Episode 10: Considerations for Clinical Supervision of Group Therapy with Leah Niehaus

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

Are you a clinical supervisor who intends to provide clinical supervision to therapists conducting group therapy in their practice?

Then you’ll enjoy this episode.

Today, Leah Niehaus, Licensed Clinical Social Worker and clinical supervisor, will provide key considerations for clinical supervision of group therapy.

Hi, Leah. Welcome back to the show. I’m so glad to have you here again.

Leah: It’s great to be back!

Kayla: For listeners who haven’t heard Leah’s previous episode, Leah, you were actually my first podcast guest back in January. At that time, we discussed how to structure a clinical supervision session.

However, today you’re back and we’re putting an emphasis on considerations for providing clinical supervision to supervisees who conduct group therapy sessions in their practice. So, I’m excited to dive into today’s episode.

But before we do, just in case any listener hasn’t had a chance to listen to the previous episode, please introduce yourself and tell us a little bit about your practice and clinical supervision journey.

Leah: Sure. I’ve been licensed as an LCSW for 21 years and been a clinical supervisor for 12 years. And I started having post master’s associates in my practice nine years ago. I currently have a group practice with five associates and one licensed clinician where we serve children, adults, and families in Southern California.

And honestly, I was starting to feel a little lonely in my solo private practice. And I had an opportunity at one point to work as a supervisor with grad students on the side and discovered that I loved supervising, teaching, and mentoring. So, it was a natural step to slowly grow into a group practice.

I became a CAMFT certified clinical supervisor in 2019, which is a special California designation for supervisors. And I also became a certified group psychotherapist in 2022. And that just supports kind of the work I do in terms of group therapy supervision. I love doing clinical supervision, being part of clinician development over time, and also supporting other supervisors in the community.

Kayla: Well, it’s great to have you back here again today. So, first of all, what is clinical supervision of group therapy? Like how does it differ from supervising other forms of therapy provision models most traditionally one-to-one therapy?

Leah:  Well, running groups is really complex and challenging, and it definitely deserves its own dedicated group therapy supervision time. When supervising groups, I focus more on what happens between people and less about what happens inside of one person. And so, it’s more nuanced and complicated because of course group work can kick up more transference, microaggressions, and conflict. But ultimately so much healing can come from interpersonal group work as well.

So the supervision time is focused on slightly different things than we might be doing in a more typical kind of supervision of individual work with clients. I have to think about and help the trainees learn how to handle group dynamics, how to work with conflict.

How to manage safety considerations in group, how to handle triggering events, how to bridge one group member with another. And these techniques are often different than what we might be using with an individual client.

Kayla: So, for clinical supervisors who are providing clinical supervision for supervisees who are providing group therapy, what are the considerations for clinical supervision within that capacity?

Leah: Yes, I think that when you’re supervising clinicians running groups, it’s really just being mindful and putting some attention toward really not getting sidetracked on individual work, and honing in on group therapy consideration. They are just slightly different and I find it’s very easy to get sidetracked in regular clinical supervision on tricky individual cases that occur or crises that occur. And often there’s even a I think sometimes a bias in supervisees, like it’s easier to talk about individual work in some ways. We all have difficult clients or challenging circumstances one on one with clients that we want to delve into. And it’s harder sometimes to articulate the dynamics about what’s going on in a group or to ask for the kind of help you need when you feel like you’re in over your head. And so, we all can easily get sidetracked. And so, I like to just make sure I spend enough time as a supervisor attending to the group therapy dynamics and having a separate space that it’s just for that.

So that’s one thing I would say, and I think things can just go off course quickly in groups. And so, there’s, a disruptive effect that can affect many individuals. So even just to cover your license, to cover the client progress and to make sure our clinicians are developing like appropriately, and their professional growth, it’s really best to prioritize that time together to go over techniques, go over how to manage the conflicts that come up. And really celebrate gains in group therapy when we see interpersonal benefit between group members.

It also helps to really get creative inspiration from other clinicians leading groups because we begin to speak the same language about what’s really helping in those group therapy sessions. And you need, like, a lot of support around holding a group.

Kayla: That makes sense. And you kind of talked a little bit about really the benefits, but are there specific risks that clinical supervisors may encounter when supervising supervisees who are conducting group therapy instead of say individual therapy.

Leah: Yeah, just some risks that come to my mind is sometimes in a group, things go off course. Like we might be running a middle school girls’ group and one person asked to go to the bathroom, and then another person asked to go to the bathroom and then they’re running around the building. So, there’s like risks like that.

There’s also bigger risks in terms of if someone shares in a group and a public setting with a number of people in the room. That they’re self-harming, or they’re restricting, or they’re suicidal, or they’re being abused. We have to attend to it clinically and we have to attend to keeping the whole group safe.

And for this group to feel like the clinician has been able to contain it, is going to follow up on the safety considerations, will hold a group member afterward if need be and somehow get the group able to work through some of this process, show concern and empathy for each other and compassion. But also stabilize the group by the end of the session time so that they’re able to leave. And then we follow up with a group member who might be more troubled.

So those are just some of the things that come to my mind off the top, but it’s just complicated if somebody comes in with a lot of heightened emotion, a big thing in their week, and it could potentially trigger other members in the group and we can have a snowball effect if it’s not attended to properly.

Kayla: You know, that’s some food for thought, and I think that it’s interesting that we don’t always talk about the difference between one to one and group therapy. However, there are different skills, different issues, different risks, different benefits, different ethical dilemmas that might arise.

