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6. The Scandal of Clinical Supervision: How to Resolve It (Part 2 of 2)

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In the previous post, I described the 3 common pitfalls of clinical supervision, which are “theory-talk”, “pad-on-the-back”, and the lack of monitoring progress.

Here, three key methods are suggested on how to enhance the use of clinical supervision.

Here’s How:

Keep in mind the use of the “3-Dimensional Perspective” I proposed in an older post Why Our Self-Assessments Might be a Delusion of Reality. I suggested this to guard against the fallacy of the illusion of expertise.

Quick recap: The three approaches are

1. The use of formal client feedback measures;

2. Video recordings of sessions; and

3. Clinical supervision.

In order to fully benefit from clinical supervision, I’d suggest the following three features:

1. Stay Close to Client Engagement:

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We often assume that we have consensus to pursue a particular track with our clients.

First, make sure we have consensus on the goals. Then explicitly check on client’s willingness to engage in a particular area.

We make the mistake that once the client explicates a goal, that we have her will on-board, which may not be the case. For example, a  client might have a goal on making friends as she is experiencing loneliness that’s making her depressed. Through therapy, it’s established that she sees herself as unlovable, based on her past abusive relationship with her father and recent divorce. The self-attacks keeps her isolated and depressed.  The therapist cannot simply assume that since there is consensus on the goal (i.e., to develop friendships), that she is willing to work on her self-deprecation, which has been keeping her away from the social world. The therapist needs to ask – by knocking on the doors of her inner life – and to request for permission to be invited in as a guest.

“Is this something you want to work on?”


Second, the therapist needs to systematically monitor if client is engaged in the process and rationale of the particular method of treatment. For example, where working with her core emotions through a two-chair dialogue, does she see the rationale for doing so? Does she see the causality of how her self-attack is keeping her depressed?

Third, all of the above can only take place when there is an emotional bond and a sense of emotional safety working with you. Take the time to check in on their perspective on this. (Also see Matthew Bambling and colleagues excellent supervision study1).

2. Listen to the Music First:

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Imagine a friend comes to you and tries to describe to you a beautiful and inspiring song that he recently heard. Would you rather him continue his description with his best of intentions, or would you rather him let you have a listen to the piece of music instead?

Without a skip of a beat, I’d pick the latter.

This is where the value of recording your sessions reaps its rewards. Bring in the audio/video recordings of the session to supervision. Hearing the start of a session is often useful; how we start a session has a ripple effect on how the rest of the hour unfolds. Thereafter, pick a 10 min segment to let your supervisor listen/watch. This clip could be one of the following:

a. thin slice of the representation of the quality of the engagement;

b. a difficult interaction/alliance rupture moment; or

c. If you do not have either of the above, randomly pick some where in the middle of session. You would be surprised at would might be useful from this!

This is not only helpful in clinical supervision, but also useful in self-supervision. (More on this in a later post).

When a sound rationale is given to clients on the purposes of recording (e.g., “I record my sessions so that I get to ensure the highest service delivery and experience in therapy… I would review them, and sometimes with the help of a supervisor, when necessary.”), clients are more likely to agree. Clearly, when the client is not comfortable of the idea, do not process with the recording. Let them know that you respect their choice. Nonetheless, the rate of compliance to be audio/video recorded is dependent more on the therapist than the client.

3. Use Routine Outcome Measurement + Revisit The Case: 

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For supervisors: Try out this little experiment. Once you’ve got your supervisees routinely monitoring their client outcomes using measures, get your supervisees to pick 3 cases that show no improvement and advise them to bring them up in supervision.

Pick another 3 cases that show no improvement, and put them on your “wait-list,” that is, hold off providing case consultation on these cases. The verdict: see if there’s a difference in outcomes for the 2 groups (Supervision vs. No Supervision) of 6 cases. This definitely lacks the rigor of a randomised clinical trial (RCT), but it is definitely worth testing it out. Whatever the verdict is, reflect on it. What factors in your supervisory encounter impacted the supervisee/therapist to act similarly or differently, that led to client improvement, or the lack of?

For supervisees: Do likewise, and note down what pointers you applied into your 3 cases in the supervision group. How did it go? Did it help, or was it off-the-ball? Did it have an impact on the outcomes and alliance ratings? Either way, reflect this back to you supervisor.

This lets your supervisor know how on-target their guidance has been, and allows continuity or re-calibration when needed.


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1. Bambling, M., King, R., Raue, P., Schweitzer, R., & Lambert, W. (2006). Clinical supervision: Its influence on client-rated working alliance and client symptom reduction in the brief treatment of major depression. Psychotherapy Research, 16(3), 317 – 331. doi: 10.1080/10503300500268524

What are the Perennial Pillars for Psychotherapists?

For songwriters, the perennial pillar is song craft. It is not technical mastery.

A songwriter knows that technical agility at an instrument is not going help him create a better song. It’s easier to identify and work at improving techniques. It’s much harder to improve on their ability to engage with listeners through their songs.

