Sunday, February 22, 2009

Supervision: Part I: Professional Clinical Supervision

Here's the first part of an article I wrote for the 2009 Winter edition of the NJAMT News (NJAMT is the New Jersey Association for Music Therapy):

Supervision: Part I: Professional Clinical Supervision
Roia Rafieyan, MA, MT-BC
 What is “clinical supervision”?
“The focus of the supervision relationship is to address the complexities involved in helping supervisees in their ongoing (and never-ending) development as competent and compassionate professionals.  Supervision is a relationship, one in which both supervisor and supervisee actively participate and interact.  It is a process of unfolding- not simply following a recipe, but engaging in a rich and dynamic relationship.  Supervision then is also a journey, or odyssey of sorts, in which supervisor and supervisee learn and grow and from which both will very likely leave transformed in some way.”  (Forinash, 2001, “Overview” p. 1, in Music Therapy Supervision (Forinash, Ed.); Gilsum, NH:  Barcelona Publishers)
 We all receive some form of clinical supervision when we are students- either in our field placements or as a crucial element in our internships.  Many of us, however, are unaware of the benefits and availability of clinical supervision once we are finished with our schooling and begin our professional lives.
With the advent of licensure and an increased need for accountability, along with a desire to deepen understanding of music therapy and the various approaches which make up this complex field, supervision has begun to be recognized as a necessary and important part of the process of becoming a practicing music therapist.  
Common misperceptions about supervision:
§       The clinical supervisor will criticize me.
Some music therapists see supervision as being a continuation of their school experience, and they are concerned with being judged (i.e., expecting an encounter similar to that of being graded in school on their skills).  This is an unfortunate misconception. In fact, clinical supervision offers less experienced music therapists the chance to explore and develop their own professional identity. 
§       I’m finally on my own, and I want to try out some of my own ideas. My supervisor will expect me to do exactly what s/he does/says.
Supervision often involves learning from a music therapist whose work is admired and, at least initially, emulated.  Ideally, however, the supervisee is supported as s/he begins to discover and try new or different approaches that are adapted to his/her own personality and style. 
§       My supervisor will give me activity ideas.
In fact, the supervisory relationship is a rich resource, well beyond that of simply sharing ideas for new activities and music experiences.  A skilled clinical supervisor will help the music therapist to process difficult sessions (or relationships with challenging clients) by actively engaging the supervisee in music-making and self-examination.  The use of music during supervision serves as a way to model different ways to use music therapeutically.   
§       My supervisor will have all the answers.
Clinical supervision often follows a developmental process (not unlike the process found in providing music therapy) in which the supervisor offers guidance, not criticism.  It’s a relationship, and it develops in much the same way any therapy relationship develops; however, the focus is somewhat different than in therapy.  It is not uncommon for music therapists to wish for or hope that their supervisor will be able to offer them answers to their most challenging work situations.  One of the ways the clinical supervisor will help is by validating the music therapist’s experiences, reframing a particular problem, or, at the very least, helping to formulate new questions.
(Note: The chapter “Parallel Experiences” by J. Dvorkin and R. Rafieyan [in Inside Music Therapy: Client Experiences, edited by J. Hibben; 1999, Barcelona Publishers] describes the developmental process in the supervisory relationship as it parallels the music therapist’s developing relationship with one of her clients.) 
Who gets clinical supervision? How does one go about finding a clinical supervisor? 
Students get clinical supervision as a part of their schooling.  Professionals, at any point in their work, may choose to receive supervision.  Generally, the supervisory relationship is one in which the supervisee pays the supervisor for the service s/he provides.  Some music therapists work within a creative arts therapy department in their facility.  As such, they may receive clinical supervision within the context of their job.  Others may work under social workers, psychologists, psychiatrists, or psychotherapists.  Again, they may receive ongoing supervision as a benefit of their employment. 
Most music therapists, however, tend to feel somewhat isolated in their workplace, often being the only person providing this specialized service.  Furthermore, while professionals outside of the music therapy field may respect and even be intrigued by this specialized form of work, they may not fully understand what it entails, and they may not be able to offer the kind of support which may be needed. 
Some clinical supervisors advertise their availability in regional and state music therapy newsletters.  Another way to find a supervisor is to contact a music therapist whose work you admire and ask if s/he would be available to provide supervision.  Fees are generally negotiable, and most clinical supervisors will charge about the same fees a music therapist receives for providing private individual music therapy services.  
Additionally, there are ongoing music therapy supervision groups. These are different from peer supervision groups in that they are led by a clinical supervisor who is paid to offer this service.
Who provides clinical supervision?
Clinical supervisors are generally music therapists who have advanced training and experience.  Within the music therapy field, there are a number of specialization areas (Music PsychotherapyGIM, Nordoff-Robbins, Neurologic Music Therapy), and those seeking further training in these areas will often have supervision as a component of the learning. 
It may be helpful to note that clinical supervisors explore countertransference material which the supervisee brings to the supervision session. At times an issue may warrant further exploration which may go beyond the boundaries of the supervisory relationship.  When this happens, an effective supervisor will refer the supervisee to seek his/her own personal psychotherapy (some opt to receive music therapy from another therapist), thus maintaining the boundaries of clinical supervision.
 What does clinical supervision look like?
As you would imagine, clinical supervision is meant to be an interactive process.  Ideally, when supervision is done live, the supervisee is able to explore the clinical issues using music. Generally, the supervisee brings material from his/her work to the session (this may include, but is not at all limited to, work with particularly challenging clients, uncertainty as to how to proceed with a group, strong angry reactions to a co-worker or client, fears of burnout, secondary traumatic stress reactions, difficulty using music, finding oneself attracted to a client, etc.).  
The clinical supervisor helps the supervisee by creating a therapeutic framework within which to understand what s/he is experiencing as a therapist, what her clients(s) may be experiencing, how the music can be used, etc.  How this happens depends, of course, on the needs of the supervisee.  This is why the supervisory relationship is of such importance.  Without the relationship, which provides a solid base, it is difficult for the supervisee to feel safe in exploring all aspects of the work of therapy. 
The second part of the article (which I'll need to finish writing soon) will address peer supervision for music therapists. 


