To the outside observer, the licensure process to become a therapist seems bizarre.
The part where you pay someone to gain clinical hours baffles even the closest of friends. While this part of the journey has been tough at times, attending clinical supervision has been fundamental in my development as both a therapist and human.
In my graduate school internship, I was paired with a supervisor who actively worried about my difficulty using clinical jargon in note taking and describing exactly what I was doing in session.
I was a new therapist, and because my supervisor didn’t see this as a developmentally appropriate struggle for a fresh graduate, I picked up on her fear and began to doubt myself.
After graduation, finding the specialized clinical supervision I needed was difficult due to scarcity in my area.
In a city of just under 200,000 people, there were THREE practicing supervisors from which to choose. I went with whoever had an opening.
On top of that, I was a recent graduate and hadn’t found a steady job yet. I was seeing two clients in private practice and the majority of my time was spent catching up on everything I didn’t have time for in school (which is definitely reading books).
The supervision I found may have been inexpensive, but it was ineffective, though not harmful (more on this later). Very early on, I got the sense that while this clinical supervisor had been in practice a while, their job had become routine and they had difficulty inspiring a new member of the profession.
I found myself once again resisting their advice and doubting my own abilities.
Around this time, I took a job in a different city. In this new place, I found a different individual supervisor who was both specialized in my area and a wonderful fit for me.
Over the next two-and-a-half years and three jobs, I met weekly with this new clinical supervisor who quickly became a mentor.
They served as an anchor for me and gave me a sense of direction, validation, and hope. It was exactly what I needed to endure the confusion and self-doubt that was my constant companion.
Clinical supervision felt like part-therapy, part-career coaching, and part-mentorship.
My new job also provided me with a supervision group.
Each month, the six of us met at our supervisor’s house to drink coffee and discuss cases, and it was the highlight of my month and a huge perk of the job.
Months after I had left this job, I was working the drive-thru at Starbucks (during an existential crisis) when this same supervisor pulled up to drive-thru window. I served her coffee and she gave me the opportunity to re-explore my love for two things, writing and therapy, by writing for her new startup, Motivo.
My expectation of clinical supervision was to focus solely on my clients and my interactions with them, but what I found was a personal and professional lifeline.
I talked about my clients to gain clear direction AND my very specific issues in this career.
You can’t have good supervision without some form of personal development.
I learned to:
My reality is that I also had to experience “lukewarm” supervision to get all my hours.
For me, this looked like answering factual questions about my clients and then answering more questions about what I’ve done so far. These updates usually took up the whole hour.
I found it unhelpful because it only mired me in my own perspective; I never came away with new insight.
When the focus is only on the client, there is no opportunity for the supervisee to grow.
There is also such a thing as just plain bad supervision.
Watch out for those who refuse to help you conceptualize a case in any other way but their own, are demeaning, and/or actively doubt you (and cause you to doubt yourself).
A co-worker recently went through a time where the provided (free) supervision became wildly unhealthy. She often came away from supervision feeling discouraged and confused, but continued to tough it out.
The breaking point came when said supervisor mentioned the exorcisms she sometimes does with clients. My co-worker has since found a very good replacement and pays out of her own pocket; she finds this agreement much better.
More often than not, I find fellow pre-licensed practitioners feel neutral towards their supervisor.
When I ask why they don’t find a different supervisor, the most common answer is that they don’t know of anyone else better in the area, who has availability, is affordable, or fits with their schedule.
Many therapists don’t know this, but there’s always online clinical supervision — one of the fastest and most cost-effective ways to get connected with high-quality, AAMFT-approved clinical supervisors in your state.
Pre-licensed therapists do have options. Especially when it comes to finding clinical supervisors they love.
Having a good relationship with a supervisor is a huge buffer to prevent burn out. The hardest therapy jobs are more doable if you are able to learn from them, and an amazing supervisor will help you to do that.
It is possible that your company will provide you with supervision (which is great)! Leverage that, but also find your personal supervisor on your own. If you have to pay out of pocket, consider this an investment in your career.
The high turnover rate in agency work means that you may not stay at one place the duration of your pre-licensure stage. If, like me, you end up moving jobs, you will reap the benefit of having access to your personal supervisor.
Confront yourself with the realities of what your entire supervision journey will cost and the amount of hours you will need to accrue per week.
In the beginning, I avoided doing this because the cost and time seemed so astronomical I did not think it could be achievable. Supervision hours accrue very slowly, as opposed to direct client (or clinical) hours.
As an example, in an average private practice or community health clinic, you can amass anywhere from 5-25 clinical hours a week by working with patients and clients. Your practical experience grows quickly.
By contrast, to accrue even five supervision hours, it would take you OVER A MONTH (if you are seeing an individual supervisor at the typical one hour per week model). But you can utilize both weekly individual and monthly group clinical supervision. Create a timeline with goals and stick to it.
When you feel overwhelmed by the enormity of this task, remember, you are not alone.
This too shall pass and the Motivo community is right there with you.
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