Supervision and Consultations

It isn't, unfortunately. It is my opinion that is absolutely should be, and I wouldn't see a T who isn't having regular supervision.

My therapist doesn't have a supervisor, but she mentioned once that she has a consultation group. I don't know if it's a regular thing or not. It makes me uncomfortable to think about because even though they don't use clients' names, it feels violating to have people I don't know discuss me (not that I know if I have been a topic or not). It comes down to the stability of the therapist and their ability to know their client and to use consultation to see their own stuff, rather than take actions in therapy that could be harmful, such as terminating someone based on advice from other therapists (which I think is what happened to me as there did seem to be a sudden shift in my therapists's attitude).

My therapist has also said that she has her own therapist. I think she shared that because I said I didn't think she understood what it was to be a client. But even so, I think the dynamics are different when both are in the same profession.

And echos, I think you make for a great therapist. You know what both good and bad therapy look like, and you bring a lot of honesty to your own work.

I think that consulting with peers (whether it is called supervision or something else) is highly beneficial in every profession, even in those that do not involve dealing with people. It's not only for reality checks but also to help keep up with the developments of a field that one person perhaps will not discover. However, it is only useful if it is quality consulting/supervision and not just a means of getting validation from and venting with another individual.

I am not a clinician/therapist but have worked with many in my job and often participate in clinically-oriented meetings, conference sessions etc with Ts and psychiatrists. To be honest, I am too often surprised (and also kinda grossed out) at how much client detail they sometimes present openly in forums like that. Also how (usually the same people who do the TMI) they often focus completely on the client in a case discussion and don't integrate what they do, don't question what they do - an alarming lack of introspection. The pattern often tends to be that those individuals go into unnecessary details of their experience with a client in a way that presents the clients as quite disturbed and flatters the skills of the clinician. Of course it is not everyone but, at least in the forums I go to, I encounter it with a frequency that seems alarming to me as an outsider (non-clinician, ex therapy client). So imagine if a person with that lack of introspection and responsibility teaches/supervises students... luckily the students usually have multiple mentors throughout their training. Of course this is not a special characteristic of mental health clinicians but a general feature that is present in every profession - there are bad teachers, supervisors, practitioners everywhere. Why, IMO, it is so important to receive mentoring and consult with a variety of peers instead of only one and the same one for years. Not sure how most Ts handle this in their private sphere, whether they use different supervisors or stick with one? I guess depends on the T. If I were a T dealing with many different client issues, I would probably try to consult with separate experts in the different issues/fields instead of just one person that I happen to like and click with.

I only ever hired one who admitted to having a sort of supervision out of the 4 I saw more than one time - and that one said it was intermittent if she thought she needed it. But I always hired those who were in their 60s-70s -so they generally thought they did not need it. Frankly I don't think, from when I have cases against them, that it helps them in any good way for the client. It might make the therapist feel better about themselves but certainly not the client. Adding in a third party's meddling who does not know one of the parties is a really super bad plan in my opinion.

Isn't this actually what we also do here on this forum, discussing our therapy experiences? And many people who post here find the information and discussions quite useful (myself included, especially when I was in the early phases of my therapy). For ourselves though, probably not for our therapists, especially if the T gets scrutinized or fired as a result of this client group discussions - so in a way it is often bad for them. I can see how some biased supervision or other peer T discussions can also be bad for the clients in a similar way... Can be kinda 'us against them'.

I see it as different due to the difference in roles (not to mention that those guys hold themselves out as experts - I disagree -but they are paid and they do believe they are a "profession").
If therapists just want a group to ***** with about clients, then fine. But when they use it as "My supervisor told me to do X with this client so I did" - I think it is a problem.

I agree, that is a big difference. That is referring to "professional advice" to justify or reinforce a (bad) decision/act and shift blame. I guess this goes back to what I said about lacking introspection, autonomous investigation and avoiding responsibility in certain people. My two therapists were polar opposites in that sense - basically the main reason I liked the last one was what came across as a strong sense of responsibility and professionalism - whether the actual therapy helped or not. I don't know if he has supervision (he's ~age 60) but his willingness to admit fault, not become defensive much and reliable acts struck me more as his natural personality traits rather than the result of training or feedback. I still did not find therapy with him very useful for the main concerns I went in for but at least his professionalism was stellar. Again, I am pretty sure it's primarily an individual feature and autonomy in him rather than the effect of ongoing peer influence. Part of the reason why we were a decent match, I think. I do know that he likes to consult with experts in many different areas in his own life for the information, just like I do. I think there is indeed a big difference between consulting for information or for the sake of rationalizing and validating choices.

