Why Does Clinical Supervision Give Me Anxiety?

Anxiety is out there. We’ve all experienced it, we can all describe it.  Some of us have it all the time, some of us only have it sometimes but we’ve all experienced it at one time. We see anxiety as the most common symptom in our clients and we hear about anxiety as the most common complaint from our friends and family. In order to be a successful psychotherapist you need to have a good understanding of anxiety. So if you want to help your clients with anxiety, sometimes it pays to look a little inward first. 

For many people, they couldn’t dream of a more anxiety provoking situation than clinical supervision. It’s an assigned, recurring meeting where the main focus is on your work and how you do that work. There aren’t many other fields where supervisors are directly involved in your everyday life to this degree. And we’ve been over why this is in other blogs (see here) so today will just focus on accepting the things we cannot change: you have to be supervised and supervision is likely to bring about anxiety.

Supervisors Get Anxious Too

In fact, anxiety is the most recognized emotion for both supervisors and supervisees (Kuo et al., 2016). One of the many theories for why anxiety is so prevalent in clinical supervision is the many roles that a supervisee might take on a daily basis. They could be a student, a parent, a partner, a therapist and a supervisee all in one day. These dual roles of the student and trainee at the same time can lead to role conflict. The roles of student and the role of therapist are quite different, yet we expect supervisees to effortlessly sway back and forth between the two roles. The two roles are behaviourally-distinctive from one another (Holloway, 1995) so having to switch between the two can be anxiety-provoking.

Lessen Clinical Supervision Anxiety

One way to lessen this anxiety is to spend some time analyzing your dual roles and how you can use them to further your career. When you are seeing clients, you are the therapist. You are using your clinical judgment to create the best possible intervention according to what you have been taught. But once that session is over and your notes are written, you can go back to being a student again. No one on earth has ever learned all there is to know about therapy. Even if you came close, new interventions are being trialed every day. There is no perfect therapist therefore, it’s ok to be a perpetual student. Treat your clinical supervision in Toronto or Ottawa  as a chance to keep learning after you’ve closed the textbooks. It’s a chance to dive deep into some of your own biases and preconceptions. It’s a chance to try things a different way or to challenge your perceptions about a particular client.

A Clinical Supervision Contract

Another way to lessen anxiety in clinical supervision is to have a supervision contract. This simple document, discussed and agreed upon before supervision begins, outlines the expected outcomes of supervision as well as what can be expected from both parties. This simple contract takes away a lot of the ambiguity around supervision and puts tangible goals into words. This makes the whole process seem a little less abstract, in turn lowering anxiety for both parties. If you are both working toward a mutually-agreed upon goal and require one another to accomplish said goal, what is there to be anxious about?

Clinical supervision contracts don’t need to be complicated but they do need to outline the goals and tasks of supervision in a clear manner (Kuo et al., 2016). Like any relationship, the supervisory relationship works best when both parties are getting something out of it. The supervisee gets their hours for their college and the supervisor gets to use what they learned with their next supervision client. It’s important to view clinical supervision as an alliance. It is not you vs. your supervisor. It is you and your supervisor vs. your career. 

Anticipatory Anxiety and Clinical Supervision

Anticipatory anxiety is likely the most common type of anxiety in clinical supervision. Fretting before the supervision about what topics your supervisor will bring up can lead to significant anticipatory anxiety. Although it can’t be prevented entirely, having a supervision contract can go a long way in aiding this type of anxiety. If both parties know what is (generally) supposed to happen each session, that anticipatory anxiety will go away. If instead your supervisor is unpredictable and moody, your anticipatory anxiety will persist. Having this simple document that outlines the responsibilities of both parties can go a long way in lessening anxiety for everyone involved.

Expectations and Clinical Supervision

Unclear expectations are another reason for anxiety in clinical supervision. It’s been shown that many supervisors fail to use a supervisory contract (McCarthy, 2013) which leads to unclear expectations on the part of the supervisee. That is why all of our clinical supervisors at OntarioSupervision.ca employ a supervision contract. This contract forms the basis of the sessions and what can be expected from both parties. We have found this significantly lessens anticipatory anxiety in clinical supervision sessions and leads to better outcomes for new therapists. Whether you are getting clinical supervision in Toronto, Ottawa or anywhere in between, you will have a supervision contract you can refer to at any time. It's a formal way of guiding the sessions so that both parties benefit and anxiety is lessened for everyone. 

Reducing Burnout

Effective use of clinical supervision has been shown to reduce burnout (Koivu, 2013) but of course this will only be true if the supervisee and supervisor are on the same page. That’s why it’s important to try out a few supervisors if the first one you landed on wasn’t a good match. This is the person you will be depending on in order to grow as a therapist, so if you don’t respect them and want to learn from them, then there isn’t really much they can offer. 

It's ok to interview a few different supervisors as well. It's a big decision, and one that will surely have consequences (good or bad) for your career. Choosing the right clinical supervisor from day one can launch your career in the right direction. But unfortunately choosing the wrong supervisor can stop your career right in its tracks. 

Find a New Clinical Supervisor if Need Be

Just like anything in life, we don't have to keep doing it if it isn't working. If you don't gel with your supervisor, find another one. Talk to colleagues, professors and people in the industry and get recommendations. This isn't something you want to skimp on. Effective clinical supervision in Toronto could very well make or break your career so it's worth the effort required to find a good one. 

As for the anxiety, well , what would you tell a client? Probably to use their coping skills. To practice mindfulness. To use deep breathing and progressive muscle relaxation. 

If clinical supervision really induces loads of anxiety just remember that you can, and you will, get through it. You teach people all day how to live with anxiety. Now, just apply it inward.

We know, of course, it's not that easy, but never underestimate the value in some good box breathing and self-CBT to calm the nerves. After all, if we are recommending it to a client, we should be comfortable doing it ourselves.

This is all to say that anxiety is a part of life and as therapists, it's a big part. We will see it in our clients, we will feel it in our minds and maybe feel it racing through our veins. But we don't need to let it slow us down. Use your own experience of anxiety to better understand your clients. It's one of the rare universal emotions that we have all felt and it's going to happen whether we like it or not. Even in clinical supervision. 

Find a Clinical Supervisor in Toronto or Ottawa

If you are a Registered Psychotherapist (Qualifying) in Toronto or Ottawa or perhaps a Masters of Counselling Psychology student starting your first placement, email us today and we can help get your career off to a good start. You can contact us through our website at ontariosupervision.ca or via email at admin@ontariosupervision.ca

We specialize in clinical supervision in Toronto, Ottawa, Barrie, Missisauga, Timmins, Windsor, North Bay, Sudbury and everywhere in between. If you are a Registered Psychotherapist in Ontario, let’s work together. All of our appointments are virtual so as long as you are practicing in the province of Ontario, we can help.

References

Holloway, E. L. (1995). Clinical Supervision: A Systems Approach. Sage Publications.

Koivu, A. (2013). Clinical supervision and well-being at work; A four-year follow-up study on female hospital nurses.

Kuo, H.-J., Connor, A., Landon, T. J., & Chen, R. K. (2016). Managing Anxiety in Clinical Supervision. Journal of Rehabilitation, 82(3), 18 - 27.

McCarthy, A. K. (2013). Relationship between supervisory working alliance and client outcomes in state vocational rehabilitation counselling. Rehabilitation Counselling Bulletin.