Clinical supervision is an important part of ethical and competent mental health practice, and provides a structured space for learning, reflection and professional development for supervisees. Although issues can emerge at any point of the supervisory relationship, addressing them early can help develop a supervisee’s personal and professional confidence. Here are 7 potentially controversial issues which can come up in supervision:

1. Conflicts with values, theoretical orientation and cultural differences

When the values of supervisees differ from those of their supervisors, or from the expectations of their professional setting, tensions may arise. Disagreements about the supervisor and supervisee’s chosen theoretical models may also occur. These conflicts can affect a supervisee’s willingness to be open and vulnerable in supervision. Supervisors have an ethical duty to explore any discriminatory attitudes of supervisees with sensitivity, cultural humility and open dialogue. Supervisees should also ask about their supervisor’s preferred theoretical frameworks from the beginning to ensure compatibility and develop a shared understanding. 

2. Power imbalances and authority challenges

The power difference between supervisor and supervisee can be another source of potential conflict, especially in work environments where supervisors have multiple roles. Supervisors are responsible for evaluation, gatekeeping and ensuring client welfare, and must foster a supportive and collaborative environment for the supervisee. If supervisors dictate decisions, minimise the supervisee’s perspective or fail to invite reflection, this can create a stressful, unproductive supervisory relationship. Conversely, some supervisees may struggle with constructive criticism, particularly if they are disillusioned with their work or authority in general. These issues should be addressed constructively by the supervisor and supervisee as soon as possible.

3. Ethical disagreements

Clinical supervision often involves ethical decision-making from both parties. But disagreements over confidentiality, dual relationships, boundary management or reporting can be difficult to navigate. The supervisor must protect client welfare and uphold professional standards while also trying to support the supervisee, but if ethical mistakes are made, supervisees may experience anxiety or embarrassment about their actions. Supervisors should collaboratively discuss these disagreements guided by the relevant ethical framework, as this can help with a mutual agreement on how to manage dilemmas.

4. Personal disclosure and emotional safety

Supervisees often process and disclose emotional reactions to client work in supervision, such as deeply personal feelings, trauma histories or strong countertransference reactions. While openness can lead to meaningful growth, it also increases vulnerability for the supervisee. Supervisors need to balance reflection with maintaining boundaries and candour with the supervisee to create safety. Careful disclosure from a supervisor which is focused on the supervisee’s learning and development can also help normalise their difficulties and encourage professional growth. 

5. Competence concerns and evaluation

Raising concerns about a supervisee’s clinical, ethical or interpersonal competence is one of the most challenging aspects of supervision. Supervisors may also feel conflicted when deciding whether a supervisee is struggling to practice safely, particularly when certain issues are not clear cut. But transparent expectations and regular formative feedback which gives them an opportunity to learn from their mistakes and documented evaluation criteria can help minimise misunderstandings. 

6. Use of technology

Technology in therapy and supervision introduces new ethical and relational dilemmas. Navigating dilemmas when supervisees and their clients (or supervisees and supervisor) are in two different locations, particularly if they are in different countries, can create issues with different laws and ethics in relation to therapy. There may also be different generational or cultural attitudes toward digital communication. Supervisors can help supervisees explore the best way to work with these dilemmas through open dialogue and consultation of the relevant ethical frameworks.

7. Legal issues

Conflicts arising from legal problems in clinical supervision can significantly impact the supervisory relationship. One major issue is liability - if a supervisee engages in unethical behaviour, questions may arise about the supervisor's competence. Disputes may also occur over confidentiality breaches, documentation errors, scope of practice or failure to report certain issues, such as client harm. Open communication about mistakes and uncertainties from both parties is important, and advice from professional bodies and legal experts can minimise any potential negative impact on the supervisory relationship.

-Dr Angelina Archer,

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