Clinical Supervision
Clinical Training, Mentoring and Guidance for Licensed and Pre-Licensed Mental Health Workers
Learning is a lifelong endeavor. I am grateful for the past and present teachers, mentors, counselors and guides who collaboratively help me grow as a person and as a clinician. And I am honored to be in that role with others as a Clinical Supervisor.
Clinical Consultation (for Licensed Practitioners): We all need guidance from time to time, even once we are licensed. A part of cultivating wisdom is knowing when to ask for help, whether in the form of your own counseling (as a client) or through seeking some clinical consultation / supervision. The path of the therapist is not an easy one. Our ability as counselors to truly show up and be authentically present is foundational to our helping clients make deep, lasting changes. So we must be committed to the very growth in ourselves which we are seeking to foster in others (or our impact will be muted at best, and damaging at worst)—we must be engaging in the same difficult work we invite our clients to step into (otherwise we will be unable to to truly help them go where they need to go).
Counselor-in-Training Pre-Licensure Supervision: Graduate school introduces you to various concepts, methods and models of psychotherapy, and teaches you the fundamental skills of counseling. But your multi-year Residency is where you discover much more of the unique contribution you bring to our field, and are shaped into the therapist you will become. Rather than being a period to rush through on the way to licensure, Residency is an extremely formative time during which your habits and your relationship with your supervisor will shape you. And how you are shaped and formed during this season will then set the tone and the course of your clinical work (along with how well, or not, you care for yourself as a clinician) for years to come. For these reasons (and more) I encourage all Counseling Residents to give careful attention to whom they decide to be Supervised by and the context in which they do their Residency.
Note that I primarily Supervise Licensed Mental Health Workers and Post-Graduate Residents. Graduate Student Interns will be considered on a case-by-case basis. I do not offer Undergraduate Internships.
Considerations in Choosing a Supervisor (Particularly for Residency)
Regardless of whether you and I decide to work together, I hope the below can help you process through whom might be a good fit for Supervising your Residency. Consider these questions as you evaluate who you wish to approach, and as you have initial consultations with potential Supervisors.
- Which therapy models and theories do you (the Resident) gravitate toward and want to grow and develop in?
- How does your personality mix interact with other personality mixes? In particular, are there some personality types which you have difficulty understanding or learning from (and thus might make for a less ideal match in a Supervisor)?
- In the strengths and weakness of your personality mix, do you need a Supervisor to help provide you with a lot of organizational structure, or do you prefer to have more autonomy?
- In the long term do you desire to work in an agency setting (which probably will have more rules and structures, but has a higher likelihood of working on/with a team) or in private practice (which affords much more autonomy and decision making power, but requires more intentionality to maintain connections with other clinicians)?
- Are there aspects of the human experience that are important for you to be able to engage with your Supervisor regarding (e.g., faith tradition, ethnic/cultural background, sexuality, gender)? And are there any of these which you would want your Supervisor to share in common with you (e.g., share the same faith, race, etc.)?
- What client populations are you hoping to work with?
Distinctives of Supervision with Sean
Philosophy of Counseling and Supervision: Emphasis on Character Development
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I believe our role as counselors is not primarily the alleviation of suffering, but rather the collaborative cultivation of character, which often does feel better in the long run, but not because pain is necessarily absent, but rather the individual has grown in their capacity to stay present to it and more fully metabolize it. I often summarize this idea as, learning to bear the beauty and the burden of our life.
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This work takes great courage, both from the client and the counselor, as well as great compassion. Compassion is necessary because the work of growth and healing can be quite difficult and scary at times, as we choose to turn towards the places within our self and our life that we have been afraid to go. So we need much gentleness, patience, kindness and understanding for just how hard this all can be. And, precisely because of how challenging this process is, we also need courage and firmness, within ourself and from others, because we will so often be tempted to give up on ourself and the work of healing. Just as athletes need coaches to push them, so too do we, in the building of emotional/characterlogical muscles, need kind, wise, courageous coaches who will push us to do the hard thing that feels so difficult, yet is just within our reach.
Implicit in the above is that, with great kindness and very collaboratively, I challenge and push my supervisees to become more mindful of how their own issues might be showing up in the therapy they are providing to their clients. Supervision with me is not therapy—I expect you to be working on your own growth and healing (whether in your own therapy or some other context) outside of supervision—but it is therapeutic. You will be unable to help someone walk through anything you are unwilling to face in your own life—this does not mean we must have in common every single detail of a client’s experience, but rather we must be able to be with the underlying emotions which all humans share.
