Self-Reflection in Supervision: Why it Matters

by Shirley Katz, Ph.D., RP, CCC (Clinical Supervisor)
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Reflection is not just a buzzword.  It is a well-known essential pedagogy in many fields, recognized as an effective way to deepen learning (Fernández‐Balboa, 1998).  It is common in experiential learning, which is effective in skills development overall (Veine, et al., 2020).  Self-reflection is crucial in developing new clinical skills (e.g. Cooper & Weickowski, 2017; Knapp et al. 2017; Prasko et al. 2012) and in ongoing development and effective practice (de Stefano, Overington and Bradley, 2014, Rodolfa et al. 2005). 

What is Self-Reflection?
Effective reflection is a learned skill that is not always taught in schools or practiced regularly.  Many are unfamiliar with how to integrate it and make it effective.  Therapists and their supervisors may benefit from guidance to help make their interaction and learning more meaningful, and for Supervision to be more than just venting and direction.

Self-reflection has been described as the capacity to inspect one’s ongoing experience to develop professional knowledge, solving problems by thinking while doing (Schön, 1983). In therapy, it is about developing awareness and insight into one’s own patterns to practice safely within the therapy relationship.  Prasco et. al., (2023) describe it as an analytical process of deep examination of a therapist’s own thoughts, biases, past experiences or feelings aimed at understanding how these may influence their practice.

Benefits of Enhanced Self-Reflection
The College of Registered Psychotherapists of Ontario (CRPO) recognizes self reflection as an essential competency towards entering the field and necessary for quality assurance in ongoing professional development, especially regarding the Safe and Effective Use of Self (SEUS).

In training therapists who used effective self reflection enhanced therapy outcomes,
making more effective and ethical decisions and were able to differentiate their own needs from client’s needs (Prasco, et.al., 2023).  It further helps to bridge theory into practice, particularly if it is purposeful and directed.  In a recent review of the literature on self-reflection Aprilia, et al., (2024) found that this activity was linked to enhanced empathy, better management of countertransference, stronger integration of theory to practice and more ethical behavior as well as fostering personal and professional growth. 

Effective self-reflection is an important tool in clinical supervision particularly in Constructivist models of Supervision, which encourage and empower supervisees to find their own answers rather than following their supervisor’s approach (Guiffrida, 2015).  Supervisors who support self-reflection arguably strengthen their therapists’ capacity to model it to their clients, who in turn could grow in their own self awareness.  Using reflection models, a supervisor can help a therapists explore and develop.
 
Reflection Frameworks

Aprilia  et al., (2024) argue that self-reflection should be a supported continuous process in the development of therapy skills.  They suggest that supervisors use structured exercises to enhance competency. 

Here are two reflection frameworks that are great for developing reflective skills. One common one is called the What? So What? Now What? model (Borton, 1970)

What? Asks the learner or, in this case, the therapist to describe the nature of their experience, their role, observations and reactions.  The supervisor might cue the therapist to think about what happened, what they thought, felt, or expected, and what they learned about themselves or the client.

So What? Explains the significance or the relevance of the experience and interpretations. The supervisor may ask what it is that makes the issue or incident matter or stick out to the therapist, or, what might be the meaning, result or consequence of the issue.  The supervisee may be asked to think about connections to their theory or practice, or their overall development and learning goals. 

Now What? Here, one would explore the impact of the experience, and the interpretations made may have on future actions and thinking.  A Supervisor might ask the therapist to think about what they are planning to do because of the discussion or experience discussed.  How might they approach the client or similar situations differently, or how they want to apply what came up in supervision and what they learned overall.

Another helpful model for reflection is called the ICE model, developed by Fostaty, Young and Wilson (2020) for students. It can easily be adapted for supervision. It stands for Ideas, Connection and Extensions.  These stages are inter-connected and recursive, not linear.

