Supervision Models Part I: How We Support and Care for Clinical Staff

1. Supervision Models Part I: How We Support and Care for Clinical Staff Bart Andrews, PhD CAPA Training Institute June 23, 2014

2. Developmental Models • There are 3 stages of supervisor and supervisee development: • Stage 1- Naïve Enthusiasm • Stage 2- Trials and Tribulations • Stage 3- Calm after the Storm • Lets take a look at how these stages apply to my preparation.

3. Naïve Enthusiasm

4. Trials and Tribulations

5. Calm after Storm

6. Credit Where Credit Due “Powell is the man!”- David Patterson, June 17, 2014 BTW-why are there so many awesome Davids?

7. Understanding Change • 30% of change is related to quality of relationship between client and counselor and/or counselor and supervisor • 40% from extratherapeutic factors • 15% is derived from hope/expectancy • 15% specific to therapeutic technique

8. Relationship Drives EVERYTHING • Better Clinical Supervision = Greater Job Satisfaction • Better Clinical Supervision = Better Retention • Better Clinical Supervision = Better Clinical Outcomes “ . . .counselors view their supervisors as a primary resource for education, training, coaching, morale building and consultation,” (Powell and Brodsky, 2004).

9. The 4 ‘A’s’ of Supervision • Available • Accessible • Able • Affable Good supervision is largely a matter of caring for staff and mutually beneficial interdependency

10. Care Experiences • What care have you received from a supervisor? • What has a supervisor said (or not said) that has had the biggest impact on you? • What has a supervisor done (or not done) that has had the biggest impact on you?

11. So What is a Model of Supervision?

12. Philosophy Continuum Insight: Process, Goals, Traits Skill: Processes, Goals, Traits Acquiring new behaviors Action is the catalyst Problem resolution Symptom relief Skill development Problem oriented Directive Therapist Driven • Experimentation • Exploration • Discovery • Interpretation • Self Development • Life Enrichment • Self Awareness • Facilitative • Client Driven

13. 9 Descriptive Dimensions • Influential: Affective Vs Cognitive • Symbolic: Latent Vs Manifest • Structural: Reactive Vs Proactive • Replicative: Parallel Vs Discrete • Counselor TX: Related Vs Unrelated • Information Gathering: Indirect Vs Direct • Jurisdictional: Therapist Vs Supervisor • Relationship: Facilitative Vs Hierarchical • Strategy: Theory Vs Technique STAGES OF DEVELOPMENT ALWAYS RELEVANT

14. Psychodynamic Model • Focus on the intrapersonal and interpersonal dynamics of the counselor in relation to ALL others • Dynamic Awareness Goal: understanding dynamic contingencies: • Impact of past learning on current situations • Observing changes in the dynamic • Making therapeutic use of dynamic in counseling • Goal is to refine supervisee’s mode of listening • Increase sensitivity to transference and countertransference • Awareness of drives and defense mechanisms

15. Assumptions • Similarities in structure and dynamics of therapy and supervision- ISOMORPHIC RELATIONSHIPS • Parallel processes between relationships • Supervisor interprets this dynamic • What is said and done is just the surface

16. Supervisor Kkills(sorry, Freudian slip) I meant Skills • Listening • Musing • Suspension of judgment • Tolerance for ambiguity • Rejection of illusion • Think confession for therapists!

17. Developmental Stages • Childhood • Space to play, home base • Bonding • Demarcating space • Adolescence • Structure building • Work and play-experimentation • Conflict • Adult • Internalized values • Identity settles • Transition to colleague

18. Descriptive Dimensions-Psychodynamic • Influential: Affective • Symbolic: Latent • Structural: Reactive • Replicative: Parallel • Counselor TX: Related • Information Gathering: Indirect+ • Jurisdictional: Therapist+ • Relationship: Facilitative • Strategy: Theory+

19. Skills Model 3 Basic Tenets • Counselors must learn the appropriate skills and extinguish inappropriate behaviors • Supervision assists counselors in developing and assimilating specific skills • Counselor knowledge and skills should be formulated in behavioral terms

20. 9 Methods of Skill Supervision • Establishing a Relationship between supervisee and supervisor is a dynamic component of the learning process • Focus is on skill acquisition via instruction and modelling • Supervision begins by asking what one needs to lean to be an effective counselor • Current skill level? What skills are needed? Task list? • Set realistic, measurable and timely goals to enhance motivation • Is this reminding anyone of SMART goals and MI?

21. Methods Continued • Modeling and reinforcement are basic tools • Two way modeling: supervisor to supervisee and back again • Skills monitoring is ongoing

22. Methods Continued • Role Playing and Simulation • Microtraining-breaking down skills into small steps • Simulated session that is video taped • Supervisor provides feedback and re-demonstrates on tape • Other Techniques are added • Self management • Overt and covert stimulus control • Relaxation Training • Generalization of Skills • In what other situations might you use . . .

23. Task Oriented Model

24. Taking Supervision to Task • Drawn from behavioral and computer science models • Behavioral variables are manipulated to influence outcome of supervision • By reinforcing the variables of counselor behavior, supervisor can train more effective counselors • Not specific to any theoretical models • Tasks and reinforcement/shaping can be applied to specific skills for whatever model or technique an agency is using

25. Direct Observation • Direct viewing of work is key • Modeling, feedback and programmed interventions • Using live material for supervision

26. Hierarchical System/3 Levels/Parallel Activity Client level • Client database-what is going on with me • Client comes with set of hopes/goals • Make goals overt • Establish treatment plan • Put treatment in place • Goals met • Termination

27. Counselor Level • Preparation • Establish client data base/evaluation-what is going on with client • Determine goals • Develop treatment plans • Carry out treatment plans • Evaluate progress • Goals met • Termination procedures

28. Supervisor Level • Supervisor and Client Database-what is going on with them? • Supervisor preparation task • Determine supervisee’s preparation task • Determine Supervision goals • Supervision Plan • Determine Assessment Procedures • Determine Observation Procedures • Present Supervision Plan • Observe Therapist • Observe Delivery • Observe Impact • Evaluate and Intervene • Case file and assessment results • Interview with Counselor • Determining Counselor Progress • Update counselor database • Determine need for additional training/supervision • End Supervision

29. Developmental Stages-Skills • Apprentice • Motivated • Inwardly insecure/anxious • Eager to please • Journeyman • Demonstrates some skill • Some challenging behavior • Starting to generalize • Expert • Able to generalize across contexts • Mastered technical skills • Integrated personal model of therapy

30. Descriptive Dimensions-Skills • Influential: Cognitive • Symbolic: Manifest • Structural: Proactive • Replicative: Discrete • Counselor TX: Unrelated • Information Gathering: Direct • Jurisdictional: Supervisor • Relationship: Hierarchical • Strategy: Technique

31. Descriptive Dimensions, Really? DynamicSkill • Influential: Affective Cognitive • Symbolic: Latent Manifest • Structural: Reactive Proactive • Replicative: Parallel Discrete • Counselor TX: Related Unrelated • Information Gathering: Indirect+ Direct • Jurisdictional: Therapist+ Supervisor • Relationship: Facilitative Hierarchical • Strategy: Theory+ Technique

32. What’s Next: Blended Model • Blended Model acknowledges that substance use providers need their own model • Also called contemplative because it includes spiritual and faith based elements • Recognizes that successful supervision BLENDS both insight and skill based models • Philosophical model is evidence based AND consistent with substance use professionals training and agency goals COMING SOON TO A CAPA NEAR YOU