Amy Maricle is a blogger, Board Certified Registered Art Therapist, and also a Licensed Mental Health Counselor in Foxboro, Massachussetts. It was about two years ago she and I and began chatting about the clinical supervision that she and I provide. Today I have asked her to share her thoughts with you about one of the many judgement calls that clinical supervisors have to make each and every time we meet with our supervisees.
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A Guest Post by Amy Maricle, LMHC, ATR-BC
Supervisees often come to outside supervision looking for a place to discuss issues that don’t feel safe or timely to discuss with an in-house supervisor. Time is precious, so supervisees need to get the most out of sessions as possible.
Especially for newer clinicians, while their agenda is often clinical, it is just as frequently non-clinical topics, such as:
- Problem solving relationships with coworkers,
- Understanding agency culture and policies,
- Time management, or
- Self-care and boundaries.
With so much time dedicated to these topics, when do clinical supervisors discuss clinical issues? When do we grapple with how to treat Josh’s anxiety or Jenna’s cutting? Is the other stuff even important? Isn’t the clinical work the “real” work we should be doing with supervisees?
When do we talk about the clients?
In my practice, and my own supervision, I have found “professional development” issues to be an important part of overall growth. If we do not assist clinicians to develop skills to be effective team players or to understand the philosophy and process driving agency policy, they likely won’t be effective therapists.
When discussing agency issues in supervision, I look for the intersections between “organizational” and “clinical” issues.
- Does the adolescent treatment center tend to be reactive to crises? Are staff somehow “cliquey?”
- Is the geriatric center experiencing some “dementia,” perpetually repeating the same unsuccessful interventions with residents?
Identifying these connections can assist therapists in understanding psychological process at the organizational level and, armed with this knowledge, help therapists work more effectively within their system both with coworkers and clients.
Self-Care and Boundaries
In my first year internship, I worked in a long-term treatment facility with women survivors of trauma and addictions. I loved the work, but I gave too much initially and experienced secondary trauma. This was ultimately a gift, as it taught me the importance of consistently monitoring my boundaries with my work. Setting up good habits from early on can help prevent burnout and secondary trauma throughout our careers. Clinical supervisors should be helping supervisees assess their self-care and risk for burnout or secondary trauma on a regular basis.
Imagine a typical scenario: Your supervisee comes to session discussing her overwhelming workload and struggles with time management. No doubt clinicians working in community agencies are overtaxed. You assist her in thinking through prioritization, time management squares, to do lists, and possibly asking for support with her supervisor. After covering all the nuts and bolts, though, you might also think together about whether or not any clinical issues might be at play here.
- Is she spending too much time with clients?
- If so, what is her fear or hesitation in setting clear and predictable limits with her time?
- Is she trying to “save” the client in some way?
- Is she making herself too available without allowing the client some space to grow?
These are incredibly important areas of clinical growth, and also important red flags for therapist burnout and secondary trauma that you can pay attention to together.
It is important to also inquire about her self-care more generally:
- What do you do for fun?
- Have you spent time with friends, family, and your partner this week?
- Have you spent your own money on office supplies?
- Have you made time to take care of the intense feelings that came up during the last group?
Good self-monitoring will allow therapists to self-correct when needed and work through these issues in supervision or therapy when stress or trauma has gotten the best of them. The National Child Traumatic Stress Network has a good facts sheet with links to helpful articles and self-assessments.
Supervision: An Evolving Collaboration
In supervision, I try to strike a balance between discussing “agency” and “clinical” issues by taking a bird’s eye view of supervision topics. I also try to be as collaborative as possible in supervision. When I feel that purely clinical issues are “losing out” to more agency-focused topics, I name that. Keeping an eye on the supervisee’s needs and goals will help us to identify the next step in supervision and hopefully keep the supervisee growing clinically and professionally.
Do you find that professional and clinical growth overlap in some way? What are the issues you find that supervisees most often bring to supervision? How are supervisors helping therapists keep focused on self-care?
Amy Johnson Maricle, LMHC, ATR-BC is a psychotherapist and art therapist in Foxboro, MA. She loves helping teens and adults find ways to live happier, healthier, and smarter.