Why Reflective Supervision Matters More Than Traditional Feedback

Why Reflective Supervision Builds Better Clinicians

After more than 30 years supervising OTs across paediatrics, community health, schools, and private practice, one truth has remained constant:

The clinicians who grow the fastest are not the ones who receive the most advice.
They are the ones who learn how to think.

This is echoed in the work of Donald Schön, whose foundational writing on reflective practice highlights that true professional growth comes from learning to analyse your own thinking, not simply following directions.

Reflective supervision shifts the focus from:

• fixing

• correcting

• giving answers

to:

• expanding insight

• strengthening reasoning

• increasing self-awareness

• building clinical identity
  

This is what leads to safe, confident, sustainable OT practice.

Why Feedback Alone Is Not Enough

Feedback answers the question:
“What should I do?”

Reflective supervision answers:
“How do I understand this situation, and why does it matter?”

Feedback is external.
Reflection is internal.

Feedback gives you tools.
Reflection teaches you when and why to use them.

This mirrors the developmental processes described by:

• Schön’s Reflective Practitioner model

• Porges’ Polyvagal Theory (understanding nervous system responses)

• Greenspan and Wieder’s DIR work (relational meaning-making)

• Ayres’ Sensory Integration Theory, showing how behaviour communicates the regulation state
  

Skilled therapists don’t just “do strategies” — they understand the mechanisms beneath behaviour.

The Three Core Competencies Reflective Supervision Builds

1. Behavioural Pattern Recognition

Clinical mastery requires learning to see what is not immediately visible.

Experienced clinicians learn to interpret:

• sensory cues

• emotional signals

• relational patterns

• interoceptive distress

• environmental demands

• parent-child interaction cycles
  

This aligns with work from Ayres (sensory processing), Porges (neuroception), and Schore (right-brain regulation).

Reflective supervision helps clinicians connect these dots.

2. Professional Identity and Clinical Confidence

The OTPF-4 (Occupational Therapy Practice Framework) emphasises professional identity as essential for ethical and effective practice.

Reflective supervision strengthens:

• values clarity

• boundaries

• caseload rhythm

• therapeutic use of self

• confidence in uncertainty
  

Many early-career therapists feel lost not because they lack skill, but because they lack a sense of who they are as clinicians.

Identity → confidence → sustainable practice.

3. Emotional Literacy and Self-Awareness

Co-regulation is central to paediatric therapy (Tronick, Porges, Perry).
Supervision helps OTs understand:

• their triggers

• transference and countertransference patterns

• emotional reactions in sessions

• their nervous system state

• moments that activated fear, shame, or confusion

This awareness is essential for ethical, attuned OT intervention.

A therapist who can regulate themselves can better support a child who cannot.

What Effective Reflective Supervision Looks Like

A high-quality reflective supervision session often includes:

• unpacking one small moment in detail

• linking behaviour to theory

• analysing both child and parent cues

• understanding the therapist’s internal response

• exploring developmental, sensory, relational, and environmental layers

• identifying a micro-skill to practise
  

This mirrors Schön’s “reflection-in-action” and is widely regarded as foundational for true professional mastery.

External Links

• Donald Schön’s Reflective Practice Overview
  https://infed.org/mobi/donald-schon-learning-reflection-change/

• The Polyvagal Theory (Stephen Porges)
  https://www.stephenporges.com/polyvagal-theory

• AOTA OT Practice Framework (OTPF-4)
  https://ajot.aota.org/article.aspx?articleid=2763042

• DIR Floortime Model
  https://www.icdl.com/dir

• Overview of Sensory Integration Theory (Ayres)
  https://www.spdstar.org/basic/understanding-sensory-integration

• Co-regulation and Development (Tronick)
  https://developingchild.harvard.edu/resources/aces-and-toxic-stress-frequently-asked-questions/

References

 Ayres, A. J. (1972). Sensory Integration and Learning Disorders.
Bronfenbrenner, U. (1979). The Ecology of Human Development.
Dunn, W. (1997). The Sensory Profile.
Greenspan, S., & Wieder, S. (2006). Engaging Autism.
Porges, S. W. (2011). The Polyvagal Theory.
Schön, D. A. (1983). The Reflective Practitioner.
Schore, A. (2003). Affect Dysregulation and Disorders of the Self.
Tronick, E. (1978). The Still Face Experiment.