At the time of this writing, in 2017, we commemorate three critically acclaimed albums.  


Perrenial Albums

If there are any three records you’d need to hear in your lifetime, it’s these.


Half a century ago, The Beatles released Sgt Pepper’s Lonely Heart’s Club Band. 30 years ago, U2 brought us the follow-up album from The Unforgettable Fire, Joshua Tree. And 20 year ago, Radiohead released Ok Computer. Modern music has never been the same since.

Sgt Pepper would never have had the chance to grow if the Beatles did not take the time away from touring.

The Irish boys from U2 narrowed the focus based on the American landscape in the making of Joshua Tree. Because they made that decision, the album reflected their evolving social consciousness of their time. The album become a timeless piece of art.

Radiohead’s Ok Computer, was spawned from the band’s disillusionment with a relentless touring schedule, resulting in their lives becoming a tour-bus race at the speed of light from one concert venue to the next. They had enough. A break was needed. 

(As an aside: It is significant to note that none of these records were the artists’ first albums.)

Consider three lessons we can draw from these landmark albums:


1. Take the Risk and Push Your Limits,

2. Get a Guide, and

3. Study the Process, Not the Outcome.


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Do Not Seek Out A Supervisor

Do Not Seek Out A Supervisor


Seek out a portfolio of supervisors, mentors and coaches.

The apprenticeship model of clinical supervision certainly has its merits. It takes us beyond what we read and what we derive from experience in clinical practice. After all, clincial supervision has been defined as the “signature pedagogy” of our field.[1]

However, clinical supervision as we know it, has little to no impact on our actual improvement. If we are to truly develop, and have a deep impact on our clients’ lives, we need to take a more expansive view about this master-apprentice model of professional development.

Instead of enlisting a supervisor for guidance,

we should instead build a portfolio of supervisors, mentors, and coaches.


No one person has all the keys to guide you. It would be unwise to expect to learn everything from one teacher. Instead, we need to first identify areas that we have gaps in our knowledge, and then seek out coaches in that particular domain of expertise.[2]

Do your prep before you approach your guides. Figure out what you need to be working on. Make it concrete and write them down. (It’s not enough to just think about them in your head). Date it. When you look back, you get a sense of your evolution.

Remember: Keep one eye on your performance (i.e., client outcomes), and the other on your development (i.e., how you are learning).[3] Enlist the community of guides to make sure you have both eyes focused on where it should be.


Surround yourself with people that can help you become a better version of yourself, not become a mimicry of them.


Your Partner in Crime, 



[1] Watkins, C. E. (2010). Psychotherapy supervision since 1909: Some friendly observations about its first century. Journal of Contemporary Psychotherapy, 1-11.doi:10.1007/s10879-010-9152-2

[2] Some of these terminologies were borrowed from Dorie Clark’s book, Reinventing You.

[3] Chow, D. (2017). The practice and the practical: Pushing your clinical effectiveness to the next level. In D. Prescott, C. Maeschalck, & S. D. Miller (Eds.), Reaching for Excellence: Feedback-Informed Treatment in Practice: APA.

Signs That Therapists are Barking Up the Wrong Tree in Our Professional Development 


Signs That Therapists are Barking Up the Wrong Tree in Our Professional Development

Sometimes you climb the ladder to the top,
only to discover that you’ve placed it against the wrong wall.

~ Joseph Campbell


I’m going to re-look at some deeply held truths  we were taught to believe about professional development in the field of psychotherapy.

Actually, if these truths are closely examined, they are perpetuated lies.


What’s worse than falsehood is a distorted truth.


This is not an attempt to put up a straw man about our field. Rather, I hope we can

a) Stop digging ourselves into a deeper hole, and

b) Get ourselves out of the entrenchment.

Before you read on, answer the following question:

Do you consider yourself a person who is open to challenging your own assumptions

If you are, read on. If not, the following list is going to cause you some discomfort.

Here it goes:

In no particular order, here are signs that we are barking up the wrong tree in our professional development:

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#4. Why Our Self-Assessment Might be a Delusion of Reality



It seems that we share more in common with Homer Simpson than we like to admit. Did you know that social psychologists found that in general, people rate themselves as more attractive that they really are?(1)

In my doctoral study of highly effective psychotherapists(2), the results of an area investigated about therapists self-ratings of their Healing Involvement (HI) in therapy left us initially scratching our heads. Orlinsky and Ronnstead(3) describes someone with high HI as someone who views themselves as personally invested, efficacious in relating with the client, affirming, and highly skilling, experiencing flow states in therapy, and employ constructive coping strategies. What we found was a negative relationship between their outcomes performance and HI rating. In other words, therapists who rated high on their HI scores were more likely to be less effective than their peers! How is this possible? Going further, the same group of therapists we studied, half of them rated their current effectiveness as above average. None rated below average. What’s more, these self-assessment of effectiveness ratings did not predictor their actual client outcomes. Continue reading