Clinical Integration: Working with Mind, Body and Spirit
Whether through overt trauma or through the more subtle effects of modern culture, so much of the painful symptoms we experience as humans are the result of various forms of disintegration. That is, various aspects of our lived experience being disconnected from each other. Thus one of the fundamental goals of psychotherapy is to help clients re-integrate (or in many cases, integrate for the first time) whatever aspects of themselves they are less connected to. What are the experiential places in their internal and external experience that they are currently unable to go? Most likely those are the very places where they need our help in moving toward those parts and bringing them into relationship with the rest of their psyche.
Cognition, Emotions and the Body
Our thoughts and beliefs are a part of who we are and certainly influence our experience of ourself and others. But focusing only on helping clients change their thought patterns is insufficient for bringing about deep, lasting change—cognition simply does not penetrate deeply enough to significantly influence entrenched patterns (as neurobiology research continues to demonstrate). Thus one of the fundamental goals of therapy is to help clients work towards emotional and embodied changes that can persist over time.
Relationships
We are shaped (for good and for ill) by our relationships. Understanding how we have been related to can help us make sense of why we relate to others and ourselves in the ways we do currently. And learning to attend to our present patterns of relating opens up the possibility of developing healthier patterns. The therapy relationship is a context in which we help clients start to notice not just the patterns they play out with others (and within their own psyche), but also the ways those patterns emerge in the the counseling relationship via transference. This has powerful implications not just for the client’s growth, but also for the growth of those they interact with outside of therapy. By keeping in view the interconnected web of relationships, both external systems (e.g., family, friends, work, etc.) and internal systems (e.g., IFS, disassociated states, etc.), we can work towards not just the healing of our client, but the growth and healing of their community.
Spirituality (and Christian Spirituality in Particular)
Our role as clinicians is not to impose our own will or views on the client, but to be ready to walk alongside them wherever it is they are ready and needing to explore. In order to do this well we must be aware of, and be making peace with, our own spirituality (because what we deny within ourselves, or pretend to others we do not believe, will then unconsciously be a part of the relationship). Clients are seeking (and needing) a true person-to-person encounter in therapy, and so we must learn how to be present with them in a real way (including our spirituality) that both models for them, and invites them to step further into, their own realness. One of the ways that I do this is by being up front with clients about my Christian perspective while making clear that I am happy to work with them regardless of their faith or non-faith background. When done well this actually affords clients more freedom to be where they are at, including exploring spiritual topics that they know to be places of difference between client and therapist. When lived healthily Christianity brings good things to the counseling process (e.g., compassion, hope, and respecting the dignity of others).
I am happy to consider supervising folks from all faith and non-faith contexts. If you are hoping to see clients under the Transitions banner the scope is more limited—because Transitions is openly a Christian perspective counseling practice, there needs to be much more alignment of beliefs between us (which we will discuss if you are interested). But for supervisees seeing clients elsewhere that is not a constraint. Either way, I would be happy to explore working with you as a supervisee.
Other Areas of Clinical Attention
Video Recorded Client Sessions
Residents seeing clients at the Transitions office will be trained in how to video-record all of their counseling sessions (using secure, encrypted equipment provided in the Transitions office). For Residents seeing clients elsewhere we will explore options for secure video or audio-only recording of sessions, but if neither is possible we can conduct supervision based on self-report. Supervision sessions will typically involve the review of a portion of a therapy session, exploring an area where the Resident is feeling stuck regarding how to help their client. Residents seeing clients at the Transitions office are able to review videos of their sessions on their own time, outside of Supervision. Note that recordings can only be viewed within the Transitions office where they are securely encrypted, and Residents only have access to their own recent sessions (i.e., older sessions are automatically permanently deleted after a set time).
Soliciting Client Feedback
I will teach you how to use a simple feedback tool with your clients that helps clients reflect at the beginning of session on how they have been feeling recently across multiple domains, and reflect at the end of session on how they have experienced their interactions with you that day. Both components are useful, but the end-of-session feedback is very helpful in teaching clients to take more ownership of the therapy process and in helping the therapist quickly catch and repair therapeutic missteps from the session.
Private Practice Expertise
Coming from a business background and with over running my private practice, I have a wealth of experience with the joys and challenges of being a small business owner. I write my own code for my website, I do my own marketing (and have given a lot of thought to what I call, “ethical marketing”), and I handle my finances (including decisions around things like pricing and sliding-scale discounts). Supervisees pursuing an eventual private practice will appreciate the range of practical business topics we can explore together in supervision, though implementation is always up to the supervisee themselves.
