Top 5 Mistakes Clinical Providers/Administrators Make Working with Peer Support Specialists: #5 Failing to Provide Ongoing Clinical Supervision

All employees, including Peer Support Specialists, have a work supervisor who directs their work and evaluates them.  Most Peers do not have clinical supervisors who meet with them regularly to talk about their work with clients, to build their skills as a Peer, to develop their clinical expertise, to encourage them by pointing out their strengths and successes, and to improve their work by pointing out their failures and helping them to learn from those failures.

The term clinical supervision has been defined as “a formal process of professional support and learning which enables individual practitioners to develop knowledge and competence, assume responsibility for their own practice and enhance consumer protection and safety of care in complex clinical situations’ (Department of Health, 1993). While there is limited research on the impact of clinical supervision, the available data support the view that it is a core element in the training and oversight of clinicians, it has a positive impact on provider practice, morale and retention, and is seen by many clinicians as critical to skill development (Edwards et al., 2005; Wheeler & Richards, 2007)

The lack of clinical supervision for Peer Support Specialists is surprising, given the fact that all clinicians have received years of clinical training that always involves regular clinical supervision.  Many have ongoing clinical supervision as part of their job. Most clinicians see clinical supervision as one of the most, possibly THE most important form of education for people working in clinical settings. Why would Peer Support Specialists not be receiving ongoing clinical supervision?

I have heard different clinicians and administrators use various excuses for not providing clinical supervision, including

A. It is not required for Peer Support Specialists,

B. Our organization doesn’t have experienced Peers to provide it, and clinician supervisors are not appropriate for Peers,

C.  Peer’s work is informal and should not require the level of review and skill development involved in clinical care.

D. We don’t know how to provide this supervision to Peers.

These arguments are short sighted and reflect a poor understanding of the role and contributions of Peer Support Specialists. Consider the following:

·        Peer Support Specialists play a complex and challenging role within clinical settings, providing nuanced work with a wide range of clients within complex healthcare settings.  Clinical supervision is needed simply to understand and provide effective peer support interventions to those clients. While it may not be “required” by the organization, it is required by CARF because of its relationship to quality clinical care. It is important to note that “required” is very different from “needed”.

·        Peers have very limited classroom training – far less than any other member of the clinical team.  Given that difference, ongoing clinical supervision is more important for Peer skill development than it is with any other professional group.  By not providing the needed supervision, Peers are being set up to make unforced errors that further undermine their contribution to the work.

·        Clinical supervision is being provided by some programs, including supervision by clinicians and by more experienced Peer Support Specialists.  For example, the Veterans Healthcare Administration has a range of settings in which clinical supervision is an ongoing support for Peer Support Specialists.  Clinical supervision provided by clinicians or by other Peers has been found to work well, depending on the skill and supportiveness of the supervisor. 

·        There are educational resources available for organizations related to the supervision of Peer Support Specialists.  The National Association of Peer Supporters published guidelines for the supervision of Peers in 2019.  Researchers have published additional guidance on clinical supervision for Peers (Foglesong, Knowles, Cronise, Wolf, & Edwards, 2022; Stefancic et al., 2021).

·        Peer work does have an “informal” aspect to it, as peer support interventions often involve small and large conversations that are not seen as billable or standardized procedures.  “Informal” does not mean unimportant or unsophisticated.  Providing those “informal” interventions effectively requires a solid understanding client psychology, psychopathology, and family dynamics.  It also requires a full understanding of the variety of pathways to recovery, as well as the ability to understand the complex, ever-evolving clinical setting.  That type of learning requires ongoing individual supervision.

·        The ongoing use of self-disclosure is the THE central duty of Peer Support Specialists, creating a particularly complex challenge and a unique emotional vulnerability for Peers.  Clinicians know that self-disclosure is an advanced intervention that has great potential for positive and negative impacts on the client (Arroll, & Allen, 2015; Ding, Johnsen, Hartman, Flye, & Rendleman, 2025). Clinical training typically involves significant education and supervision around self-disclosure.  Peers use this intervention on a daily basis and with less classroom training on how to do it effectively.  Ongoing clinical supervision is needed to help Peers master this skill.

·        Providing ongoing clinical supervision is a concrete statement about the strategic value of the work of Peers and the importance of including the patient’s experience within their care. Programs and clinicians who do not support the need of Peer Support Specialists for supervision don’t understand the value of the work that Peers provide or are unwilling to invest in this important resource.

There have been increasing calls for the provision of clinical supervision for Peer Support Specialists by Peer professional organizations, including NIH, SAMSHA and a variety of researchers (Pollice et al., 2025). CARF requires that peer support providers receive ongoing clinical supervision, but this has not resulted in uniform adoption of quality ongoing supervision for Peers. Clinicians and Peers need to continue to organize and advocate to push for change around this key support. 

REFERENCES

Arroll, B., & Allen, E. C. F. (2015). To self-disclose or not self-disclose? A systematic review of clinical self-disclosure in primary care. The British Journal of General Practice, 65(638), e609.

Department of Health (1993) A Vision for the Future Report of the Chief Nursing Officer. HMSO, London.

Ding, H. T., Johnsen, C., Hartman, J. P., Flye, B. L., & Rendleman, R. (2025). Therapist self-disclosure: supervisory challenges and imperatives. The Journal of Mental Health Training, Education and Practice, 20(4), 269-280.

Edwards, D., Cooper, L., Burnard, P., Hanningan, B., Adams, J., Fothergill, A., & Coyle, D. (2005). Factors influencing the effectiveness of clinical supervision. Journal of Psychiatric and Mental Health Nursing, 12(4), 405-414.

Foglesong, D., Knowles, K., Cronise, R., Wolf, J., & Edwards, J. P. (2022). National practice guidelines for peer support specialists and supervisors. Psychiatric Services, 73(2), 215-218.

National Practice Guidelines for Peer Specialists and Supervisors. Washington, DC, National Association of Peer Supporters (2019). https://www.peersupportworks.org/wp-content/uploads/2020/ 08/National-Practice-Guidelines-for-Peer-Specialists-and Supervisors.pdf

Pollice, G., Bodini, C. F., Menchetti, M., Da Mosto, D., Negrogno, L., Betti, L., ... & Quaranta, I. (2025). Exploring the Integration of Peer Support Workers and Their Experiential Knowledge in Mental Health Services: An Ethnographic Study from the Dual Perspectives of Peer Support Workers and Professionals in Trieste and its Region.

Stefancic, A., Bochicchio, L., Tuda, D., Harris, Y., DeSomma, K., & Cabassa, L. J. (2021). Strategies and lessons learned for supporting and supervising peer specialists. Psychiatric Services, 72(5), 606-609.

Wheeler, S., & Richards, K. (2007). The impact of clinical supervision on counsellors and therapists, their practice and their clients. A systematic review of the literature. Counselling and Psychotherapy Research, 7(1), 54-65.