Episode 17: Level Up Your Clinical Supervision Practice with Best Practices with Tara McRae

Kayla: Welcome back to Your Clinical Supervisor’s Couch podcast, and I’m your host, Kayla Das.

Following our standards of practice and code of ethics is critical when running a therapy practice, but how does our standards of practice and code of ethics apply when running a clinical supervision practice?

Well, in today’s episode, Tara McRae, registered social worker and clinical supervisor will share how to level up your clinical supervision practice with best practices, rooted in standards of practice and code of ethics.

Hi, Tara. Welcome to the show. I’m so glad to have you here today.

Tara: Hi, Kayla. Thanks so much for having me.

Kayla: Tara, before we dive into today’s episode, please introduce yourself, where you’re from, and tell us a little bit about your practice and your clinical supervision journey.

Tara: Yeah, so my name’s Tara McRae, as you said. I work out of Ottawa virtually. I’ve been in the mental health field for about 13 years now in various settings. I’ve done some student supervision and mentoring. But I recently launched clinical supervision for social workers and social service workers in private practice. In my own private practice, I work with couples, I work with autistic folks, and I work with a lot of young people who have high anxiety needs.

Kayla: Amazing. So, you know, standards of practice and code of ethics is probably my favorite thing to talk about. I am such a like policy nerd, and this is such a great topic.

So, first of all, how does standards of practice and code of ethics inform clinical supervision practices?

Tara: Yeah. Well, I feel similarly to you, as you’ll see throughout. That’s probably our shared social work background coming up.

So, the code of ethics for each professional’s regulatory body must be followed. And of course, there’s not only ethical risks if this isn’t done, but also legal and potential disciplinary risks.

Whereas the standards of practice seem to be more. Like the best practices seem to be more guidelines, but it’s like the standards determined within the community and the research community as to what we should be striving towards.

I do believe there’s a lot of barriers to having these implemented. So, while I believe they should strongly inform the way clinical supervisor’s work. There’s always a waya to go to make this the gold standard. So, kind of ethical, legal, and then separate from that is like best practice is what we’re trying to strive toward.

Kayla: I love how you broke it down that way. And I’m even thinking, and I’m thinking specifically the Alberta College of Social Workers standards of practice, there’s very little about clinical supervision overall.

And I think that what’s really important to also understand is that some of these standards or practices and even the code of ethics for that matter, are created for kind of like the general social worker in mind. So, no matter if you’re a therapist, no matter if you’re a case manager, you’re a clinical supervisor.

So sometimes it’s really thinking critically of how does this standard, or how does this ethic fit with me as a clinical supervisor or any other role that you may hold as a social worker.

Tara: So, adapting it to the specific context, right.

Kayla: You know, as we were just mentioning, we were talking about kind of the lack of overlap with respect to clinical supervision within standards of practices.

So, for therapists who are regulated with a regulatory body that have limited written guidance for standards about clinical supervision, how can they ensure that they are following the best practices?

Tara: Yeah, so that’s definitely true. Like you mentioned, Alberta. I wanted to speak a little bit about the Ontario College of Social Workers.

So, for instance, for them, like though they don’t mandate certain trainings, et cetera, if you dig around on the college’s website, you will notice that they do require you to have specialized skills that they don’t feel evolves automatically from direct therapy practice. So, they want you to be aware of the parameters of your competencies. They want you to develop skills through formalized training, supervision, or supervision and mentorship of your own supervision practice. They want you to document your supervision sessions and they recommend liability insurance. So again, this isn’t mandated, but these are like strongly recommended and so that’s what you’ll see like in the various colleges, there’s a lot of discrepancies or differences in terms of what they do mandate or what they strongly suggest. But I do think that that’s when we can rely on the best practices for governing bodies that have less information regarding their standards of practice specifically for clinical supervision or where it’s harder to adapt these ethics specifically to a certain context, that’s where we can turn to the literature on best practices. And I’ll be outlining some of those today and we can link that information for the listeners as well.

