From Talking About Cases to Practising Clinical Skills: How I Teach in Supervision
Practical learning, useful feedback and growing independence
By Dr Nicholas Harris | Clinical Psychologist and Board-Approved Supervisor
Learning by doing
A psychologist can understand a therapeutic approach and still feel unsure how to use it in a difficult moment. You may know why a boundary matters, yet struggle to find the words. You may understand an assessment result, yet find it harder to explain what it means to a client or parent.
In supervision, I enjoy working at that point where understanding needs to become action. My teaching background has shaped an approach that is practical, interactive and responsive to the person learning. We can talk through a case, then try out the part that feels difficult.
Making your clinical reasoning visible
One question I often find useful is: “Talk me through how you arrived at that.”
We might map what you know, what you are inferring and what remains uncertain. For an assessment, that could mean considering how test findings fit with developmental history, observation and everyday functioning. For therapy, it could mean tracing the link between your formulation, the client’s goals and the intervention you have chosen.
I want to understand your reasoning before offering mine. That gives us something specific to examine together: a missing piece of information, an assumption to test, or an interpretation that needs more careful wording. It also gives me the opportunity to notice and name the sound clinical thinking you are already using.
Trying the conversation before you have it
Sometimes we spend considerable time discussing what a psychologist should say without giving them a chance to practise saying it. In supervision, we can rehearse a brief part of a conversation, pause, adjust the wording and try again.
The examples below are illustrative, rather than accounts of particular clients or supervisees.
Example one: communicating a boundary
Imagine a client has asked for contact outside the arrangements you have agreed, and you feel anxious about declining. We would first clarify the context, including any safety concerns, your responsibilities and the purpose of the boundary.
Then we could practise the conversation. I might model a possible response, or you might try first while I take the client’s role. We could pause where your explanation becomes overly apologetic, where the limit is unclear, or where there is an opportunity to acknowledge what the client needs.
The feedback might be:
“You recognised that they were distressed and explained what support was available. Let’s make the contact arrangement clearer, so they leave knowing what to expect.”
You can then try again in language that sounds natural to you. At the next supervision session, we can review how the actual conversation went and what you learned.
Example two: explaining assessment findings
Imagine you are preparing to explain a cognitive profile with uneven results. We could start by checking what the findings support, their limitations and how they relate to the referral question.
Then I might ask you to explain the main finding as though you were speaking to the client or parent. Where does the explanation become too technical? Where might a score be heard as a fixed limit on someone’s abilities? Have we connected the results with their everyday experience without claiming more than the evidence allows?
We could sketch a visual explanation, practise a clearer summary and check that the recommendations follow from the findings. We might also rehearse how to communicate uncertainty or respond when the person’s experience differs from our interpretation.
The aim is an explanation you understand well enough to adapt, rather than a script you need to memorise.
Feedback you can use
I aim to offer feedback that identifies what you did, why it matters and what you could try next. “Be more confident” gives you little to work with. “State your recommendation first, then explain the evidence and its limits” offers something you can practise.
I also want feedback to be a conversation. Did my suggestion fit the client, the setting and your way of working? Was my explanation clear? Is there information I have missed?
Warmth, humour and encouragement are part of how I teach. So are clear expectations and thoughtful challenge. I want you to feel able to experiment, ask questions and receive specific feedback without needing to perform certainty.
Adapting the way we learn
Different people need different forms of support, and those needs can change from one task to another. You might benefit from a visual formulation, a worked example, a short role-play, written prompts or time to think before responding.
A newer practitioner may need me to model a skill and explain each step. A more experienced psychologist may want to test a formulation, examine a subtle clinical decision or practise a difficult consultation. We can agree on the level of structure that is useful and adjust it as we go.
My experience teaching complex material has made me attentive to the moment an explanation stops helping. When that happens, we can change the example, break the task down or try another way of approaching it.
Growing into your own judgement
As your skills develop, I progressively invite you to take more ownership: propose the formulation, identify possible responses, explain your preference and recognise what would lead you to seek further advice.
That might mean moving from watching me model a feedback conversation, to practising it together, to bringing your own plan for us to review. Independence includes recognising your limits and consulting appropriately.
I want supervision to help you develop a way of practising that is thoughtful, accountable and recognisably yours.
Bringing one practical learning goal
You do not need to prepare a polished presentation for every supervision session. One specific question can give us a useful starting point:
- “Can we practise how I will explain this?”
- “Can you help me check the reasoning behind my recommendation?”
- “Could we map why this intervention does not seem to be working?”
From there, we can agree on something to try and return to it next time. That connection between discussion, practice and review is central to how I teach in supervision.