Supervision of novice counsellors

1. Supervision of novice counsellors Amy Marco, M.C., CCC Erin Musick-Neily, M.C., R. Psych May 7th, 2014

2. Introductions • Who we are • Who you are 

3. Show of hands! • Who in this room has experienced good supervision? • What made it good? The experience of good supervision has a lasting impact on us as professionals (Orlinksy, Botermans, & Ronnestad, 2001). It is a relational experience and one that shapes us personally and professionally.

4. What we’re going to talk about today: • Why talk about supervision and new/novice counsellors? • Defining supervision • Counselling practicums • Common presenting issues • Developmental model • Mirroring process • Unique challenges • Tips for interns and new counsellors • How supervision can help/tips for supervisors • Questions

5. Why Talk about supervision? • Supervision plays a critical role in the preparation of future mental health professionals • Two central purposes: • To foster the supervisee’s professional development (a supportive and educational function) • To ensure client welfare (the supervisor as a gate keeper to the profession) (Bernard & Goodyear; Bornsheuer) ETHICS! Good supervision contributes to the future of the profession and supporting the development of competent and ethical professionals This relates to competency and also public accountability (Rodolfa et al., 2005).

6. Supervision: a definition • Many conceptualizations and models of supervision • We are not suggesting a cookie cutter approach but will outline a model that can be applied for supervisors to consider • Two main categories of supervision: developmental and administrative • Developmental supervision focuses on training/education/mentorship • Administrative supervision focuses more on management as a function Canadian Psychological Association; Starr

7. definitions • The Mutual Recognition Agreement (2001, p.10) defines supervision as: “A kind of management that involves responsibility for the services provided under one’s supervision and may involve teaching in the context of a relationship focused on developing or enhancing the competence of the person being supervised. Supervision is the preferred vehicle for the integration of practice, theory, and research, with the supervisor as role model” (Canadian Psychological Association, 2001).

8. DEFINITIONS • Bernard & Goodyear (2009) offer the following definition: “Supervision is an intervention provided by a more senior member of the profession to a more junior member or members of the same profession. This relationship: • Is evaluative and hierarchal • Extends over time, and • Has the simultaneous purposes of enhancing the professional functioning of the more junior person(s); monitoring the quality of professional services offered to the clients that she, he or they see; and serving as a gatekeeper for those who are to enter the particular profession.” (p. 7).

9. Qualities of a good supervisor • It is erroneous to assume that all good counsellors make good supervisors. • They are unique and distinct processes, that have some shared characteristics. (Scott, Ingram, Vitanza, & Smith, 2000) • Specialized training in supervision is recommended in order to engage in the process ethically and competently • (Bernard & Goodyear, 2009)

10. CounsellOR TRAINING • Master’s level or Doctorate level of education in a related field (psychology, social work etc.) • Require specific number of hours at counselling practicum site • Specific direct and indirect client hours • Specific number of supervision hours • Observation and shadowing • Carry own client caseload • PD activities and seminars • Work with clients is supervised • Present own client work

11. Clients commonly assigned to interns/novice counsellors • Most common: depression, anxiety, stress, academic concerns, transitions/adjustment, relationship issues • Less common for practicum students or new counsellors to see: complex trauma, couples/family counselling, Axis II diagnoses • Note: sometimes other issues present themselves part-way through counselling, such as trauma, so practicum students do end up working with these issues at times So one role of the supervisor would be to manage these types of issues so that new counsellors are not overwhelmed or taking on presenting concerns they are not equipped to deal with.

12. Integrated Developmental model (Stoltenberg, McNeill & Delworth (1998) LEVEL 1 – SUPERVISEE • Exhibits high anxiety • Exhibits high motivation • Is dependent on supervisor • Focuses predominately on the self, particularly on performance or technique or following of guidelines (cookbook) • Is fearful of evaluation (Falender & Shafranske, 2004, p. 12)

13. Integrated Developmental model (Stoltenberg, McNeill & Delworth (1998) LEVEL 1 – SUPERVISOR Should: • Be supportive & prescriptive • Provide structure and positive feedback • Minimal direct confrontation • Have the supervisee work with only mildly distressed clients • Institute observation and role play • Emphasize and encourage conceptualization, skill acquisition and development, self monitoring of skill development, and attention to the client response to intervention (Falender & Shafranske, 2004, p. 12)

14. Integrated Developmental model (Stoltenberg, McNeill & Delworth (1998) LEVEL 2 – SUPERVISEE • “Trial and tribulation” period • Experiences dependency-autonomy conflicts • Fluctuates in confidence and motivation • Shifts focus to the client with increased empathy • Links mood to success with clients • Increased understanding of own limitations • Uses therapeutic self in interventions • Uneven theoretical and conceptual integration • Sensitive and anxious re: evaluation (Falender & Shafranske, 2004, p. 12)

