Negative Effects of Clinical Supervision(Frontiers Friday #229) ⭕️

A few days ago, I stumbled upon a 2017 Special Issue in the journal of The Clinical Supervisor. In this series of articles, it was devoted to the topic of harms caused by clinical supervision.

I just came back from a conference and did a workshop on clinical supervision. I wish I had specifically addressed this.

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Here’s my coda to the topic of harms caused by clinical supervision.

If differences between therapists exist (5-9%), more so than differences between therapy models (0-1%), it shouldn’t be surprising that there are all clinical supervisors are created equal.

According to clinical supervision researchers Michael Ellis and team, despite the “do no harm” ethical mandate, the disconcerting reality is that harmful experiences in supervision aren’t a rare phenomenon. It occurs at an alarming rate.

Here’s an overview of how prevalent harmful clinical supervision is:

1. 25% and 35% of mental health supervisees in the United States (Ns = 363 and 151) and 40% of mental health supervisees in the Republic of Ireland (N = 149) were classified as currently receiving harmful supervision, multiple times.

2. 38% to 51% of U.S. and 52% of Irish supervisees were classified as receiving harmful supervision at some point in their training or career, multiple times.

3. When classification shifted to any occurrence of a harmful supervisor behaviour, the percentages increased to 66% (US) and 73% (Irish).

In the Introduction to the 2017 Special Issue, Michael Ellis and colleagues stated,

The fact that supervisors, who are responsible for modeling appropriate professional conduct, are harming supervisees is unacceptable.

Anecdotally, given my conversations with other therapists around the world, the experiences of harmful and bad supervision is more common that I expected it to be.

Ellis et al. made a distinction between Harmful and Bad Supervision:

Harmful Clinical Supervision:

supervisory practices that result in psychological, emotional, and/or physical harm or trauma to the supervisee. Harmful supervision can be through self-identification (self-identified harmful supervision; SIHS) or occur when the supervisor’s behavior (or inaction) meets specific criteria (de facto harmful supervision; DFHS). The two essential components of harmful supervision are: (a) that the supervisee was genuinely harmed in some way by the supervisor’s inappropriate actions or inactions, or (b) the supervisor’s behavior is known to cause harm even though thesupervisee may not identify the action as harmful. Thus, harmful supervision may result from the supervisor acting inappropriately or with malice or supervisor negligence, the supervisor clearly violating accepted ethical standards and standards of practice and care.

On the other hand, bad supervision refers to ineffective supervision practices that are not harmful or traumatising, albeit inadequate.

For clarification, the authors highlighted that harmful supervision

does not include situations where supervisees struggle with painful issues in supervision (e.g., personal reactions to clients or sexual attraction), or when supervisors provide challenging feedback (i.e., difficult to hear and emotionally upsetting) about supervisees’ professional competence problems that is necessary for professional growth and protects client or public welfare (i.e., professional gatekeeping). That is, it is not harmful for supervisors to focus on supervisees’ professional development within the context of a positive supervisory relationship and to be respectful of supervisees’ boundaries.

However, it is harmful when supervisors put their needs and interests over those of clients and supervisees.

Surprisingly, the researchers noted that not all professionals are supportive of looking into harmful clinical supervising practices and protecting supervisees from harm, especially for trainees and those new in the profession.

In the Special Issue of The Clinical Supervisor, Michael Ellis provided 11 narratives written by supervisees. Before we look at some of the specific stories, I summarised the core themes mentioned about the harms caused, which can be categorised into Professional and Ethical Harm, and Psychological Distress:1

Professional and Ethical Harm:

1. Negligence: Neglect of required duties, modelling unethical behaviours, failure to provide consistent training.

2. Lack of competence: superficial feedback, failure to provide skills.

3. Abuse of power differential: Coercive self-disclosure, inappropriate personal remarks, using personal information against supervisee, blurring administrative/clinical roles

4. Jeopardising professional future: fear of negative evaluations or professional repercussions.

5. Racial/Cultural discrimination: Microagressions, explicit racial remarks, lack of cultural sensitivity.

6. Failure to address harm: Agencies lack of objective oversight, over-protection of harmful supervisors on site.

Psychological Distress:

1. Isolation and silencing: Fear of speaking out, feeling guarded, professional distrust.

2. Self-blame: internalisation of blame, self-doubt, viewing that the consequences of harmful clinical supervision was the supervisee’s personal failure.

3. Emotional and physical decline: intense experiences of stress and anxiety, including feelings of dread, helplessness and being traumatised. Manifestations of physical symptoms like migraines, digestive issue, weight loss.

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I’d provide samples from two of the 11 practitioners who shared their stories. I recommend that you read a couple of others in this paper, Narratives of Harmful Clinical Supervision.

A multiracial doctoral student at a correctional setting, described being publicly criticised in group supervision.

I would receive constructive feedback from the other clinical staff; however, Supervisor X would criticize my performance without constructive feedback (e.g.,“I have no idea what you were doing”,“that’s a weird thing to say”) or shake her head disapprovingly without a word.

