Episode 16: The Heart of Supervision: Nurturing, Connection and Teamwork with Nikki Nary

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

In today’s episode, Nikki Nary licensed marriage and family therapist and clinical supervisor shares the essential components that are at the heart of clinical supervision.

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

Nikki: Hi, Kayla. Thank you so much for having me on your podcast.

Kayla: Nikki, before we get into today’s episode, please introduce yourself and tell us a little bit about your practice and clinical supervision journey. Well, like you said, I’m Nikki Nary, and I’m marriage and family therapist. I’ve been licensed for 10 years and practicing for longer than that, and I work in my own practice, Nikki Nary Therapy and Associates. So I live in a suburb of Los Angeles, outside of LA in Thousand Oaks.

So I primarily work virtually now ever since Covid I’ve been working virtually. And I have two associates and one licensed clinician in my practice right now. And they work a combination of virtually and in person in LA and I love supervising.

So that’s why I was so excited to be on your podcast because even though I still see clients, the primary thing that I do in my practice is supervise, train, and help therapists to grow so that they can eventually start their own practices if they want to and build their caseloads and become really great clinicians.

And I really like that you said what are the essential components of the heart of supervision? And I think that speaks truly to me because I have a big heart and I’ve always loved to give that to clients and help people. But I think the heart of really good training is the supervision and the care that you give to your trainees or your associate.

Kayla: I agree a hundred percent. So let’s get into the heart of clinical supervision. So what are those key components and why are they important?

Nikki: So, some of the things that I think are the most important in being a good supervisor, especially in private practice, but if you work in a treatment center or a supervisor really anywhere, it’s really key to be a nurturing person. To have really strong connections with your associates and to have a sense of teamwork.

So one of the things when I like meet with my associates for the first time, I want them to understand that it’s a relationship and it’s like when we meet with clients too, right?

We explain to our clients, the relationship between you and your client is what’s most important for the therapy to work. So I always tell clients you have to like me to a certain extent in order for the therapy relationship to be healing. And I think the same thing applies to working with associates. So we always wanna be a nurturing person in their life.

And the supervisor in this situation is similar to a parent figure. And I come from an attachment perspective. So if we want a client to be able to be vulnerable or we want an associate to be able to be vulnerable, we have to be able to create that safe space and that secure attachment with our associates. So that they feel like they can be vulnerable, they have unconditional acceptance from us. And that we support them through anything because they’re nervous and they’re newer to this, so we wanna be like that role model or like that parent, that helps them to grow, find their potential, and feel safe to try new things. So it’s being secure base is really important as a supervisor. So that’s how I feel about nurturing.

And then the other important things that you wanna have as a supervisor is being connected to your clinician. So it’s not just about, I’m the boss and you guys work for me. It’s really a reciprocal relationship.

And so I always wanna make sure, ask my supervisees, how are you doing this week? What’s going on in your life? It’s not just about, Hey, tell me about your clients. We usually spend sometimes 15, 20 minutes at the beginning of our supervision, just hearing how each other are doing, because that connection really makes the supervisees feel safe in your practice.

And then, like I said, we don’t wanna be seen just solely as the boss or as a manager, the relationship is really collaborative. And so that requires teamwork. I always tell my supervisees I know a lot because I’ve been doing it longer, but I’m not the expert and you’re the one that is going to be making the biggest decisions for you and your client because you’re the clinician. I’m just wanna guide you. And so I always ask them questions to say like, how can we work as a team? How can you get information from me or from our other associates in the group so that we can all learn together?

Kayla: I love that. So, when we’re thinking about teamwork and clinical supervision, what are key roles or responsibilities that the supervisor and the supervisee hold in the supervisory relationship? And how can both parties work as a team within those respective roles?

Nikki: So, I guess the first thing for me to say is whenever I am interviewing a new associate for my practice, I explain to them when I’m your supervisor, the first thing that I want you to know is that I want you to be able to trust me and feel like you can tell me anything.

So that means that if you have any red flag issues that come up with a client that’s suicidal or is talking about things like passive suicidal ideation or self harm, or any other risk factors. Like what if your teenage client is engaging in drugs and you don’t know what to do?

So, when you’re a new clinician, you can, these things can make you feel really nervous. And so what I always tell them is I want you to feel like you could come to me with anything and that I would not judge you, that I would be able to help you figure it out. And even if I don’t know exactly what to do in the moment, we’ll work it out together and that they shouldn’t be too scared to tell me anything. That’s where I really want them to know that I’m a human too. I’m not just your boss, or your supervisor, and I’m not gonna shame you, but I want you to know that especially the most scary things that you can encounter as a clinician are things that I wanna hear about. So I always start off with that when I meet people for the first time.

And that’s how it was for me with my supervisors, I had a lot of really, really positive supervisory relationships. That’s why I wanted to become a supervisor because these wonderful clinicians were role models to me, and I felt like I could trust them and that they were guiding me, but also that they wouldn’t judge me. And so I tend to be a person that I can’t keep anything to myself. And I would share so much with my supervisors, and that’s how I became a good clinician. So I encouraged new people to share a lot, even the things that feel the worst. Especially if you’re having any counter transference with your clients or transference issues, like anything that comes up where you feel funny in the room with a client. That’s something you should talk about with your supervisor, which means you wanna have a good relationship.

