What is therapeutic supervision?

In the past week, I have found myself in tears with the people that I support in my work.

I don't mean uncontrollable sobbing. I’m talking about tears pricking at the corner of my eyes during moments of connectedness and emotion in our shared humanity.

What brought the tears?

At times I was touched by the pain of what was being shared, and at other times by the unexpected, joyful transformation I was witnessing.

It's a real, human thing to be touched in this way; and it's an important part of what can make this work so transformational.

We see, we hear, we feel the impact of life on others, and we in turn are impacted.

Whilst transference and countertransference have always been part of the discussion, for a long time the importance of distinguishing between the personal and the professional for health and caring professionals was emphasised.

The message was clear: keep the personal at home, and the professional at work.

However, people are messy and not so black and white.

And there are many shades of grey that are important to explore as a clinician, not only for ourselves, but in ensuring the wellbeing and best outcomes for the people that we support.

Luckily these days, it is much more broadly accepted that being aware of, connecting with and understanding the crossover of the personal and the professional in clinical work is an important resource.

Being aware of all of these parts of ourselves, being able tease out what is ours, what belongs to someone else, what is present, what is past, what is shared and what is separate, is essential in this work of being with other humans.

And sometimes delving into what is happening in these moments of nervous system / emotional tangle, going into the real, human response, is what makes this work transformative.

Certainly, sometimes we need therapy, but not every time we feel emotional.

As a starting point, what we do need, is to:

• be aware of our embodied, emotional experience
• be able to differentiate between our own response and that of another
• sense and flexibly hold the boundary between ourselves and others
• attune to our own thoughts, feelings, sensations and responses, whilst holding space for another
• sit in discomfort with ethical presence

This is often easier said than done!

This is where therapeutic supervision comes in.

What is therapeutic supervision?

Therapeutic supervision embraces a holistic approach to supervision that values and prioritises the psychodynamics at play in the therapeutic relationship, the supervisory relationship, and the wider context of the work.

Therapeutic supervision acknowledges and values:

• the importance of the personal and the professional in supervision, for the supervisor, the supervisee, the person accessing support, and the context / systems involved. (Importantly therapeutic supervision sits at the intersection of these points).
• both conscious and unconscious aspects of the work, and making the implicit explicit
• bringing transference, countertransference and parallel processes out into the open
• attunement, connection and differentiation
• therapeutic use of self as both important data and an essential tool, for the supervisor as well as the supervisee

What therapeutic supervision is not

Therapeutic supervision is not therapy within supervision.

However, personal responses and experiences may be explored to support greater ethical presence for supervisees, facilitating clarity, insight and better outcomes for those accessing clinical services.

Therapeutic supervision recognises brave rather than 'safe' spaces

As Brené Brown articulates so articulately, we can never offer a 'safe space' but we can offer brave spaces that can be safe enough. These are spaces created in vulnerability, moral courage and trust so that we can engage in honest, challenging or vulnerable conversations, even when discomfort arises.

Of course, the usual areas of supervision (outlined in a previous blog here) are still important in therapeutic supervision:

1. Educational: professional learning, and the development of knowledge and skills
2. Administrative: relating to standards of care, quality control, and professional accountability
3. Supportive: referring to self care practices/ personal wellbeing, and collegial and emotional peer support
4. Practice focus: development of clinical skills and insight, ethics, evidence-base and reflective practice

Therapeutic supervision however, broadens and deepens its scope to also explore the emotional, psychological, physiological, spiritual and interpersonal needs and impacts of helping work, to enquire, to recognise, and to discover the inherent value and information they offer the clinical work.

This enables the supervisee to sit within a stance of ethical presence, thereby facilitating greater insight, both for the wellbeing of the supervisee and their clinical work.