Ideas.  In this part, learners identify basic facts like what happened, what processes were involved, what skills were needed and what questions emerged. Supervisees can be prompted to describe basic but important factors in a case, and to formulate a question for supervision-based learning.  

Connections. In the Connections part of the model, learners might be cued to think about tying in prior learning to current experience. In Supervision, a therapist can be prompted to tie the question to their own working theory, or to themes in their professional development goals, for example. 

Extensions. At this higher level, learners hypothesize, extrapolate, apply knowledge to new contexts, and understand implications.  In therapy this might be represented by being able to effectively bridge theory, reflection or supervision-based learning into practice.
 
Overall Benefits of Reflection in Supervision
Overall, integrating self-reflection into Clinical Supervision is important.  It makes learning deeper and more meaningful.  It can also optimize therapy for clients as the therapist becomes more aware.  A supervisor should emphasize the importance of these self-reflection skills and set an example by using reflection in Supervision as this activity differentiates "great therapists" from "average therapists" (Prasko, 2021).  Safe and effective use of self depends on strong self-reflective skills which can and should be practiced in supervision.
 
Sources
Aprilia, N., Ramadhin, N., Wulandari, T., & Asbi, A. (2024). Self-awareness and self-reflection on the counselor’s personal development. Journal of Psychology, Counseling and Education, 2(2), 154–161. https://doi.org/10.58355/psy.v2i2.38

Borton, T. (1970). Reach, Touch and Teach. London: Hutchinson

Cooper, L. D., & Wieckowski, A. T. (2017). A structured approach to reflective practice training in a clinical practicum. Training and Education in Professional Psychology, 11(4), 252–259. https://doi.org/10.1037/tep0000170

Fernández‐Balboa, J. (1998). The Practice of Critical Pedagogy: Critical Self‐Reflection as Praxis. Teaching Education, 9(2), 47–53. https://doi.org/10.1080/10476210.1998.10335494

Fostaty Young, S., & Wilson, R. J. (2000). Assessment and Learning: The ICE Approach. Winnipeg, MB: Portage & Main Press

De Stefano, J., Overington, L., & Bradley, S. (2014). Developing Repertoire: A Qualitative Study of Trainees’ Self-Reflection on Clinical Practice. Canadian Journal of Counselling and Psychotherapy, 48(4). Retrieved from https://jmss.org/index.php/rcc/article/view/60969

Guiffrida, D. (2015). A Constructive Approach to Counseling and Psychotherapy Supervision. Journal of Constructivist Psychology, 28(1), 40–52. https://doi.org/10.1080/10720537.2014.922911

Knapp, S., Gottlieb, M. C., & Handelsman, M. M. (2017). Enhancing professionalism through self-reflection. Professional Psychology, Research and Practice, 48(3), 167–174. https://doi.org/10.1037/pro0000135

Prasko, J., Mozny, P., Novotny, M., Slepecky, M., & Vyskocilova, J. (2012). Self-reflection in cognitive behavioural therapy and supervision. Biomedical Papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia, 156(4), 377–384. https://doi.org/10.5507/bp.2012.027
 
Prasko, Jan & Abeltina, Marija & Vanek, Jakub & Dicevicius, Darius & Ociskova, Marie & Krone, Ilona & Kantor, Krystof & Burkauskas, Julius & Juskiene, Alicja & Slepecky, Milos & Bagdonaviciene, Lina. (2021). How to use self-reflection in cognitive behavioral supervision. Activitas Nervosa Superior Rediviva. 63. 68-83.

Prasko J, Ociskova M, Abeltina M, Krone I, Kantor K, Vanek J, Slepecky M, Minarikova K, Mozny P, Piliarova M, Bite I. (2023). The importance of self-experience and self-reflection in training of cognitive behavioral therapy. Neuro Endocrinol Lett., Jun 14; 44(3), 52-163. PMID: 37392442.

