The Difference Between Clinical Supervision And Consultation


Cultural Differences

I have a friend that I’ve only met online who is a Board Certified Music Therapist.  She is also a professional singer, songwriter,  musician, and blogger.  Her name is Roia Rafayen and here is a comment she left recently in response to a previous post I had written about clinical supervision .

Tamara, thanks for your post. As always, you boil everything down very nicely and clearly. I do have a few questions, though regarding clinical supervision for counselors (since I’m not one). First, I presume it’s required. Second, is it only required if one is working toward licensure? Because then I can see that there would be an evaluation component to it.

Is it different when it’s simply professional clinical supervision for ongoing growth andDifference Between Clinical Supervision & Consultation insight as a counselor? Just trying to figure out how it all differs from music therapy. I know we’ve had various “conversations” about this before, but there are still elements that seem to be very different in our professions. Maybe that’s why you folks have had an easier time of getting licensure.”

Roia is picking up on the differences in the way that some of the mental health disciplines use the term “supervision” so this seems like a good day to address this issue.

First of all, I’m chuckling at having “an easier time of getting licensed.”  Roia, you just might have a few counselors here taking you to task, of course, because we don’t think it’s so easy at all.  But, you are right in picking up on the difference in the way that some mental health disciplines use the term “supervision.”  I think of these as cultural differences.

State by State, Discipline by Discipline

As far as I know, all licensed mental health professionals in the United States of America are required to go through a period of clinical (as opposed to administrative) supervision in order to satisfy conditions for licensure. Each state determines what the specific requirements for licensure are for each discipline and they may vary considerably from state to state and discipline to discipline. For example, although licensed social workers and professional counselors require at least a Master’s Degree in a specific discipline, licensed psychologists require a Doctoral Degree. Individual states also dictate which graduate schools provide sufficient training (typically based on the type of accreditation a university has) to satisfy licensing requirements.

Additionally, to become a licensed professional counselor / licensed clinical social worker / licensed psychologist / etc. , each state also requires face-to-face clinical experience and clinical supervision.  For example, to become licensed as a professional counselor, the State of Colorado requires 2000 hours of clinical counseling and 100 hours of clinical supervision; the State of Texas requires 3000 hours of experience with at least 1/2 of that being direct contact with clients while under supervision.  (It’s worth noting that in a society as mobile as that in the USA, these differences in requirements can play havoc with a mental health professional-in-training trying to get licensed.)

Clinical Supervision

Clinical supervision for these disciplines implies a hierarchical relationship with one of the components being evaluative.  While under clinical supervision, the supervisee is legally and ethically required to comply with the supervisor’s directives.  And, the supervisor is legally and ethically responsible for everything that takes place between the counselor-in-training and the client.  It is a significant responsibility, commitment of time, and potential liability for any supervisor.

The evaluative component is included because the purpose of clinical supervision is to both support the counselor-in-training’s professional development and also to protect the public from incompetence.  At the end of supervision, the supervisor must attest to the competence of the counselor-in-training.  That same supervisor is obligated to note whether this individual is actually ready to function independently as a professional counselor.  The same is true for licensed social workers, licensed psychologists, and licensed addictions professionals.

Professional Consultation

Once a professional license is obtained, the standards of clinical practice, professional codes of ethics, and / or best practices in risk management dictate that professional counselors, social workers, and psychologists are to engage in peer or professional consultation on a regular basis (rather than clinical supervision.) Like clinical supervision, the purpose of professional consultation is to continue professional growth and development as well as provide access to collegial input on specific cases.  However, while the difference between clinical supervision and professional consultation may appear at first glance to be simply one of semantics, those within these disciplines recognize “consultation” to indicate a collegial relationship with no evaluative component and no obligation to comply.

That’s the difference – It’s a difference in connotation that is unique to some of the mental health disciplines.  And, until I met you, Roia, and we started our dialogue about this topic, I, too, made certain assumptions about those terms based on the culture of professional counseling.  I assumed that one was  under supervision, s/he was either in training or under the scrutiny of a licensing board for some type of corrective action!

Thanks to you, I’ve done a bit more research and have reigned in some of my assumptions. And, I’m hoping that some of you reading this post can join the conversation and expand the discussion.

