Episode 18: Consultation vs. Supervision: What’s the Difference? with Jillian Papineau

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

In today’s episode, Dr. Jillian Papineau, Director of Clinical Education at the Culminate Group, will discuss the difference between consultation and supervision in clinical practice.

Hi, Jillian, welcome to the show. I’m so glad to have you here today.

Jillian: Hi, Kayla. Thanks so much for having me. I’m thrilled to be here.

Kayla: Jillian, before we dive into today’s episode, please introduce yourself and tell us a little bit about your practice and clinical supervision journey. I.

Jillian: Absolutely. So hi everyone. My name is Jillian Papineau and I would call myself a very, very proud psychotherapist and clinical supervisor.

I’m thrilled to be here with you today. This is now my second podcast with Kayla. So, I hope I can do it justice on this side of the mic. Originally from Toronto, but moved to Ottawa for my studies and I ended up staying here because I was conducting research on clinical supervision. And Ottawa was a great setting for that. I had deep connection and ties with the community to do some of this research. I specialize my research in professional development for clinical supervisors. So essentially looking at what makes a good supervisor good.

And honestly, this is because I had some fantastic experiences in clinical supervision and I wanted to learn more. I wanted to know how did these professionals come to be? So I began my journey here in Ottawa. I ended up staying here and I’ve dedicated much of my professional career to supervision education.

Kayla: Amazing. And yes, this is Jillian’s second podcast, but first podcast episode on the Your Clinical Supervisor’s Couch. If you want to listen to her previous episode, it was three weeks ago. It was Episode 128 on the Designer Practice Podcast. So, I encourage you to head back and listen to that after this episode.

So, Jillian, what is clinical consultation and what is clinical supervision? Because I am going to tell you that this is a heated debate across at least Canada and probably in the States as well.

Jillian: It’s a big question and I get asked it a lot, and I think it’s because there is some overlap for sure between consultation and supervision, but also because we tend to use the term so interchangeably. But in reality, there’s a distinction between the two. And really, they are different terms, different concepts and different roles.

So, if you’re listening to this podcast episode right now, and you may have already completed a supervision course in the past, you’re probably very familiar with the term of the definition of supervision.

All share a definition that’s commonly referred to by Bernard and Goodyear (2019), who are for me are the rock stars of supervision research. But essentially, “supervision is considered an intervention provided by a more senior member of a profession to a more junior member of that same profession. It’s evaluative, hierarchical, extends over time and has the simultaneous purpose of enhancing the professional functioning of the junior member while monitoring the quality of services provided to the clients.”

So, you can see here how supervision in this definition is very structured. It’s evaluative. It’s two-pronged approach to care in the sense that on one hand you’re looking after client care, you’re gatekeeper to the profession. On the other hand, you’re looking after your supervisee in their professional growth and development. So, it’s very important to keep this in mind, there’s an evaluative, hierarchical components, and there’s that two-pronged approach. Supervision is pedagogical in nature, meaning that it’s fundamentally a teaching and learning process. It’s educational.

So, although there might be a consultative component to supervision, clinical consultation itself has its own uniqueness and nuance to it. When we think of clinical consultation, it’s different from supervision in the sense that the consultant does not assume responsibility for the client. So, the Consultee does in fact bear responsibility for client care for decisions that are made and whether or not they take the advice offered by the consultant.

So very important nuance here is that the consultee has choice. They’re able to decide what information they’re going to take, and they’re able to decide their own next steps. So, with this understanding the Consultee is typically an independent practitioner, so they don’t require supervision. They likely have their own practice. They’re independent practitioners, but they’re looking for additional support, maybe advice or guidance on their cases.

Very, very different from supervision. Where there is an evaluative components, the school may be involved, they may be students or new grads that still require supervision. So in that sense a key nuance difference between supervision and consultation would be who bears responsibility for client care and whose choice is it ultimately for what goes forward with client care?

Kayla: I absolutely love those definitions and I couldn’t agree with you more. And one of the things that I have noticed reviewing Canadian regulatory standards of practices is that many professions and many jurisdictions don’t really explain the difference between consultation and supervision and kind of lump it all together.

