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Jan 29, 2024

Internal vs. External Clinical Supervision: Which is Best for Your Organization?

Clinical supervision is a benefit that can improve your organization's recruitment and retention. Should you choose internal or external supervision?

Carla Smith, Ph.D, LCSW, LMFT

Chief Clinical Officer

Who handles clinical supervision administration responsibilities in your organization?

  • Does it fall to the clinical director?
  • Do you have an internal clinical supervisor position?
  • Do you distribute it among your more experienced staff (and take away from client time?)

And what about tracking state regulations and supervision documentation?

These complexities are why many organizations shy away from adding pre-licensed counselors to their counseling teams.

But avoiding clinical supervision could be costing your organization more than you know.

Why should your organization offer clinical supervision to your counselors?

Are your open positions getting harder to fill?

Are your counselors leaving for other opportunities?

If you’re like most other organizations in addiction treatment or mental health counseling, the answer to both of those questions is a frustrated, resounding “yes.”

Pinnacle Treatment Centers added Motivo's external clinical supervisors to their team benefits.

They improved their recruiting, time to fill, and their retention.

Read the case study

Mental health organizations are competing against each other for the same job candidates

You’re not the boss of the interview anymore.

While you’re interviewing your candidates, they’re interviewing you. They know they can choose to go elsewhere.

Not only that, but many counselors are looking at their workloads, benefits, and pay rates—and leaving the counseling field entirely.

Even recent graduates who’ve worked their tails off for their dreams and their Master’s degrees are leaving before they get their licenses. Finding a position, finding clinical supervision, and supporting their family while they meet licensing requirements is too much for 57% of them.

So if you want to entice candidates, you need to show them you have something to offer them. Offering clinical supervision is one benefit that makes sense.

Support clinicians who want to elevate their skills

As practitioners develop in their careers, they see the need for additional credentials.

After a time in the field, substance use counselors often decide to go on for a Masters degree so they can treat the co-occurring disorders underlying many addictions.

Mental health counselors, MFTs, and LCSWs seek specializations that serve their clients better.

When you provide clinical supervision, they don’t have to look elsewhere to fulfill licensure requirements, and they bring deeper skills and insights to your organization.

Clinical supervision opens up an entirely new hiring pool

With clinical supervision in your benefits package, you’re able to hire pre-licensed counselors who would love a full-time position where they could learn from experienced colleagues.

Pre-licensed counselors are a solid option because there are more open positions and more people who need help than we have therapists.

If you can offer a full-time position with reasonable pay, benefits, clinical supervision, and the potential to move up in their careers, you’re providing an environment that welcomes new therapists and says “We want you to stay.”

But what type of clinical supervision would work best for your organization?

Should you provide clinical supervision internally?

It depends on your organization and your resources.

**Pros for in-house supervision: **

  • You create a system for nurturing your staff and building them up in their careers while also guiding them within the culture of the organization.
  • You gain insight into where your counselors need to grow and can address it quickly.
  • You have the potential to build mentor relationships that last

Cons for in-house supervision:

  • State regulations are complicated, especially if you function in multiple states.
  • Workloads for clinical directors and licensed counselors are already demanding. Clinical supervision time takes away from client time.
  • Not every licensed counselor is good at being a clinical supervisor. It’s a skill.
  • Sometimes it’s hard to create the safe environment needed for a clinical supervision relationship when there already is a power dynamic between boss and worker.
When we asked Motivo partners what the biggest benefit of working with Motivo was, it was the relief it gave to their licensed staff to focus on other work.

External clinical supervision—another option

Costs, regulatory complications, and an already overworked clinical team make in-house clinical supervision a non-option for many organizations unless they leave it up to the counselor to find their own clinical supervision — and then you have to worry about whether they’re attending.

Pre-licensed counselors then deal with the burden of finding a clinical supervisor in the proximity (and in many mental health workers shortage areas, they’re often not close), making the time to attend outside of work hours, and paying out of pocket if their employer doesn’t offer a stipend.

You can lift this burden off their shoulders without bearing the weight of it on your own:

  • An external clinical supervision service provides affordable, virtual appointments with clinical supervisors who match your counselor’s specific needs.
  • Regulatory compliance is managed by a compliance department for each state it serves. Motivo operates in all 50 states.
  • The service vets, trains, and matches clinical supervisors with your clinicians and their needs.
  • Virtual supervision means no travel time, which saves on travel reimbursement costs and frees up more time to see clients.
  • Outside clinical supervisors function alongside your organization. While you continue organization and client-specific training for all your therapists, the clinical supervisor can provide additional insight.
  • External clinical supervisors bring different expertise, specializations, populations, ethnicities, gender orientations, and life experiences that help develop skills your organization may not already have but would be beneficial.

What are the downsides to external supervision?

When we created Motivo Health, we did so with the desire to create as few downsides as possible. But here is some of the feedback we’ve gotten from our clients on this issue:

  • External clinical supervisors can’t speak to specific issues within your organization, but they can share their experiences and give perspectives.
  • Some services that offer external supervision only function within one state or a few states, so make sure any clinical supervision service you partner with functions in the states you operate in.
  • You still need to devote some time to monitoring your pre-licensed therapists, but the amount of time is significantly reduced.

Commit to Developing Your Counseling Team

Counselors endure a lot because they’re devoted to bettering the world, one client at a time.

Huge workloads, low pay, and frustrations meeting licensure requirements plant the first seeds of burnout for associate therapists.

When you create a friendly, supportive work environment, you’re laying the foundation for the future -- for them, for their clients, and for your organization.

If external supervision is an option you'd like to explore, we’d love to talk to you about how we can help you support your counseling teams while we provide the clinical supervision infrastructure.

Click on the round button with the speech bubbles in the lower right corner of the screen and fill out our form. We’ll be in touch ASAP.

Carla Smith, Ph.D, LCSW, LMFT

Chief Clinical Officer

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