The Need for Ongoing Supervision

HypnosisAustralia, May 2002

By Dr Tracie O'Keefe DCH, Clinical Hypnotherapist, Psychotherapist & Counsellor
Editorial Director of HypnosisAustralia Online.

As hypnotherapy becomes more recognised as a profession there is greater need for clinical and academic accountability. This applies to both those hypnotherapists who consider themselves hypno-psychotherapists and those who see hypnotherapy as a psycho-biological discipline.

In the training of hypnotherapists, psychotherapists, counsellors, psychologists and psychiatrists, clinical supervision is now generally accepted as a statutory requirement. During clinical supervision a trainee consults with a recognised supervisor for guidance concerning their clinical actions, caseloads and academic progress. This has progressively, over the past decade, become part of the training of competently trained clinical hypnotherapists.

Clinical supervision is quite different from clinical co-practice. During clinical co-practice a trainee may sit in on the therapy session of a more experienced therapist to learn how to handle clients. However, because of the level of confidentiality required by a therapist, some clients can be very uncomfortable and not disclose intimate information during co-practice sessions. Because of those particular psycho and clinical dynamics it is generally considered more preferable for a trainee to have clinical supervision rather than co-practice. Students have also done a great deal of practice in the classroom before they are ever allowed to work with the public.

How many hours per month are required of a trainee is usually determined by the guidelines of different schools and professional associations to which trainees belong. It can range from two hours per month to 90 minutes per every six face-to-face client hours during training.

These requirements are expected from therapists in training in order to monitor their professional competency and development. They also help validate the responsibility of the training establishment or association to which the trainee belongs.

For students employed by health authorities or government bodies, these supervision sessions are paid for as part of their professional duties. When a student is training privately and is commencing in private practice, however, the supervision fees are down to the student themselves. Any training organisation needs to recognise the additional financial burden on the students in paying for their supervision along with the other costs of studying. This is why anything more than two hours per month for the private student needs to be considered unjustifiable since as they are only starting in practice they are unlikely to be overrun with clients anyway. The sum total of clinical supervision required in hypnotherapy is generally around 50 hours over a period of two years during training.

After the first two years of training the student hypnotherapist is then allowed to undergo mutual peer supervision with a practitioner of the same discipline at no cost to the both of them. This is generally timed at 90 minutes per month for each practitioner. During peer supervision each therapist reviews and assists the other in guiding forward their clinical work and dealing with any difficult cases.

All supervision must always be written up in a record book and is part of a therapist's career log that they should be keeping for inspection by associations and insurance companies during their entire career. Associations often carry out spot checks of their members to make sure that all therapists are complying with supervision requirements. At the end of every year each therapist needs to get a letter from their clinical or co-supervisor stating that they have undergone supervision that year and what has been covered to keep as a part of their records. Respected professional associations and registers will not admit therapists anymore unless their training and supervision records are in order and fully recorded.

There will of course be times when hypnotherapists may need to seek clinical supervision once again. This might be when they need help outside the expertise of their co-supervisor, when they may have a particularly difficult case or their personal issues are affecting their caseload. Review and disciplinary boards may also ask a therapist to go into clinical supervision for some time if they believe that the therapist's professional performance could benefit from such a move. During periods of advanced study or research a clinician may need to seek extra supervision to correlate research or consult a statistician. Therapists also go into supervision with other therapists to learn particular techniques or model clinical abilities.

Hypnotherapists may also at times choose to go into clinical supervision with clinicians from other disciplines to help them hone their skills of diagnosis or to understand other approaches to therapy with therapists from other disciplines, psychologists, psychiatrists, doctors or nurses. Such periods of supervision away from one's own core discipline should not really exceed more than a year in line with the concept of continual professional development having annual obligations.

At times, work as a therapist can be very isolating, particularly when someone is in singular private practice, and it is only human that all clinicians need help to focus their own professional caseloads. Therapists who drift out of or are not in clinical supervision run the risk of becoming opinionated and entrenched in particular ways of working and thinking, losing flexibility.

Since clinical supervision in the practice of hypnotherapy and study of therapy and the social sciences is an ever-evolving journey, many schools and associations do not currently agree on the qualifications a supervisor should have. It is possible for a supervisor to gain qualifications specifically in supervision above their normal hypnotherapy qualifications. Most hypnotherapy schools and organisations do not require this and prefer the supervisor to have good academic postgraduate qualifications in the field of hypnotherapy, clinical practice experience and knowledge of research methodology. Experience in hypnotherapy alone is insufficient qualification for a supervisor and the need for academic qualifications is absolutely essential.

For clinical supervision, the supervisor has to be approved by the school or association prior to the student engaging them. This can often be difficult when a student may live in a remote area but supervision is now being supplemented via e-mil, telephone and by webcam in order to overcome these communication difficulties.

While a supervisor may hold the position of a student's teacher and supervisor it would be inappropriate for the supervisor to then hold the position of examiner. This would be considered top heavy and abusive. The clinical supervisor should never be the examiner of the student because part of the job is to help the student fine tune their essays and dissertations to go forward for marking. If a supervisor were to find themselves in this position they should immediately resign from one of those positions to redress the balance.

Abuse of the supervision in clinical supervision by the supervisors or supervisee is one of therapy's great untalked about issues. Sometimes there can be conflict within the supervision situation and should that occur it is the duty of the clinical supervisor to seek their own supervision and consider their position.

Certainly supervision, both clinical and peer, is here to stay throughout the well-respected hypnotherapist's career. Students need to sign contracts with their clinical supervisor so that both are clear what is expected from each other's role and to avoid confusion. Good supervisors can help make or break a student's hypnotherapy career and they should always consider it a position of great privilege to be the student's guiding light.

©HypnosisAustralia, May 2002