Psychotherapy: Clinical Supervision and Training

therapist and patientClinical supervision is the primary training model for psychotherapists learning to be psychotherapists. Psychotherapists may be trained or supervised in the context of a particular theory, and trained to apply particular techniques based in that theory, but the best supervision is useful across techniques and will help a therapist gain competence regardless of his personal style or theoretical orientation. A clear exception occurs when the supervisor and therapist are invested in contradictory views of human nature and assumptions about the goals of psychotherapy: for example, if the supervisor sees the goal of psychotherapy as facilitating emotional integration and self-understanding, and the therapist sees the goal to be the control of behavior within the context of social norms.

Teaching new techniques may be helpful, but in fact the most difficult – and perhaps the most important– factors in successful psychotherapy are the subtleties around the relationship between a therapist and his patients. Therapy always takes place within the context of the relationship between patient and therapist, and the ways in which a therapist and patient experience each other are critical to understand. Issues of trust, empathy, and being direct are typically more important than theoretical orientation, or the application of techniques.

In any interaction between a therapist and patient, there are very powerful factors within both parties which affect the patient’s ability and motivation to change; these are broadly referred to as transference and countertransference.While they may be directly experienced and expressed, these factors are often unconscious and expressed inadvertently. Beyond this powerful dynamic, our assumptions and judgments always exist within a cultural context, so there will be blind spots around issues that are reflexively taken for granted by both therapist and patient.

A clinical supervisor’s primary task is to bring these factors into the therapist’s awareness. Issues for the therapist such as inadvertent guilt induction, reflexive negative judgments, people pleasing, modeling negative behavior, issues around personal boundaries, collusion with patients, and unconscious seduction can be present, and it is important to uncover and address these issues. To do this, the supervisor must be both a teacher and a kind of therapist to the therapist – not a therapist to the therapist regarding issues in general, but regarding the therapist’s mode of interaction with his patients. As in psychotherapy, supervision must be empathetic and non-judgmental as well as firm and direct. A supervisor’s interaction with the therapist provides a model for the therapist to interact with his patients. An effective supervisor will be an effective psychotherapist as well.

Article Name
Clinical Supervision and Training
Clinical supervision of new therapists requires both teaching skills and the ability to identify issues that arise between the therapist and his patients. Effective supervisors are effective psychotherapists in their own practices.

About Marc Handelman, PhD

I am a licensed clinical psychologist practicing in New York City. My office is located on the Upper West Side of Manhattan, near Columbia University. I work with adults from college age and up who want help addressing problems ranging from depression, anxiety, and relationship issues to addiction, co-dependency, and the effects of early trauma. I believe psychotherapy should provide a sense of comfort and support as the starting point for addressing emotional problems. I have more than 30 years' experience as a psychotherapist, and have been affiliated with The Hazelden Foundation since 1997. Please see my professional website for more information:
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