Kayla: You know, it makes me think, we talk about that fear that supervisees have. Obviously there’s an inherent imbalance of power when it comes to the supervisee and supervisor relationship. Can you tell me a little bit about how you manage that inherent imbalance being a gatekeeper of the profession?

Nikki: So, when it comes to the power dynamic, I think that it can be really easy to fall into that role of like, I’ve been doing this longer. I have seen more clients than you possibly have. And I think that when you’re supervising newer clinicians, you want them to know that you’re confident and that you have resolved a lot of problems in your career as a therapist, but that you always want to work with them to get their opinion.

So, one of the things that I specifically do with my clinicians, which is hard to remember to do as a supervisor, is after they ask you, Nikki, what should I do in this situation? I always pause and say, well, first, before I give you my answer, or before I give you multiple choices of what we could do, what do you think that we could do? I think that a lot of supervisors forget that part of our role as a supervisor is training, which means that we’re asking the clinician to think for themselves. Because eventually, hopefully they will be in your position and they’ll be on their own, not under supervision. And we want them to be able to think constructively and intuitively know what they should be doing. So part of our role is asking those important questions so that they can first come up with some ideas and some answers. And then we can also guide them to what we think is best among those choices that they’re making.

Kayla: I love that! And I think this even goes outside of the clinical supervisory relationship, but sometimes we do think we are the experts in everything. And we may have experienced situations in the past. But I love that you mentioned giving them the opportunity to identify possible solutions. Because the truth is just because we as practitioners, we may have had similar experiences. That doesn’t mean that’s the only answer, the only solution. It is great to have multiple options, especially if you’ve experienced it, but they come up with a different option than you would’ve thought of.

Nikki: Yes. And sometimes they surprise me where they’ll come up with an answer that wasn’t even one of the things that I would’ve thought of. So, staying humble as a supervisor and recognizing that even though we have experience, we don’t know all the answers. That the client is still that therapist’s client and they know that client better than we do. We’re not the ones sitting in the room with them. My clinicians will pull pros to me, hey, Nikki, what should I do? Here and we’ll come up with a couple of ideas together.

And what I love about specifically some of my clinicians is that they’ll say, oh, you know what, Nikki, I actually don’t think that’s the best idea for this client. And I will always defer to what they say because they’re the one that knows their client the best. So even if I come up with an answer that’s based upon my own experience or what I’ve done in the past. It doesn’t matter because that clinician knows their client.

And so, there’s a lot of, when we talk about the supervisory relationship and the heart of it, like there’s a lot of respect that happens. We have to remember that these clinicians that are greener or newer, that they still know a lot and they know their clients best and that we have to really give a lot of respect to that. So, I try to stay on the same level as my clinicians. We’re equal in a lot of ways. We both are going towards the same goal.

Kayla: I love that. Do you have any tips or strategies for clinical supervisors who may have a supervisee who expects the clinical supervisor to do most of the work in supervision?

Nikki: I think that this goes back to what I was just saying about asking questions in the direction of the clinician to answer first.

I’ve had many supervisees who start out as very anxious clinicians and they’ll call you or email you or text you about every little thing. And when we want to not have to be doing all the work for them. We have to encourage them that they know more than they think that they do. So that’s where the compassionate parental supervisory relationship and becoming that secure person for them to tell them more than you think you do, you can have the confidence to make these choices. And I see them grow in that way. So I think that if you’re a supervisor and you have a supervisee who’s constantly asking you the questions or expecting you to do the work. Just like as a good parent does you give that person opportunity to do things on their own and then see them grow from it.

I don’t know. This is probably like a little sidebar, but I have a 3-year-old son and not that clinicians are anywhere similar to a toddler. I wouldn’t make that comparison. But I think when you think about having a parental role with a child, like I see for Noah, that if I give him some responsibility, even in areas where he doesn’t think he can do it yet, like if we’re cooking in the kitchen and I’m like, you could cut the carrot. And he’s like, oh, I don’t know. I’ve never used a grownup knife before. If he tries it and sees it, he gets the confidence. And so, my point is clinicians are similar in that way. They won’t necessarily feel emboldened to try new things unless we encourage them and believe in them and tell them that they can do it.

Kayla: I think it is fear, right? The fear of am I going to be successful, or what is the outcome going to be? For many practitioners, the fear is, am I going to do something wrong? Am I going to hurt the client? But by giving people that encouragement, you are providing them that resource and almost that permission to make that decision so that they can prove to themselves that the worst isn’t going to happen.

Nikki: Yes. And even if the worst does happen, if you fail as a clinician or you try a new technique, or you say something wrong with a client. One of the things I always tell clinicians is there’s pretty much nothing that you can do in a therapy session that can’t be repaired. Obviously, there are few things that we put off to the side that we wouldn’t ever, ever wanna do with our clients. However, most things in the therapy relationship can be repaired.

