Holding mind in mind: Building trust and reflection in NHS coaching supervision
By David Eaton, Service Manager, CAMHS & YoutherapY, Blackpool Teaching Hospitals NHS Foundation Trust; Executive Coach and Coaching Supervisor.
Introduction
Internal coaches in the NHS usually work inside the same organisation as the people they coach. This can create challenges because they are juggling more than one role, dealing with unclear boundaries, and needing to be especially careful about ethics (Passmore and McGoldrick, 2009). As St John-Brooks and Duncan (2026) point out, internal coaches must stay aware of organisational pressures, political issues, and hidden assumptions. Because of this, supervision that encourages reflection is essential to help them work ethically and effectively. Supervisors play an important role by helping coaches reflect on their work while also offering a safe space, emotional support, and help to manage pressure.
Mentalizing can help with these challenges. It is defined as ‘the capacity to understand behaviour in terms of underlying mental states such as thoughts, feelings, intentions and desires’ (Fonagy and Bateman, 2019). Coming from attachment theory and clinical psychology, mentalizing focuses on being curious about others, showing empathy, and accepting that we cannot always be certain. This article looks at how using a mentalizing approach in supervision for internal coaches can build trust, deepen reflection, and support the development of epistemic trust in NHS settings.
Mentalizing as a supervisory stance in NHS contexts
Mentalizing means paying attention not just to what people do, but also to what might be going on inside their minds, such as their thoughts and feelings (Allen, Fonagy and Bateman, 2008). In supervision, this involves looking beyond coaching techniques and results, and noticing the emotional and relational aspects that influence the work. For coaches in the NHS, where practice is shaped by hierarchy, safeguarding duties and experiences of moral distress, this approach allows space to reflect without jumping to quick judgements.
A supervisor using a mentalizing approach stays curious about the internal coach’s experience, while also being aware of their own thoughts and feelings. This two-way awareness helps to manage emotions and keeps supervision from becoming too focused on quick fixes or technical solutions, especially when there is pressure from the organisation.
Mentalizing and reflective depth
Mentalizing helps shift reflection from simply looking at what happened to understanding how meaning is created. First-order reflection focuses on actions and outcomes. For example, in NHS coaching supervision this might involve looking at how an internal coach responded to a distressed clinician or a hesitant leader.
Second-order reflection goes deeper. It explores what was happening underneath the situation, such as emotional triggers, assumptions about responsibility or authority, and the relational dynamics shaped by the wider system. Mentalizing supports this deeper level of reflection by encouraging curiosity about these underlying processes, rather than staying only with surface-level actions and results.
When internal coaches feel understood by their supervisor as people who think and feel, it helps them handle uncertainty and complexity more confidently. Being “mentalized” in this way makes it easier for them to stay open and curious, rather than feeling they need to prove their competence or defend their actions. This deeper level of reflection is particularly important in NHS settings, where pressure to act quickly can sometimes limit opportunities for learning.
Epistemic trust and psychological safety
Epistemic trust refers to an individual’s willingness to accept knowledge from another as trustworthy, relevant and personally meaningful (Fonagy et al., 2015). In internal coaching supervision, epistemic trust is closely connected to psychological safety, especially when supervisors and internal coaches are part of the same organisation. Worries about being judged, keeping things confidential, or overlapping roles can make coaches more cautious about what they share or accept, increasing what is known as epistemic vigilance.
A mentalizing approach in supervision helps build epistemic trust by showing humility about knowledge. Supervisors who speak in a tentative way, recognise uncertainty, and invite shared exploration demonstrate that learning is something done together, not imposed. Over time, this helps internal coaches feel more comfortable taking in feedback and strengthens their ability to reflect on and develop their own coaching practice.
Rupture, repair and containment
Trust in supervision can change and be easily disrupted, especially in high-pressure NHS settings. A mentalizing approach helps supervisors notice when reflection starts to break down, for example, when thinking becomes fixed, blame emerges, or there is a quick move into problem solving. When these moments are acknowledged and explored together, it helps repair the relationship and strengthens the supervisory alliance.
This connects with Bion’s (1962) idea of containment, which is the supervisor’s ability to take in emotional experiences, process them, and return them in a way that can be understood and thought about. Mentalizing is the relational process that makes this possible, helping supervisors and coaches work with emotions in a thoughtful and manageable way.
Examples of mentalizing in the supervisor relationship
The following examples show how a mentalizing approach might sound in supervision conversations. They demonstrate how supervisors can help coaches reflect on their own thoughts and feelings, question their assumptions, and develop a deeper, more balanced understanding of relationships and interactions.
Challenges to mentalizing
Mentalizing is not without its challenges. It can become too focused on thinking and analysis if not enough attention is paid to emotions and the quality of the relationship. Supervisors may also slip into assuming they understand what the supervisee is thinking or feeling, which can limit open and shared exploration. Because of this, a mentalizing approach requires supervisors to stay curious and to accept a level of not-knowing about the supervisee’s inner experience.
At the same time, mentalizing needs to be balanced with an awareness of the wider system. Without this, there is a risk of seeing problems as purely individual, when they may be shaped by organisational factors. Holding both perspectives helps supervision stay focused not only on thoughts and feelings, but also on the broader organisational and relational context influencing the supervisee’s experience.
Conclusion
Mentalizing offers a strong relational approach for supervision in internal coaching within the NHS. By building trust, supporting openness to learning, and encouraging deeper reflection, it helps internal coaches work both ethically and effectively in complex systems. As both a way of being and an ongoing practice, mentalizing allows supervision to become a space where uncertainty can be tolerated, learning can continue over time, and people feel understood and held in mind.
References
- Allen, J.G., Fonagy, P. and Bateman, A.W. (2008) Mentalizing in clinical practice. Washington, DC: American Psychiatric Publishing.
- Bateman, A. and Fonagy, P. (2016) Handbook of mentalizing in mental health practice. Washington, DC: American Psychiatric Publishing.
- Bion, W.R. (1962) Learning from experience. London: Heinemann.
- Fonagy, P. and Bateman, A. (2019) Mentalization-based treatment for personality disorders: A practical guide. Oxford: Oxford University Press.
- Fonagy, P., Luyten, P., Allison, E. and Campbell, C. (2015) ‘Mentalizing, epistemic trust and the phenomenology of psychotherapy’, Psychopathology, 48(4), pp. 253–262.
- Hawkins, P. and Shohet, R. (2012) Supervision in the helping professions. 4th edn. Maidenhead: Open University Press.
- Passmore, J. and McGoldrick, S. (2009) ‘Supervision, reflection and reflective practice in coaching’, The Coaching Psychologist, 5(2), pp. 83–88.
- St John-Brooks, K and Duncan J (2026) Internal Coaching: The Inside Story. 2nd edn. London: Routledge.