The
exhilarating and at times devastating world of mental health services is both
challenging and exhausting, to say the least. When a trainee or an intern is
first spreading their wings, they require a strong, stable branch to launch
from after leaving the safety of the nest that is graduate school. This branch
consists of adequate educational preparation and some practice of theory, but
mostly it is a foundation laid by one’s clinical supervisor. The basis of care
and guidance created by a supervisor or director is critical to the success of
a therapist both with their clients and with their own professional growth. A
cracked or unstable foundation has the potential to level even the most tenacious
structures, and a clinical supervisor or director has the power to cripple a
rising clinician at the drop of a hat.
Much like a
child who has never had to know the pain of starvation in a nation of gluttony,
many therapists who have had the luxury of a chorus line of kind, supportive,
competent supervisors will never know the true value of the blessing afforded
to them. Care and concern is consistent, guidance and support, unwavering. When
one staggers through the bog of poor leadership, it can be debilitating,
damaging, and discouraging as one sets out to begin their career. I have had my
fair share of the two; I learned many things from both dichotomies and moved
forward one unsteady step after another, bearing the scars of one experience
and carrying the ensuing apprehension to the next.
Now if you
think I am being melodramatic regarding the nature of the supervisor-supervisee
relationship, let me clarify its depth: a clinical supervisor is not your
typical run of the mill department superior who writes you up when you come in
late or start a paper ball war in the office (well some of them do). They
aren’t the boss who sends you off running to get them a sandwich for lunch like
a personal assistant even though you have a Master’s and your job description
encompasses no such stipulation of degrading modern day drudgery. While a
clinical supervisor may have some HR responsibilities, their position is mostly
managed by the BBS, the state licensing board for California therapists. They are
licensed therapists with special certifications who reign over the cases
trainees and interns collect and provide supervision as it relates to treating
clients. Likewise, they provide the aforementioned necessities of support and
guidance to the supervisees they take under their wings.
Given that
mental health services are clearly demanding of the provider, because let’s
face it, no one comes in to the clinic lamenting “I’m fantastic, everything in
my life is going perfectly and I just wanted to pay you 100 bucks to tell you
so!”, this relationship between these two entities is an intimate one.
Difficulties arise in cases that trainees and interns have not yet developed
the faculties to cope with; in some cases, these difficulties have gone above and
beyond the faculties of the supervisor. But, whatever sends the therapist
running for their supervisor’s door, they hope to find a haven on the other
side, a small corner of the world where they can unmask, unload, rant and rave,
or just break down and cry. And they can only hope that their supervisor will
be welcoming when such a time comes. Sadly, mine was not.
Growing up
in a situation that fostered pure self-reliance, where I was generally left to
my own devices when trauma and emotional struggles arose, one of my biggest
obstacles in my professional and personal life has been allowing myself to seek
support from others and accept it when it is given. However, faced with my
first case that included extensive child abuse and neglect, I couldn’t manage
it alone and mustered the courage to approach my supervisor for help. I was
turned away, informed that emotional support was not something that would be
given because it was “not her job.” I was admonished for “crossing boundaries,”
and I was advised to seek personal therapy. Embarrassed for what I thought was
an infraction on my part, I receded back to my office and learned to keep my
mouth closed because clearly, whatever I was going through, I was going to go
through it alone…yet again. Many other incidents took place that shattered my
confidence and destroyed my sense of adequacy as a therapist, and after a while
I felt as “incompetent” as I was once accused of being. Before leaving that
agency, I was thrust into the care of another clinical supervisor where a
supportive relationship was present, but it helped that we had been friends
before she received her certification as a supervisor; the relationship had
already been built.
Entering a
new agency, I walked on eggshells with my new supervisor and presented as the
battered intern I felt I was: timid, meek, shy. I evaded discussing anything
that might be considered “crossing boundaries” and restricted conversation to
the progression of the clients and cases. Counter-transference chats were not
an option. Gradually my confidence in myself grew and I developed a level of
comfort with a supervisor who not only supported me but encouraged me and
lifted my self-esteem and my spirits. Never one to turn an intern away because
she was busy, and God help her she was so busy, we had our foundation. I soon
found myself at her door, seeking that haven, not as often as I needed because
after all, I was still me, but when convenient. And then our world was turned
upside down. One day, I received the news that our supervisor was being
transferred to another department. The next day, I received news of a horrific
situation involving one of my clients that sent me reeling. I was in crisis. I
was shattering. I had a catastrophic case and was losing my one foothold in the
mountain I was trying to climb. And worse of all, her replacement was a mere
shadow, unknown, undetermined.
The
transition was harrowing, and we soon found we would have two new supervisors,
a clinical supervisor and a clinical director, one for case supervision, the
other for case consultation and HR responsibilities, respectively. Not one to
adjust to change or new people well and cloaked with the residual trauma of my
client’s case, my first few meetings with these individuals found me intensely
silent, eyes averted, meek and shy once again, fearful of the personalities we
were entrenched with this time.
Over time, I
began to develop a sense of comfort with the new sups. My clinical director was
a constant presence in our office and soon a welcome nuisance, harassing me
with pranks such as toilet papering my cubicle (above) and engaging in guerrilla warfare
with Nerf guns (which consequently reignited my trauma from ‘Nam). She navigated
through my ODD tendencies and menacingly poked me until I fell back into
compliance. She even gave me a time machine. She provided support even when I
struggled to accept it and slowly but surely, she chipped away the wall I had
built up around myself until I wanted to hug her and simultaneously slap her for property
damage. And then the memo came that she too would be leaving us to pursue a
promotion in the agency at another office. Reacting in a manner that I soon
likened to one of my own clients who had become upset that I was having to
terminate with her, I fell into a spiral of conflicting emotions, passive
aggression, and the struggle with another loss.
The
transition that followed was much more gradual but no less harrowing as we again
waited for some unknown replacement, another shadow that hadn’t even been found
yet and I found myself anxiously biting my nails over fears that my first supervisor would be reincarnated into the position. At times I found myself systematically trying to distance myself from my
supervisor in order to lessen the blow when she finally left; other times I
failed miserably and bought her another Diet Coke. After nearly three and a half months of
uncertainty, she left last week.
We began
with our new supervisor this week, a transition I’m attempting to adapt to, and
in the midst of losing our recent supervisor to another position, we received
the memo that our last supervisor was leaving the agency. No longer will she be
just a few short miles away under the same umbrella of our company, but gone
with a sense of permanency and detachment. Coupled with the loss of our
resident Band-Aid sup, and a beloved co-worker, needless to say this week has
been fantastically shitty for one who avoids change at all costs.
Now please
don’t misunderstand, I am thrilled for my supervisors and their progression to
greener pastures, professional growth, and more fascinating life experiences. I
know they will both succeed where they have landed. But I’m still going through
my selfish phase of "Get your ass back here and be MY supervisor now! Please and
thanks."
As I
mentioned before and it has occurred to me in random moments of clarity, it
seems odd that I’ve become so attached to supervisors. Employers. Really just
co-workers with bigger offices. But working in our environment, they are the
crucial supportive structure that keep us sane (as sane as we can manage
anyways) and really, anyone who can pick me up and make me smile in the darkest
of times, anyone who can take a Nerf dart to the back with minimal whining (or
a crapload of whining so long as she takes the next shot as well) holds a
special place in my heart.