15. Integrated Developmental model (Stoltenberg, McNeill & Delworth (1998) LEVEL 2 – SUPERVISOR • Balances autonomy with support and structure • Works to increase autonomy and confidence in the supervisee • Introduces and considers countertransference • Deals with self, defensiveness, transference, affect and the supervisory relationship • Articulates theory and conceptual framing • Challenges supervisee to increase self awareness • Helps the supervisee identify and understand strengths and weaknesses • Accepts de-idealization of him/herself • Monitors use of videotaping and live observation • Encourages multiple theoretical conceptualizations (Falender & Shafranske, 2004, p. 12)

16. Integrated Developmental model (Stoltenberg, McNeill & Delworth (1998) LEVEL 3 – SUPERVISEE • “Calm after the storm” • Stable motivation • Secure in autonomy • Focuses on client, self and process • Professional identity at the core of his or her treatment • Is not disabled by remaining doubts • Accepts strengths and weaknesses (high level of insight) • Exhibits high empathy and understanding • Uses the therapeutic self in interventions • Integrates client information, personal responses, theoretical information and empirical information • May find it a challenge to be flexible in approach • Has accurate empathy • Addresses areas of weakness with increased confidence and non-defensiveness (Falender & Shafranske, 2004, p. 13)

17. Integrated Developmental model (Stoltenberg, McNeill & Delworth (1998) LEVEL 3 – SUPERVISOR • Assesses consistency in performance and works towards integration • Emphasizes autonomy and growth • Less structure and less intrusive • Engages in confrontation • Devotes attention to parallel process, countertransference, and the supervisory relationship • Encourages self discovery and insight in the supervisee • Encourages experimentation and exploration • Provides advice re: job searches and professional development (Falender & Shafranske, 2004, p. 12)

18. Parallel Process • The process in therapy (between counsellor and client) is mirrored in the supervisory relationship • Supervisee awareness of the similarities in both relationships (client/counsellor & supervisor/supervisee) = benefits for therapeutic relationship • Increased understanding of client • Learn to respond to clients in same/similar way that their supervisor responds to them Russell et al. as cited in Bernard & Goodyear, 2009; Starr, 2014

19. transference IN SUPERVISION • Transference – can be positive or negative (for example, supervisee views supervisor as more critical than they actually are (from their own internal self-criticalness) or supervisee idealizes supervisor which is important in early stages • Other examples: the supervisor becomes the critical parent, the nurturing parent, the dismissive spouse etc. Allphin as cited in Bernard & Goodyear; Lewis as cited in Bernard & Goodyear, 2009

20. Transference in counselling for new counsellors • Positive or negative • Examples where Intern/Novice Counsellor: • Is idealized by client • Is viewed as inferior • Is viewed as a peer

21. Countertransference in supervision • One of the main tasks of supervision is to address countertransference in the supervisory relationship • Very strong feelings can arise in supervision for both supervisor and supervisee • Sources of countertransference: • Supervisee’s interpersonal style, supervisor’s own unresolved personal issues, supervisor’s personality characteristics; nature of learning and teaching Falender & Shafranske, 2004; Omand, 2010

22. Countertransference clients • Examples: • Viewing client as more intelligent/ capable; • Viewing client as peer (feelings of friendship or romantic attraction) • Feeling threatened or intimidated by client (academically or otherwise) • Viewing client as partner, spouse, friend, etc. • Over identification with client (similar age, experiences, schooling) resulting in non-therapeutic discussion

23. Resistance in supervision Resistance in supervisees may occur when: • There is lack of trust in the supervisory relationship • Parallel processes interferes • Disagreement about supervision tasks and goals • Supervisor is too directive • Personality clashes/traits Bernard & Goodyear, 2009

24. Unique challenges for novice counsellors • Clients with very high intellectual/academic abilities • Increased complexity of client issues (i.e. Cairns et al., 2010) • Lack of resources—not enough counselling staff to respond to large numbers of clients • A mismatch between the type of supervision offered and the type of supervision that is needed (one paint brush)

25. Stages in therapy de Rivera (1992) outlines four stages of individual therapy: • Commitment -Mutual goals, client motivation, client-counsellor match • Process -Identify problem(s), gain clarity • Change -Relapse prevention, applying tools, making and maintaining changes • Termination -Develop independence in client, therapeutic gains maintained on own

26. The mirroring process • The stages of individual therapy in part mirror the stages of development in supervision • Stage 1: Commitment • Mirrors Level 1 of IDM • Relationship development • Mutual goals

