June/July 2024 Issue
Dietetics Education: The Role of Professional Supervision
By Carrie Dennett, MPH, RDN
Today’s Dietitian
Vol. 26 No. 6 P. 10
Discover this critical component for life-long learning.
Learning doesn’t end once a dietitian earns a degree, completes an internship, or passes the registration exam. For all RDs, continued growth as a nutrition professional includes earning the requisite continuing education credits, but it goes a step further than that. Many dietitians, especially those providing individual or group nutrition counseling, invest in professional supervision because it can be an essential asset for continued professional and personal growth—as well as for preventing burnout.
Whereas continuing education is generally knowledge-based and didactic, professional supervision is reflective.1 And while it may be confused with supervision in the job setting, professional supervision is very different. “Supervision in an employment setting can be referring to a managerial relationship or a competency assessment,” says Lisa Pearl, MS, RD, LDN, CEDS, a Lexington, Massachusetts-based founder of Counseling and Nutrition Center 360. “Supervision [that’s] not tied to the workplace allows the supervisee to freely express their needs or concerns so that they receive full support for their professional development.”
Melbourne, Australia-based Fiona Sutherland, APD, RYT, director of The Mindful Dietitian, says there’s no single agreed-upon definition for supervision in dietetics. “Professional, clinical, or reflective supervision are all terms that describe the supportive space where we can explore and reflect on our practice for the benefit of our clients, ourselves, and our field and the broader profession. It’s ideally done with someone who’s experienced clinically and as a supervisor, and can hold a space where the care of the dietitian and their clients is prioritized.”
The Mental Health Field
Sutherland says professional supervision is very common in many areas of mental health. “It’s a built-in part of doing therapy work, whereas in dietetics, it’s seen more as an optional add-on,” she says. “The reality is that the work of all dietitians, in all sectors, brings with it challenges of all sorts and the type of support that supervision can provide really gives us the unique space that’s often missing in our profession.”
Pearl says one reason professional supervision isn’t common in dietetics may be because dietetics education includes minimal preparation for dietetics as a counseling practice and that’s where supervision as a professional activity would most likely be encouraged. “Many dietitians just don’t know about it and don’t know how to access resources,” she says. “Dietitians in the eating disorder field have benefitted from supervision more than other RDs because their work so closely intersects with other mental health providers.”
Both Pearl and Sutherland are supervisors and receive supervision themselves. Pearl says she feels fortunate that she’s received supervision since she began her career over 40 years ago working in a psychiatry department.
Sutherland credits Australian dietitian and psychotherapist Tara MacGregor, APD, PACFA, director of Dietitian Supervision Resources Australia, for her pioneering work in the supervision space in Australia, adding that, historically, there’s been little support for reflection—both self-reflection and reflection regarding professional practice—in dietetics. “For some people, asking questions, being curious, and being interested in our own experiences hasn’t been well received at some point, and we can become reluctant to explore the intersections of where our own life intersects with our professional life.”
Supervision Supports Professional Growth
Just as mentors and preceptors help dietetic students and interns develop and grow, professional supervision is a career-long endeavor that adapts to the needs of the supervisee and to the profession as it evolves, Pearl says. “Good reflective supervision for any RD or practitioner provides learning, support, and accountability. It provides different things at different developmental phases in our profession.
“For example, in the beginning, there may be more development of nutrition skills, counseling techniques, treatment strategies, or issues with boundaries. Over time, supervision may shift to be more about counseling, such as relational dynamics, countertransference, parallel process, and self-care. Eventually, the supervision may be about perspective, introducing new models of care, engaging with systems, and supervision of supervision. I don’t believe there’s ever a time when supervision isn’t helpful. I’m still actively receiving supervision in multiple forms.”
Sutherland says that even if dietitians are getting support within a workplace, she always recommends that they seek supervision externally. “When we’re getting supervision outside the workplace, we’re also able to confidentially discuss issues that might be happening in the workplace,” she says. “This can shed new light on a situation or experience. We might see things from a new perspective and gather some new ideas about how we might proceed with a workplace dilemma with more clarity.”
