the value of supervision

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The Value of SupervisionPatricia Henry Hensley PhD, LCSW a ba Social Work Program, Central Connecticut StateUniversity, USAb The University of Connecticut School of SocialWork, Smith College School of Social Work, USAPublished online: 08 Sep 2008.

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The Value of Supervision

Patricia Henry Hensley

ABSTRACT. In a qualitative study examining clinical social workers’theories of cure, supervision emerged as an essential resource for clinicalsocial workers. Their relationships to, and experiences with, supervisorswere regarded as highly influential in the formation of their professionalcompetence and identity. All had experienced important and profoundsupervisory experiences that helped form the basis of their professionalcompetence. This paper describes the benefits of supervision as reportedby the clinical social workers interviewed and validates supervision as asustainable ingredient of clinical social work practice.

“They were very, very patient. I was, I mean I had . . . I was a God-damn mess, I didn’t know anything and the fact that my supervisor didn’tlean across the desk and strangle me I think really shows tremendous re-straint on their part” (Male # 2). [Article copies available for a fee from TheHaworth Document Delivery Service: 1-800-HAWORTH. E-mail address:<[email protected]> Website: <http://www.HaworthPress.com> © 2002by The Haworth Press, Inc. All rights reserved.]

KEYWORDS. Supervision, qualitative study, clinical social work, the-ories of cure

Patricia Henry Hensley, PhD, LCSW is Assistant Professor, Social Work Program,Central Connecticut State University. She has taught practice courses at The Univer-sity of Connecticut School of Social Work and Smith College School of Social Workand has been in private practice since 1980.

Address correspondence to: Patricia Henry Hensley, PhD, 385 Waterville Road,Avon, CT 06001 (E-mail: [email protected]).

The Clinical Supervisor, Vol. 21(1) 2002http://www.haworthpressinc.com/store/product.asp?sku=J001

2002 by The Haworth Press, Inc. All rights reserved. 97

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INTRODUCTION

Supervision has been an essential component in the training of clini-cal social workers for many years. The quotation above gives an exam-ple of thoughts a clinical social worker had about his supervisor. Wetake it for granted that a student and later beginning clinical socialworkers will receive supervision. The history of social work supervi-sion has paralleled the history and the development of casework(Kadushin, 1985). Training to become a caseworker in social work re-quires the student to have a supervisor. After obtaining a masters de-gree, supervision is then required to either become certified or licensedby most states. In spite of this, because of the present practice environ-ment there is a threat to supervision time in agencies that are countingon billable hours to stay afloat. After twenty years as a supervisor, in-structor for a supervision seminars and field liaison to agencies, I amconcerned about the present erosion of supervision time for studentsand the nonchalance with which some supervisors treat supervision forlicensing. This paper is written as a reminder of the many benefits of su-pervision and the value that these clinical social workers attributed totheir supervision experiences. It is also a testament of their efforts to im-prove their clinical skills through supervision in order to provide thebest treatment for their clients.

In a study focusing on clinical social workers’ ideas concerning howclients improved with better in treatment, important information con-cerning supervision was uncovered (Hensley, 1996). One question thatdeveloped from this qualitative research study was the following: Is su-pervision in Masters training or later seen as shaping or influencingpractice and views of client change? Twenty clinical social workers, 10men and 10 women, were interviewed for the study. A qualitativegrounded research design was selected using the methods of Corbin andStrauss (1990). For the purposes of this paper a broad definition of su-pervision was selected. It includes any supervision the subjects had inagencies, in Masters training, and supervision for licensing and pri-vately contracted.

Relevant Literature

The various areas of supervision have been explored and writtenabout since the early years of social work. The abundant literature ad-dresses history, styles, methods, approaches of supervision and muchmore. Some of the best known authors or classics in the field are

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(a) Kadushin, with his comprehensive text covering all major aspects ofsupervision; (b) Shulman, with multiple texts on supervision for staff,managers and field instructors; (c) Munson, who specifically focuses onclinical social work supervision; (d) Ekstein and Wallerstein, with theirclassic on supervision of psychiatric residents as well as social workers;and (e) Reynolds, with her arguments on how teaching and learningtake place. This paper examines supervision as a resource clinical socialworkers bring to treatment. The literature will focus on the need forsupervision, the educational and learning aspects of supervision, su-pervision as support, qualities of the supervisor, and the mutual orintersubjective experience between supervisor and supervisee.