A few comments:
I can see SD's point here, that the T is the one who works closely with the client, and a third party, through supervision or consultation, wouldn't have that knowledge of the client when offering suggestions. So they could suggest something that really wouldn't help the client or that could potentially be harmful.

One of the other things about supervision and consultation is that it's still ultimately up to the therapist to decide what to get advisement on and whether to follow that guidance. I think of my ex-marriage counselor. Had he consulted with another T or a supervisor and said, "So I'm being really inconsistent in my boundaries with a marriage counseling client. Sometimes I'll tell her we have to keep the focus on marriage stuff, but other times I'll spend 45 minutes on the phone with her just talking about her transference for me, without charging for it," then I imagine, if that other T/supervisor was ethical, they might have said, "Uh, stop doing that. Consistent boundaries are important. And it's marriage counseling, so you should treat them only as a couple, no individual stuff." But I doubt ex-MC would have gone to someone about that because he probably didn't think he was doing anything wrong. Or...he realized he was doing something wrong, so he wouldn't want to share that. So I'm not sure that supervision/consulting would necessarily prevent harm by T's who think they're infallible. (No, I'm not bitter at all, why would you say that?)

However, for T's who DO realize they can make mistakes or who have a lack of experience in a certain area (say, DID or strong transference), then I think supervision/consulting could be extremely beneficial. I have no idea if my current T has consulted with anyone about me. But he has admitted to not having much experience with clients being attached to him--for example, I was apparently his first client (in 17 years) to request a transitional object. I could see that being a case where he'd want to consult with someone more experienced in that area on how to handle it (I know he didn't consult regarding the object, since I requested it and he gave it to me in the same session). He has seemed to improve significantly in how he deals with my attachment, but I have no idea if that's because he sought supervision/consultation or if he's just a fast learner and has figured out by my reactions what is and is not helpful to me (I also give him feedback).

Anyway, back to T's in general: I think consultation/supervision could also be a place to get a reality check on techniques one is using, to get suggestions for other ways to approach a situation, to help if a T feels "stuck" with a client, to address potential countertransference and how to deal with that, etc. But a T needs to be self-aware enough to realize they need that consultation.

I have never seen a therapist with less than twenty years’ experience, so they’re no longer under formal supervision. Several mentioned informal supervision or consultation about me. It’s always come across to me as a means for self-justification of (what I think are) their mistakes, or just impractical.

For instance, last session Info mentioned she had sought consultation over my hearing disability and the advice she got was “just be with her over it.” I asked what that meant and got slightly-changed versions of the same phrase: “sit with her over it.” Useless.

I could give her better advice over it, but apparently I don’t count.

ETA: my point is that just because a therapist seeks consultation or supervision, it doesn’t mean it’s a plus for the client. Just as the quality of therapy one receives depends on the quality of the therapist, so too with supervision. I would be careful not to mistake supervision for quality.

I laughed out loud at this. I SO needed to laugh today. Thanks, LT.

Over here (UK) accredited therapists have to go to regular supervision as it’s considered essential. I would be super uncomfortable with a T who didn’t have it.

And I wouldn’t see a therapist in the US who wasn’t licensed, as is required here. Yet those licensed therapists still screw clients up.

The same is true for required supervision. It guarantees absolutely nothing except that a professional box has been checked.

I don't think my t is in supervision. he is a supervisor himself tho. I know he saw a therapist because he took me to meet her. but idk if he still sees her. it's not really my business

My previous T did consultations with other T's once a week.

My current T has a supervisor (she has been in practice for 14ish years), and also sees a T.

I fall in with SD and a few others about this. Supervision, much like teacher observation, sounds nice in theory, but operates largely without scrutiny--and so, without any critical evaluation. I've never had a teaching supervisor who knew enough about pedagogy to assess me, let alone supervise me on a regular basis. I always welcomed expert observation, largely for the purpose of teaching references, from respected colleagues at my rank or above.

