WELCOME to THE GEORGIA SCHOOL : 2009 CLINICAL SUPERVISION ETHICAL PRACTICES SHELDON L. ROSENZWEIG, M.A., LPC, CCS,

1. WELCOME to THE GEORGIA SCHOOL : 2009CLINICAL SUPERVISION & ETHICAL PRACTICES SHELDON L. ROSENZWEIG, M.A., LPC, CCS, MLAP&CARL SHANTZIS, Ed.D., CSAPC

2. PURPOSE of This Track* is to: ENGAGE in the �supervisory conversation � ENHANCE knowledge & skill in the area of AODA Clinical Supervisors PREPARE those taking The IC&RC Written Exam LOWER test taking anxiety (*As developed by David Powell & endorsed by IC&RC,AODA,Inc.)

3. DISCLAIMER Completion of this training does not imply that you have obtained mastery of competencies needed for the position of Clinical Supervisor. Completion of this training does not imply that you are ready to successfully sit for the IC&RC,AODA, Inc. Clinical Supervisor written examination.

4. AGENDA: Welcome & Brief Introductions Housekeeping Ground Rules Expectations Game Plan Work Break Work Some More Feedback & EOT

5. WHO IS HERE? Who are you? How long have you been in this field? What are you doing now professionally? What else have you done professionally? How long have you been providing supervision? A quality of your least liked supervisor ? A quality of your most liked supervisor ? One of my supervisory �weaknesses� is� One of my supervisory �strengths� is�

6. Justification For Clinical Supervision Agencies are faced with challenges: Meeting financial; ethical; legal & credentialing requirements demands management. Sound business practices help �insure� quality treatment. Clinical supervision provides the supervisee a rich opportunity to develop professionally & personally. Clinical supervision improves morale, care & outcomes. Clinical responsibility is shared. Supervision provides the agency an effective way to monitor staff performance, behavior & professional growth. Supervisors have an ethical & legal responsibility to supervise. Our profession is constantly changing. Supervision is an avenue of communicating/monitoring the changes in our work. Ask participants to rank order these�from 1 =Most Important to 7 = Least Important Next take info back from group as to how they ranked eachAsk participants to rank order these�from 1 =Most Important to 7 = Least Important Next take info back from group as to how they ranked each

7. SHARED ETHICAL SUPERVISION ASSUMPTIONS The number one task of supervision is to protect client well being The supervisor is more experienced than the supervisee Staff performance is monitored through either indirect or direct observation YOU CAN OBSERVE A LOT JUST BY WATCHING

8. WHAT OUR FIELD LOOKS LIKE In 2003, there were 135,000 (estimated) CD workers� By 2010 Mental Health Workers could comprise 27% of the National Work Force The 26th �fastest growing field of employment �(Bureau of Labor Statistics) Mental Health Workers are approximately 5% of the National Work Force Majority of direct service staff is� female � 70% of new counselors Majority of management staff is� male Work force is 75% white. Private agencies have fewer minority staff than public agencies The main reason people enter the CD field was the challenge � it surely wasn't to get rich! Other reasons most often mentioned included personal recovery or family involvement in CD Dr. David Powell

9. MORE WHAT OUR FIELD LOOKS LIKE 75% of workforce is over 40 years of age Only 50 to 55% of direct service staff are CD credentialed The average reported case load was 29 20% of all work-time is reported as dedicated to paper work Annual turnover in management is almost 50% Counselors turn over their jobs every two years WHY?

10. DECREASING TURNOVER & INCREASING PROFESSIONAL CONTINUITY Improved, ongoing clinical supervision Greater job autonomy Better communication between management & staff Assistance with paperwork/paperwork reduction More & improved training programs for personnel Improved recognition & reward system for performance

11. Traits Of An Effective Supervisor Clinical knowledge, skills & experience Incorporates �Best Practices� Has been supervised & is currently supervised Professional education & training Good teaching, motivational & communication skills A desire to pass on knowledge & skills to others (passing the torch) A sense of humor, humility & balance in ones life Good helping skills, observation skills & affective qualities Ethically well grounded