When her clinical reports were reviewed, commentaries were not given when changes were made. When she asked for feedback, hoping to learn from the edits, she was labeled as “challenging of authority,” and that she should “accept changes without question.”

She also started to notice that she was treated differently by her supervisor.

Supervisor X asked each student about their agenda for the day; however, when it became my turn, she interrupted and stated,“Well, everyone have a great day!” and left the room. The students noticed I was ignored and asked if I was okay. I brushed it off in order to save face because I did not know how to address when a supervisor is passive-aggressive.

…(She would) often invite the other students to lunch and proclaim,“I’m taking my

girls to lunch!” before leaving the premise; and I would be the only student left.

In another revealing example, this supervisee talked about a humiliating experience:

The students and I were sharing information about our cultural heritages; the other students identified as European-American and I identify as multiracial. Supervisor X joined the conversation, listened, and remarked positively to the other students and shared her own European heritage. When I shared my ethnicity, Supervisor X interrupted abruptly and stated,“Yeah, we get it. You’re a mutt.” The other students looked shocked by her statement and I excused myself quickly. I felt degraded and could not process why as a supervisor she would treat me this way. Never had a supervisor been overtly racist towards me and I did not know how to handle the situation other than to leave immediately and cry in the bathroom.

Later, she added,

Throughout these experiences I did not consider her behaviors as abusive or harmful but indicative of my failure(s) as a student.

Another supervisee recounted her experience of a smart and charismatic but intensely psychodynamic supervisor. Her supervisor questioned her to a point that she felt small, consequently thinking she had some “deep dysfunction” on her part.

Everything I did and thought was questioned, Socratically and analytically. The Socratic questioning was worse because I had to make sure I didn’t mention anything he didn’t already know or agree with, or else I was punished by what felt like harsh criticism. Or maybe it was just the questioning that felt so harsh. What were you thinking? Did you consider x, y, z?

It was only when she sought outside support to manage the supervisory sessions (even though supervision is meant to be the source of support), she began to realise the authoritative stance and the supervisor’s need to be right.

He hurt me and it still feels so weird and confusing that I am at a loss to recall facts and details. My experience was disheartening, confusing, and distressing. It was the experience of being caught in someone else’s saga and totally invalidated; it was nearly impossible to reconcile the doubt and confusion I experienced in session with him with the confidence and competence I experienced in other arenas, then and pretty much ever after. No doubt my anxiety that accumulated session to session only exacerbated his belief in my incompetence.

My guess is that as you read the stories of harmful experiences in clinical supervision above, you might see some of your own as well.

Being in this profession for over two decades, the odds are I would have my fair share of negative clinical supervision too. A few affected me significantly.

I moved from Singapore to Australia, For registration purposes, I had to get all of my paperwork lined up, including supervision logs signed. I soon released I didn’t have all of the digital or hardcopies with me, and began asking my various clinical supervisors to e-sign those. This was the last thing I needed to submit to the local governing body that was outstanding. My supervisors were happy to help and got back to me with well wishes.

Except for one.

So I rang him. He said to me, “I am not going to sign them.”

“What do you mean? Why not? Are the dates wrong? I can double check.”

“No… because you’ve said negative things about me at our meetings.”

“What? What did I say??”

“You said that supervision has not been helpful to you.”

I was in shock by then. My license to practice in another country was on the line.

To be fair, I had been critical of the over-emphasis on model-specific trainings and supervision, which led to us introducing a feedback-informed treatment approach and running a year-long study investigating the impact of this, of which he supported. Specific to clinical supervision, I also told him, who was my clinical supervisor and administrative supervisor at my workplace, that I wished to discuss specific stuck cases as I wasn’t making progress with some of them. He continued to defer the topic, and wanted me to read-and-discuss chapters he prescribed for supervision on treatment specific manuals. I repeatedly told him, as gently as I could, that I wasn’t benefiting from focusing on readings and wanted more case discussions and session reviews. I was fearful of offending him. He was not only my reporting officer, someone who can affect my pay-grade based on his evaluation, and he was also someone in important committees high up there.

After some time, he changed tack and said I needed to be more motivated to do the readings like my other colleague, who was a dear friend to me. He went on to make further comparisons between me and my friend/colleague. I couldn’t help it and exclaimed, “Are you kidding me? You think that comparing me to X is a good idea?” He continued to make his case, that he was trying to motivate me. I said to him that he was putting me down and causing unnecessary comparison between my mate and I.

Anyway, we had our disagreements from time to time, but we kept it civil, we bantered and even went out for lunch from time to time.

Back to the signing of documents situation. I am separated by hundreds of miles away. I am stuck. I can’t submit my application to register as a psychologist until he signs the log. He refused to sign. I was in despair, as my livelihood depended on it.

I called for external help from my boss and asked to speak with the CEO if I have to. She advised since this was an issue between him and I, I should deal with him directly. I said I’ve tried and I was at my wits end, which was why I was contacting her in the first place. I couldn’t believe that I was left to deal with this on my own, given how things have escalated.

