Category Archives: Supervision

What really goes through my head when I make a self-disclosure

How can I expect my client to trust me, if I am unprepared to ever appear vulnerable?  How can I expect my client to comfortably explain a missed session or extended absence from therapy, if I am unprepared to do the same?

In a clinical context self-disclosure refers to the act of revealing personal details about yourself to your client.  I think self-disclosure in a therapeutic sense can be broken down into two different types;

  • self-disclosure in order to aid the process of therapy
  • self-disclosure when my personal life impacts on my work as a CBT therapist

For me, both types of self-disclosure are equally important as part of effective cognitive-behavioural therapy and are wonderful tools to build trust within the therapeutic relationship. In my experience many therapists are frightened of self-disclosure as in our training the importance of ‘boundaries’ is consistently drummed into us, from lecturers, clinical supervisors and academic literature.

However, I believe that whilst cognitive behavioural therapy is evidence based,  (which I strongly believe in, and support) there are some aspects of any type of psychological therapy and many medical interventions that make it an art. It is well-known that it is very difficult to measure empathy and the strength of a therapeutic relationship.  Measures of such things are highly subjective, and necessarily so, we do not have a better way of measuring (apart from extremely expensive neuro-imaging equipment) such intricacies other than self-report. Nevertheless, just because we cannot accurately measure something it does not mean it is not essential or unimportant.  For example, try to describe and measure love…… very difficult.

As a  scientist-practitioner and a social scientist the art of the therapeutic relationship is built upon trust. How can I expect my client to trust me, if I am unprepared to ever appear vulnerable?  How can I expect my client to comfortably explain a missed session or extended absence from therapy, if I am unprepared to do the same? It’s all very well saying to a client “I’m ill” and not expanding on it, but I find clients then often ask questions. Turning round and saying ‘I cannot tell you what’s wrong with me because it may affect our therapeutic relationship and would break boundaries’ sounds reasonable enough. However, clients are then likely to feel rejected (after all they haven’t studied the science and research behind boundaries) and moreover, worried. They may think, ” does she have a life threatening illness?”, “has she got an illness that gives her pain so it means she can’t concentrate during out sessions?” etc… In instances such a these I find truth is very powerful. By telling my client about my illness, I am given the opportunity to reassure them that my competence is not affected (otherwise I would not practice) and it also says to them, “I am a vulnerable human being just like you and that’s ok.”. Clients are so grateful for my honesty and it invariably builds mutual understanding and trust.

The other type of self-disclosure works slightly differently. This is useful for therapeutic gain by demonstrating to your client that in some situations you can personally relate. This communicates that as a therapist you are also vulnerable and imperfect but also shows that you practice what you preach. For example I am happy to tell my clients that struggle with insomnia that I have struggled with this in the past and still do from time to time.  Certain CBT techniques work better for me than others and I appreciate than sleep hygiene is not an overnight cure (pardon the pun) and that it can be tough and sometimes take perseverance before benefits are to be had.

I will not bore you with what are and are not appropriate self-disclosures, as this is very much down to personal discretion and a matter I have (and all therapists should) discussed in clinical supervision. I guess my message is this: Self-disclosure is a beautiful thing, therapists need not fear it as long as your intentions for self-disclosure are always in the best interests of your client and are not damaging to your own mental or physical health and well-being.

Why do I have clinical supervision, and how do I feel about it?

Firstly let me explain exactly what my understanding of clinical supervision is, for those of you that would like to know. I will then describe how I feel about clinical supervision, before, during and after a session. 

What is clinical supervision, and what do I understand it to be?

Clinical supervision is different to the general concept most people have of the English word ‘supervision’. In a nutshell it isn’t supervision in the sense of having a manager like you might in a job, giving you orders. Your clinical supervisor is not someone you are accountable to for your work, you are accountable for your own practice  (however when you are a student the relationship is slightly different). Clinical supervision is there to support therapists in their work, it is not therapy for therapists.

I can only talk about my experience of cognitive-behavioural psychotherapeutic supervision. To me, my clinical supervisor is someone who helps me look at my clients problems and goals from different perspectives when I need an alternative way to support someone. They also make sure I keep on top of my clinical skills, and help me improve them where necessary. This can be done in various ways, for example by listening to recordings of sessions (recordings are only ever made with the consent of my client and I always tell them that my supervisor is much more interested in what I am saying than them, which is true!), or role playing different scenarios during supervision  My supervisor also helps to monitor how my own thoughts, feelings and behaviours may be influencing my work, positively and negatively. For example, a clinical supervisor, from their external perspective may be able to notice if my stress levels might be interfering with my work, before I am able to notice myself. Or perhaps they may identify that the themes I am discussing with a client are too emotionally relevant to me for me to remain objective. In other words, in would not be appropriate for me to support a client through a bereavement if I was still grieving profoundly myself.

How do I feel before, during and after a supervision session?

When I was a student, and first started my training, I felt very nervous before supervision. I was worried that I wouldn’t be good enough and that I would be constantly criticised. Well I was right! I wasn’t good enough, but how could I possibly expect to be, I was learning! However I soon began to be accepting of my inexperience and my wonderful supervisor would constantly remind me to ‘allow myself to be crap’! I was also constantly criticised, but in a very constructive way, with both positive and negative comments.

Nowadays, before supervision I am invariably aware of one strong emotion. Excitement! To be honest I am a bit start struck by my current and previous supervisors. These are CBT practitioners with far more years experience than me, and are aware of so many more different resources and useful books/workshops/exercises than I am, and frequently point me in the right direction. I am also eager to get ideas from someone else about how to help a client, when the client and I are struggling with something. I often have light bulb moments in supervision along the lines of ‘of course, that would be so helpful, why didn’t I think of that?’ or ‘ Wow, that sounds really interesting, I am not familiar with that way of doing things and I really want to learn more about it’.

During supervision I feel inquisitive. I always want to know how I can do things better, and of course I feel warmed when my supervisor compliments me on something I have done well ( I have a tendency to be very hard on myself). Sometimes, being a therapist can be a lonely profession. Nobody else is in the room with you (at least in individual therapy) except the client. Of course clients often say lovely things to me and express their gratitude, which feels great (although I genuinely think the hardest working person is my client; therapy can be hard work). However, when a client is really suffering or things are rather difficult, you don’t have a colleague alongside you to say ‘it’s ok, you are doing a good job’. It is only in supervision where you can describe a difficult situation and get someone else’s opinion on what you decided to do.  After supervision, my overwhelming emotion is feeling inspired. I come away with lots of new ideas, different ways to help my clients and new exercises, and concepts to learn about.

At this stage in my career, supervision provides me with someone to give me a fresh perspective on things, to help me recognise my strengths, or make improvements where needed, and to metaphorically and sometimes literally give me a pat on the back.