The Location Doesn't Determine the Quality of Clinical Supervision. The Supervisor Does
As conversations continue across Michigan regarding BCBSM's proposed changes to reimbursement for Limited Licensed Professional Counselors (LLPCs), one assumption seems to be emerging beneath the surface:
That supervision provided in hospitals, community mental health agencies, and large healthcare systems is somehow inherently better than supervision provided in private practice settings.
As someone who has worked in both environments—as a clinician, supervisor, and behavioral health leader, I can confidently say that's not how supervision works.
The quality of supervision has very little to do with the building where it occurs.
It has everything to do with the supervisor.
I've Worked on Both Sides
Over the course of my career, I've provided direct clinical services in hospitals, integrated healthcare systems, community mental health settings, and private practice. I've also held leadership positions responsible for developing clinicians, supporting teams, and ensuring quality care.
What I've learned is simple:
There are exceptional supervisors in every setting.
There are ineffective supervisors in every setting.
A hospital badge does not automatically make someone a skilled mentor.
A private practice owner is not automatically less qualified to train new clinicians.
The difference is rarely the organization itself. The difference is how seriously the supervisor takes the responsibility of developing the next generation of mental health professionals.
What Quality Supervision Actually Looks Like
Quality supervision is not simply signing paperwork once a month.
It involves:
Reviewing clinical decision-making
Discussing ethical dilemmas
Developing treatment planning skills
Strengthening diagnostic reasoning
Processing countertransference and clinician reactions
Building professional identity
Increasing confidence while maintaining accountability
Creating opportunities for consultation and feedback
The best supervisors actively teach.
They challenge assumptions.
They help clinicians think critically.
They support growth while protecting client welfare.
None of these activities require a hospital setting.
They require an invested supervisor.
The Mental Health Workforce Has Changed
Many assumptions about clinical training appear rooted in a behavioral healthcare landscape that no longer exists.
Today, a significant portion of mental health services are delivered in outpatient settings. Telehealth has expanded access. Group practices have become training sites. Specialized private practices serve populations ranging from children and families to trauma survivors, couples, substance use disorders, and perinatal mental health.
Some private practices have built supervision programs that are more structured than those found in larger organizations.
Some supervisors intentionally limit their caseloads so they can devote substantial time to training and consultation.
Some clinicians seek private practice supervision specifically because they receive more individualized attention than they experienced in large systems.
To suggest that supervision quality can be determined by organizational type ignores the reality of today's workforce.
The Unintended Message Being Sent
Perhaps most concerning is the message these discussions send to LLPCs themselves.
Many new clinicians are working incredibly hard to develop their skills. They participate in supervision, seek consultation, complete continuing education, and dedicate themselves to becoming competent professionals.
When policies imply that their training environment is somehow less legitimate because it occurs outside of a hospital or community mental health setting, it diminishes the value of the work being done by both supervisors and supervisees across Michigan.
That narrative is not only inaccurate—it is discouraging.
Access to Care Matters Too
Michigan already faces behavioral health workforce challenges.
Many communities struggle to find therapists.
Many practices have waitlists.
Many clients face delays in receiving care.
In fact, a recent statewide behavioral health access study published by the Michigan Health Endowment Fund found that while Michigan has made progress in expanding behavioral health services, significant workforce shortages and access challenges remain across many regions of the state. The report notes ongoing provider shortages, particularly in rural and underserved communities, despite increased efforts to strengthen the behavioral health workforce.
If reimbursement policies make it more difficult for LLPCs to practice in private settings, the impact extends beyond clinicians.
It affects clients.
It affects families.
It affects access.
Every barrier placed in front of developing clinicians ultimately becomes a barrier for the people seeking care.
A Better Question
Rather than asking whether supervision occurs in a hospital, community mental health agency, or private practice, perhaps we should be asking a different question:
What makes supervision effective?
The answer is not a location.
It's not a building.
It's not an organizational chart.
Effective supervision is created by knowledgeable, ethical, engaged supervisors who view mentorship as a professional responsibility.
That's true in hospitals.
It's true in community mental health.
And it's true in private practice.
If our goal is to strengthen Michigan's mental health workforce while protecting quality of care, then we should focus on the quality of supervision itself—not assumptions about where it happens.
Because the location doesn't determine the quality of supervision.
The supervisor does.