It is not surprising that a discussion on therapeutic cure included theclinical social workers’ feelings and thoughts concerning the supervi-sion they remembered. Evidence in the literature supports the idea thatthe interaction of a supervisor and clinician influences the interactionsof the clinician and client, and vice versa. This includes interpersonal aswell as the interpsychic relationship between supervisor and student.Various authors have written about this phenomenon which was firstdescribed by Ekstein and Wallerstien (1958) as parallel process. Theconcept is essential in understanding why a positive supervision experi-ence is an important resource for the social worker and can aid the cli-ent. The concept refers to the idea that what goes on between the clientand social worker can be reflected between the social worker and super-visor. Kadushin (1985) refers to it as the “parallel reflection” process(p. 204). This includes interpersonal as well as the interpsychic relation-ship between supervisor and student. When positive interactions arehappening between the supervisor and social worker, then we can ex-pect positive energy between social worker and client. These parallelsin the relationship between supervisor and supervisee are essential inunderstanding practice with clients (Shulman, 1995). However, not ev-eryone agrees with how the concept has been used. In a recent article onparallel process, Mothersole (1999) points out there is no real empiricalevidence to support the concept of parallel process. He acknowledgesthe helpfulness of the concept but adds a word of caution as well as abroader definition of the term.

According to Kadushin (1992), supervision needs to “maximize theworker’s capacity to do his job more effectively and to help the workerfeel good about doing his job” (p. 20). The ultimate goal is, then, effi-cient and effective social work services to clients. There are otherfunctions of supervision, and Kadushin divides supervision into threecategories: administrative, educational, and supportive. Munson (1993)

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defines supervision in a narrower manner and is referring to clinical so-cial work only: “Clinical supervision is an interactional process inwhich a supervisor has been assigned or designated to assist in and di-rect the practice of a supervisee in the areas of teaching, administrationand helping” (p. 10). He separates supervision and consultation. Super-vision, according to Munson, is what happens in agencies, involving apower differential and evaluation. Consultation is what happens whena social worker seeks “supervision” outside of an agency, involving asocial worker contracting privately for consultation with practice.Munson believes by combining supervision and consultation one runsthe risk of minimizing the authority that a supervisor has in a situationwhere the worker is mandated to have supervision with no choice in-volved.

What is the best way to teach a student or novice how to be a socialworker? Literature linking supervision to education and teaching can betraced back in the history of social work. Students want to learn skillsand understand the complicated process of the helping profession. Evenexperienced supervisors continue to be interested in learning practiceskills (Shulman, 1992, p. 201.). Both Reynolds (1970) and Hamilton(1954) have described in detail a developmental model for the socialworker learning the profession. During the five stages that the learnergoes through, Reynolds (1970) emphasizes that new social workersneed help and guidance while learning this new art. Ekstein andWallerstien (1972) believe that among the responsibilities a clinicianhas to clients is the obligation of the supervisor to teach skills to thelearner. They also believe it is the supervisor’s responsibility to see thatthe benefits from the services are being rendered. An additional exam-ple of social workers wishing to learn is given by Kadushin (1985). Hementions that in a survey he conducted, supervisees felt their supervi-sors were not critical enough about their work to help them learn.

Social workers regularly operate in challenging venues with difficultclients. Stress and burnout are a natural consequence of such pressures.Supervision can provide a shield to prevent burnout. Kadushin (1992)reports “The supervisor can supportively help to reduce stress imping-ing on the worker or remove the worker temporarily from a stressful sit-uation” (p. 263). Munson (1993) is clear in his view that supervision isessential and reports that trends in social work require it: “These trendsare: the resurgence of clinical practice, the social work dominance inmental illness treatment, the theory explosion, changes in professionalstandards, limited supervision training and therapist influence, practi-


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tioner stress and burnout prevention, and unethical practice and super-vision influence” (p.19).

