The History of Clinical Supervision: A Look Back at Key Milestones and Innovations

Clinical supervision may look very different today than in the early days, but it still has the same purpose.

Clinical supervision ensures that all therapists develop the necessary skills to care for their clients and meet the ethical requirements of the profession. 

Knowing the history means you can shape the future.

The Early History of Clinical Supervision

On Wednesday nights in a small office in Vienna, familiar names like Erik Erikson, Alfred Adler, Karen Horney, Anna Freud, and Carl Jung met together under the guidance of Sigmund Freud to discuss their cases and share their observations about life.

For a long time, this was the model—psychiatrists and psychotherapists would spend years under the mentorship of a respected authority who took them by the hand and taught them their theories and practices.

Eventually, these budding therapists would cement their own theories and take on the teacher mantle. 

It didn’t take long before they were no longer working out of their private offices or small institutes. After World War II, eminent psychotherapists found homes in universities where they could teach, write, and conduct research (especially in the U.S.). In the universities, they could build entire departments upon their psychological paradigm. 

The Growth and Development of Clinical Supervision

Other schools of thought were born as noted thinkers rejected psychoanalytic theory. Clinical supervision played a role but wasn’t often defined or mentioned in the literature. Instead, its presence was assumed. Supervision focused on guiding the supervisee in the principles and practices of the mentor’s paradigm.

For instance, if your clinical supervisor was a Rogerian person-centered therapist, they would focus on empathy, unconditional positive regard, and congruence. They’d analyze the way you rephrased your client’s statements and kept the conversation moving.

Big changes in the history of clinical supervision: World War II and the urgent need for psychotherapists

Before WWII, psychiatrists were the guardians of psychotherapy. Psychology was mostly an academic field, focused on research and assessment.

They needed to establish a solid route for training and clinical supervision to prove that they could be competent therapists without psychiatric training.

The opening came during World War II. After the First World War, the Veterans Administration wanted to prepare for the number of soldiers who would suffer from battle fatigue (PTSD). They developed and funded a successful comprehensive training program for psychologists, including intensive clinical supervision.

In 1946, Virginia was the first state to codify mental health licensure of non-medical doctors. Eventually that provided the foundation for practitioners with Master’s degrees to gain licensure.

New programs with different perspectives on etiology and treatment

Traditional psychotherapy focuses on the bond between therapist and client. This relationship is where healing happens. But starting in the 1950s and 1960s other approaches were proposed. New professions developed around these theories. 

• Marriage, family, and child counseling,now called marriage and family therapy, grew out of Family Systems Theory by Murray Bowen. Family Systems Theory sees the individual and their struggles as a member of a complex system rather than as an isolated entity. If something is going wrong, the whole system is out of whack. The person with the “presenting problem” is expressing that imbalance. Marriage and family therapy traditionally treated the whole family and that takes a different set of skills than one-on-one therapy. The first state to grant licensure to MFCCs (later changed to MFTs) was California in 1963.
• Clinical social work sees the person and their problems as part of their social environment. Facilitating healing includes accessing community resources to provide for physical and social needs. Clinical social workers sought to add psychotherapy to their toolbox so they could treat the whole person. California was also the first state to license LCSWs in 1965.
• Licensed professional counselors possess Master’s degrees in a counseling or psychology program and then undergo clinical supervision and examination. Virginia was the first state to offer an LPC license in 1976.  
• Addictions counseling started as a certification program without degree requirements but with a high requirement for clinical supervision—3000 hours in many states. Substance use counseling specifically deals with issues surrounding addiction and recovery. It has developed into a tier program because of the need to professionalize the field and also protect those who have extensive experience under previous definitions. But without a Master’s degree and licensure as a professional counselor, they can’t engage in diagnosis and psychotherapy. 

What this means for clinical supervision

Originally, the focus of clinical supervision was to mentor trainees in the methods associated with specific paradigms. And this rang true in the early stages of these professions. But now LCSWs, LMFTs, and LPCs can all subscribe to various therapeutic paradigms or take an integrative approach. Clinical supervision tends to be more allied to the license instead of the therapeutic modality or the population served—though most states do allow part of the clinical supervision requirement to be fulfilled by a supervisor with a different license.

The history of clinical supervision and the law: Tarasoff, boundaries, and the need to train ethics

In 1976, Tarasoff v. Regents of the University of California held that therapists have a duty to warn if they are made aware that a client is a threat to the safety of a third party. This ushered in a focus on ethical behavior. 

Many areas of therapist behavior were re-examined. 

• Dual relationships—therapists shouldn’t treat clients that they know from other circles. This includes romantic, work, friendship, or any type of relationship—but most especially any type of relationship that puts the therapist in any kind of authority or power over the client.
• Ethical boundaries—including ways to communicate outside the office, self-disclosure, payment policies, exchange of gifts, practicing within your area of expertise, and other issues.
• Confidentiality and privacy—confidentiality has always been a critical issue, but HIPAA regulations identified gaps and codified patient rights.

As these areas become more necessary (and complicated), clinical supervision has incorporated ethical behavior into the supervision interaction so that the associate therapist learns how to think about these issues regarding their clients.

Training the trainers: defining what should be included in clinical supervision

It wasn’t until the 1970s and 1980s that we paid more attention to what quality supervision should look like. The first major textbook on social worker supervision, Supervision in Social Work, was published in 1976. This was followed by Psychotherapy Supervision: Theory, Research, and Practice, in 1980. By the 1990s, models started to converge around the concept of the supervisor-supervisee alliance, based on the client-therapist alliance.

Clinical supervision is regulated at the state level, with each state setting its own laws and rules. But these guidelines are generally based on the standards put forth by the Association for Counselor Educators and Supervisors (ACES), which developed ethical guidelines for clinical supervision in 1993. Each governing body, such as the American Mental Health Counseling Association and the American Association for Marriage and Family Therapy, also sets professional standards for its members. 

Some of these associations offer certifications in clinical supervision. These courses aren’t required but can help clinical supervisors tighten up their processes.

The Future of Clinical Supervision: Where We’re Headed

Clinical supervision has come a long way and as psychotherapy changes, clinical supervision changes with it.

Virtual supervision was finally given the chance to show its value during the 2020 pandemic shutdown, but it’s been needed for a long time. When state and federal regulations were relaxed, associate therapists could conduct their therapy sessions and their clinical supervision remotely.

Finding clinical supervision has been a challenge for many associate therapists. They often have to pay out-of-pocket for the sessions. They may have to travel to where their clinical supervisor is to meet the in-person requirement, especially if they live and work in mental health worker shortage areas.

Virtual clinical supervision makes the experience more affordable and increases access to clinical supervisors who have experience in their specialty or chosen population.

That’s why Motivo exists. We help associate therapists access the best clinical supervision experiences so that their careers start off strong.

Learning and growing is a lifelong effort. Today’s clinicians and mental health organizations face a wide range of challenges that are best solved with clear-eyed understanding. That’s why Motivo has developed an extensive library of continuing education courses that address various facets of modern client care. Help your clinical staff become the best they can be, while also meeting their continuing education requirements. Learn more or sign up for an annual membership today!