Rodolfa, E., Bent, R., Eisman, E., Nelson, P., Rehm, L., & Ritchie, P. (2005). A cube model for competency development: Implications for psychology educators and regulators. Professional Psychology, Research and Practice, 36(4), 347–354. https://doi.org/10.1037/0735-7028.36.4.347

Schön, Donald A. The Reflective Practitioner: How Professionals Think in Action. New York: Basic Books, 1983

​Veine, S., Anderson, M. K., Andersen, N. H., Espenes, T. C., Søyland, T. B., Wallin, P., & Reams, J. (2020). Reflection as a core student learning activity in higher education - Insights from nearly two decades of academic development. International Journal for Academic Development, 25(2), 147–161. https://doi.org/10.1080/1360144X.2019.1659797

Why Slowing Down Matters in Trauma-Informed Therapy
In trauma-informed therapy, real progress often begins not by doing more, but by slowing down enough to listen and notice—especially to the wisdom of the body and emotions. These signals may have been ignored for years in the name of survival.
In a fast-paced world, healing requires slowing down. The usual pressure to be productive, fix things, and hurry is about survival, not recovery. That’s why therapy can feel unfamiliar, even frustrating. It may feel like two steps forward, one step back—and that’s okay.

Why Slowing Down Feels Uncomfortable
When clients are invited to check in with their bodies, common reactions include:

• “Why can’t I feel anything?”
• “I should be able to name my emotions.”
• “Why is this so hard?”

Behind these judgments is a protective part of the self, trying to avoid discomfort or push feelings away. These instincts aren’t failures; they’re survival strategies.

Honoring Protective Parts with Internal Family Systems (IFS)
One approach we use is Internal Family Systems (IFS) therapy, which teaches us to recognize and honor these protective parts. Instead of ignoring or running away, we notice and acknowledge them with gratitude. Slowing down and feeling might not have been safe in the past—therapy creates new experiences where we respond to the present, not react to old wounds.

For Trauma Survivors: Safety First
For those with trauma histories, being present in the body can feel scary. The body may have been a place of tension, betrayal, or pain. So we go slowly, using trauma-informed protocols that build safety and trust. Noticing sensations—tightness in the chest, a lump in the throat—can stir up old patterns. Our goal is to grow capacity for awareness and acceptance, consciously and collaboratively.

Somatic Awareness: Listening to the Body
We often use gentle, guided noticing called Somatic Awareness, asking:

• Where is your breath right now?
• Is there an area that feels more activated or more at ease?
• What words describe the sensation—tight, pulsing, dull, warm?

Instead of analyzing, we listen and accept. We heal the relationship between sensations and thoughts by letting go of the need to fix or run away.

Building Emotional Vocabulary
Sometimes we use metaphors:
Does it feel like a storm? A cage? A whisper?
Curiosity replaces criticism, helping rewire old survival-based patterns.

The Quiet Signs of Progress
Progress isn’t always dramatic. It might look like:

• A deeper breath
• A softened jaw
• Tears that finally come
• Laughter that breaks tension
• The realization:
  “I’m allowed to feel this.”
  “I don’t have to rush through my pain.”
  “My body feels like mine again.”

Clients move from confusion to clarity, from self-judgment to self-compassion. Emotions become manageable signals, not overwhelming storms. Peace, joy, and wholeness emerge.

The Bottom Line - Therapy is not a race.
It’s a return to the truth of the body—our nature and capacity to be whole and held.
And it begins by slowing down.

Understanding Theories

Psychotherapy is about helping people grow and change.  When clients come for help, therapists gather information and make decisions about how to intervene or proceed to best helping clients to make the changes they seek by using theories to organize and simplify the information clients share. A therapists’ theory is a kind of map and includes knowledge of human development.  The theory leads to the type of techniques and tools a therapist may use, though some draw from other theories when it fits.  A theory should fit with the way a therapist views mental health, but also fit the client issue and personality, as well as their resources.  Overall, the theory is not as important as a good fit with the therapist. 