Do you have any examples for clinical supervisors how they can navigate a situation, something like you just identified, if they’re working through it with a supervisee who is saying, hey, I had this type of disclosure that happened in my group therapy, and I’m not really sure how I navigate this. And maybe how would you deal with it? Or do you have any examples of something like that?  

Leah: Sometimes these situations happen in the moment and the clinician or the associate has to figure out how to promote safety and stabilize the group before the ending of the group. And they get a lot of training in my practice before they begin running groups and they shadow my groups and they shadow more experienced clinicians and things like that to kind of help prepare.

But sometimes in the moment they’re faced with having to figure this out. And then they call me right after group and we talk about what happened and there might be follow up things. There’ve been many times over the years where in running a group. somebody is really struggling and I have them stay after with me for a few minutes. And I assess for safety if I need to enlist parents or support system or give crisis information or hospitalize someone, of course, all of those things I do. But sometimes the group work doesn’t end at the time that the session ended. Sometimes there is follow up with somebody individually afterward. There’s often follow up for me with the whole group. There have been times when I’ve had to, whether it be text the whole group, whether it be call individual members, make sure everybody’s okay. There’ve been times when I say to young people, I’m going to let parents know about the content of what came up tonight just to support everybody at home.

So, in any kind of higher risk situation, I’ve trained my clinicians. Always be a human being in the room first. We have to ensure safety. We have to express our care and concern. And actually, sometimes when there’s something so big that’s unsettling or very concerning, it actually really brings the group closer. It’s an opportunity for the group members who struggle interpersonally to express compassion, empathy, altruism, to be there for each other. I want them to be there for each other and also feel that myself as the adult or my clinician is going to make sure we keep somebody safe.

It’s not always a real negative in the group life. There’s a lot of learning that comes out of it and continued processing. I mean, we kind of often process it for sure the next week, we might be processing it still a month later, and there’s a lot of learning in that. And I have found if we communicate, if they know we’re concerned, if they know that we’re taking the leadership steps we need to take, families are pleased. They’re feeling confident with us and the group members are retained and we keep working through it. So, communication is just really key and are being a good human.

Kayla: I love that and I couldn’t agree more. So, how do you structure your clinical supervision sessions? Like, if we were to conceptualize it almost in a step-by-step format, how would you structure clinical supervision sessions when working with supervisees who conduct group therapy in their practice?

Leah: Yes, I think that one thing that’s helpful to just consider is some supervisees have limited exposure to group work by the time they reach you, and some have much more experience. And so really tailoring their learning to where they are. When I think about the structure of group therapy supervision, I think about three components.

I think about dyadic instruction, which is teaching, observing groups, reading about group work, taking a class, or joining an experiential group. I’m part of AGPA, an international organization that has a lot of wonderful trainings and supports and consult groups. So, I encourage my supervisees to look into those things.

I think the second component is considering their own group experience. Maybe some clinicians have the unique experience of having attended a group therapy in the past, but many have not. But even group supervision is run as a parallel process to group therapy. If it’s done in an inspired, intentional way.

So, thinking about how you run your groups. Thinking about console groups they’ve been part of. Thinking about their primary group in their life, which has been their family of origin. Thinking about book clubs, church groups. All of these groups facilitate one’s understanding of the benefits of being part of groups.

And then I think the third component is supervision of their clinical work. So, whether that’s observation or co-leading groups with them or their own self report about how their work is going in groups. Looking at their progress notes and their group notes, from their client work. And also, I encourage mine on occasion to send out group session rating scales and get feedback from group members about how they feel in group.

So that all helps structure my kind of thinking around how to do group therapy supervision. As it works out in my practice, they have a lot of supervision every week and then once a month we do a two-hour group therapy supervision meeting and so that is just around groups and there’s often a learning or training component, a mutual sharing of how their groups are running, we have time for sharing what is working in group and what is challenging in the work. Time to explore creative group activities, or ways to further their processing together in groups. Everyone checks in regarding how their group is running, like who’s graduated, any new intakes, issues with marketing to the community. Ruptures and repairs. How they may have handled triggers or safety concerns, or their own counter transference.

I like to think of group therapy supervision as a parallel process to running client groups. As their supervisor, I facilitate and model for supervisees some of the techniques that I use in running my clinical groups. So, I am aware to include more introverted members. I try to connect and bridge supervisees with each other. I encourage them to speak to each other and help each other in supervision. And I instill inspiration and hope, during the supervision session.

Kayla: Wow, that’s a really great way to conceptualize how to structure clinical supervision sessions for group therapy.

Leah, are you currently accepting supervisees in your practice?

Leah: I am accepting I sometimes have an associate position available in our practice in Hermosa Beach. And then I often have individual or triadic supervision slot online if people want to reach out. I love working with supervisees who enjoy working with adolescents, young adults, families. I love clinicians who are excited about running groups. We’re a rare breed. There’s not a lot of us. And if it speaks to you, it really speaks to me.

So anyway, happy to talk to anyone who might be interested or support supervisors who are supervising groups as well. That’s also a niche that there’s not a lot of us. I do that.

Kayla: Perfect. So, if you’re interested in working with Leah, you can connect with her at leahmniehaus.com. So don’t forget the M.

Or you can simply scroll down to the show notes and click on the link.

Leah, thank you so much for joining us again on the podcast today to discuss the considerations for providing clinical supervision to supervisees conducting group therapy in their practice.

Leah: Thank you so much for having me.

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

Until next time, bye for now.