Part of learning in social work includes a development of self-aware-ness as part of the development of a professional self. Hamilton (1954)as well as Reynolds (1970) proposed a developmental model for thesocial worker learning the profession. Self-awareness, according toHamilton, has three phases, with phase three continuing throughoutprofessional life. In this phase the learner works on her own as well asthe clients’ problems. Urdang (1999) reminds us that we grow as pro-fessionals from many sources. The challenges of becoming a supervisoroffer social workers another developmental step on the path to consoli-dating a professional self.

The style and personality qualities that a supervisor brings to super-vision are important ingredients to the learning process. Munson (1993)describes style as “a manner that permits the supervisor to use it to pro-mote learning and guide interaction in supervision” (p. 95). Munson en-courages supervisors to examine themselves and determine whetherthey have an active or reactive style. He offers different techniques ofsupervision depending on which style the supervisor has.

Support and validation are needed by anyone learning a new profes-sion. Writers have referred to the need for a safe environment, a placewhere one can be oneself and learn (Winnicott, 1965). Certainly the so-cial workers who feel support and protection from their supervisor areable to cope with the stress originating from the clients, agency pres-sures, and feelings of not knowing.

If we agree that as clinicians we always have blind spots and see thecomplications of cases through our own eyes, then having a supervisorto aid in practice is essential. Countertransference feelings can best behelped in the supervision situation. Ekstein and Wallerstein (1972),Kadushin (1992), and Munson (1993) all address the issue of supervi-sion as an antidote for burnout and stress. Stress and burnout can be feltat all levels. A particular challenge to supervisors, as Munson remindsus, is that supervisors not expose their supervisees to their own burnout.

Obviously supervisors serve as role models to the young social work-ers they supervise and this gives added emphasis to the importance ofthose qualities in a supervisor that not only enhance teaching and train-ing but also are associated with clients receiving good care. The quali-ties a supervisor demonstrates to the learner often form the bases forbehavior and action on the part of the supervisee. Kadushin (1992) seesbeing a role model as important for job growth of the supervisee and de-scribes qualities of good supervisors as “available, accessible, able and


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affable” (p.19). Munson (1993) has helped us understand the need forcertain qualities in supervisors. In his introduction to clinical social su-pervision he outlined the elements of good supervision and the tech-niques that help learning. Fox (1999) describes the process interns gothrough in learning to become social workers. According to Fox, un-conscious mechanisms come into play with the interns identifying withthe supervisor in ways outside of their awareness: “Interns transform in-teractions with and characteristics of their field instructor into inner reg-ulations so that what is internalized becomes part of the structure of selfand is integrated into the professional persona” (p. 64).

In psychodynamic writing, the themes of intersubjectivity are cur-rently being explored and applied to supervision (Berman, 2000; Jaffe,2000). Although I agree with Shamess (1999) when he says, “Many ofthe observations intersubjectivists make about therapeutic processes areso self-evidently true, I marvel that it has taken eighty or so years for dy-namic therapists to “discover them” (p.188), never-the-less these ideasare important to include. Intersubjective perspectives include the twopeople rather than one-person psychology. From this perspective, theclient’s narrative created in the relationship between therapist and clientand emphasize minimizing the power differential in the clinical situa-tion. In spite of the fact that supervision often includes evaluation, wecan think of supervision as a two-person situation with a shared cre-ation. The supervisor is often known to the supervisee, unlike a personaltherapist. Intersubjectivity calls for authentic and genuine interactionsin the therapeutic situation. It seems self evident that those traits areamong the important ingredients for good supervision. Writers in thepast have agreed with these ideas and referred to the notion of an equalpartnership in supervision and creating something new together. De-constructing the power and authority both in treatment and supervisionis part of this approach.

(The mutuality and collegial relationship that often develops in su-pervision is one way to think about good supervision.)

“Supervision should be a mutual sharing of questions, concerns, ob-servations, speculations, and selection of alternative techniques to ap-ply in practice” (Munson, 1993, p.12). Shulman (1995) describes thesupervision he writes about as interactional. Surely he is describing atwo-person situation in which something is created in the interaction.Kaiser (1997), I believe, refers to the co-creation of meaning in the su-pervisory relationship when she says, “I have defined shared meaningas both mutual understanding and ideally, mutual agreement betweensupervisor and supervisee” (p. 88). A supervisor who is willing to share


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her professional self, be genuine, and discuss her own challenges inlearning can be the most helpful to the learner.