Practical Aspects of Supervision
Supervisee Income
(For Residents Seeing Clients at Transitions)
As part of the supervision experience I want supervisees to begin practicing managing their income and expenses in preparation for eventually having their own private practice. Thus my normal arrangement is for supervisees to receive as income the full client fee that their clients pay them, and then to have supervisees separately pay me for any expense items (e.g., supervision sessions, office resources fee, etc.). This is in contrast to the common scenario of the supervisor taking 40-60% of whatever the supervisee is charging clients (e.g., under that scenario, if you are charging client’s $90/session, you might have pre-tax income of $36-54/session at some agencies).
I believe that the arrangement of keeping the supervisee’s income and expenses separate (as opposed to my deducting everything out of the supervisee’s income prior to them being paid) better approximates the private practice financial dynamics that supervisees will need to be able to navigate in their future. Note that this arrangement means that supervisees are considered 1099 Contractors (which means you are responsible for your own health insurance, State/Federal Taxes, etc.).
I collaborate with each supervisee in the setting of their fee and the corresponding discounts they will offer their clients, helping the supervisee to wrestle with the tension between making services accessible and making services sustainable (i.e., the supervisee needs to have enough income to sustain continuing to help clients over time). An example fee with corresponding discounts would be $120/session, with discount rates of $110, $100, and $90/session. In addition to offering income-based discounts I recommend supervisees always offer the the first session at half-price. Sessions are usually 50 minutes long.
Supervision Fees
Supervision Session Fee
My fee for one-on-one supervision is the same as my counseling session fee, $320, with sliding-scale discounts (based on income) as low as $180 (subject to availability), and with additional discounts for dyad and group supervision. Supervision sessions are 50 minutes long. Longer sessions are prorated accordingly. Supervision sessions consisting of more than one supervisee are discounted per the below table. Note that the Virginia Counseling Board considers supervision sessions consisting of two or fewer supervisees to count towards “Individual” supervision requirements, while supervision sessions consisting of three to six supervisees are considered “Group” supervision.
| Number of Supervisees Present | Fee Per Supervision Session (after any discount) |
|---|---|
| 1 Supervisee | Regular Session Fee (including any income-based discount) |
| 2 Supervisees | Regular Session Fee x 0.70 |
| 3+ Supervisees | Regular Session Fee x 0.55 |
Supervisees will be expected to pay for each supervision session at the beginning of the session (preferably via online payment).
Example if your regular session fee is $320 (i.e., you are not receiving a discount):
- 1 Supervisee ($320/session)
- 2 Supervisees ($224/session)
- 3+ Supervisees ($176/session)
Example if your regular session fee is a discounted rate of $180:
- 1 Supervisee ($180/session)
- 2 Supervisees ($126/session)
- 3+ Supervisees ($99/session)
Office Resources Fee
(For Residents Seeing Clients at Transitions)
Learning to think strategically about various logistical resources is an important part of preparing for private practice. I charge supervisees a nominal fee for the use of various office resources such as the use of the space, internet, printer/copier/scanner, and the secure notes software that I require my supervisees to use (situations wherein a supervisee wishes to use different software will be considered on a case-by-case basis). To keep things simple all of the above (and more) is wrapped into a single fee the supervisee will pay each month, and this fee is tied to how often the supervisee reserves time in the office (in part because that is the simplest metric to track resource usage by). The fee is tiered such that the more a supervisee uses the office the less their cost per hour of use is. This mimics private practice in that the more clients one sees the more one is spreading the cost of renting an office (and incurring other resource expenses) across a larger number. I also use this tiered approach with supervisees because it keeps their overall cost from getting too high (whereas various flat-rate structures would either be too cost prohibitive while they are building a client load, or quickly balloon in cost as they see more clients).
| Hours Per Month (of Office Use) | Fee Per Hour |
|---|---|
| 0 to <40 | $4.00/hour |
| 40+ | $2.50/hour |
Other Expenses
These are some of the additional expenses which supervisees are responsible for, but which are not payed to Transitions.
Insurance
Supervisee’s are responsible for securing their own health insurance and liability insurance policies. CPH & Associates is a recommended option for liability insurance.
State and Federal Taxes
As mentioned above, I do not take out any taxes from supervisee income—it is the supervisee’s responsibility to consult with an accountant regarding paying quarterly estimated taxes. There are several CPA’s to choose from in the Harrisonburg area—Miller & Jameson, LLP and Daugharty & Company, P.C. are two worth considering.
Supervision Interest Form
Note: The below will ask for your Myers-Briggs Personality Type. If you are unsure of your Type I recommend taking a quick assessment before beginning the form.
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