When practitioners contact me, it usually sounds like one of these
- I have no idea what is going on with this client, and I am doubting my own competence.
- I am struggling personally and I need help now, because I have to keep working.
- This client’s material is touching my own. I need help quickly so that I can stay in the room with them, because they are in no position for me to withdraw.
Those three account for most of what I am brought. Not one of them is about a technique. They are about the practitioner.
They have three things in common. They are urgent. They are difficult to say out loud. And underneath all of them is the same fear, which is having to stop working.
Nothing is too difficult or embarrassing to bring to supervision. Especially your own personal failings.
If you need to be seen quickly
Two of those three sentences contain the words right now, so alongside ongoing supervision I keep space for a single urgent consultation.
One session, usually within a few days, for something that will not wait until your next scheduled supervision. It commits you to nothing further. If you want ongoing supervision afterwards we can talk about that then, and if you do not, that is a complete and proper use of it. Book it like any other session. There is a note under Starting, below, on how to tell me it will not wait.
What people bring
Supervisors and trainers. Doubting a supervisee’s competence while being the one who carries the risk. Putting a supervisee into fitness to practise measures. A supervisee under investigation by their professional body. A supervisee required to attend a coroner’s court after a client’s death by suicide. A parallel process you cannot see from inside it. Holding the supervisor role and the line manager role at once. Supervising someone more experienced than you, or working in a modality you do not practise. A supervisory relationship that has quietly become comfortable after several years. I also supervise people who train supervisors, people training to be supervisors, and people delivering therapy training courses.
Coaches. When you suspect there is an underlying mental health problem. When your client is having an adverse effect on you. When a client is not responding to something that ought to be straightforward, such as receiving feedback or learning to present. When somebody cannot stop overworking and is burning out. Severe imposter syndrome or rejection sensitivity. And sometimes simply wanting the reassurance that you are well supported and have considered every angle.
Leaders. The isolation of the job at the top, where you cannot take it to your own team and the board is not a safe place either. Holding a decision that is correct and will still harm someone. Inheriting an organisation whose defences are already set.
The perception you cannot use
One thing supervisors bring more often than almost anything else has no name in most supervision contracts.
You know something before you can say it. A quiet sense that something is not quite right in a supervisee’s account, assembled out of tone, hesitation, what gets mentioned twice and what never gets mentioned at all. Sometimes you even sense what it might be.
The literature calls this implicit relational knowing. I think of it as over the horizon empathy: you are picking up something that has not yet come into view. It is not quite the same as what happens in the consulting room, because a therapist is responding to somebody sitting in front of them, and a supervisor is responding to somebody who is not in the room at all.
You cannot put it to a supervisee as a conclusion, because you might be wrong, and being wrong in that particular way damages the relationship you need in order to be any use. You cannot ignore it either, because the times it turns out to be right are the times it mattered most.
So it has to go somewhere before it goes to them. That is a large part of what this work is. A third position from which to ask whether this is about your supervisee or about you, and to find what a sayable version would sound like.
Work that will not be new to me
Some of what gets brought here is heavy, and it helps to know in advance that it will not be the first time I have heard it.
Ten years as group clinical supervisor to a team of therapists working with children who had committed serious sexual offences.
Six years supervising work with combat veterans carrying war zone PTSD, frequently layered on top of complex trauma, across every branch of the armed forces.
Practitioners whose ordinary working week contains material most people never see: probation, air accident investigation, paramedics, fire, police across traffic, investigation, counter terrorism and specialist divisions, emergency medicine, intensive care and neonatal intensive care. In that work countertransference is not an occasional event. It is the condition.
There is a free self supervision worksheet on countertransference, written for practitioners, on the worksheets page.
Supervising leaders, and which way difficulty travels
I supervise chief executives and directors who carry responsibility for practitioners who in turn carry responsibility for vulnerable people: children in schools and specialist settings, patients, care home residents, prison inmates, people seeking asylum.
The principle I keep returning to with them is that difficulty has to travel up an organisation rather than down it. When it travels down, it does not disperse. It accumulates at the bottom, with the people least equipped to process it and most likely to act it out. In a service for vulnerable people, those are the very people the organisation exists to help. They get worse rather than better, and the organisation quietly defeats its own purpose.
Containing that, so that it stops with you instead of passing through you, is a large part of what senior leadership actually is. It is also the part nobody is trained for.
I have written that argument out in full: Why difficulty has to travel up an organisation, not down.
If you are under investigation
If you are facing a complaint, a fitness to practise process, or a coroner’s inquest following the death of a client, I will supervise you through it.
