Clinical Guiding Lights

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.