Written by Alexandra Nobel, MA
Acknowledging the Power Dynamics in Clinical Training // Alexandra Nobel, MA
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…
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/.