Where it is useful I will also write a statement or a report, and I am willing to be named as your supervisor of record. Practitioners in this position often struggle to find anyone who will, which strikes me as exactly the wrong way round.
I am not a lawyer and this is not legal representation. Your professional body, your insurer and your union each have a role here that I do not.
Before you spend money with me
For something every one of us is required to buy, there is surprisingly little evidence that supervision improves client outcomes at all. Watkins reviewed thirty years of research in 2011 and found it thin. If you have been practising a long time, this will not surprise you. You have probably sat in supervision that met the requirement and changed nothing.
I think that is worth saying out loud.
Two things done in supervision do show up in client outcomes: collecting structured client feedback, and working properly with countertransference. Both are central to how I supervise.
Not every model uses that second word, so to be plain about what I mean. Countertransference is the effect the client has on the practitioner, and in supervision of supervision, the effect a supervisee has on their supervisor. Attraction, or a prurient interest you would rather not have. Shock, disgust, horror. Fear, or feeling intimidated. Fascination that tips into preoccupation. Envy. Boredom. A sense of superiority, or of being the only one who could possibly help. And some of it is provoked less by what the client brings than by what they are: fame, or infamy, or extreme wealth. Everybody has a reaction to those, including the people most certain that they do not.
None of that is evidence of a defect in you. It is information about the work. It is only dangerous when there is nowhere to take it.
My doctoral research looked at 321 clients of 27 therapists and asked what actually predicted outcome. The answer was the quality of the relationship, not the model. It won BACP’s 2011 prize for Outstanding Research Project. I have run my own practice for more than twenty years as a series of single-case studies, measuring what changed and what seemed to move it.
If you want to use outcome measures with your own clients, I can show you how to make them tell you something you did not already know. You will not be required to.
Who this is for
This is not supervision for trainees, and it is not supervision to satisfy a requirement.
It is for practitioners who are already good. Supervisors who need their own supervision. Senior clinicians and coaches working at the edges of what they can hold. People who have stopped asking whether they are doing it right and started asking what the next level actually looks like.
It is also for the work that does not fit anywhere else. A client you cannot get traction with and will not give up on. A colleague or an employee who is difficult in a way that is costing you. A caseload that has become heavy. The particular isolation of being the person everyone else brings their problems to, including the problems they bring about you.
And it is for practitioners who publish. If you are writing, filming or posting about clinical work, or want to be, that raises questions most supervision never touches: what is safe to say, what belongs to your clients, how visibility changes the work, and how to stay recognisably yourself in a format that rewards being someone else. I do this myself, so these are live questions for me too rather than ones I am answering from the outside.
What we work on
In my book I set out a map of 48 skills across 12 human capacities, each on a five-point scale. It applies to practitioners as much as to clients.
Early on, supervision is mostly about structure, attunement and follow-through. In the middle it is about complexity and relational repair. At the senior end it becomes something different, and less often named:
- Integrity under moral complexity
- Existential presence, and the tolerance to stay in what cannot be resolved
- A sense of self that stays coherent while it keeps changing
- Setting your own direction rather than meeting someone else’s standard
Those are the four I find myself working on most often with experienced supervisees. They are not problems to fix. They are what growth looks like once the obvious work is done.
Most people arrive because of something urgent. They stay for this.
Where and when
Most of my supervisees work with me online, from anywhere in the world. In person at Horseheath, near Cambridge, if you would rather. Monday to Friday, and Saturday mornings, UK time.
What it costs
Supervision of supervision, and supervision of senior practitioners: £155 an hour. A single urgent consultation is charged at the same rate.
That is above the usual rate for clinical supervision, and deliberately so. My fees have always tracked the level of responsibility involved rather than the hour on the clock, and this is the work where that is most true.
Group and organisational supervision: from £345 an hour, depending on numbers and scope.
Starting
The first session is paid, and it is a mutual assessment. You are deciding whether you would grow under my guidance. I am deciding whether I am the right person for what you are bringing. Either of us can say no.
I can usually offer a first meeting within a week, and sooner if what you are carrying will not wait.
If this is genuinely urgent, book my next available appointment that you can make. When the confirmation arrives from Calendly, forward it to me and ask whether I can see you sooner. If I can, I will.
Schedule a supervision session: calendly.com/drtonyweston/clinical-supervision
Schedule therapy for therapists: calendly.com/drtonyweston/reg-session
Access to the resources at PsycheVita.com and on the App, start at: psychevita.com
References
Watkins, C E (2011). Does psychotherapy supervision contribute to patient outcomes? Considering 30 years of research. The Clinical Supervisor.