Kayla: Amazing. So I have to ask you, what led you to explore clinical supervision standards of practice, code of ethics, and best practices in such depth so that you can talk about it here today?

Tara: Yeah, well as we mentioned a little bit, I think that my social work journey has made me very aware of ethics, but I think I’ve always had a strong sense of justice. Some might even say quite rigid in that way when I was younger. Really focused on like what is right, what is wrong? But definitely when I took my training for clinical supervision through Culminate group, I was reading an article on the best practices for supervision and I was like, wow, this has not been my experience as a supervisee.

And I really felt relieved to know that there was like a push to have supervisors work towards these best practices. I really thought about how enriching it would’ve been to have a supervisor that like encompassed all of these things. I think I had elements of all of these best practices spread out through all these different supervisory experiences, but it definitely was not all embodied in one person.

And then there was a specific study that I read where, they were looking at supervisee experiences of their clinical supervisors. And 51% of supervisees reported at least one ethical violation by their supervisors. And most often, these were related to like inadequate performance evaluation, confidentiality issues, and their ability to work with alternative perspectives. But what stood out for me most was that like these breaches and kind of ethical guidelines significantly impacted the supervisory alliance and lower supervisee satisfaction. So, it also benefits clinical supervisors to work with these best practices in order to like retain their supervisees also. Right.

Kayla: I couldn’t agree more and I’m even just thinking of like my own experience as a social worker. It’s, as I mentioned before at the beginning of this episode, I love policy and understanding, what are the rules, what are the regulations? And that’s a huge part of my job as a business coach as well is helping people find the right policies and regulations, even though, of course I’m not a lawyer, so I don’t give any legal advice, but just guiding within that parameter.

And sometimes, when it comes to, whether it’s legislation, whether it’s regulatory documents such as standards and ethical codes, they can be confusing sometimes. And not just that I run a Facebook group and I know that someone will say, what am I supposed to do with this respect? And then you have 10 different answers, and they’re all probably right, but they’re all from different regulatory bodies or different professions within a regulatory body. And I know we’re talking about social work here because of course we are social workers, so we can talk about those more confidently. But there are so many regulatory bodies. There’s psychologists, registered psychotherapists, social workers, and of course it changes from province to province. Like we mentioned, I’m in Alberta, you are in Ontario. And sometimes it’s not as clear as we would like it to be. So, it’s really up to us to really try to find those answers and to really interpret and think critically of our regulatory bodies standards and what’s required.

Tara: Definitely. I mean, that’s the responsibility of each clinician. And I think what’s even more important is the fact that if we can have clinical supervisors who are following best practices, then that’s going to take away the fear and the uncertainty for the clinician, and then they’ll be able to do better work with their clients, right? Which is ultimately what we want, so.

Kayla: Yeah, and I’m just going to answer the question for myself. Why do I love policy? And I think you just kind of hit on it. I want to make sure that I know what I’m supposed to do and not supposed to do. And if it’s lack of clarity, sometimes I’d have to try to find that answer or work within that gray parameter.

But it’s really us taking that responsibility on of how can we support ourselves in to whatever role we’re in, but of course we’re talking about clinical supervision right now.

Tara: Yeah. And I think there is a lot of gray area and I think what we can count on is if you know that you are doing your research, you’re doing your best, you’re actually following those cues. When you have a question like an internal question or an internal uncertainty and you’re going to follow the steps that you can access in order to get the information, then you’re doing your best right? Then you can kind of rest easy after that. All we can do is our best, but. We can rely on the research that we have access to, to help inform those decisions.

Kayla: And I also want to add too I think the gray areas are intentional. I hear therapists say all the time, I wish they would just tell me what I need to do instead of it being so gray. But that’s intentional so that we have autonomy over being able to decide what is best for us, our practice, our clients, right?

If it was so black and white, it would feel very micromanage-y and we would begin to resent the best practices and the ethics because it is putting us in a box. Whereas of course there are some black and white things that we as social workers or practitioners need to consider. But overall that gray area is intentional so that you can critically think about what is best for you in this situation and your client.

