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Jan 11, 2024

How clinical supervisors set up a solid supervision relationship (even over a computer screen)

Virtual behavioral health clinical supervision is ideal for both supervisors and associate therapists, but how do you build a solid relationship?

Rachel McCrickard, LMFT

CEO and Co-Founder

The bond between a clinical supervisor and supervisee is the foundation for effective clinical supervision.

So how do you build that bond when you’re talking to each other over a HIPAA-compliant computer screen and there are more than a few miles between you?

Best clinical supervision practices are still the answer — only more so

Virtual behavioral health clinical supervision is a godsend for many who would otherwise struggle to make their appointments or even find a clinical supervisor within hundreds of miles.

Most aspects of the virtual clinical supervision relationship work the same way as in-person does, but just like all online communication, some nuances are lost. The same principles for clinical supervision hold true — but you need to lean on them even more.

1. Good boundaries are even more crucial in virtual clinical supervision

Good boundaries require good communication. We use contracts when beginning a therapy relationship. Take the same approach with supervisees.

Define your boundaries:

  • Cancellation & rescheduling terms – How much notice do you require? Can they reschedule without penalty?
  • Billing arrangements – Payment due at the time or billed?
  • Communication – How can you be reached (i.e. phone, text, email, through your platform)?
  • Reporting – What do you need to communicate to the employer and the state licensing board?
  • Awareness – What is working with you like? What does a session look like?
  • Reciprocity – What can they expect from you regarding all of the above?

Don’t let this slide because you’re dealing with a professional who should have courtesy and responsibility. Contracts set the stage because they define terms, and both parties agree. They create the environment for your relationship to function in.

2. Flexibility is important, too

The other side of setting boundaries is determining how flexible you’re willing to be.

Remember when you were an associate therapist? They have a lot to deal with:

  • Large and complicated caseloads
  • Difficulty finding positions or places to earn hours
  • Challenging populations and working conditions
  • Low pay
  • Low control over their time and decisions

For instance, if an employer calls a surprise meeting or adds an appointment to their caseload — or if a client has an emergency — it may be impossible for them to cancel with 24-hours notice.

You’re going to become intimately familiar with your supervisees’ work situations so use your judgment.

3. Attending skills are top priority

You’re not sitting in the same room with your supervisee. They can’t see your body language, and you can’t see theirs. You both can miss signals that you’d easily notice if you were in the same room. Clenched hands or fidgeting doesn’t show up in a screen view of someone’s head and shoulders.

  • Body language Make sure the body language they do see shows that you’re open and attentive. Face the computer and look at the screen (Turn off distracting notifications)
  • Active listening Nod to show you’re hearing them, Rephrase what they say so they know you understand and to help them explore their thoughts.
  • Open-ended questions Ask open-ended questions so you gain a fuller understanding and encourage them toward active reflection.

Some therapists suggest turning off your microphone while your supervisee is talking (and vice-versa) since internet speeds can set you up to interrupt each other, even when you’re not.

4. Communicate about difficult things

A supervision relationship carries a power imbalance. You’re not only guiding and supporting the process, you’re evaluating. The associate depends on you to reach licensure. Depending on temperament — some are going to feel that dynamic more than others.

If you’re supervising in-house, the dynamic may be even stronger.

The virtual environment could make that even more difficult so it’s important to be aware of it,

Address the 800-pound anxious gorilla sitting on your therapy couch. It’ll shrink the problem down to an annoying chimpanzee. Describe your role as mentor and be clear about areas where you would be called upon to take on the role to protect the patient, your organization (if you’re in-house), or the profession.

Invite them to say “I have an issue, but I’m unsure whether it’s a performance issue I need to work through or a clinical one I need guidance on.”

"...There’s nothing about virtual supervision (except the tech) that’s different than how you’d conduct your in-person sessions. Everything is the same… only more so."

5. Be prepared for your sessions

As you’ve learned in your training courses, clinical supervision is a process. Your new supervisees have different needs than those who have a couple of thousand hours under their belts and are approaching their exam.

You’ll need to cover a range of clinical, administrative, ethical, and self-care topics in the 2-3 years you’ll work together.

And with every session, there’s the possibility that you’ll need to change course and focus on a more immediate need.

Be prepared but be ready to pivot.

Clinical supervision and the work-from-home life

When we’re working remotely instead of in an office, it’s easier to get more casual — work life and home life flow together.

You cut it close frying up a grilled cheese… so you race to your office, load up your (HIPAA-compliant) Zoom one minute before your session starts…

And you’ve been logged off and the confirmation code doesn’t come through until the third time you click “resend.”

(You don’t get that kind of detail unless you’ve lived it.)

This issue isn’t unique to therapists, but being late to a meeting is different than being late to a session.

Make sure you give yourself time so you’re ready to focus on your supervisee. It’s one of the many ways you communicate the importance of the relationship.

6. Virtual clinical supervision and ethical obligations

You might be virtual, but safeguarding your supervisee’s privacy is still top priority.

  • Conduct sessions in a private location. Don’t be in a place where others are present or walking through — including children.
  • Avoid multitasking. Give your supervisees your full attention.
  • Be diligent about your notes. Complete them right after the session. Incomplete notes create huge complications when the time to submit documentation comes up.

7. Make sure your tech works and is appropriate to your needs

  • Is it up to date or are you getting by?
  • Do you have a backup plan if your tech fails?
  • Does your tech meet HIPAA standards?
  • Are you backing up your documentation?

You’re choosing to work in the virtual space. Be ready for it.

Model the behaviors you want to build

As a clinical supervisor, you’ve taken on a serious obligation. You’re helping each associate therapist navigate the incredibly challenging profession of therapy.

They’ll be helping others face their pain and find healing for (hopefully) decades to come.

You’re laying the foundation — you’re helping them as they develop their professional judgment, build confidence, and learn ways to cope. It’s more than a job… It’s a sacred vocation… And it’s a privilege.

In the end, there’s nothing about virtual supervision (except the tech) that’s different than how you’d conduct your in-person sessions. Everything is the same… only more so.

When you create a solid foundation and treat the relationship with the respect it deserves (and I know you believe this)... you’ll succeed in building the best possible relationship you can with your virtual clinical supervisees.

And thank you for being willing to do it.

Rachel McCrickard, LMFT

CEO and Co-Founder

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