Tag Archives: Internship

Resolving Problems in Supervision

img-article-are-you-too-stressed-outI am having problems with my supervisor and am thinking about requesting a new supervisor. She seems impatient and critical of me, so I feel intimidated and that makes it hard for me to take in her feedback. When I tell her how I feel, she says she’s trying her best to help me learn. I don’t know how to make this better so maybe I should change to someone else.

This is a painful situation, since supervision is a crucial part of growing into the therapist role. It’s easy to feel hopeless and think that a change of supervisor is the only alternative. My experience has been that this kind of impasse can often be improved with thoughtful self-reflection and conversation, so I’ll first suggest some ways to examine the possible dynamics of this situation. Then, I’ll outline some recommended steps to approach the conversation that are likely to make it more clear whether your supervisory relationship can improve and contribute to your learning and growth.

My first comment is that engaging in self-reflection and finding ways to shift your feeling of intimidation to one of empowerment will contribute to your ability to handle other difficult clinical situations. You are likely to face interactions with clients, family members, or other professionals that contain some of the same features of this supervisory relationship. Since your supervisor’s job is to support your clinical growth, she is likely to be most responsive to your efforts so it is a good place for you to test out some new relational skills.

To begin your process of self-reflection, I encourage you to shift your attention from your supervisor’s comments to your own response. You mention feeling intimidated, so explore the thoughts, feelings, and images that are present in that sense of being intimidated. You may identify thoughts undermining your self-worth and competence, feelings of shame and inadequacy, and/or images of yourself as a child being chastised by a parent or other authority figure. As you identify your response on a deeper level, remember that these thoughts, feelings, and images are yours and are stimulated by your supervisor but are not the only response you might have. Although your supervisor is an authority figure, you are not a child dependent on a parent’s care and approval but an adult growing into a professional role. When your supervisor gives your feedback on your clinical work, it is not confirmation of incompetence but confirmation that you are in the early phase of learning a set of new skills.

It may be helpful to talk with other supportive people while you engage in this process of self-reflection, especially if your supervisory interactions stimulate unresolved issues from your early life. Talking with your therapist, academic mentors, or past clinical supervisors may be useful. It can be hard to recognize and challenge old patterns when your feelings are strong and painful. It may also be helpful to talk with peers and friends to gain support and encouragement; however, be careful to avoid presenting the situation in a way that will lead them to see the situation as hopeless and affirm your fear that it can’t get better.

After you made progress in understanding your response, challenging some of your underlying beliefs, and grounding yourself in your clinical role, it is time to return your attention to your interaction with your supervisor. Consider the possibility that simply shifting your response from one of intimidation to collaboration will change the dynamic in a positive way. I would suggest initiating a conversation about your supervisory relationship, acknowledging it has been difficult and sharing that you have examined your response and are attempting to shift some of the things that have interfered with your openness to her feedback. State in a positive way what you feel you have received from supervision and what you wish to gain from her expertise.

If supervision continues to be difficult after having a conversation like I describe above, the next step that may be helpful is to talk with the director of training or another clinical supervisor in the agency. Your agency may have a procedure in place for resolving supervision difficulties, which you should follow, but if not seek out someone who has some supervisory and/or administrative responsibility for the training program. A conversation with a third party may give you further insight into the difficulty you are facing and lead to a more fruitful conversation with your supervisor, or it may lead to a decision to schedule a meeting between you, your supervisor, and the third party to discuss the problems and attempt to reach resolution. A decision to change to a different supervisor is rarely necessary if you follow all of these recommended steps.

I hope you are able to use these suggestions in understanding difficulties you face in supervision. Please email me with comments, questions, or suggestions for future blog topics.

Professional Practice Decisions

therapy1I’m about to leave my counseling internship and I want to keep seeing a few of my clients.  Should I look for a private practice internship so I can continue working with these clients?

Leaving an internship is a big transition and it usually brings up many different feelings.  Transition always involves uncertainty and we sometimes deal with uncertainty by looking for something that can stay the same, to give us a feeling of security in the midst of change.  If you haven’t given thought to these issues, I encourage you to talk with your supervisor more about the upcoming change and the feelings you have about leaving your current placement.

Regarding the question of looking for a private practice internship, this is a decision to make based on your professional goals and direction rather than based on a desire to continue working with a few clients.  A private psychotherapy practice is a business that requires a significant investment of time, energy and money.  It only makes sense if it fits with your vision of what you want your professional life to be in the next several years.

I suggest asking yourself a few questions before exploring a private practice internship.  How will I feel if one or two of my clients don’t want to continue working with me after I leave the agency?  How will I feel in six months if I have no clients?  Am I avoiding some feelings of sadness or guilt about ending with these clients?  Am I worried that no one else can help them as much as I can?  Your honest answers to these questions will help you sort out your motivations and determine the right course to take.  Bringing these issues to supervision will also help you clarify what to do next.

If you do pursue a private practice internship, be sure you know the requirements of your agency in transferring clients to another setting and the requirements of your private practice supervisor in bringing clients with you into your new internship.  There are legal, ethical and licensing board issues and regulations that need to be met.  Make sure to have clear conversations with the private practice supervisor about the expectations that both of you hold about the business and clinical parts of your relationship.  Each of you may have assumptions about how you will operate, and these need to be shared to maximize your satisfaction and success.

Most importantly, use this transition as a time of personal and professional growth.  Take time to reflect on your training and supervision experiences, what you have learned and what you want to take on as your next step in training.  Think about all the clients you have seen and what you learned in working with them—about yourself as well as about clinical work.  Take time to say goodbye to your peers and supervisors as well as your clients.

Recognize what you’ll miss as well as what you’re glad to leave behind. Each phase of training contains lessons and prepares you to take on the next challenge.

Please email me with comments, questions or suggestions for future blog topics.