Tara: Yeah, it’s really interesting that you say that because I’m actually just started reading decolonizing Therapy by Jennifer Mullen. And just thinking about like structures and though I enjoy like the ethics piece, like the policy, the navigating, all these little like loopholes and everything. I like that you say the gray area is intentional. So, we have autonomy because a lot of these mechanisms that are in place are a result of colonization. And we’re upholding kind of that white supremacy in some of these structures.

So, I like that you touch on like, maybe the gray is intentional so that we have that autonomy and things aren’t becoming too rigid and we’re not having to move away from certain types of interventions. That makes sense.

Kayla: A hundred percent. And I love that you applied that to this conversation as well.

So what steps, strategy, standards should clinical supervisors follow to level up their clinical supervision practice with best practices?

Tara: Okay, so there’s a lot of literature on this, but I’m going to go over when I’ve found to be the most common themes, and I like amalgamated what I read into themes that tend to come up a lot.

So, the first one is informed consent. This one is really interesting because I’m not sure that all of us do this as clinical supervisors. So, what I mean by informed consent in this situation is that the supervisee feels that they have engaged in informed consent within the clinical supervision. So, is there a contract outlining what the services are that are going to be provided by the clinical supervisor? Have they been informed about your experience and your credentials? Do they know the parameters of supervision? Do they know their own rights and responsibilities as well as what you expect from them and what they expect from you.

So, the next theme that comes up a lot is multiculturalism. So I think this all starts with having an open discussion about this with your supervisee, you’re looking to find out from them what is important to them in terms of their own cultural identity, their own sensitivity around issues such as race, ethnicity, gender, sexual orientation, socioeconomic status, privilege, family characteristics, country of origin, language, worldview, spirituality, religion and values that that supervisee feels is important to address from the get go within that supervisory relationship.

And then also being aware of all these multicultural topics so that you are modeling this within the clinical supervision. So being aware of local indigenous groups, understanding whether a specific culture is more collectivistic or individualistic, understanding the norms and societal nuances within a specific culture, understanding power, respect dynamics within a certain culture. Understanding ethical and legal standards might be different depending on the culture.

So, you have awareness of this around your relationship with the supervisee. You also have awareness of this topic when it comes to client relations and modeling that therapeutic teachings while keeping this in mind. And then you also have to have awareness of this about yourself. So how does your cultural background impact your relationship with your clients as well as your supervisee? How does the position of power that you are in, not only with clients, but also with your supervisee impact that therapeutic alliance? And then just like relational skills. So, you have to be able to interact with people from different cultures within that supervisee supervisor relationship.

A third theme is goal setting and evaluation. So again, from setting to setting, this can be different. And so, when you’re doing your informed consent, when you’re doing your contract with your supervisee, having a proactive conversation around, okay, how are we evaluating what works for you within the setting that you’re working in. Do you want me to be evaluating you? Do I have to evaluate you based on the standards that you’re trying to meet or the hours that you have to meet, et cetera? Being proactive, purposeful, goal-oriented, and intentional about this.

So, feedback. I think this goes both ways, right? Creating an environment where the supervisee feels comfortable offering feedback and also where they are open to receiving your feedback and having a discussion around like, in what way do you want me to deliver you feedback? Letting them know there are certain times I’m going to have to give you feedback if I feel like an ethical line has been crossed, right?

The supervisory relationship is another big theme. So, creating an environment of trust, openness, growth, and making repairs when necessary. And again, I think this is great for the supervisory relationship. It’s also great to model so that when there are ruptures in the therapeutic alliance with your clients, you’ve had practice working through this.

Ethical considerations. So, making sure that you are following your code of ethics with supervisees and that they are following their code of ethics as a supervisee. And that you are applying your code of ethics with the supervisee as if they were your client. So, you’re adapting that code of ethics such as your supervisee is your client.

Documentation is another big theme, and I won’t get super into it, but basically, it’s all about accountability. So clinical supervisors should be documenting their clinical supervision sessions.

