Clinical Supervision, Workplace Culture, and Therapeutic Engagements with Youth at Risk for Suicide

Abstract

Clinical supervision practices and workplace cultures are highly influential in shaping the quality of care that clients at risk for suicide receive. The purpose of this qualitative study was to document counselors’ and supervisors’ views regarding the supervisory practices and conditions that enable useful and life-enhancing practices when working with youth who struggle with living. We conducted two, 1.5-hour focus groups with counselors who work with youth at risk for suicide in two separate clinical sites in British Columbia, representing the views of seven counselors. Two clinical supervisors who each supervise a small team of counselors were interviewed individually. Reflexive thematic analysis, informed by a constructionist lens was used to organize and interpret the qualitative data, with a strong emphasis on researcher subjectivity, reflexivity, and the contextual nature of meaning-making. Four themes were generated: being guided by a flexible framework; addressing anxiety in a systemic way; resourcing self and others; and expanding possibilities for engaging with complexity. We argue in favor of flexible, relational, and reflexive approaches to supervision, where the development of useful responses to suicidal behavior can best be understood as a shared, system-wide responsibility, which does not place the onus for “saving lives” onto the shoulders of individual counselors.