The Basics of Clinical Supervision
Lately, I’ve found myself in a lot of conversations about clinical supervision. If you’re getting ready to graduate from your clinical program in one of the mental health professions, it’s time to start thinking about your own clinical supervision.
Prior to obtaining your license as a professional counselor, social worker, or psychologist, you will be required to obtain 1500-4000 hours under clinical supervision. If you are fortunate enough to work in an agency, hospital, or school, it is likely that your employer will provide clinical supervision for you on site at no expense to you. If that’s the case, consider it a benefit of the job.
However, if following graduate school you attempt to go directly into private practice (as is the option in some states) or end up working for an employer that does not provide your clinical supervision, then you will need to find a supervisor and pay for supervision on your own. (Look for 10 Questions You Must Ask Your Potential Supervisor next week to learn more about how to find a great supervisor.)
"Money Jar" by Automania / Mike
Supervision and Money
I’m not sure why but not one of my professors in graduate school ever thought to talk with us about those additional costs that we would incur following graduation. So . . . let me break the news to you. . . .
One of the many reasons you may want to start out working for an agency that provides your clinical supervision is that it can be expensive if you have to pay for it on your own. If you are paying out of pocket, you should expect to pay whatever a typical clinical hour costs in your geographic area.
I charge the UCR – usual and customary rates – for those working on the Front Range in Colorado. My fees are $100 – $125 / hour for individual counseling and $60 / hour for group counseling. I charge the same rates / hour for clinical supervision and you will find that most reputable supervisors charge based on their hourly clinical rate as well.
Too Expensive
If you find those rates to be objectionable, you have a right to understand why these are actually reasonable fees and that good supervisors are not simply gouging you for “easy money” (as one new graduate noted this week on a discussion list). Here are some things to consider . . . .
- The professional standard for clinical supervision has shifted in recent years. Your clinical supervisor is now expected (and in many cases, required) to obtain formal training in clinical supervision at her own expense. In the State of Texas, that requirement is a minimum of 40 hours plus ongoing continuing education in the area of supervision.
- Your clinical supervisor is legally and ethically responsible for each and every client that you come in contact with. S/he is also responsible for every decision that you do / do not make and every action that you do / do not take. That’s a LOT of additional responsibility.
- Your supervisor is responsible for reading every bit of your initial client assessments, progress notes, all correspondence, and termination paperwork and providing feedback as needed. That’s a LOT of time.
- Your clinical supervisor will typically meet with you on a weekly basis for 1-2 years. That’s additional time out of her schedule every week s/he could be using to see a client and earn her hourly fee.
- During your weekly meeting with your clinical supervisor, s/he is required to essentially develop your abilities as a mental health professional. Her roles will alternate between teacher, mentor, consultant and evaluator.
- For every hour that your clinical supervisor spends with you, s/he is most likely spending another hour in preparation — completing paperwork, refining a plan to help develop you as a counselor, gathering materials, reviewing literature to meet your unique needs and interests. That’s MORE TIME.
- Your clinical supervisor remains on call for you 24 hours / day.
- And, long after you have completed your hours of clinical supervision, s/he remains liable for all those decisions you made while under supervision. Assuming you are seeing 20-30 clients / week while your supervisor is also seeing that many clients / week, her choice to supervise you, in effect, doubles her risk of being sued.
I’m sure there are other risks / costs involved in being a clinical supervisor. If you can think of them, please share them with us here so that new graduates will have a clearer understanding of why fees are set the way they are.
And, if you are a new or soon-to-be-new graduate who is considering clinical supervision, let me know if any of this is new information for you.
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Yes, this is news for me, I had no idea that supervision would cost. Thanks for this information. Brian
So glad to be of help! My graduate program was really great BUT there was so much more to learn!
I would like to point out that the services you are outlining should be provided by the supervisor do not necessarily appear to be followed by all supervisors (and may not be required in all states). While my personal experience with post-graduate supervision has been great (partially because I have a great person as my supervisor and partially because Michigan has set requirements for training etc. of the supervisor), it appears that supervision usually is limited to assuming legal and ethical responsibility for the clients and meeting with the supervisee on a semi-frequent basis. When that is the case, it truly is a matter of making easy money, especially with the prices that are charged.
It currently appears that there is a lack of qualified supervisors available, at least in some areas of the country, which will perpetuate these practices – and frequently, graduates are held hostage by the need to obtain paperwork documenting supervision rather than actually get supervision. That is a problem.
Personally, I don’t believe graduates would have too many objections to paying for the quality of supervision you are outlining above – I just question the extent of it actually happening that way.
Hi, Tore! Thanks for joining in the conversation. I think what you are describing as less-than-ideal supervision falls into the category of administrative supervision (which is very different from clinical supervision). I’ve got a post coming out later this month addressing this issue so I hope you’ll check back in as we continue the dialogue.
The bottom line for me is this . . . if a therapist is pushing just to get the supervised hours completed and is not getting quality clinical supervision, she’ll pay for it down the road. She’ll make mistakes, struggle with what to do, may harm her clients (with the best of intentions), and may find that she ends up being sued.
