Self-Reflection in Supervision: Why it Matters

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

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