The Tao of Direction: Structure and Process in Clinical Supervision

The Tao of Direction: Structure and Process in Clinical Supervision

by Jay Reeve

Therapist Jay Reeve offers advice on balancing structured, direct instruction and process-oriented exploration in supervision sessions with new therapists.
Most of my time in the hospital where I work is spent providing clinical supervision in psychotherapy. My supervisees are a mixed lot in terms of their training: doctoral students in clinical psychology, psychiatric residents and fellows, as well as bachelor-level line staff. Naturally, my style of supervision varies according to their experience and training, but not as much as one might think. Advanced psychiatric fellows who have completed their residency training and are pursuing postdoctoral studies sometimes get anxious about the stuff of basic psychotherapy: what to say next, what to do if a patient is mad at them, and so forth. On the other side of the coin, there are milieu therapists without any college training who can craft and implement therapeutic interventions stunning in their creativity and depth. There is no clear way to tell what sort of therapist a person will be from the degree and training they have—a counterintuitive truth reflected in the research which documents the lack of correlation between therapist training and therapist efficacy. The unpredictability of what kind of therapist a student will turn out to be is part of what's interesting about my job—the job of clinical supervisor.
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Jay Reeve is a clinical psychologist who serves as a senior psychologist at Bradley Hospital in Providence, RI, and is a clinical assistant professor of psychiatry at Brown Medical School. He is the Director of the Bradley Hospital Predoctoral Psychology Program, and is actively involved in teaching and supervision with psychiatric residents, post-doctoral fellows, psychology interns, and psychology practicum students. He also holds a Master's degree in Theological Studies from Harvard University, and has published on topics ranging from the psychotherapeutic treatment of pediatric AIDS sufferers to discussing tragedy with children.

See more about Jay at his university webpage:
I learned a lot from this article and it inspired me to balance my own supervision style.
Nicholette Leanza
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CE credits: 1
Learning objectives:

  • Supervisors and supervisees will gain a clearer understanding of the differences between process-oriented and structure-oriented clinical supervision.
  • Supervisors will be able to identify supervisory situations in which process-oriented or structure-oriented supervision is more appropriate.
  • Supervisors will learn how to keep structure and process in balance in supervision so they can best train supervisees that are stronger in one area and weaker in another area, always working toward an integrated, balanced approach to therapist professional identity and interventions.
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