As a result, there are people providing what they identify as clinical supervision. However, it’s actually clinical consultation and vice versa. So, I think that even at least across Canada, it’s not quite clear with some of our regulatory bodies what the difference is. So, I love that you highlighted that so that people have a clearer understanding that they may not be providing clinical supervision. They might be providing clinical consultation.

Jillian: Absolutely. And to add to that, I think a helpful way of thinking about it rather than so distinct and separate in two different things, it would be thinking about it on a continuum. So, I challenge you to try considering them as a continuum where you start with supervision as a student, not yet independent. You need the oversight. There’s the evaluation that’s necessary and part of the gatekeeping function.

With time that sort of changes in supervision might look a little bit different. You’d be less of a teacher, more of a mentor, and a guide. And then with even more time and experience, it might shift into clinical consultation where it’s no longer required. But it is a good solid practice and one that we should engage in.

Kayla: Do you have any examples that can help illustrate the difference between consultation and supervision?

Jillian: Absolutely. I’m going to give you a general example that illustrates this continuum of the competency in motion. So, if you consider Jamie the student. Jamie, the student who requires supervision, you’re going to have a contract, you’re going to have evaluation, maybe the formative, the summative evaluation. Jamie’s going to have their own goals that they’re trying to work towards, the school or the supervisor might have identified learning areas, areas of growth, and have lumped those into goals. So, supervision for Jamie the student is very, very specific and structured. And then there is an outcome that everyone’s working towards.

Now, Jamie, the new grad. In Ontario, you still need supervision. You’re a qualifying practitioner, so not yet independent, but it might look a little bit different. You don’t have a school involved anymore, so evaluation might look a little bit different. Jamie, the new grad might have different goals. They might be trying to specialize in different areas. But you as a supervisor, you’re still responsible for client care. You still have different types of liabilities and areas that you’re looking at. Maybe not evaluative through the school, but on your own.

And now you have Jamie, the independent practitioner. And Jamie might have moved onto private practice or somewhere else in his life, but still wants that supportive function of supervision in the form of consultation. Somewhere where they can go check in, get more support bounce things off, engage in a reflective practice and learn in that setting.  

Now I’ll say if Jamie five, 10 years down the road decides, hey, I want to become a couples therapist and goes to do a couples certificate or diploma, hey, guess what? They’re back in supervision at this point, just because it’s a new competency, it’s a new area of growth. And maybe that does necessitate a different type of relationship with the supervisor or consultant, so it looks a little bit different. There is a continuum. It’s kind of gray. It depends on supervisee needs, but most importantly, whether it’s consultation or supervision. It requires an informed consent process, a contract and agreements and understanding of what you’re both working to words together as a professional relationship.

Kayla: Those are really great examples and I’m just picturing, yeah, like even myself as I was going through the continuum, and I think that was a really great way to illustrate how we can go through and even go back through that continuum.

Are there any ethical, legal, or practical considerations between clinical consultation versus clinical supervision?

Jillian: Yes, and I’ll begin answering this by saying I’m not a lawyer. And this is not legal advice. So always check in with your professional body’s regulations, guidelines, expectations. So, I’ll speak to this question in more generalities, but at the end of the podcast, I’ll also share a training with you that will do absolute justice to this question and go far more in depth into liabilities, risk, considerations for you as a consultant or a supervisor?

Spoiler alerts, we’re all liable. Students hold liabilities, supervisors, consultants, we all have to maintain a standard of care, whether you’re in supervision or consultation or you’re a clinician or whatnot. So, we all have that responsibility and it’s very, very important to know where that falls for us, so. To do a little bit of homework and maybe check that out after.

But in terms of considerations between the two of consultation, supervision, I would say there should always be an informed consent process when engaging in either supervision or consultation. So, this means clear contracts. If something is vague or ambiguous, sit down, figure it out, write it out, and have an agreement on that.

Boundary clarification. So, understanding what your role is, who’s responsible for client care– ultimately, responsible. Documentation. Consultation or supervision necessitates clear documentation.