In my state--I don't know if this is true elsewhere--only Ts with certain credentials beyond the usual degrees and license can supervise. I think the designation is HSPP--Health Service Provider in Psychology. What is required to get that certification, IDK--it may be reciprocal with APA board certification. My former T supervised the post-doc interns in the Univ counseling center as part of his position and he was board certified. I think he usually had 2 or 3 each year completing their supervised hours to be eligible for licensing. The center was APA accredited. I know it was pretty time consuming for him with hour long weekly meetings with each individually, plus a 2 hr a week "seminar" together. I think such training supervision prior to licensing is more important than post license in order to catch potential problems and, if necessary, remediate deficiencies. Post license, if supervision doesn't have any standards and controls, I don't see it as necessary or particularly helpful.

I, too, don't see a T who doesn't have decades of experience, and I'm lucky to have lived in the same area for a long time, so I know who in town "has legs." Not to say a newbie couldn't be fabulous, but a lengthy and solid reputation goes a long way for me. That said, former T told me he had a colleague he would talk to as needed, and on the rare occasions he was out of town, this same T covered his practice.

Seeing a T with years of experience can sometimes be counterproductive as with a supervisor. Just because you are a t or a supervisor with years of experience does not mean you are a good t or supervisor. Likewise if you are a mother and have had lots of children and experience does not mean you are good.
Supervisors should be regulated.
I read some research lately and it said that the more a t practises the less efficient they become. I will try find the link to this but I just wanted to say that therapists themselves seem to idolise supervisors and other ts who have been in the business for years without having any experience of them as therapists or supervisors.
I think clients know best what their is like and we should trust that.

I think the situation is culturally very different in the UK. But my experience of supervision is very collaborative and not authoritative. ie the supervisor is not instructing or sticking their oar in when it comes to what they don't understand.
It's a place where the therapist can freely explore their own unconscious motivations and responses to working with their clients and the supervisor is very respectful of the fact that they are not the one in the room, and don't presume to know. A lot like how the therapist can't presume to know what's best for their clients.
In my experience there is a good degree of scrutiny of supervisory practice. In my case, my supervisor has a supervisor (my supervisor also has 40 years experience). It's just a massive cultural difference I think. But I'm glad I have a therapist who values his supervision. It's made a huge difference when we've had ruptures and he has had that space to reflect and explore what has been happening at his end.

I agree with this completely. Just sit with her? What does that even mean, and wasn’t your t sitting with you anyway?
Supervision and experience does not equate to quality anything!
Just because a t has twenty plus or 40 plus years does May make a good therapist nor does doing their own work or a lot of crappy things therapists do that make them feel superior to everyone else. If you ask me they go int the profession just to feel superior and better than their clients and to put others down.

Well, I do believe experience counts. It isn't a guarantee--there is no such thing--but when coupled with other criteria (including having done their own therapy), it bolsters the odds of competence. Do you want a mechanic who has never worked on your model of car before, or one who has? Do you want an accountant to do your taxes who is familiar with your financial profile, or a graduate of a 2 week training course? How about a surgeon--want to be her first patient? No thanks!

But that kind of experience can be measured and exhausted. They either do the surgery, fix the car and are competent or incompetent.
How does one measure a ts competencies, for me experience and doing their own personal work is not a measure of anything. I know lots of psychotherapists who have been therapists for over 20 years and they are complete twats, bonkers and full of their own importance- spouting ethics this and ethics that but they all break their own codes of ethics in different ways but are too blind to see how they themselves break it but are quick to point out when others do it.
I am not saying I am right it wrong or you are right or wrong, each to their own. I can only speak from own experiences with them and therapy and to be honest it wouldn’t matter to me if they were trainee or experienced because either have their own issues and problems

I think there are a variety of ways to measure competence, experience being only one variable, but not everyone agrees on their validity. And even with basic competence, effectiveness will always vary client to client. The same is true for teachers: basic competencies can be measured, but not every competent teacher is the most effective teacher for every student. I just prefer to stack the odds in my favor by looking at a wide variety of criteria, rather than say it's all a gamble and take your chances.

T has been in practice for almost 40 years so she doesn't need supervision. EMDR T has pra,ticked for 13 years. She does participate in a no that consultation group. It sounds like they all sit around and discuss any issues the T's might have.