Typical Dilemmas of Supervision
Despite the potential wealth of knowledge, resources, and guidance that supervision provides, certain dilemmas may arise within the supervisory relationship. Typical issues include: supervisors and supervisees involved in multiple relationships, therapists experiencing pressures to accumulate "billable" hours, supervisor's limited access to raw data (live or taped sessions) of the therapist's clinical work, supervisor's limited experience with HBFT, and potential problems associated with limited awareness varying contexts. Each situation poses specific dilemmas that may potentially challenge the supervisory relationship and the therapist's investment in the process.
Storm, Peterson, & Tomm (2002) describe three types of multiple relationships that supervisors and supervisees experience:
- A mentoring relationship
- Overlapping professional and personal boundaries
- Combining supervision and therapy
They note that these multiple relationships can involve certain dangers while also enhancing the relationship between supervisor and supervisee. The inherent danger of multiple relationships suggests that the scope of supervision reaches beyond the stated expectations of the supervision contract.
Dangers arise when the supervisee feels exploited when asked to perform duties that are clearly outside of the scope of the supervisory relationship and for which the supervisee is unable to say no for fear of reprisals. Potential harm arises from the supervisor's inherent power of her/his evaluative and gatekeeping position (Russell et al., 2007). Crossing boundaries to include personal engagements such as having lunch together, visiting one another during time off, or the supervisee receiving therapeutic service can leave the supervisee feeling powerless to address potential conflicts of interest. The evaluative power of the supervisor places the supervisee in an untenable position. The supervisee may have difficulty reinforcing professional boundaries for fear that her/his efforts may jeopardize her/his position or upcoming pay raise.
The nature of the mentoring relationship may broaden the professional scope of practice and supervision to include additional teachable moments for the supervisee. Supervisor and supervisee involvement in other professional duties can potentially expand the scope of supervision to address broader professional issues influencing the supervisee's professional development. Prouty et al. (2001) describe the challenges associated with balancing between collaborative and hierarchical approaches to supervision. Extra care must be taken at the outset of the relationship setting clear, shared expectations to prevent the relationship from becoming exploitative.
Required Billable Hours
Therapists in agencies requiring quotas for "billable" hours each week often discover that they must choose between meeting that standard or including supervision sessions. Therapists often struggle to prioritize their involvement in supervision because supervision is not considered a "billable" hour. Therapists are faced with weighing the cost of getting behind with their quota while spending that time in supervision. The immediacy of meeting the current demands of the agency has the potential to take precedence over the perceived long-term benefits of supervision. The demands can outweigh the perceived benefits of receiving support, guidance, and strengthening the supervisory relationship.
Eighty-seven percent of therapists involved with the HBFT Partnership report receiving an average of at least 1 hour of supervision per week (see Figure 2). However, therapists attending the Core Training repeatedly note that despite their interest in nurturing a relationship with their supervisor, the demands of the job often take precedence over supervision.