You sound as if you’ve been out of school for a little while and in the work force now. I really appreciate that you are continuing to voice your concern for the development of other counselors that come after you. Looking forward to hearing from you again.
Hi,
While I respect your description of what YOU do as a supervisor, I do not see that at all in Hawaii. First off, there are NO requirements for supervisors, not even length of time in practice, let alone training. There is also no allowance for pre license grads going into private practice (unless they can find all cash clients who are willing to pay for counseling from someone who is not allowed to say she is a mental health counselor). Many sites do not provide supervision so we are forced to pay for it. The additional liability supervisors take on in this case is minimized by the fact that the sites will most likely be sued rather than the supervisor of the counselor who doesn’t even work there. From what I have seen, no supervisor is offering to read all our notes or spend a bunch of extra time on us – just charging for the hour or more we spend in group or individual supervision and that’s it. And being available 24/7? – in your dreams! I’m not sure what it is like in other States but I think your description may be very idealized compared to what many (most?) of us grads are really dealing with. For perspective from the other side – how would you like to be forced to pay $250 – $500 a month out of a salary of $30K – 40K (going rate for unlicensed counselors at agencies around here). That is, if you are lucky enough to even find a job as the State of Hawaii continues to decimate mental health services with extreme budget cuts. Many of us work part time or on contract with no benefits and STILL have to pay these rates for supervision. Luckily, we have a sympathetic professor who may get a supervision class going as a continuing ed program – otherwise we might be forced to take on another job just to pay for supervision! I’m sorry but i do fee gouged – your comments have not convinced me as they are so very far away from my own experience.
Hi, Shari! Thanks for joining the conversation here. It sounds as if you are totally frustrated and I don’t blame you! Having less than adequate clinical supervision and paying good money for it would certainly sour my outlook on the profession. I want to offer you some steps to take that may help you improve your own and others’ situations. I’ll try to get a post out next week that does that.
However, in the mean time, if you are seriously looking for a better solution for your clinical supervision, I would be happy to post on this blog a job description and call for competent clinical supervisors in Hawaii if you can draft it and send it to me. Our online community here is mushrooming quickly and we can use this to find resources that you, as an individual counselor, may not.
Let me know what you think about my offer and check back in next week to see a related post.
It seems to me that there is an ongoing racket collecting fee’s from social workers. The supervision requirement is a major barrier to incoming professionals and students. After 50K on a master’s degree in social work I now need to pay $100 an hour for supervision? Even after you pay the hundreds for a lame license exam that admittedly does not test the body of knowledge learned in school, the student is again fleeced for ongoing “continuing education” hours that if he fails to continue to pay out for every year then his license lapses and pays even more fees. The whole system for becoming a therapist is dysfunctional. I completely agree with Shari. Social workers are getting payed 40k with a license! How are we supposed to pay these crushing fees and meet these requirements?! I have worked in Utah, Colorado and Nevada and i can tell you first hand what a complete waste of time most of the “continuing education” classes are. They are a requirements that simply collect fees and check off a prerequisite box. It is amazing how many people block you from doing what you already know how to do…and how many of them are social workers! I have been working in the field for over seven years and still cant get my license because i cant find supervision that qualifies. Companies either hire Licensed social workers (lcsw) or “mental health counselors” that they do not offer supervision and pay 11-14 dollars an hour. It leaves me feeling like you are either in the club or barred from entry. If I had known that even after I got a masters degree there would be nothing but blockade after blockade to actually being allowed to work, I never would have gone to grad school.
Hi, Donald! Thanks so much for dropping in to chat! Wow! You’ve really had a rough time! If I’m reading this right, you are looking for clinical supervision by a licensed social worker? On second thought, perhaps you are looking for employment? Donald, I’m happy to help you network to find what you are looking for if you can let me know exactly what that is and where you are willing to go for it.
I’m sure that there is a racket out there somewhere for social workers and other mental health professionals. However, what I have found is that there are gaps in communication between the graduate programs and students, between potential supervisors and professionals in training, and between professional development opportunities and the professionals out there looking for those opportunities. Building a network of professionals and professional resources is critical to survival as a mental health professional for just these reasons. Those who remain as silos can’t survive (much less thrive) in mental health.
By the way, Donald, I wasn’t impressed with most of the continuing education opportunities that I found when I moved to Colorado, either. Those states that do not require continuing education (yes, they did / do exist) for mental health professionals are not likely to draw high caliber professional development / training. Fortunately, Colorado finally enacted requirements for professional development and are phasing them in even as we sit here! You may have to be a bit creative to get the ongoing training that we all need to build our skills and grow our competence as mental health professionals. You may want to consider putting your own workshops together and inviting more experienced therapists to present, crossing your state lines to attend trainings that are higher caliber, or even seeking distance courses to keep you sharp.
Quality clinical supervision is worth pursuing. Your learning curve under the right supervisor can be greater than everything you learned in graduate school and have direct application to the work you will do with clients. If that has not been your experience, . . . keep looking for the right supervisor. They are out there and worth every one of those $100 / hour fees.
Again, Donald, if I can help you make the right connection, feel free to drop back in and let me know.