Is Therapy Effective?

Research consistently suggests the effectiveness of therapy with between 75% and 80% of clients benefitting after 10 to 20 sessions, with lasting benefits.
What makes therapy effective?  Outcomes depend largely on how effective the therapist is using what is called “Common Factors”.  That is, factors common to all therapeutic approaches.  It is about their ability to develop a good therapeutic alliance, with real and genuine empathy, as well as both the clients’ and the therapist’s positive expectations for change, and the hope that clients experience at the beginning of therapy.  Clients need to feel heard, understood, accepted and hopeful for therapy to be effective.

Clients themselves actually attribute 40% of the change they experience in therapy to external factors such as their own resources or supports and opportunities.  About 30% of outcomes are tied to the therapist–client relationship, and only 15% to techniques.
Though differences in positive outcomes of therapy from different theoretical approaches are not strong, the approach still should fit a clients’ needs.  The therapeutic alliance is of great importance but the tools they use may be in part responsible for the development of the therapeutic alliance.  The therapist’s confidence and competence in their method influences their ability to create hope and positive expectations. These factors are inter-related.  Overall, the methods should be a good fit for the therapist and the client.

Common Factors

A common set of variables are important, regardless of the differences in approach.
Some of the factors that are important towards effective therapy outcomes are:

• A therapy relationship of trust, genuine compassion, emotional safety, positive regard for the client, support for autonomy, empowerment, spirit of collaboration.
• A shared understanding of the nature of the problem or concerns.
• Clear goals and therapy plans.   
• An understanding of what interventions are being used and how they will help a person make progress on their goals.
• A belief in clients’ ability to create change/positive expectations.
• Understanding of client motivation and resources or challenges.
• Client willingness and readiness to do the work needed.
• Openness to feedback.

Effective Therapists

The quality of the therapy relationship is the most important aspect of the therapy process. A therapist should be friendly, patient, warm and genuine.  They should be able to make appropriate and helpful self disclosures not sharing distracting stories because of over-relating. They should be encouraging, honest, and flexible with respect for differences without losing sight of what they believe to be healthy, based on in-depth knowledge of human development and wellbeing.  They should be ethical, objective and fair with good communication skills that demonstrate enthusiasm and hope. Good therapists are self aware, up to date on relevant issues and research, dedicated to life-long learning, aware of their own limitations and open to feedback from clients.

How to Get Started

Sometimes clients are unclear about their goals.  That is ok.  It can take time to feel safe, heard and understood about what feels “wrong” and what the problems really are, before deciding what change would look like.  Still, it is important to collaborate and come up with somewhat measurable goals in order to be able to track if therapy is helping.  It is important to feel safe to ask questions and to give feedback to the therapist about client experience.  Therapists are usually very well intentioned but not always effective at judging if the rapport is intact, or when there has been a rupture.  Clients can feel just a little bit less understood one day and not return to therapy.  At our clinic we value feedback and understand the importance of effective alliance building skills.  Our therapists possess the personal qualities that make for effective therapy.  We make it our ethical obligation to try to fit the client to the therapist and prefer to refer to another practice if we cannot meet the needs of a client rather than keeping them with us.  Feel free to reach out by email, clicking here for a consultation about which therapist could best fit your needs. 

Clients with eating and body image concerns come to therapy after years of suffering in silence, and some after years of ineffective interventions.  Our Clinic Director has had success in this area in part from research and personal experience suffering, extensive reading on this subject and have an approach that is personal, direct, honest and integrative.  It is often different than what they are used to.

Shirley Katz, Ph.D., RP, our Clinic Director has written about her beliefs on this topic and supervises therapists who work in this area.  She believes that any compulsive behavior, defined as that which is repetitive, unhealthy, unwanted, mindless  - is avoidance of Self which is made up and informed by emotion.  Most have learned for some reason or another that there was no room for the emotions.  Trauma, childhood neglect or abuse, growing up with someone whose emotions were out of control - these are just some of the reasons people learn to sweep their feelings and opinions under the rug.  People learn overt and not-so-conscious ways of controlling themselves and interpersonal relationships only to find that painful patterns keep coming back and they are out of control of their harmful behaviors despite so much effort.