27. The mirroring process • Stage 2: Process • Mirrors Level 2 of IDM • Naming of transference and countertransference in supervision • Intern/Novice counsellor makes gains • Self awareness – role of self in therapeutic process

28. Mirroring process • Stages 3 and 4 mirror IDM Level 3 • Stage 3: Change • Integrating knowledge and skills, increased autonomy and independence, intern more self directed • Stage 4: Termination • The ending of the internship, moving forward with acquired knowledge and skills

29. Good supervision • Strong working alliance • Guidance that matches developmental level • Encourage supervisees how to arrive at solutions • Assist in managing all experiences, especially uncertainty • Don’t provide therapy by proxy • Set boundaries -Omand, 2010; Rousmaniere, 2013; Starr, 2014

30. “Bad” supervision Haynes et al. (2003) outlines these 10 qualities of inadequate supervision: • Lack of interest • Lack of availability • Rigid approach • Lack of knowledge and experience • Lack of reliability • Irregular feedback • Overly critical approach • Lack of empathy • Lack of organization (no structure) • Lack of professional ethics

31. Broadening vs. narrowing • Power (equality vs. differential) Power differential Egalitarian approach • Challenge and support Both are needed – it’s a delicate balance • Structure (engagement, roles and boundaries) • “Supervisees experienced narrowing when they perceived that (a) the feedback was overly critical without being contextualized, (b) the theoretical stance of the supervisor was inflexible, and (c) they were indiscriminately treated as apprentices” (Gazzola& Thériault, 2007)

32. Tips for interns & new counsellors • Honesty • Read and use resources • Patience • Self care • Consult • Openness • Personal counselling • Boundaries • Ethics, ethics, ethics!

33. TIPS FOR supervisors • Be approachable and open • Team work approach • Don’t supervise from a place of power • Keep current • Consider additional training specific to supervision • Supervise with intention • Name transference and counter-transference as issues in supervision • Ensure appropriate monitoring throughout (of notes, videos etc.) • Encourage self care, balance, outside therapy in supervisees (be mindful of dual roles – be the supervisor, not the supervisee’s counsellor)

34. Questions?

35. contact Erin Musick-Neily, M.C., R. Psych Registered Psychologist – Lethbridge Counselling Services (private practice) counsellorerin@gmail.com Amy Marco, M.C. Counsellor – Alberta Health Services Email: amysmarco@gmail.com

36. References Bernard, J.M., & Goodyear, R.K. (2009). Fundamentals of clinical supervision (4th ed.). New Jersey: Pearson. Cairns, S.L., Massfeller, H.F., & Deeth, S.C.(2010). Why do postsecondary students seek counselling? Canadian Journal of Counselling, 44, 34-50. Canadian Psychological Association (2009). Ethical guidelines for supervision in psychology: Teaching, research, practice, and administration. Retrieved from http://www.cpa.ca/cpasite/userfiles/Documents/Su pervisionGuidelinesfinal25Jan09.pdf Casey, D.A. (2007). Students with psychological disabilities in allied health sciences programs: Enhancing access and retention. In J.L. Higbee, D.B. Lundell, I.M. Duranczyk (Eds.). Diversity and the Postsecondary Experience. Retrieved from http://www.cehd.umn.edu/crdeul/docs/monograph/Diversity.pdf de Rivera, J.L.G. (1992). The stages of psychotherapy. European Journal of Psychiatry, 6, 51-58. Falender, C.A. & Shafranske, E.P. (2004). Clinical supervision: A competency-based approach. Washington, DC: American Psychological Association. Gozzala, N., & Thériault, A. (2007). Relational themes in counselling supervision: Broadening and narrowing processes. Canadian Journal of Counselling, 41, 228-243.

37. references Haynes, R., Corey, G., & Moulton, P. (2003). Clinical Supervision in the Helping Professions: A Practical Guide. Pacific Grove, CA: Brooks/Cole Thompson. Orlinsky, D. E., Botermans, J. F., & Rønnestad, M. H. (2001). Towards an empirically-grounded model of psychotherapy training: Five thousand therapists rate influences on their development. Australian Psychologist, 36, 139–148. Rodolfa, E., Eisman, E., Rehm, L., Bent, R., Nelson, P., & Ritchie, P. (2005). A cube model for competency development: Implications for Psychology Educations and Regulators. Professional Psychology: Research & Practice, 36, 347-354. Ronnestad, M.H., & Skovholt, T.M. (1993). Supervision of beginning and advanced graduate students of counseling and psychotherapy. Journal of Counseling and Development, 71, 396-405. Scott, K. J., Ingram, K. M., Vitanza, S. A., & Smith, N. G. (2000). Training in supervision: A survey of current practices. Counseling Psychologist, 28, 403–422.