Supervisory Alliance: How to Address Conflict in Clinical Supervisory Relationships
We recently announced that clinical group supervision for AASECT sex therapy certification and clinical consultation services are now available for licensed professionals located throughout the United States.
You can learn more about what clinical supervision is, including the different models of clinical supervision, in our previous blog post.
Today, we will teach you about supervisory alliance, ways to address conflict in supervisory relationships, and various forms of supervision.
Supervisory Alliance
The supervisory alliance is a collaborative relationship between a supervisee and supervisor based on the mutual agreement of goals for the supervisee. The strength of the alliance is critical because it can predict how well the supervisee functions with clients and lay the foundation for the supervisee’s alliance with the clients.
Like all relationships, conflicts can occur between a supervisor and a supervisee. Given the nature of the power differential and the amount of time supervisors and supervisees spend together, it is natural that conflicts can arise. Clinical supervision can be a dynamic that has struggle, which provides an additional opportunity to work through interpersonal conflict in constructive ways.
Any number of the following can contribute to conflict in the clinical supervision relationship:
Agency or clinic challenges, e.g. high demands on supervisee’s readiness
Relationship factors between supervisee and supervisor
Supervisor factors:
Lack of transparency of performance expectations
Hesitance to address problems early in the relationship
Supervisor expectations not matching supervisee’s developmental level
Supervisee factors:
Supervisee resistance
Supervisee behavior that communicates an attitude that supervision is not needed
Supervisee transference issues in relationship to authority
Supervisee having more clinical experience than the supervisor
Given conflict resolution is essential to healthy relationships, and a therapist's role is to form and maintain a healthy relationship with their clients, it is critical that a clinical supervisor and supervisee can work toward conflict resolution in a healthy manner.
There are many ways that conflict can be addressed in the supervisory relationship by a clinical supervisor; some include the following.
Reflective Processes
Write down and talk about contributions toward the conflict.
Look out for parallel processes and transference/countertransference issues.
Increase and express empathy.
Seek out your own supervision or consultation on the issues.
Accept and own limitations and contributions to the conflict.
Interpersonal Strategies
Slow down the situation; take as much time as you need to process.
Avoid negative tone or language as part of giving difficult feedback.
Technical Interventions
Become more active with the supervisee, using active skills, behavioral approaches, problem solving, and modeling of desired behaviors.
Use humor in teaching how conflict and conflict resolution are naturally occurring events in relationships.
Healthy supervision includes active management of the power differential, transference, and countertransference.
In the role of a clinical supervisor, there is a power differential, so it is essential to empower a supervisee to raise concerns about the power differential. The supervisor must create a safe space to address any issues with the power differential.
It is the supervisor’s role to address the supervisee if there are subtle changes in connection. The supervisor will explain that clinical supervision is where supervisees can explore relationship dynamics and that mistakes on either side are learning opportunities. Early in the relationship, it is important to help supervisees understand transference and countertransference and to normalize countertransference as inevitable.
Attending to attachment ruptures in the supervisory relationship is critical to maintaining a healthy relationship. Utilizing the parallel process in the rupture and repair process models for the supervisee how to repair conflict with their clients. Supervisees are encouraged to take a risk and share their feelings. A good supervisor will acknowledge the rupture and encourage supervisees for input on how to repair it.
Self-disclosure in a clinical supervisory relationship by a clinical supervisor looks different than in a therapist-client relationship.
It is helpful when a clinical supervisor can share mistakes they have made in their own clinical development as a therapist, emotional responses they have had to clients, struggles in professional development, difficulty in work-home balance, or other personal reflections as appropriate.
It is important for a clinical supervisor to have the ability to self-reflect, have a mindfulness practice of their own, stress management practices, and self-care routines. Modeling a healthy lifestyle is an important learning component of good clinical supervision.
Forms of Supervision
There are a number of forms of supervision that can be utilized for supervisees at different stages of development:
Case presentation and discussion (when a supervisee reviews current cases with a supervisor and gains feedback on requested areas of concern)
Live observation (when a supervisor sits in on a supervisee’s session to observe)
Co-counseling (when a supervisor and supervisee co-lead a client session)
Audio-video recordings (when a supervisor reviews an audio or video recording with a supervisee after the session has occurred)
Interpersonal process recordings (when a supervisor reviews a video or audio recording with a supervisor and processes why the supervisee choose the interventions they did during different periods of the session)
Internal Family Systems (IFS) parts mapping with a supervisee who has a strong reaction to a client to process their parts that got activated (working with countertransference)
During case presentation and discussion of clinical supervision, it is helpful for supervisees to have basic information available to discuss cases.
Considerations for a supervisee to address before bringing a case to supervision may include:
Provide identifying information about the client.
Attach the client’s genogram.
State the agreed-upon issue the client is seeking help for in therapy and note anything in it that carries personal meaning.
Describe personal reactions to a client and the client’s reactions.
Address whatever cultural or spiritual values may be coloring how clients are viewed.
State the aspect of the issue to be addressed with a supervisory session and highlight anything in it that carries personal meaning.
Give a detailed explanation of a hypotheses about the roots and dynamics of the client’s issue.
Explain the therapeutic strategy being utilized with the case and the aspect of the case to be discussed in supervision.
Detail how the treatment’s technical interventions are being implemented.
Detail how the therapist can use themself in conjunction with the chosen interventions.
Identify personal challenges in working with a particular client around the issue.
Discuss the plan for meeting any personal challenges in this case.
Group Supervision
There are many advantages of having group clinical supervision. When there are a number of professionals in need of similar supervision or consultation, it is helpful to utilize a group strategy.
Groups offer different perspectives that supervisees can be exposed to based on the unique makeup and background of group members. Groups allow for the ability to do group exercises to assist with case conceptualization, techniques, problem solving, and treatment planning.
Learn More About Clinical Supervision + Clinical Consultation Services at Kimberly Keiser & Associates
Are you interested in being part of our new clinical group supervision for AASECT sex therapy certification and clinical consultation services?
Our founder, Kimberly Keiser, has recently finished her AASECT sex therapist supervisor certification and is starting one sex therapy supervision group, which is open to any therapist in the U.S.
We will also have clinical case consultation services available at a rate of $220 per hour.
Please contact our team to learn more and apply today!