12. More Traits Of An Effective Supervisor Ability to create an open, trusting atmosphere Respect among peers, colleagues & supervisees Good time management, executive & delegation skills Familiarity with legal & ethical issues, policies & procedures Cognitive & conceptual abilities Concern for the welfare of the client, the agency & ones community A non-threatening, non-authoritarian, diplomatic manner Decision making & problem solving skills Crisis management skills Could do another Rank Ordering or match these to their brainstormed listCould do another Rank Ordering or match these to their brainstormed list

13. THE FOUR A�s of Supervision� Available: open, receptive, trusting, non-threatening Accessible: easy to approach & speak with freely, there for you Able: knowledgeable & skilled Affable: pleasant, friendly, reassuring The road to success is always under construction

14. Traits of an (un)Effective Supervisor The most common supervisory weaknesses: Difficulty in exercising management authority Poor decision making Not giving constructive feedback Unable to advocate on behalf of staff Insufficient time allocated for staff needs (-) Personal qualities (rigid, loud, insensitive, overwhelmed, impatient, unrealistic) Lack of supervisory knowledge, skills & experience THE ROAD TO HELL IS PAVED WITH GOOD INTENTIONS

15. CLINICAL SUPERVISION MODELS Philosophical Model Reflects the Supervisors Therapeutic approach Generic or competency-based models A counselor � is a counselor �is a counselor Discipline-specific Models Defines the tasks & issues of supervision based upon the requirements of the clinician's discipline � Can an LPC supervise an MSW � etc.? Developmental Model Defines the stages through which a counselor develops skills Impacts the supervisory expectations & time spent supervising Talk about Tap 21 A as a road map Talk about Tap 21 A as a road map

16. THE BLENDED MODEL It�s what we call � eclectic! Is a disciplined process with a regular schedule & stated goals. Is a tutorial process � teaching the Supervisee � what they need to know. Has aspects of a therapeutic alliance between the Supervisor & the Supervisee � without the Supervisor becoming the Supervisee�s therapist. Recognizes Supervisee strengths & weaknesses. Provides the Supervisee with realistic support & the expectancy of eventual competency. Since all approaches appear to have equal effectiveness � it is important to match Supervisee needs with the approach chosen. Tap 21 ATap 21 A

17. The Blended Model of Clinical Supervision for the AODA Field The philosophical foundations of the Blended Model are: People can get better with the help of a guide 2. People do not always know what is best for them � there is something, particularly in addiction, called denial 3. The key to growth is a blending of insight/attitudinal & behavioral change in the right amounts � at the right time 4. Change is constant & inevitable 5. In counseling & supervision, the guide focuses on what is changeable, solutions vs. problems. We accomplish much more when we look forward to where the person wants to be. It is not necessary to know a great deal about the cause or function of an issue to resolve it. 7. There is more than one way to see the world & to do counseling

18. The Blended Model of Clinical Supervision for the AODA Field Philosophical foundations (continued): The aim of counseling & supervision must always be on whether it brings about desired change. If it does not � try something else. 9. We�re talking about you � not the client or the supervisee. YOU are the changing agent , as well as the agent of change ! People inherently know what is right for them, although they might be blinded to that by their current �false self�. But, all human beings have a �True self�,

19. SCAT Environmental Scan * Develop career paths for all levels of staff to encourage staff to view themselves as professionals Develop an executive management curricula to train the next generation supervisors, managers & leaders Focus on clinical supervisors Establish standards for in-service training & clinical supervision Develop standard guidelines for internships *Note� No mention of Supervisory Ethics!

20. RECOMMENDATIONS In 1974, Dr. Powell generated the following recommendations: 1. Clinical supervision training for managers & supervisors 2. Leadership development & successful planning for the next generation of leaders 3. A system of credentialing counselor training programs Development of credentialing systems for counselors & a career path for supervisory, clinical & management personnel in the field Failure of our profession to enact & insist on a commitment to training & developing qualified clinical & management personnel has put our profession at risk. With the creation of a Supervisory credential & examination the IC&RC began the long over-due process of enhancing our profession & our potential to better serve our clients.

