A qualitative investigation of the nature of “informal supervision” among therapists in training

Abstract

Objective: This study investigated how, when, why, and with whom therapists in training utilize “informal supervision”—that is, engage individuals who are not their formally assigned supervisors in significant conversations about their clinical work. Method: Participants were 16 doctoral trainees in clinical and counseling psychology programs. Semi-structured interviews were conducted and analyzed using the Consensual Qualitative Research (CQR) method. Results: Seven domains emerged from the analysis, indicating that, in general, participants believe that informal and formal supervision offer many of the same benefits, including validation, support, and reassurance; freedom and safety to discuss doubts, anxieties, strong personal reactions to patients, clinical mistakes and challenges; and alternative approaches to clinical interventions. However, several differences also emerged between these modes of learning—for example, formal supervision is seen as more focused on didactics per se (“what to do”), whereas informal supervision is seen as providing more of a “holding environment.” Conclusions: Overall, the findings of this study suggest that informal supervision is an important and valuable adjunctive practice by which clinical trainees augment their professional competencies. Recommendations are proposed for clinical practice and training, including the need to further specify the ethical boundaries of this unique and essentially unregulated type of supervision. Clinical or Methodological Significance of this article: This is the first study to detail the wide-ranging uses and impact of “informal supervision,” with significant clinical implications for psychotherapy training, education, and development, including a proposal for legitimizing and integrating informal supervisory practice into doctoral training programs, and an important discussion of ethics. Thus, this paper highlights the diverse range of important ways that trainees use “informal supervision” throughout their training to enhance their clinical and professional development. Results of our study show that “informal supervision” is a ubiquitous and often secretive practice that is a valuable complement to, rather than replacement for, formal supervision. Several important differences between these modes of learning (formal versus informal supervision) are also discussed.