So even if you try it, say something to a client, or you try a new technique and it doesn’t go the way that you had hoped. Or you feel that the relationship between you and the client isn’t going well. You can always repair and you can always bring it back. And that’s what the cool thing about the therapy relationship versus many relationships we have in real life is that we have that opportunity to say, Hey, I wanna talk to you, the client, about the relationship and about something that I said or did.

The same thing applies for the supervisory relationship. We show clinicians that they can try anything and that they can fail, and that you can always test it out again or repair the relationship. And so I encourage my supervisor, he’s like, yeah, try that new technique. I’m game for it. If it doesn’t work, like we’ll figure it out. Everything can be resolved.

Like we were talking about with kids, you wanna give them the opportunity to succeed or fail because in failure we do actually learn a lot. And I tell my clinicians, if you mess up, I’ve probably already made that mistake in my career and have survived to tell the tale. So if I can do it, you can do it.

Kayla: That is such great advice. And I agree. If any practitioner out there said they never made some sort of quote unquote fail in their life, they would be lying. So for any listener who’s listening, if this is your worry that you’re going to make a mistake, sometimes we need to make those mistakes to learn from them.

Nikki: Yeah, and most of the therapists that I have in my network that I truly appreciate and think our great clinicians are the ones that do still talk to their colleagues and say, Hey, I wanna talk to you about this case. I think I messed up. And I have friends, colleagues that we call each other and we still talk openly because you don’t wanna live in isolation as a clinician, as a supervisor, as an associate, or a trainee, because that’s where you start to find when you make mistakes you’re not learning from them as well because it’s just you with you. And you do wanna still open up to others and express that vulnerability so that people can tell you, oh, yeah, maybe that was a mistake, but here’s how you could repair it with the client or change your tactic. Or maybe they say, Hey, that wasn’t really a big mess up, like, it’s gonna be okay. We have to bounce these ideas off of each other. And that’s probably one of my favorite things about being a therapist is that it’s all about the relationship. About the relationship to our clients. It’s about our relationship to our other colleagues consistently. And also with our supervises.

Kayla: And this also makes me think too, you mentioned that if we fail that we can repair it, but sometimes it’s, we don’t even fail. But having that other person, that clinical supervisor kind of sharing experiences, allowing you to reflect on some of those approaches that you had implemented in your therapy sessions, you can learn from that. Because you’re having that feedback. Like you mentioned now, it’s not just you with you. You have an alternate opinion and an alternate side that you can learn from as well.

So you don’t even have to fail to be able to get that support and learn how to make things better or improve or even just have a second option for the future.

Nikki: And you know, something that just popped into my mind as we were talking about this that I think is important when we’re talking about the supervisory relationship is also the relationship between the clinicians, especially if you’re working in a private practice. Because in my practice, the clinicians don’t necessarily all work in the office at the same time. They don’t see each other. A lot of them work virtually and at different times of the day or on the weekends. So when we come together for supervision is when we’re getting ideas not just from me, but from our other peers.

And I think especially in the virtual world, we join a Zoom, everyone stays on mute, and we kind of expect the supervisor to be the one guiding it. I appreciate so much more when my supervisees, like we’re in a triadic supervision, we’re bigger. And they all stay essentially like unmuted, but are paying attention and will choose to chime in to give information to their other peers. Or to chime in to give of maybe what they would do or an experience that they’ve had. And that’s my favorite, favorite thing because like I said don’t want to be considered the only expert in the room. Every clinician, and no matter how many years you’ve been working, you have your own experience with clients that can be valuable and techniques that you’ve used that could be useful to any of the clinicians in your supervision.

So I really encourage supervisors to have their associates speaking to one another about what they would do. Not just the supervisor as the only person in the room kind of dictating or guiding.

Kayla: I love that. Nikki, I know you are currently accepting both therapy clients and clinical supervisees into your practice. Can you share a little bit about your therapy and clinical supervision approaches? In addition, which jurisdictions do you currently practice?

Nikki: So, always looking for more associates to join my practice. I specialize in eating disorders as well as anxiety and trauma, and have been working in those arenas for a long time. But my supervisees, I like to work with people that specialize in all different areas. So my practice is not entirely eating disorders. I have clinicians that work with, young children, clinicians that work with trauma, or OCD that work with teens or couples. And so what I look for when I build my group is variety, because I also still like to learn. And if I was only working with clinicians that did the same thing as me, I think I would get bored. And I really like having the novelty of people who are interested in different areas of therapy.

So that being said, yes, we’re always looking for clients. Like I said, I specialize in eating disorders and I have clinicians who specialize in all different areas. It’s important to note that we also do take Cigna. So I know a lot of clients can be looking for insurance and we do offer one of those insurances, which can be helpful.

We provide therapy services across the state of California virtually, and then in person in Los Angeles and just outside Los Angeles in Thousand Oaks.

Clinical supervision, we are able to supervise in the state of California as well and virtually or in person, depending on where you live.

Kayla: Amazing. So to connect with Nikki, check out her at nikkinarytherapy.com

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

Nikki, thank you so much for joining us on the podcast today to discuss these key components that are at the heart of clinical supervision.

Nikki: Thank you, Kayla.

Kayla: 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.