Clinical supervision for psychologists: preparing a case and writing it up

Clinical supervision is a regular meeting in which a psychologist presents clinical situations to a more experienced practitioner to reflect on their practice, while protecting patients' identities.

Here is how it differs from peer supervision, what the French code of ethics says, and how to prepare and write up a case without exposing the person.

Supervision, peer supervision, practice analysis: the differences

All three formats help you step back from your practice. The definitions below reflect common usage in France, as no official text sets them.

Supervision

You choose a supervisor, usually a psychologist or psychotherapist experienced in your approach. Meetings are regular, one to one or in a small group. You work on specific cases, how they affect you and your choices of intervention. Clinical responsibility stays with you.

Peer supervision (intervision)

Peer supervision brings together colleagues at the same level, with no appointed leader or with a rotating facilitator. Each person presents a situation in turn, and the others ask questions and suggest ideas. It helps break the isolation of private practice, but sometimes lacks an outside view.

Practice analysis groups

Practice analysis, often called APP in France, is group work led by a facilitator from outside the team. It is mostly found in institutions. It focuses on professional situations and how the team works more than on the clinical detail of one patient.

In all three, the same confidentiality rules apply. We advise making the anonymisation more thorough the larger the group.

What the French code of ethics for psychologists says

The French code of ethics for psychologists was updated in 2021 and signed on 5 June 2021 by 21 organisations brought together in CERéDéPsy. It does not use the words supervision or peer supervision, and only article 41 refers to those who "supervise". Several articles nonetheless govern this work. The quotations below are our translation.

• Article 7. Psychologists are bound by professional secrecy under the French Penal Code (articles 226-13 and 226-14). This secrecy "covers everything the psychologist learns in the exercise of their profession".
• Article 8. In any exchange between professionals about people or situations, the psychologist "shares only the information strictly necessary for the professional purpose". Taking the context into account, they try to inform the people concerned beforehand of their part in such exchanges.
• Article 17. Where a situation may harm the psychological or physical integrity of the person consulting or of a third party, the psychologist "may inform their decision by seeking advice, in particular from experienced colleagues".
• Article 20. "A psychologist's practice is inseparable from critical reflection on their choices of intervention."
• Article 23. Psychologists collect, file and archive their personal notes so as to protect people's privacy. When this data is used for publication or communication, "it must be handled with absolute respect for anonymity".
• Article 38. In the part of the code on training psychologists, it states that "case presentations respect the dignity and integrity of the people concerned."
• Article 41. Those who "oversee or supervise professional practice and placements" ensure the code is respected, in particular confidentiality, professional secrecy and informed consent.

The code has no regulatory force to date. According to CERéDéPsy, its use is nonetheless recognised by judges and lawyers through case law.

In practice, share only what serves the question, present the case anonymously and, where the context allows, tell your patients that you work under supervision.

Preparing a case with an anonymised sheet

We suggest a one-page sheet. It forces you to state your question and avoids bringing the patient file.

• First write what you expect from supervision, in one or two sentences.
• Reread your session notes and pick only the elements that shed light on that question.
• Remove everything that identifies the person, then everything that could make them recognisable by cross-checking.
• After the meeting, destroy the sheet or store it with your supervision notes, never in a shared folder.

Replacing a first name with an initial is not enough. The CNIL, the French data protection authority, distinguishes pseudonymisation, which replaces direct identifiers and remains reversible, from anonymisation, which makes any identification impossible in practice, irreversibly. For a case presentation, aim for the latter.

Testing the anonymisation before the meeting

The CNIL sets out three criteria, drawn up by the European data protection authorities, for judging whether a dataset is anonymous. They can be applied to a supervision sheet.

• Singling out. Could someone point to one single person from the sheet? A rare job in a small town is sometimes enough.
• Linking. Could someone connect the sheet with another source, such as a news story, social media or what a colleague already knows?
• Inferring. Could someone deduce, with near certainty, a piece of information about the person, even without a name?

Then reread the sheet with these practical questions.