We would like to assume that supervisors act in an ethical manner to-wards their supervisees and model ethical behavior in all areas of theirprofessional lives. Unfortunately, this is not always the case. Thereevolved, in the examination of the text, examples of confusion and vio-lations of boundaries between supervisors and supervisees. Values andethics have been discussed by Munson (1993) in the supervisory litera-ture. His research indicates that practitioners and supervisors do not al-ways keep current or sometimes forget some aspects concerning theNASW Code of Ethics. In the Code there are references discussing be-havior between client and social worker but none that specifically referto supervisors and supervisees. This is left to the individual supervisorand is a rather gray area for social work in general. There is discussionin the literature concerning the confusion of supervision and therapy.Kadushin (1985) admits some similarities but clearly points out somedifferences in purpose, focus and the relationship in supervision andtherapy. Ekstein and Wallerstein (1972) devote a chapter to the differ-ences and in their discussion of the training of psychiatrists and socialworkers point out the main difference between psychotherapy and su-pervision. The goal of psychotherapy is to resolve inner conflict. Thegoal of supervision is to help the student to greater skill in their workwith clients. Supervision can be “therapeutic,” but supervisors need notmake therapy out of supervision.

Methodology

A qualitative grounded theory research design was selected basedon the methods of Corbin and Strauss (1990). They offer a three stagecoding process. The first stage involves open coding, or indexing ofthe interviews. The next stage entails discovering the properties orcharacteristics of the text unit. The last stage, called axial coding, leadsto the eventual discovery of the story line that emerges from the data.Interviews were conducted that allowed the participants to speak freelyconcerning their views on the subject. Then the three stage coding pro-cess proceeded.

The respondents discussed their views of cure and also their own ex-periences in personal therapy and supervision in terms of how theythought change in psychotherapy. The qualities of supervisors in train-ing and early jobs were discussed as well as the supervisees’ thoughts


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about how the supervision had contributed to professional and personalgrowth.

Coding of the data was assisted by a qualitative software programQ.S.R.*NUD-IST (Nonnumerical, Unstructured Data, Indexing, Search-ing and Theorizing) according to the method recommended by Corbinand Strauss (1990). The three stage coding process resulted in axial cod-ing. The transcripts were coded in the order of the date of completion. Aline was chosen as the unit of text. The transcripts were then reviewedand analyzed line by line. As recommended by Corbin and Strauss, thisopen coding process involved discovering in each line a concept rele-vant to the study. Discovery and axial coding followed where categorieswere identified, with notes and ideas constantly being written down. Athird examination of the data revealed the properties of each text unit.Occasionally it was difficult to judge the optimal meaning of a unit oftext. An example of a challenging text was the following: “I think thatunder that, the supervisor has a good knowledge base and knows whatthey’re doing” (Male # 5). At first this sentence was coded under teach-ing and learning, but on further examination it became evident that hewas speaking of qualities. As the coding progressed, in some instancesthe data made more sense by further collapsing some codes and this wasrepeated throughout the project. For example the separate codes ofteaching and learning were collapsed together to capture the dual mean-ing of some text units.

FINDINGS

A summary of the coding of the data for the larger project revealedrelationship as the core ingredient that runs through every aspect of thetreatment situation. This includes the resources attributed to both the so-cial worker and client. For the clinical social worker, supervision is akey resource. The following are important aspects of supervision thatwere revealed by the social workers interviewed: teaching/learning,professional growth, and qualities of the supervisor and the mutuality ofthe relationship, and teaching and learning. A final code of group as atype of supervision was established.

The clinical social workers used ideas from their former supervisorsas a reference point for their own work and often thought of a particularsupervisor when at a clinical impasse. A solved clinical dilemma of the


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past could provide reassurance that the present problem could be workedout in supervision and gave hope to social workers who could then helpthe client in treatment. Teaching and learning, professional growth,qualities and mutuality emerged. These findings will be discussed.