21. RECOMMENDATIONS According to Powell, a multi-faceted approach is needed to address the lack of supervisory preparedness: 1. Increase emphasis on leadership & supervisory development Including an emphasis on credentialing managers & supervisors The Clinical Supervisor Credential needs to become the �gold standard� of/for the SA field 2. Training of clinical supervisors is needed based upon the development of consistent & standardized models for clinical supervision in SA practice Powell�s work is the foundation of this model 3. Create Accreditation standards for training & trainers Develop statewide systems of supervisory training & credentialing

22. HISTORY & OVERVIEW What is IC&RC ? Where did the Supervision Credential come from? What is the current status of the Clinical Supervision Credential? THE FUTURE AIN�T WHAT IT USED TO BE

23. CREDENTIALED CLINCIAL SUPERVISOR STANDARDS Credentialed as an AODA Counselor at the reciprocal level. Verification of 5 years (10,000 hours) of counseling experience as an AODA Counselor. Verification of 2 years (4,000 hours) of clinical supervisory experience in the AODA field. Verification of 30 hours of approved didactic training specific to clinical supervision. Submission of 3 references from individuals familiar with the applicant�s work as a clinical supervisor, one of whom must have supervised the candidate�s clinical supervision. Passing the written examination approved by IC&RC. IT�S NOT TOO FAR. IT JUST SEEMS LIKE IT IS.

24. EXAMINATION CONTENT 1 Counselor Development 36 mc?s/24% 2 Professional & Ethical Stndrds 30 mc?s/20% 3 Prgrm Devel & Qlity Assurance 18 mc?s/18% 4 Performance Evaluation 18 mc?s/18% 5 Administration 15 mc?s/10% 6 Treatment Knowledge 33 mc?s/22% Six Performance Domains 150 mc?s/100%

25. D I. COUNSELOR DEVELOPMENT:  9 TASKS (36?) Task 1 = 12 K & 12 S Task 2 = 9 K & 9 S Task 3 = 5 K & 5 S Task 4 = 7 K & 6 S Task 5 = 6 K & 10 S Task 6 = 7 K & 9 S Task 7 = 5 K & 6 S Task 8 = 4 K & 4 S Task 9 = 7 K & 7 S

26. D II. PROFESSIONAL & ETHICAL  STANDARDS: 16 TASKS (30?) Task 1 = 7 K & 5 S Task 2 = 7 K & 5 S Task 3 = 6 K & 3 S Task 4 = 8 K & 5 S Task 5 = 5 K 7 6 S Task 6 = 4 K & 2 S Task 7 = 6 K & 4 S Task 8 = 3 K & 3 S Task 9 = 7 K & 5 S Task 10 = 8 K & 4 S Task 11 = 5 K & 4 S Task 12 = 4 K & 3 S Task 13 = 7 K & 5 S Task 14 = 2 K & 3 S Task 15 = 5 K & 4 S Task 16 = 4 K & 3 S

27. D III. PROGRAM DEVELOPMENT & QA:  9 TASKS (18?) Task 1 = 5 K & 9 S Task 2 = 3 K & 4 S Task 3 = 6 K & 3 S Task 4 = 6 K & 3 S Task 5 = 7 K & 5 S Task 6 = 5 K & 9 S Task 7 = 5 K & 5 S Task 8 = 7 K & 11 S Task 9 = 8 K & 10 S

28. D IV. PERFORMANCE EVALUATION:  11 TASKS (18 ?) Task 1 = 6 K & 7 S Task 2 = 5 K & 3 S Task 3 = 6 K & 4 S Task 4 = 6 K & 7 S Task 5 = 3 K & 3 S Task 6 = 4 K & 5 S Task 7 = 4 K & 4 S Task 8 = 4 K & 5 S Task 9 = 3 K & 3 S Task 10 = 3 K & 3 S Task 11 = 3 K & 5 S

29. DV. ADMINISTRATION: 5 TASKS (15?) Task 1 = 7 K & 3 S Task 2 = 8 K & 5 S Task 3 = 10 K & 4 S Task 4 = 5 K & 5 S Task 5 = 11 K & 3 S

