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Keep an Eye on the Positives in Supervision

Sarah M. Thompson, PhD

Specific positive feedback is critical to clinical supervision. But how to provide it effectively as a supervisor?


When I started graduate training, I had very particular ideas about the appropriate response to positive feedback. Ideas around humility, the importance of deflecting praise, the necessity of not being too aware of your own accomplishments. These values had been inculcated across my lifetime and (I suspect) reflect the ways that females in particular are socialized in American culture. In order to avoid seeming cocky or overconfident, you should appear as if you pay no attention to your strengths, like praise has no effect on you.


It was complete nonsense, of course. I doubt that anyone who has spent most of their life in school could truthfully claim that external reinforcement has no effect on them. But I clung tightly to the unspoken edict that to appear aware of my abilities not only reflected poorly on me ("ugh, she's so full of herself," my imaginary critics would say) but was also insulting toward those who didn't have the same strengths. What an unfortunate cycle: work hard to achieve, receive the praise you have desperately been seeking, and deflect it, keep your head down, keep working. There is little space for joy or reward on that path.


I maintained my unhelpful beliefs about the necessity of deflecting praise until one perspective-altering experience: the first time I tried to praise a supervisee.


I was a fifth-year graduate student serving as a peer supervisor for a beginning student conducting individual ACT. I can't remember what praise I was offering to the student, but I already understood that it was important to provide not only suggestions for improvement ('corrective feedback' in supervision-speak) but praise and reinforcement around successful actions in the therapy room. And I watched as the supervisee did the exact same thing I had been taught to do: eyes down, gentle smile, wave of the hand as they told me their success was nothing, that it was really not important, that they had only lucked into such behavior and it didn't reflect positively on them at all.


I instantly understood what I never had before: it's actually an enormous problem when someone refuses to accept positive feedback.

It doesn't seem like this sort of behavior should be a problem. Again, in American culture, we are often socialized to treat positive feedback as some sort of embarrassment, especially for females. We express surprise. We deny our own role in our success. (And this is in a culture that is generally quite proud of itself! I suspect the challenge with positive feedback is even more acute in other cultural contexts.)


What I realized in that moment is that as a supervisor I don't need modesty and denial. I need my supervisees to really hear and take in what I'm saying. If I tell a supervisee that they did a wonderful job of reflecting the client's emotions, I need them to accept that feedback and integrate it into their conceptualization of themself as a therapist. Why? Because if they cannot do that, then it's unlikely that they will successfully maintain the behavior in future sessions and with other clients. If they perceive positive feedback as embarrassing, overwrought, or inaccurate, then it's going to be difficult for them to integrate the praised behavior into their clinical repertoire.


Since that day with my supervisee, I have changed quite a bit about how I approach positive feedback as a supervisor. The clinical supervision literature is clear that specific positive and corrective feedback are imperative for effective supervision. And yet, many supervisors have difficulty with this essential skill. When it comes to positive feedback, there are several important considerations to keep in mind.


Provide specific feedback. This is an obvious point, but often difficult to implement without intentional practice. It's all too easy for supervisors to say something like, "Sounds like things are going great!" But...what has the supervisee learned from this kind of statement? Not much. If anything, I've found that this sort of generic praise actually tends to have a paradoxical effect. When praise is general and broad, trainees are more likely to experience it as false. They assume the supervisor is just trying to be nice, so they discount the comment. In other words, stay away from this:





Specific positive feedback identifies a clear behavior and ties praise to that behavior. For example:

  • "I really appreciate how you initially stayed silent when he got tearful. You were giving him space to just experience those emotions rather than rushing in with a statement that could have cut off his in-the-moment experience, which is great."

  • "This validation statement was super effective. Look at their face on the tape when you name how it makes sense that they are experiencing shame around being non-binary given the way that they heard their parents talk about the LGBTQIA+ community growing up. You can see how they are really grateful for that validation, and I love the way that you were leaning forward when you said it - your body position really communicates your genuine and caring stance."

  • "Let's watch this section of tape where you were assigning homework. One of the things that I like about this interaction is that you were really collaborating with her to brainstorm what level of mindfulness practice would be feasible for her this week and at this point in therapy. Like right here, when she suggests that she could do mindfulness twice a day everyday, you are very gentle when you suggest that jumping in with that amount of mindfulness might be setting herself up for failure so early in therapy when she doesn't have an existing mindfulness practice. And then I love that rather than suggesting another amount, you ask her what seems feasible for her given her schedule, so that she has more ownership over the decision of how much to try to do."


Specific positive feedback is also most effective when balanced with corrective feedback. Some supervisors struggle with striking a balance. Either everything is positive, which again, often leads supervisees to doubt the authenticity of the praise, or supervisors lean too heavily into corrective feedback, as if integrating a positive statement might cause the supervisee to lose motivation to improve. Balancing positive and corrective feedback also means striking the right balance for the particular supervisee. All supervisees need to hear both, and some need to hear one more than the other. Pay attention to how the supervisee responds to both types of feedback as this will cue you to an effective ratio. If they tend to respond to corrective feedback by getting demoralized in the moment or by rehashing the feedback days or weeks later, then you likely need to increase the positive feedback. If they seem to forget corrective feedback or have difficulty implementing it in the next session, you may need to amplify the intensity of the feedback (e.g., making your tone more serious or highlighting the importance of making this change) or switch the order/proportion of feedback (e.g., briefly checking in on positive feedback before spending the majority of supervision on corrective feedback and planning for the next session).


Recognize that everyone involved in this process often needs to be shaped to giving and receiving positive feedback. Many of my trainees hate discussing positive feedback. They feel embarrassed and awkward and just want to get to the part where I tell them all of the things they can improve on. Thus...I make sure we spend time in each session discussing positive feedback. (Sadistic, I know!) I also ask them to generate positive comments about themselves in addition to the statements I make. It's not uncommon for trainees to try to wiggle out of this by commenting on things the client did well or things that went well overall (e.g., "I thought the pace of the session was better") without specifically commenting on the behavior that they engaged in as the therapist to make that happen. So I ask supervisees to rephrase or reframe to focus specifically on a behavior they did well (e.g., "I did better redirecting the client went he became tangential, which helped improve the pace of the session"). Again, they don't always love this, but my hope is that over time, it gives them an opportunity to internalize an accurate self-conceptualization of themselves as therapists.


Positive feedback is also a space for us as supervisors to practice what we preach. When I check in with my supervisees about how our work together is going, I make a point of trying to really listen to and take in their positive feedback, even though I still feel a strong urge to demur and deflect. My goal here is to model how important it is to hear and try to internalize positive feedback, even when it's uncomfortable.


If you're currently engaged in clinical supervision, try heading into your next meeting with one or two specific points of positive feedback you would like to offer. This is where advance videotape review can be particularly helpful. Consider how to highlight the specific behavior you want to continue to see from your supervisee and genuinely lean into the emotions that arise in you when you see them succeeding. Our pride, excitement, and joy as supervisors are all meaningful to our supervisees, including when they find our expressions of these emotions embarrassing! Even in the context of cultural values that highlight humility, accurate confidence around our abilities as clinicians is important. Help your supervisees develop an accurate sense of their strengths by offering specific positive feedback in every supervision.

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