Competencies. This one is also like exhaustive. So, I think the main thing to remember here is you should be continually assessing your competencies as a supervisor. And perhaps you have taken new trainings or you feel like you’ve been developing your skills with your clients in a certain area, and so now you can add that to your competencies. As a clinical supervisor. Whereas maybe when you first started as a clinical supervisor, you didn’t have that competency to offer as a clinical supervisor, so just because you’re doing it as a therapist or as a psychotherapist, doesn’t mean that you should be supervising in that area.

Kayla: Something I’d like to add to that as well. And I think that it sort of goes in with competency, but it also kind of comes back with feedback and also supervisory relationship is– and this actually personally happened to me and I really appreciate this clinical supervisor for this. Is one of my first clinical supervisors. I basically just chose her because she’s the only one that I could find. She’s an amazing supervisor and I would recommend her to anyone who wants to learn within that specific realm.

But I’ve mentioned this on the podcast before as well, I used to leave clinical supervision sessions feeling so defeated. I didn’t know anything that she was talking about like she come from a total different theoretical orientation. She worked with different types of clients than me. I felt like I was a terrible therapist. And the nice thing is after a couple sessions she said, you know what, Kayla? I just don’t think we’re the right fit, and I think it’s really important as clinical supervisors, if you know that you and your clinical supervisee are just not the right fit.

I mean, it’s okay for anyone to start off with. Anyone that’s the same with our clients, right? Or sometimes we don’t even know if we’re the right therapist for the client until a few sessions in. And to this day, I still appreciate her for saying that because again, I went out and found another clinical supervisor who was fabulous, fit my theoretical orientations. I left feeling empowered. I wasn’t feeling defeated. At first, when I was with the previous supervisor that I wanted to leave the profession because again, I just didn’t feel like I knew what was happening. But the second supervisor made me feel like I knew what was happening. And if it wasn’t for the other clinical supervisor saying, you know what, I don’t think we are a good fit. I would probably would’ve quit social work.

Tara: Yeah. That’s so interesting because the idea of fit didn’t come up in any of what I’ve read, but I think you’re right that it falls within a lot of these different themes, especially competencies, right?

Because if we know what our competencies are, we know what model of supervision we’re using, then we know which supervisees will likely be a good fit with us. Yeah.

Kayla: I agree a hundred percent.

Tara: Another theme that came up was power dynamics. We talked a little bit about it when we talked about multiculturalism. But yeah, being very aware of that power imbalance between supervisor and supervisee. And again, modeling this because there is also that power imbalance between psychotherapist or social worker or practitioner and the client.

Training. So, ensuring that you have enough training and models of clinical supervision, even if your governing body is not mandating this, this is what I’ve found to be in best practice.

Environment of growth. This is huge for me. I think that there’s a lot of fear created within the profession, especially for new professionals who are graduating. There’s a culture of fear that people are going to get sued, people are going to get in trouble, they’re going to lose their license, and while it’s really important that we are aware and informed about laws and ethics. And to not be causing harm. I think that the vast majority of clinicians have good intentions and we need a safe space where they can discuss the areas in which they’re confused or stuck and not feel frightened to raise these with their clinical supervisor. So, it’s a supervisor’s ethical duty as well as a public service to create an environment where growth can occur without fear of reprimand.

That environment of growth also speaks about offering supervision that meets the developmental needs of the supervisee. So, like for instance, if a supervisee is early in their career or a student, they’re probably going to need more teaching. A clinician who’s been in the field for longer, might not need as much teaching, right? They might need to just reach out when they’re feeling stuck, or they have like a particularly difficult situation with a client.

So yeah, offering supervision that meets the developmental needs of the supervisee is utmost importance.

