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Live Supervision: Time Consumer or Time Saver?

Columns - Clinical Supervision

Thursday, 31 January 2002

How can supervisors obtain an accurate account of what their supervisees are doing with patients if they do not observe, or participate in, the counselor’s work? When I encourage clinical supervisors during training workshops to observe their staff at work, the responses are quick: “My counselors would never let me observe their work,” “Observing my counselors would add a dynamic to the session that would harm patient care,” or “I just don’t have the time!” However, these same supervisors share with me success stories like: “Now that I’m observing the work of my staff, they seem much more invested in their own professional growth” or “Live supervision has had a significantly positive impact on patient care.” Some even found it ultimately impacts time-efficiency.

Clinical supervision is a mutual endeavor of clinical oversight and professional development. It can be a growth experience for the supervisee and, when effective, involves much more than monitoring a counselor’s work by his or her supervisor. In fact, limiting supervision to mere monitoring leaves the relationship mechanical and autocratic (Keller et al., 1996). Live supervision has been seen by many as a valuable supervisory tool that gives the supervisor a consistent and accurate picture of the counselor’s skill level while providing a forum for shaping counselor skills through role modeling and on-the-spot feedback. Like an ancient artisan who guided the apprentice through demonstration and observation, the clinical supervisor who witnesses the work of the supervisee is given the opportunity to foster an effective learning and growth experience for the counselor being observed.

Live supervision was originally used by Jay Haley and Salvatore Minuchin in the late 1960s as a training tool for entry-level family therapists (Bernard & Goodyear, 1998). They were involved in a project to recruit and train people from an inner-city community in Philadelphia with no prior counseling experience to treat families from their own community. This model of live supervision was originally implemented to protect clients by guiding these novice counselors while they worked. Haley and Minuchin intended their brand of live supervision to be a form of coaching with the supervisor actively involved in providing guidance to the therapist during the session. In this model of live supervision, the supervisor has direct control over the counseling, as well as the outcome of the session. The supervisee learns how to do it right by being a player in a successful therapy session.

Live supervision, long considered a mainstay in supervision of family therapists, is utilized in a variety of ways that include the use of a video monitor, a one-way mirror, co-facilitation, and in-vivo supervision. While video monitoring and one-way mirrors are often accompanied by phone-ins, call-outs, or bugs-in-the-ear, co-facilitation and in-vivo more closely resemble the Haley/Minuchin model described above. Studies have shown that methods like these are superior means of facilitating professional growth since they afford the supervisor an opportunity to model their own clinical skills while providing instant feedback, support, and encouragement to the supervisee (Keller et al., 1996; Wong, 1997). Although initial anxiety is a common reaction to the thought of being observed, live supervision often leads to the development of an alliance between counselor and supervisor. Invariably this alliance tempers any apprehension that exists and paves the way for the counselor’s progressive journey of professional growth and development.

In my own experience, live supervision has been an invaluable tool in developing an effective supervisory relationship. The supervisory bond created by live supervision inevitably has led to ease in strategizing alternatives, overcoming impasses with clients and bolstering clinical confidence. I have also found live supervision to be helpful in discerning salient actions, especially with a counselor who is feeling discouraged.

Live supervision allows an immediacy of re-experiencing a session by bolstering recall of therapeutic alternatives. Usually done with the patient present, the supervisor and counselor can strategize alternatives while modeling a cooperative and collaborative relationship for the patient. In a recent study (Moorehouse & Carr, 2001), supervisors and therapists who, during live supervision, modeled collaborative positioning tended to elicit maximum cooperation from the patients while minimizing patient resistance.

Live intervention is a powerful means of monitoring treatment while developing the skills of clinicians. It provides an exceptional learning opportunity for the supervisee because it combines direct observation with modeling. Time may often be a factor in the reluctance to utilize live supervision. However, the potential for time regained through retention of staff, increased effectiveness of care and increased self-efficacy of counselors can ultimately outweigh any concerns about lack of time. Some may even see live supervision as a time-saver.

Thomas G. Durham, MA, LADC, is the director of corporate support at ETP Inc. (www.etpinc.org) in East Hartford, Conn., where he coordinates a worldwide program of clinical supervision to alcohol and drug counselors throughout the U. S. Navy and Marine Corps. A certified clinical supervisor with more than 25 years of experience, he frequently conducts training workshops and is a part-time faculty member at Tunxis Community College in Conn. where he teaches courses in counseling. He can be reached at This e-mail address is being protected from spam bots, you need JavaScript enabled to view it .

References
Bernard, J. M. & Goodyear, R. K. (1998). Fundamentals of clinical supervision (2nd ed.). Boston: Allyn and Bacon.
Keller, J. F., Protinsky, H. O., Lichtman, M, & Allen, K. (1996). The process of clinical supervision: Direct observation research. The Clinical Supervisor, 14 (1), 51-63.
Moorhouse, A. & Carr, AA. (2001). A study of live supervisory phone-ins in collaborative family therapy: Correlates of client cooperation. Journal of Marital & Family Therapy, 27 (2), 241-249.
Wong, Y-L. S. (1997). Live supervision in family therapy: Trainee perspectives. The Clinical Supervisor, 15 (1), 145-157.