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Grace Hipona
Apr 03, 2012

When Supervision Isn’t Enough

I worked with a Masters-level counseling student, “Jennifer,” a number of years ago, and I was her onsite supervisor. She was completing her internship requirement at our agency, and it was the last requirement prior to graduation. The population our agency served was severe mental illness, and the agency was a private, nonprofit providing counseling and case management to this population. The clients were voluntary, stable, living and working in the community.

Jennifer was timid and shy, but friendly and willing to engage with others. She did not have any previous mental health experience prior to her Masters program. During her interview for placement at our agency, she appeared to be eager to learn and open to new experiences. She said that she wanted to work with our clients because it would be valuable experience for her career even though she was uncertain of her exact path. However, when she actually began to engage with the clients, she seemed anxious and verbalized her fear in supervision. We processed her thoughts and feelings during supervision and devised a plan on how to deal with her anxiety. I encouraged her to receive support from her peers and supervisor at her program. I tried to help normalize her feelings and educate her on the counselor learning process as well. She seemed to appreciate my support and stated that it was enough to help her work with the clients.

Jennifer worked well with the clients when they were not experiencing any crises or acute stress. She was able to be present, help them process, problem-solve, provide support and be sympathetic. Jennifer was able to effectively build a therapeutic relationship with the clients as well. However, about mid-way through the semester, one incident changed this.

A client, “Steve,” had been experiencing an increase in his depressive symptoms (diagnosed with Major Depressive Disorder, recurrent) over the span of a couple of months. He did have some psychotic features, but typically, he was able to manage these symptoms, and they did not interfere with his level of functioning. Steve was not able to identify an exact trigger for a change in his symptoms. Jennifer was Steve’s primary counselor. As Steve began to disclose his increasing depressive symptoms to Jennifer, she began to express more anxiety. At the time, this response seemed to be appropriate given the circumstances, and I provided her with an increase in supervision time and support in general. I also suggested a crisis intervention training and some other reading material for her to read and then process in supervision. Again, she felt like this plan would suffice.

However, as a couple weeks passed and Steve did not appear to get any better (but did not get any worse), Jennifer continued to have a difficult time and began personalizing the client’s struggle. She appeared to be losing her objectivity, and she stated that her anxiety was becoming difficult to manage at times. I rode the fine line between being a supervisor and counselor. I encouraged her to receive more support, again, including individual counseling and talking with her internship supervisor. Jennifer began to “shut down,” and it was difficult to provide constructive feedback and discuss her job performance without her becoming defensive. For example, she appeared to be avoiding Steve. She would give some excuses, which may or may not have been reality-based. When I confronted her about this issue, she denied it being a “problem.”

Included in my attempts to provide support for Jennifer and collaborate with her in terms of a remediation plan, I asked to join her sessions with Steve’s permission as well. Jennifer appeared to have difficulty engaging with Steve. Her presentation was almost robotic or disconnected. In response, Steve was curt and would only provide one word answers.

With Jennifer’s knowledge, I also spoke with her internship supervisor about my concerns. Her supervisor recommended we have a team meeting, and the supervisor would also have an individual meeting with her. Jennifer continued to be defensive and unable to be open to constructive feedback. She also continued to deny there were any problems.

Jennifer’s performance did not improve, and I was ultimately concerned about the client. I discussed my concerns with Jennifer and decided to assign the client to another counselor. Jennifer did not seem surprised. Rather, she agreed that she “may not be cut out” to work with this population. She wanted to obtain another internship “to work with normal people.” I asked her to define “normal,” and she said, “People who do not have as many problems.” I reminded myself that she was inexperienced and did not understand the flexibility required to be a counselor and that not everyone can work with this population. I attempted to process this issue with her, but was met with resistance.

Because it was more than halfway through the semester, she had difficulty finding another placement. For Jennifer’s evaluation, I included all my concerns. The internship supervisor concurred with some of concerns, and Jennifer was required to take another semester of internship. Therefore, she could not graduate on her expected graduation date.

As a supervisor, I felt ineffective. Although I felt like I had done what I could for Jennifer, including receiving supervision for myself, I still partly blamed myself for how things had transpired. Through supervision and further supervisor trainings, I slowly began to realize how much responsibility I had placed on myself in the supervisor-supervisee relationship. I ended up doing more of the work, when it was the supervisee who needed to do most of the work. As with the counseling relationship, the supervisor-supervisee relationship also requires the recognition of boundaries, roles and responsibility. Not all relationships “work.” We cannot be expected to be able to work with all clients and/or supervisees effectively.

Another consideration is that not all people going into the counseling field are really “fit” to be counselors. So, who are supposed to be the “gatekeepers” for the field? I believe supervision has its place in this decision-making process. As supervisor, we need to allow it to be part of supervisee evaluation. We also need to remind ourselves that we not only provide supervision to assist upcoming counselors receive their license, but put our own reputations on the line when we endorse supervisees.

Grace Hipona is a counselor in the state of Virginia. She currently serves as a Mental Health Therapist for a clinic, a counselor for a private practice and is a doctoral candidate. She operates from a strength-based perspective.

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