So, in terms of considerations for consultation and supervision, sometimes I hear consultation is just casual advice between colleagues and it’s not a big deal. And so, I would say that that is consultation as the verb, not necessarily the noun of a formal clinical consultation. But even informal consultation can have important ethical considerations. So, it’s important for you to have clear boundaries, to have your contract in place, to have these discussions and to ensure even boundaries with your colleagues are really set. So, these informal quick consultations, which I would call hallway consultations they happen often, but they’re very surface level. So, they’re best to be kept at minor clarifications. Whereas the bigger issues, the bigger considerations that you’re working through, save those for clinical consultation or clinical supervision.

One other thing I often hear if I call it consultation, then I’m off the hook. I’m off the hook for any sort of legal or ethical issues. And the reality is, it’s not what you call it, but it’s what you’re doing. And so that’s why it’s important to really understand your scope of practice, your standard of care to be operating within it. And again, to have clear roles and guidelines. Clear, consent processes, informed consent processes. If you’re providing any sort of consultation, there’s no such thing as being off the hook. We’re all held to a certain standard of care.

Kayla: I love that. And it actually makes me think in my business coaching, I get asked a lot by my clients. If I’m a coach and I don’t call myself either a social worker or a therapist, can I be off the hook and not really have to follow my standards of practice?

And the truth is that you’re still a therapist first, and it’s not necessarily what you call yourself as your main title. It’s what you do the education and the regulatory body that you’re connected to as well. And then of course your ethics connected to that.

Jillian: Yeah, absolutely.

Kayla: So what best practices can clinical consultants and supervisors do to protect themselves when providing either consultation or supervision?

Jillian: That’s a great question and I have a bit of a checklist here of tips for best practices, things that I continue to do to date and I hope I continue to do going forward.

But essentially, if you’re a supervisor or a consultant, I always recommend getting support for yourself. So, get peer consultation for your supervision. Join a group, have this formalized group where it’s documented and everything like that, and get the proper support you need so you’re not alone.

The next one would be clear contracting, documentation. Make sure your admin is up to standards and ensure your practice is clear and sound in that sense.

Know the expectations in your jurisdiction, your professional body, and guidelines and your standards of care.

I’d also recommend reviewing your contract and getting feedback on it for clarity, so don’t just hand it over to your supervisee to sign, but sit down and go through it and ask any questions. Does it make sense to you? Anything that you would change?

In this sense, you have to have clarity of your role. Especially if someone’s just casually asking for advice. It’s ideal to have proper boundaries for client’s confidentiality and for your own sort of safety.

And then last but not least, I’d ask yourself to consider what are your needs as a supervisor or a consultant. So, consider how can you engage in your own learning, your own growth? What readings, trainings, supports do you need? And then along the lines of professional growth and development, think what goals do I have for my own development as a supervisor, a consultant, a clinician for the next year? And really set that on paper and work towards it because it is a field of ongoing growth and development and it’s important to have that in mind, your own needs.

Kayla: Jillian, you have a training that you’d like to share. Can you tell us what it is and how it can help listeners?

Jillian: Absolutely. So, I have a great training called Legal Considerations and Consultation and Supervision by Dr. McKayla Slip. Now McKayla is a fantastic professional in the field. She’s been supervising for some time and she’s done a lot of research on legal considerations in this competency.

So, I had the honor of being able to listen to her teach on this. And that’s really where a lot of my learning and understanding of the competency came from. I think it’s an important training. I think it will really support with your own confidence in the field and your knowledge of rights, responsibilities, legalities, liabilities. And I think it’s something that every supervisor or consultant should take.

Kayla: So, decide not for Jillian’s training, Legal Considerations in Consultation and Supervision. Check out canadianclinicalsupervision.ca/jillianpapineautraining

Jillian, can you also share what your website is in case someone wants to reach out and connect with you personally?

Yeah, absolutely. Check us our at culminategroup.ca. We’re a training practice that focuses on professional growth and development of therapists, so we want supported team environment and quality care.

Kayla: Amazing. So, to check out either Jillian’s website or her training, scroll down to the show notes and click on the link.

Also, if you sign up for legal considerations and consultation and supervision, you can use the coupon code. SUPERWISE, so S-U-P-E-R-W-I-S-E to receive 20% off the course.

Jillian, thank you so much for joining us on the podcast today to discuss consultation versus supervision: what’s the difference?

Jillian: Thanks so much for having me. Had fun.

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

Until next time, bye for now.