• Have the surname, first name, initials and nicknames gone?
• Are age and dates approximate, such as "in their forties" or "for six months"?
• Is the job described by sector rather than by a precise role?
• Have the town, neighbourhood, employer and children's school gone?
• Would a rare or widely reported event make the person recognisable?
• Could your supervisor or a group member know the person?

If the answer to the last question is yes, present another case. When you change a detail, keep what matters clinically and change only the surface.

In peer supervision within the same town, be stricter still, as participants often share the same networks.

Preparation sheet template

Here is an outline to copy. Each section takes a few lines.

1. Case code and date

A code that points to nothing identifying, such as "case B, second presentation", and the date of the supervision.

2. The question for supervision

What you want to work on, in one or two sentences. For example, "I am not sure whether to suggest more frequent sessions" or "I feel uneasy when the person talks about their father".

3. The framework of the work

How long, how often, in person or remotely, who referred the person.

4. The person, in a few strokes

Age range, family and work situation in general terms, reason for coming.

5. What happened in sessions

Observed facts and key moments, without quotations that could identify the person. Keep what was said separate from what you make of it.

6. Your hypotheses and what you have tried

Your reading of the situation, the interventions made and their effect. Present hypotheses as lines of enquiry, not certainties.

7. How the situation affects you

Unease, tiredness, a wish to protect, irritation. This section does not belong in the patient file.

8. Points of concern

A risk to the person or a third party, a question about the framework, a limit of competence. If it is urgent, seek advice without waiting, as article 17 allows.

9. Anonymisation check

A box to tick before you go. Sheet reread with the questions above, nothing identifying, no document from the file attached.

10. After the meeting

What you take away and what you will do in the next session.

What you note after supervision

Straight after the meeting, note the key points in a supervision notebook separate from the patient file. Note the date, the case code, the question, the ideas suggested and what you decide to try, with nothing identifying.

In the patient file, keep it brief. One line may be enough, such as "situation discussed in supervision, frequency of sessions to be reviewed with the person". Do not add your personal feelings or the supervisor's hypotheses written up as conclusions. Bear in mind that the patient may ask to access what concerns them.

Follow it through in the next session. If you take an idea forward, write in your session notes what you suggested and how the person responded.

What the supervisor keeps

The supervisor also takes notes to follow the work. They are about the supervisee and the situations presented, not about patients' identities.

• The date of each meeting and the cases presented, under their code.
• The questions worked on and the ideas suggested.
• Points of concern raised, for example a recommendation to seek another opinion or to refer.

If the supervisor is a psychologist, they are also bound by professional secrecy (article 7), and article 41 asks them to ensure the code is respected. We advise that they do not keep the supervisee's sheets and that they store their notes securely. The code already asks psychologists to keep their notes in a way that protects people's privacy (article 23).

It helps to agree from the start what is noted and how long it is kept.

Preparing supervision from your session notes

A good sheet starts from clear session notes.

Delta is the clinical assistant for mental health and allied health professionals. During the session, Delta transcribes what is said, with the patient's consent. You can also dictate your observations after the session, or add written notes. Delta generates the session report and updates the patient file, with a summary of the work and the goals being tracked. You find the whole course of care and how it has evolved in one place, which helps you choose what to present.

You still write the supervision sheet yourself. Delta pseudonymises the patient's name and identifying information before the AI, but a case presentation needs full anonymisation, which only you can check.

Delta's data is hosted in France with an HDS-certified host, no audio file is kept and the data is never used to train a model. The trial lasts 14 days with no card required, then the subscription costs €29 a month including VAT on an annual plan, or €35 a month including VAT on a monthly plan.

Further reading

• Psychologist's session notes: framework and template
• Professional confidentiality and AI
• Patient access to therapy notes
• Systemic family therapy note template
• Clinical document templates
• Delta for psychologists

Sources

• French code of ethics for psychologists, 2021 version (articles 7, 8, 17, 20, 23, 38, 41), in French
• CNIL, L'anonymisation de données personnelles (anonymising personal data), in French
• CERéDéPsy, 13 September 2024 briefing on the status of the code (FFPP), in French