Without addressing underlying social learning about emotion, teaching new ways of coping with feelings, and changing the way people think about themselves and others, there can be no real healing from eating disorders.  Whether it is body hate, counting calories, denying the self nutrition - its all the same.  These obsessions take us away from healthy relationships with our Selves, with food, with out bodies and with others.  The therapists in our clinic work with this model, including Audette, Chantel and Carolina. 

Therapy for eating disorders tends to be a bit difficult and long term.  It takes more time to feel understood and to be understood when emotions and vulnerability are repressed.  Out therapists understand the difficulty for our eating disorders clients to feel vulnerable, to trust and allow their feelings to emerge.  They work patiently to build the therapeutic relationship and help clients feel respected, heard and understood so they can feel safe to explore and make valuable changes.  This sometimes goes along with the process of learning to trust one's self and effectively manage emotional experiences.

Audette is a Registered Social Worker therapist who is also a Registered Nurse with training and special interests in this area of work.  Chantel also has special interests and training in working with this issue.  She was a varsity athlete and understands how the role of competitive career areas interact with this issue. Carolina has experience in working with Eating Disorders including a past role as a hospital based Psychologist in Brasil.

Most people addressing gender issues for the first time in therapy have kept it buried for so long...they feel shame and fear to disclose.  A good therapy alliance is essential. 

We are fully aware of how important the therapy relationship is.  Trust that we are not judging and will make you as comfortable talking as you let us, and relief will come in addressing things you may have hidden from even your self. 

Clients dealing with gender issues may be in various places in their journey of self understanding, self acceptance, and potentially transition.  There may be self esteem related issues, interpersonal or family history issues, lack of acceptance or self acceptance and sometimes a people pleasing problem.

We have supported many clients in varying stages of awareness, identification and coming out as well as transitioning.  We are aware of the research on this issue and am partial to the notion that being able to live as much as possible as who you genuinely are, finding acceptance and support for this Self- is the holy grail of well being.  

Happiness is a fleeting emotion.  Satisfaction with life, dignity, and self-worth cannot be denied.  Finding and expressing your truth is important as are healthy relationships that are reciprocal and adaptive with appropriate boundaries.  

We are also available to help friends and family who are learning how to support someone who is coming out or transitioning.  When relationships are problematic, we work with clients to learn how to assert healthy boundaries.

Clients experiencing gender dysphoria or going through transition often need support that is not standard Psychotherapy but may be related to wellbeing. 

We maintain a small referral and support net of helping professionals, and keep up to date on services available that are relevant and can be helpful.  If letters are required, we can often write them, collaboratively, when suitable.

There are a few therapists at the clinic with a background in helping with gender issues.  Please email and ask to be directed by clicking here.

A kind, compassionate supervisor once said to me, "Have you ever met anyone who had enough validation today"? 

No matter how you look at the research on human experience of challenges, problem solving behaviors, personality, mental health services, methods, etc. there is a ton of evidence that having social support is a key factor in overcoming hardship.  Yet we are living in a world where social connection is in competition with internet connection, where we log on, hook up, swipe and sometimes seek attention rather than connection.

We are all living in a world that is progressively more focused on material wealth, competition and greed and less on living in harmony with nature and one another.  Therapy is not friendship or community, but can offer a caring, attentive and healing space for a person to be seen heard and understood.  Therapy can help a person understand what makes them feel connected and whole and get back to a healthier life with a more satisfying and meaningful experience.  Reach out.  Therapists like Elissa​,  Maria, and Chantel work well with clients who are looking for meaning and connection or support in making those kind of connections outside of therapy.