Sutherland says dietitians in any field, any area of practice—and at any point in their career—can benefit from supervision. “As we progress through our career and develop a deeper understanding of where the personal meets the professional, we might lean more in the direction of considering the nuance and complexity of our work. In good supervision, the supervisor will be able to meet the dietitian’s individual needs based on stage of career, learning styles and preferences, workplace, areas of practice, and other attributes that each person brings. They can then develop a partnership that focuses on the growth and development of the dietitian, with client care also front of mind.”
Sutherland explains she’s observed misconceptions regarding professional supervision like that it’s only for early career dietitians or for dietitians working in particular areas of practice, such as eating disorders. She also says some people incorrectly think that a dietitian needs to be struggling or feeling “stuck” in their practice to benefit from supervision. “If we’re human, and we work with humans, then supervision can be a wonderful support space.”
Supervision Enhances Personal Growth
According to the CDC, 46% of United States health care workers—including clinicians and those working in mental health, public health, long term care, and other support roles—reported often feeling burned out in 2022, up from 32% in 2018.2 A 2018 study found that 64% of participating dietitians report frequent or intense impostor syndrome, which is when high-achieving individuals with objective successes, fail to internalize their accomplishments and have persistent self-doubt and fear of being exposed as a fraud or impostor.3
“Supervision is an investment of time, energy, and often financial resources. And it can be one of the most worthwhile investments we can make in our personal and professional well-being,” Sutherland says. “When supervision is going well, we typically feel more energized, reinvigorated, and clear about our role, which I really believe can make a powerful contribution to burnout prevention and longevity in the profession.”
She says as her own career has progressed, supervision has become a nonnegotiable part of her work. “I consider it part self-care, part professional practice. It just feels incredibly rewarding to work with someone who ‘gets’ me, who I don’t need to explain myself to, and with whom I can stretch my edges and continue learning,” she says. “For me, it’s exciting to know that there’s no end point and that I can continue growing through supervision.”
Tips for Seeking Supervision
Sutherland says most supervisors will offer a discovery call where prospective clients can ask questions and get a sense of whether it’s a good match, which is something that she and Pearl both encourage. Sutherland also notes that finding the right supervisor is about much more than letters or credentials. “It’s about finding someone who has the combination of skills that would be most useful for you at your point in learning.”
She explains that dietitians should look for a supervisor who’s in supervision themselves, has done some training in supervision, and has solid skills in guiding reflective practice, which may include drawing on skills from motivational interviewing. “Dietitians will also want to be thinking about clinical skills, areas of specialty, and honestly someone who they’d like to spend time having good conversations with.”
Pearl and Sutherland train dietitians to become supervisors—or simply better supervisors—through their Elevating Dietetic Supervision workshops. “We believe supervision requires a unique skill set. One that has its own training, is maintained, and evolves with the profession,” Pearl says. “Supervision is much more comprehensive than mentoring or preceptorship. It has the learning and teaching piece, but it also has a very specific support and an accountability process. We would like to see benchmarks be codeveloped by practitioners in the field that would help to identify supervisors who have the skills and experience to elevate the field.”
— Carrie Dennett, MPH, RDN, is the nutrition columnist for The Seattle Times, owner of Nutrition By Carrie, and author of Healthy for Your Life: A Non-Diet Approach to Optimal Well-Being.
References
1. Carroll M. Effective Supervision for the Helping Professions. 2nd ed. Sage Publications Ltd; 2014.
2. Nigam JA, Barker RM, Cunningham TR, Swanson NG, Chosewood LC. Vital signs: health worker–perceived working conditions and symptoms of poor mental health — quality of worklife survey, United States, 2018–2022. MMWR Morb Mortal Wkly Rep. 2023;72:1197-1205.
3. Landry MJ, Bailey DA, Lee M, Van Gundy S, Ervin A. The impostor phenomenon in the nutrition and dietetics profession: an online cross-sectional survey. Int J Environ Res Public Health. 2022;19(9):5558.