Kayla: And I want to go back to the very beginning. You mentioned how like the standards are kind of like the vision, if we were to think of it from a business perspective, it’s the vision of the organization, right? There’s the mission, the vision, and the values. And this is the vision of our practice. And I think that looking at it that way. It’s really helpful because sometimes we think of it so rigidly, right? It’s like I have to do this. Oh, I didn’t follow this standard exactly how it needs to be. Oh, now I’m going to get sued, or now I’m going to get a complaint against me. We’re all human, we all make mistakes. It’s now how are we going to move forward and ensure it doesn’t happen again? How do we build ourselves up and ensure that we improve our practice moving forward?

And what I love is you already integrated this. Even if you’re a clinical supervisor, you should be seeking clinical supervision so you can still get clinical supervision on your clinical supervision services so that you are still building your practices, you are still building upon those code of ethics, those standards of practice, so that you are your best self for you and your clinical supervisees.

Tara: I love that you said that, that this is the vision. Because the first time I read these like best practices, I was like, oh my gosh, it’s like pages and pages and we’ll link it here, but the most thorough one that I’ve seen. But yeah, I was like, how am I going to make sure I’m doing all of these things? Like, this is extensive, right? And so, it can be scary. So, I like that you say it’s the vision.

Kayla: So, do you have any additional tips, insights, or advice for clinical supervisors about following standards of practice, code of ethics and or implementing best practices into their clinical supervision practice?

Tara: So, this flows kind of a from what we were just talking about, right? I think seeing this as a, as the vision, as you’re guiding light, that’s huge. And so how do we ensure that we stay on track with this and that we’re able to implement all of this high-quality work? I think conducting a yearly self-assessment.

So, a lot of governing bodies already require you to do that. So, integrating this into your yearly self-assessment. And again, I’m going to link some of these articles, so you could literally just take the best practices that are listed and go through each one and kind of rate yourself and see where you fall and what do you want to work on? What do you want to give yourself as a goal in terms of improvement?

We already mentioned supervision for your supervision practice is important. And then I think also having a group of peers that you could meet with that have a similar standard that they hold themselves to when it comes to their clinical supervision, I think is huge to have that camaraderie and just being encouraged to kind of work towards the best way that we can do things. It doesn’t mean we need to be perfectionistic or rigid, but encouraging each other to do the best work that we can for people. That’s what it’s all about.

Kayla: I love that. Tara, I know that you are accepting supervisees in your clinical supervision practice. Can you tell us a little bit about your approach to supervision and who would be a good fit to work with you?

Tara: Yeah, so well, first of all, I definitely try to do my best to follow the practices we talked about today. I feel I have a gentle but direct demeanor. I definitely am trying to create that safe environment for clinical supervisees to not feel that they’re like living in fear around all of these rules and regulations.

And ultimately, I just really want to empower supervisees to be able to do their best work with their clients. So registered social workers or registered social service workers is who I supervise in terms of my model of supervision, I combine a psychotherapy focused model, which means like I’m dedicated to the implementation and learning and growth associated to cognitive behavior therapy.

So that teaching component, which again, if you are earlier in your career, might be a little more heavy. Later on in your career, might be not as heavy, but that’s that developmental piece. And then I also look at the relationship between supervisor supervisee. And how that relationship might be mirroring what’s happening between the client and the therapist in the therapy room. So we also have an awareness of that in the supervisor sessions.

I also work from a structural and systemic lens, a neurodiversity framework, and from the social model of disability. And I also add in mindfulness, self-compassion, adapted DBT for adults with intellectual disabilities, trauma-informed care, and person-centered planning.

So you can check out my website to find out which populations I feel comfortable supervising you with.

Kayla: Amazing. So, to reach out to Tara for clinical supervision, head to taramcrae.com/clinicalsupervision.

Also, you can simply scroll down to the show notes and click on the link to her website.

Tara, thank you so much for joining us on the podcast today to discuss how to level up a clinical supervision practice with best practices.

Tara: Thank you so much for having me. It was a really interesting conversation and I hope it sparks some thoughts in the listeners and maybe even some further podcast episodes moving forward.

Kayla: And thank you everyone for tuning into today’s episode, and I hope you join me again soon on your Clinical Supervisor’s Coach podcast.

Until next time, bye for now.