Teaching and Learning

Teaching and learning was mentioned as essential in their supervi-sory experiences. Many skills were acquired in supervision and oftenconnected to theory. One female respondent explained: “My first super-visor out of graduate school was the one that sort of indoctrinated meinto analytic thinking, it was like, my God, there’s monsters in the wa-ter, you know when you first start hearing what all goes on in peoplesunconscious and it was a revelation” (Female # 9). Another one stated,“think, just talking to somebody else and they say something and it justmakes you think, it brings back that there are other possibilities” (Fe-male # 7). Another example: “On many things, he’s an expert in thearea, so I got to see some of the, you know, a master at work which isfun” (Male # 3). And lastly, for teaching and learning, one subjectclaimed “the most helpful thing was to realize, first of all, that I don’thave to do anything, in fact, that was one of the primary things in my su-pervision that had to be undone in me, was this sort of wish to rush inand do something” (Female # 8). One experienced clinician referred toher current supervision as the following: “Yes, I need someone else tolisten to me, to see what I am not doing here. What I am missing andgive me some idea, when I am dead, I am not creative” (Female # 10).

Professional Growth and Support

In Masters training and during the practice years following, a subcat-egory that developed was professional growth. Supervision is integralin remaining up to date with theory, skills and technique. The socialworkers in the study valued the professional growth gained in supervi-sion. Many had demanding supervisors but felt that they benefited fromthe approach. One example is the following: “within her philosophywithin the gathering of history and understanding relationships and soforth really play a role in how I’m going to help that person move for-ward” (Female # 2). Another said: “the supervisor helped me to find inmy own experience the solution to the dilemma that I brought into su-pervision” (Male # 10). What made a difference for another woman was


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the support she received: “She did a lot of hand holding, in so manywords, not physically, but a lot of reassuring, a lot of comforting” (Fe-male # 3). And lastly, “I think it was sharing it and that takes off some ofthe panic” (Female # 7).

Role Model/Qualities

Supervisors often provide the first relationship a student has with aprofessional social worker. We know that supervisors function as rolemodels and mentors to the social worker new to the profession. “I didn’tsimply watch him work but there was an explanation of the dynamics”(Male # 3). There were many examples of text that fit into the subcate-gory of qualities/role model. “My first field placement supervisor influ-enced me the most. She had incredible boundaries, a wonderful sense ofhumor, and made me do all the work” (Female # 1). Another exampleexplained how a supervisor had helped: “She wouldn’t breathe downmy neck, where if I made a mistake with the Smith kids she would say,‘That’s the purpose of this, you are learning and it’s okay to make mis-takes’ ”(Female # 3). “She was just warm” (Male # 9). The clinical so-cial workers also appreciated supervisors who were not defensive:“who aren’t defensive, who are willing to say here’s what I have to offerbut who know and are willing to sort of hang in there with me to like tryto find some piece of truth and some difficult dilemmas it’s super, it’svery, very helpful” (Male # 7).

Mutuality

The interaction and relationship between supervisor and superviseeis considered the most important aspect of supervision. To many inter-viewed, the experience of supervision was described as a feeling of mu-tual experience or what can be explained as support and mutuality.Contemporary psychoanalytically informed literature refers to this asintersubjectivity. One man said, “there was a tranquility about the rela-tionship or the mood or how I felt when I talked with her that she was,she listened, she was never critical, she always helped me to take a sec-ond look at things” (Male # 9). Another example of this was, “I thinkmutual respect, which I think I’ve always had.” Another female said “Ihad one very central supervisor for a while and we continued for a num-ber of years and that has been a really central important relationship.”


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Group

Several social workers were interviewed; several had a group super-vision experience. The mutual aid that was gleaned from other workersstruggling with similar issues with clients was valuable. For example: “Ijust find that hearing the case being discussed by four or five profes-sionals, so much more multifaceted, multidimensional, I just alwaysfeel very stimulated by the process” (Female # 5). The social workerswho had group supervision all felt positive about the learning opportu-nities offered by the group. The rich mix of ideas and comments addedto their experience.

