Clinical Supervision Handbook - CAMH Knowledge Exchange ...

Ongoing Clinical Supervision
practice. Within a safe and trusting relationship, the clinician can explore the client’s
thoughts and feelings related to the client, and discuss behaviours that may indicate
the crossing of boundaries, such as spending extra time with clients, having special
clients, or doing activities with clients that the clinician does not share with colleagues.
In this way, clinical supervision is a proactive process that can prevent boundary
transgressions. Proctor (1991) refers to this function of clinical supervision as “normative.”
Normative supervision is concerned with promoting high quality care and
reducing risks. The supervisor is obligated to confront any situation or practice he
or she feels is unethical or unsafe. As mentioned previously, an ideal process is one
in which the supervisor facilitates the clinician to identify the problem and initiate
corrective action.
Transference, countertransference and parallel process
As supervision moves beyond the initial stages of developing trust and safety, a more
in-depth understanding of the client is achieved by exploring the processes of transference,
countertransference and parallel process. Transference refers to a process in
which the client transfers past or present attitudes and feelings toward family members
or other important persons in their life onto the clinician. It may be positive or negative
and, in classic psychoanalytic literature, is described as an unconscious phenomenon.
Clients may repeat interaction patterns characteristic of earlier relationships in their
relationship with the clinician. The client’s transference is important to explore with
the clinician as it contributes to greater understanding of the client’s difficulties. For
example, one might speculate that the client in the first vignette developed a negative
transference toward the nurse responding to her like a critical parent may have in
the past. The nurse, feeling as though she was “nagging” the client, and the client’s
subsequent withdrawal from the relationship, supports this notion.
Countertransference refers to thoughts and feelings experienced by the clinician toward
the client. Countertransference may also be experienced by the supervisor toward
the clinician, and by the clinician toward the supervisor. Similar to transference, these
feelings may be positive or negative. Before any exploration of countertransference,
it is crucial that there be a trusting relationship between clinical supervisor and
clinician. The clinical supervisor must also be cognizant of maintaining the boundaries
of the supervisory relationship. “The guiding principle is that all discussion
relates to the client. If the supervisor or supervisee sees a drift towards exploration
of factors relating to the supervisee’s relationships and life apart from reactions
to and feelings about the client, the supervisor should stop, rethink, and consider
alternatives.” (Falender, 2006, p. 39)
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