Since starting
graduate school, I have called the majority of my professors and supervisors by
their first names. I’ve learned
that this is intentional as graduate students are considered junior colleagues
and collaborators by most mentors. However, when there is a system in which one
individual is clearly the superior and is in charge of evaluating another,
there is a defined power structure that is bound to generate some anxiety. When I began thinking about this post,
I wanted to explore whether it might be helpful to acknowledge the power
dynamics between students/supervisees and supervisors and how this
acknowledgment might serve to enhance the training experience.
I have had numerous
supervisors in various training sites and will continue to engage in clinical
supervision for the foreseeable future…until I pass a licensure exam. I have
had the privilege of receiving some fantastic supervision thus far. My
supervisors have been upfront about the ways in which they conduct supervision
and have been supportive and receptive. There is a clear hierarchy in place,
but most would agree this is a good thing. Supervision is intended to minimize
any potential harm to the clients by ensuring that the supervisee is providing
appropriate treatment. The
supervisor has the training and the knowledge and they are in charge of guiding
the supervisee and imparting vital knowledge. The trainee is tasked with being
receptive and incorporating the supervisor’s feedback into their developing
clinical repertoire. But what happens if the supervisee/student feels that they
are not being appropriately trained and/or feel that they would benefit from a
different supervision style? What if they believe they need more supervision
and would thus require more of the supervisor’s (likely valuable) time? The
student is likely to feel disempowered in this hierarchical structure and may
not receive adequate support or training in how
to advocate for their needs and wishes.
As a student and a woman who
has had the privilege of receiving mentorship from feminist professors and
advisers, and ongoing support from feminist peers, my consciousness has been
raised to be more aware of these structures and their potential impact on those
with less power. I have also developed confidence to advocate for my training
needs and my rights within these power structures. However, this assertiveness
has not come anxiety-free.
I chose to ask several
mentors about these topics to get their perspective. I spoke informally with
two individuals - both of whom are white, male professors who have
taught/supervised for 20+ years. They both acknowledged that the power
structures in clinical psychology programs, and within the supervision
relationship specifically, surely contribute to students’ self-efficacy in
advocating for themselves if they are dissatisfied with their experience. Intersectional power dynamics (e.g.,
teacher-student, male-female, majority-minority membership) may abound in the
supervisory relationship leading students to feel even more uncomfortable advocating
for change and/or providing feedback to supervisors. We students are
advised to advocate for ourselves, but it’s daunting to do so when we are
relying on the clinical supervisors to not only provide supervision and
training, but we also NEED them to officially sign off on our hours and maybe
even write us a glowing recommendation for the coveted clinical
Internship.
There’s also the somewhat
controversial issue of evaluation procedures involved in clinical training. At
the end of each semester, my program requires that supervisors evaluate the
student’s clinical skills and students are also required to evaluate
themselves. It is seen as a necessary skill to be able to acknowledge our own
strengths and areas for growth. Students have limited opportunities to formally
evaluate their supervisors and this process leaves many students feeling
awkward and uncomfortable. Students fear potential repercussion, even though it’s
likely that many supervisors would welcome the feedback. The mentors I spoke
with when thinking through these topics both acknowledged the necessity of
supervisor evaluations due to their prioritization of students’ training. They
also acknowledged that supervisors must be open to receiving feedback and that,
even though there are bound to be ego bruises, the students’ training experience
must be paramount. An APA task
force assembled guidelines for supervision in health psychology (available
here: https://www.apa.org/about/policy/guidelines-supervision.pdf), including
the recommendation that supervisors seek feedback from their supervisees
regularly. The authors of these
guidelines recognize that many long-term supervisors may undervalue the
feedback they receive from trainees, likely to the detriment of their
supervisees.
Whether the conversation is
opened between supervisor and supervisee directly or if the student is asked to
provide feedback on an evaluation form (anonymous or not), the process of
providing constructive feedback is challenging! Concisely and effectively
communicating reasons why the experience was anything less than good is a skill
that must be honed. As I’ve
learned from professors and mentors, clinical psychologists (especially those in
academia) are evaluated by superiors and peers constantly, and are required to
evaluate their fellow faculty for their entire careers. Many clinical
psychologists also go on to become supervisors at some point in their careers
as well (potentially without any training in how to actually do it…which is
another topic for another post!). Thus, learning to provide constructive feedback
is an essential skill. Acknowledgement of the power dynamics which may make
this uncomfortable may be the first step in breaking the ice between students
and supervisors to collaboratively develop a method for sharing what may
increase the effectiveness of these evaluations and improve the supervision experience
for all parties.
Students need a forum to
provide feedback on their experiences without fear of repercussion. Supervisors
need ongoing reminders of their ability to grow and develop as well as peer support
in their efforts to empower students to advocate for their needs in
supervision. Clinical departments could likely benefit from an explicit mission
statement outlining the commitment to incorporating student feedback into
clinical training. The hierarchical structures within academia are not going to
disappear, as they are likely useful for the training of budding
clinicians. It is my belief that
explicitly discussing the power structures that exist in clinical training
could be beneficial for new clinicians who seek to make the most of their
training experiences and the supervisors who are committed to helping them on
that journey.
Not to mention these
conversations could also be an interesting and useful segue into discussing the
power dynamics which exist between the clinician and the client…
Selected references:
American Psychological
Association. (2014). Guidelines for Clinical Supervision in Health Service
Psychology. Retrieved from http://apa.org/about/policy/guidelines-supervision.pdf
Substance Abuse and Mental
Health Services Administration. (2009). Clinical
supervision and professional development of the substance abuse counselor.
In Treatment Improvement Protocol Series, No 52. Center for Substance Abuse
Treatment. Rockville, MD. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK64848/.
This is a beautifully written and powerful post on a topic that is likely relevant to all of us. Bravo!
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