Kimberly Sena Moore, MM, NMT, MT-BC said...

I have never thought about professional clinical supervision. A very interesting idea...

Roia said...

See, now that's why I wrote it. I only knew about it (initially) because I saw advertisements for people who were clinical supervisors in the newsletters I used to get from the AAMT (way back in the days when there were two associations). There are ads for supervisors in the MAR newsletter these days.

I can't recommend it enough!

Tamara G. Suttle, M.Ed., LPC said...

Thanks, Roia, for posting this article! I provide clinical supervision and often see therapists settling for mediocre administrative supervision rather than great clinical supervision.

I'm happy to link to your article here!

Have a good day!

Tamara G. Suttle, M.Ed., LPC

Roia said...

Thanks for stopping by, Tamara, and for linking to my blog. Yes, it is distressing that so many therapists don't realize how profoundly useful good clinical supervision is. I'm so glad your blog seems to (also) be addressing this very important issue.

I'm looking forward to making some time to read through your posts on the subject.

Anonymous said...

Thanks, Roia! It was wonderful to meet you at the conference, and I'm so glad you told me about your amazing blog!

-Alysha Suley, MT-BC

Roia said...

Likewise, Alysha! Thanks for remembering and coming by to check out my blog! Good luck on your music therapy journey!

BiggE said...

Thank you so much for posting this article. I am a relatively new music therapist in Ohio/Indiana area (3 years in the field) transitioning from primarily working in a day program setting with adults with ID/DD to independent contracted work with a similar population. I am really hoping to start a professional supervision relationship once I can get myself started. I have been looking online for information about professional supervision, but so far have struck out. Does anyone know of resources in this region?


Eric C. Gnagey, MT-BC

Roia said...

Hey, Eric,
I'm so glad you found it helpful, and I'm also truly thrilled you're interested in clinical supervision. Tell me what sorts of resources are you looking for? People (such as myself) provide professional supervision via Skype. I don't know if you're on Facebook or not, but there's a group called Music Therapists Unite! (yes, with the exclamation point) who have an associated document with a whole list of music therapists who provide professional supervision. I'm not sure if that's what you're looking for in terms of resources. If it's not, give another shout, and I'll see if I can be of more use to you. Welcome!