I had a trip scheduled back home several weeks later. I went to meet him in-person. Things were about to escalate. A quarrel ensued. He wanted me to apologise. I wanted to punch him. What was there to apologise for? What did I do wrong? Or was I being too stubborn and insubordinate? I couldn't help but sense that he knew what was at stake for me. After dragging it out for over an hour or two, he finally gave in and signed the papers.

He smiled at me.

To be clear, I’m not stating this story to out anyone. My intentions are to highlight how common this is and why we shouldn’t just keep hush about it and suffer in silence. Like the articles with specific negative experiences of supervision narratives, I’ve used no names, and did whatever I can to not make it de-identifiable. Also, I’m only writing about it now as there’s like 15 years distance from it.

I don’t have ill-feelings towards my supervisor now. I wish him well. But I know I can’t work with him again.

There were others instances of bad clinical supervision. They wouldn’t exactly harmful like the way Ellis and colleagues described. But these experiences left a sour taste in the mouth.

Here’s three:

#1.

In one hilarious situation, after a handful of meetings reviewing the session recordings and discussing a specific case with another supervisor, we came to an impasse. He then said to me, “Maybe you should present a different case?”

Huh?

“It’s not suitable for this model of treatment.”

I couldn't believe he concluded that the issue was that I presented an “unsuitable case” for supervision to suit a particular modality of therapy.

#2.

Another instance: At another hospital, my supervisor was both my boss and the head of the unit. All of the psychologists had to consult with her at the end of every first session, and take back the feedback to the client before we ended the session. The four of us were psychologists, and our supervisor was still in training, and held a MBA.

Because I was early in my career at that time, her comments filled me with so much self-doubt about my own clinical competencies. I felt stupid. At the same time, it become apparent to us when we discussed among ourselves that her decisions that she gave us were more financially motivated than clinical. After some months of deliberation, I left the job slightly after a year. My resume didn’t look good.

(It was also at this place that opened my eyes to how much pharmaceutical companies played a a role in influencing prescriptions by giving weekly free lunches, incentives, and pretty sales reps coming to our unit to connect with the psychiatrists).

#3.

In my post-graduate program, I was recommended to a well-known therapist to be my clinical supervisor. I was delighted that she took me on. She was very busy.

Except that over the course of our time, she talked more about herself than I thought is necessary. I thought it was nice that she was being vulnerable and all, but it started to eat into our time discussing cases and topics regarding my development. I didn’t say anything. Maybe there were gems of wisdom in her stories about herself. She treated me well, but where was the line?

§

When I look back, I found myself self-blaming for quite some time. I mean, if it keeps happening to me, it must be me.

One thing that made sense to me upon reflection was that even though I don’t have it in my bones to intentionally seek out conflict, I find it hard to keep my mouth shut when something unfair is happening. This made me seem like I don’t respect authority figures. In Mandarin, we say, “Mei Da Mei Xiao” (没大没小), literally translating to “no big, no small,” meaning one who talks back inappropriately without regard for hierarchy.
Maybe this was why another supervisor in my traineeship called me a “young punk.” I was shocked by his remarks, but I loved that guy. I could feel his care for me. And he was competent. As some of you might say, we had epistemic trust. Later he explained that he called me a young punk to evoke a response in me. I thought it was rather strange, but all in all, I had good experiences with him.

Thankfully, over the years, I developed long-lasting relationships with other supervisors, who still remained as guiding lights over the years. They also helped me when some of the crazy stuff was happening that was described above. I am so in-debted to them. Their voices helped me when I had no voice. I continue to carry them in me.

This topic is important. Clinical supervision, like the practice of therapy, happens in the confines and privacy of a closed room; no one else knows what is said.

We cannot not influence. Whether in therapy or in clinical supervision, what we say has an impact on the other.

As Gregory Bateson said, it takes two to know one. Make sure that the other person is actually someone who’s got your back.

Finally, be part of a small community. Our professional development is not a solo project.

For further recommendations, read this article from the Special Issue in The Clinical Supervisor.

1. Thank you to Tracey Burrell and the Australia Clinical Psychology Association for inviting me to Sydney to speak at your conference. The crew has been fantastic, and the crowd was super friendly. It was a blast!

2. Upcoming Deliberate Practice Training in Copenhagen:
   My colleague in Bruno Vinther is inviting me to run a one-day workshop in Denmark. If you are in that region, I hope you can join us for this in-depth workshop.
   Date: 27th of April 2026.

   Registration details here.

Daryl Chow Ph.D. is the author of The First Kiss, co-author of Better Results, The Write to Recovery, Creating Impact, and the latest book The Field Guide to Better Results. Plus, the new book, Crossing Between Worlds.

You might be interested in my other Substack, Full Circles: Field Notes on the Inner and Outer Life. FC is a return to soul and sanity, beyond the hollow promises of self-help tips and tricks.