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  1. Peer consultation I have found is very important, even though I am not required by the state to do this now that I am licensed. I have found, if you live near a large urban area like myself that you can can either find or form your own through “Meet-up.” Just make sure everyone who comes to the meetings are actual licensed therapists, we’ve had a few awkward occasions when someone has shown up with just an “interest” in the mental health profession, lol.

    • Hi, Aaron! Thanks for taking time to point out that it really is important to screen who it is that you are choosing to consult with. Over the last couple of decades, I have been a member of several peer consultation groups. They have varied considerably based on the individuals in each group. It is difficult to have high quality consultation if the members in your group do not know and trust each other’s professional competence.

      And, on a different note, Aaron, if you know of Meetup that are available to mental health professionals in the area of Fairfax, Virginia, I hope you’ll drop back in to let us know about them!

  2. Tamara, thank you so much for your kind explanations as to the technicalities of counseling licensure (sorry for my slow response- it’s been nutty here). What I meant when I said you have an easier time of being licensed was not that it’s so easy for counselors to go through a long period of supervised clinical work in order to get licensed (that is definitely NOT easy). What I meant was the fact that you require supervision is probably why, as a profession, you are now licensed, and we, as music therapists, continue to struggle to achieve licensure in all but very few states.

    Very interesting that after licensure, supervision becomes consultation. This is definitely news to me. I guess in the music therapy field we delineate between supervision as an intern (or student) and professional supervision. Well, I still wish we music therapists would make clinical supervision a mandatory aspect of the board certification process (it’s only mandatory to have completed a supervised internship- nothing post-graduate/internship is required at this point).

    One more question for you (because you know I’m always full of questions!): Are counselor’s even allowed to call themselves counselors until they’re licensed? That might end up being kind of an obvious question, but I figured I’d ask anyway. :- )

    Thanks so much for this illuminating dialogue!

    • Roia, that’s another great question – even for counselors to ask – as I learned when I left the state of Texas and moved to Colorado. The answer is that it depends. Some states actually restrict even the practice of counseling – meaning that unless you meet certain qualifications (like graduate school and supervised hours) you can’t even do counseling – regardless of what you call it.

      Other states don’t restrict the practice or the title of counselor (the latter being what you are asking about). Our professional association, the American Counseling Association, has asked that all of its members refer to themselves as Professional Counselors to differentiate themselves from not only unqualified “mental health professionals” but also from attorneys, lay counselors, etc.

      Roia, I do appreciate the questions because if mental health professionals don’t understand what different disciplines do and don’t bring to the table, then it really limits our ability to fully appreciate those disciplines and what those differences mean. You have been incredibly generous in taking time to educate me about the subtleties of music therapy and music therapists. (And, gang, if you haven’t checked out Roia’s thoughtful and introspective blog, The Mindful Music Therapist, you should do so. Just click on her name to the left of this comment. It’s one of my very favorite!)

  3. Thank you for the good advice. I have been practicing school counseling and behavioral counseling for years (for schools and agencies). I recently joined a private practice and am getting supervision from a seasoned professional who owns the practice. I have been thinking about moving out on my own with another counselor and would still like to have supervision – but already have my license. Clinical or Peer Consulatation better suits what I am looking for. On one occassion I differed in opinion from the professional I work with. Having a peer relationship should allow for that individuality or difference of opinion to take place. I am looking for that type of relationship as I move forward. I am new to private practice and want to do the best I can for my clients and need to hear other opinions in tougher situations. I have found the comments on Linkedin to be helpful within the groups I belong to. Thank you for the distinction – It really helps me understand what I am looking for. Best Wishes, Vivian

    • Hi, Vivian! Thanks for bringing your voice to the discussion today! It sounds like it’s an exciting time for you . . . anticipating leaving the nest and starting to feather your own!

      I, too, have enjoyed the discussions on LinkedIn. Just make sure that you double check the information you are finding there. I’ve found well-intentioned therapists giving erroneous information . . . and haven’t always found a good way to address it on the sight. Sometimes I’ve added my different view and sometimes I’ve chosen to just walk away from the discussions. Don’t assume that everyone there knows what they are talking about .

      I hope you’ll be back again soon, Vivian, to chat and share your thoughts.

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