Confusing Boundaries

Coding the text revealed examples of what can be considered bound-ary violations. In the study there were instances of a confusing mix ofsupervision and therapy. Interestingly, the social workers themselvesdid not mention this blending of supervision and therapy as a problem. Ifeel strongly that it is a misuse of professional relationship and can beconsidered an ethical violation: “It gets more complicated here becauseat some point after about 3 or 4 years of supervision I or we changed thecontract of our arrangement and I then spent another 3 or 4 years in ther-apy” (Male # 6). He later went on to describe, “there were often timeswhen I would say I’ve got a case that’s driving me crazy, I need to usethis hour as both supervision and therapy” (Male # 6). There seemed tobe the idea that the change in relationship was fine since a change ofcontract had been made. It has been my experience that some socialworkers confuse supervision and therapy although this did not appear tobe what had happened in the instances mentioned (see Kadushin, 1992,pp. 203-217 and Ekstein & Wallerstein, 1972, pp. 242-263.)

Some respondents discussed a field instructor’s while others dis-cussed a supervisor they had since finishing their Master’s program.Most considered supervision as essential to their learning and growth asclinical social workers. The importance of supervision and the profes-sional identification stands out for these clinicians. Secondly, what be-came evident is the “professional growth” value the social workersattributed to the supervisory experience. Supervision is not therapy butcan be of great value, enhancing clinical self-esteem and confidence forthe clinician practicing social work. There is little doubt that supervi-sion helps social workers deal with job stress and burnout.


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DISCUSSION

There is value in the study reminding us of the value supervision hasfor clinical social work professional development. If one believes inparallel process, then we can conclude that supervision contributes tothe benefits that clients receive from clinical social work treatment. Theclinical social workers themselves have said that their supervisors are inthe room with them as they practice their profession, especially at a dif-ficult moment or impasse in psychotherapy. The study sample is small,and to be more informative interviews would be needed with a more di-verse population from multiple areas of the country with varied cultural,religious, and ethnic backgrounds. It would increase the value of thestudy to have a larger sample. Although there was some diversity repre-sented in the sample, a study of this type would be more meaningfulwith cross-cultural supervision dyads.

There are several implications for practice to be considered. Clearlythe respondents in this study found supervision to be of great value totheir work. If learning, professional identity, support, growth andmentoring have traditionally been gleaned from the supervisory experi-ence, then making sure that supervision is a mainstay of agency andother practice situations is essential. Qualifications for becoming a su-pervisor need to be clarified by agencies and professional groups.Training for supervisors must be mandatory. Kaiser (1998) has recentlywritten about a supervisory institute established to customize experi-ence and background for those becoming supervisors. This is an impor-tant innovation to be considered by the social work profession. Groupsupervision emerged as a powerful tool for several social workers inter-viewed. This is important given the brevity of time and the constraintsmanaged care has placed on the environment in agencies. Group super-vision should be considered as an alternative or addition to individualsupervision. Different skills are involved and supervisors for this needtraining in group dynamics. Lastly, we need to establish specific super-visory guidelines and professional ethics that insure no ambiguousboundary areas between supervisor and supervisee.

There are many questions left for future study in the supervisionarena. The effect on a social worker becoming a supervisor has beenstudied by Kadushin (1985) but more information is needed. Further in-vestigation on the prevention of stress and burnout and its relationshipto social workers receiving or not receiving supervision is also impor-tant. Cross-cultural supervision has been reported but further study isneeded (Solomon, 1982; Kaiser, 1999). Cross gender supervision raises


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some interesting questions and we need to look at the impact this has.There is no doubt that race, class, and gender influence encounters betweensupervisor and supervisee and we need to help supervisors understand anddeal with these powerful dynamics. With the advent of managed care, so-cial workers are seeing more clients in less time, and this is another area forfurther examination. The impact on supervisor, worker, and therefore theclient needs to be examined. These questions are among the many thatremain for further supervision research. This group of clinical socialworkers valued their supervision experiences and found supervision tobe an essential ingredient in their clinical and professional self-esteemand ability.

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Ekstein, R. & Wallerstien, R. (1972). The teaching and learning of psychotherapy.New York: International Universities Press.

Fox, R. (1998). An Essay on mutuality and parallel process in field instruction. TheClinical Supervisor, 17(2). p. 59-73.

Hamilton, G. N. (1954). Self-awareness in professional education. Social Casework.Family Services of America. p. 371-379.

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RECEIVED: 10/17/01REVISED: 01/08/02

ACCEPTED: 02/04/02


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the value of supervision

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