is counter-productive and should be discarded.

On the other hand, it is a great benefit to have other professionals whom you can consult on a basis of equality. If you are a therapist and do not already have a group of other therapists whom you can use as a resource or – as importantly – for whom you can be a resource, I encourage you to approach other local practitioners and set up your own resource networks.


Notes

1 These are rebuttable presumptions, but the hurdle of evidence to rebut the presumption must be a high one

2 You may notice that throughout this article I have studiously used the term “clinical supervision”, this being the term used by proponents of the process. The term “clinical” is redundant save to add medical associations and – in my view - a spurious sense of importance to the whole process.

3 Eg perhaps an hour or two in the context of the therapy room: the therapist has not seen the client in any other contexts in his life.

4 The literature advertising the BSCH course says that it is for “experienced hypnotherapists”

5 Freud himself did not need supervision of course. Nor did Milton Erickson have supervision in Ericksonian hypnosis. It would be interesting to know how many, if any, of the “names” in the therapy had supervision.

6 As distinct from being supervised, in the sense of managed, if employed.

7 For anyone who argues that therapists are different from the other professions because they are in a particularly demanding profession, or that therapists’ clients are particularly vulnerable, I disagree: my work as a solicitor is far more demanding emotionally than my hypnotherapy practice. Further, if you are a client who has entrusted your finances to a professional, a mistake by that professional can be far more stressful than a hypnotherapy session which did not cure a phobia.

If you would like tips on how to set up or run your own resource group, Roger Gilbert will be delighted to
give
them
. His email address is: roger@rogergilbert.co.uk

© 2006 James Braid Society; all rights reserved