30. D VI. TREATMENT KNOWLEDGE:  6 TASKS (33?) Task 1 = 5 K & 5 S Task 2 = 5 K & 6 S Task 3 = 6 K & 3 S Task 4 = 5 K & 4 S Task 5 = 3 K & 3 S Task 6 = 3 K & 3 S

31. Preparing For The Exam Know Your Learning Style Relax� Don�t Plan-To-Cram Relax�Relax� Early on� Review the material, identify which Domains you think are your strengths, which Domains are your weakness Relax... Relax� Relax� Concentrate on your weak areas first Relax� Relax� Relax� Relax� Reserve time � As the test draws nearer� expand your study/prep to a complete review

32. Readying For The Written Exam Familiarize yourself with Multiple Choice Question Exams Keep in mind that the IC&RC exam is asking you for the BEST response. This is different than simply asking you to choose the CORRECT response Use the practice exams Purchase & read the Study Guide Set time aside� prioritize the time you set aside Don�t put off studying Getting an early start will help you to be �ready� Use your best studying & retention techniques� You know what works for you. Organize/Join a study group� You are not alone!!! Warning: Study Groups may involve bad eating habits! I DON�T WANT TO MAKE THE WRONG MISTAKE

33. How To Take An Examination Be rested. Don�t be hungry. Be positive. Arrive early, learn �the lay of the land� Listen carefully to & follow all instructions Look at/over the Test booklet Take a deep breath� Relax� Read slowly, carefully & completely. This is a professional exam, no one is trying to trick you. Read all the answers to every question Answer the questions you know you know first Don�t expect to know all the answers If you�ve studied, you are bound to know something Avoid Changing Answers. First choice is usually the correct choice, especially if you have studied. LEAVE NO QUESTIONS UNANSWERED! SLUMP? I AINT IN NO SLUMP. I JUST AINT HITTING.

34. Taking The Written Exam Use �the process of elimination�. Unsure of an answer� eliminate the choices that are obviously wrong & then make a reasonable choice. Leave no unanswered questions. There is no penalty for guessing. Don�t worry about your neighbors. Some one will finish before you. That is not a reflection of your knowledge or competence. It just means someone finished before you did. Be careful with your answer sheet. Only put down an answer when you are sure, otherwise write your choice on the test booklet & transfer it to the answer sheet after reviewing your choices. WHEN YOU COME TO THE FORK IN THE ROAD�TAKE IT

35. A TYPE # ONE ? What is the capital of South Dakota? A. Rapid City B. Bismarck C. Sioux Falls D. Pierre

36. A TYPE # TWO ? Both the development of and recovery from addiction depends upon: Biological factors Behavioral factors Bio-psychosocial factors Social contextual factors

37. JUSTIFICATION for CLINICAL SUPERVISION Without proper supervision there is risk that the following can/will happen: Supervisors can become a counselors therapist� blurring tasks & expectations Excessive familiarity can lead to boundary violations Judgementalism & authoritarianism by the supervisor Poor supervision as a counselor begets poor supervision as a promoted counselor Supervisor & counselor burnout High levels of staff turnover Confusion between clinical supervision & case management Have you ever had any of these problems?

38. STAGES of COUNSELOR DEVELOPMENT Level 1: Counselors in the field one to five years. Focused on basic skills Driven by anxiety & enthusiasm Looking for �cookbook answers� Can become dependent on their supervisor Tend to repeat client�s words verbatim Due to lack of knowledge they think anecdotally We like telling stories. Have difficulty with probing, confrontation & self-disclosure Or �they talk too much, probe when they shouldn�t & confront everybody! See the Supervisor as a role model �I ain�t no role model, I�m a basketball player.� Charles Barkley

39. STAGES of COUNSELOR DEVELOPMENT Level 1: They initially treat counseling as �painting-by-numbers� They �don�t know what they don�t know� & that can be very scary They like clients who look like them & often lack confidence stepping outside their own life style & culture They have been known to take on the client�s problems as their own They need structure & feedback They may have limited or grandiose self-awareness They struggle with termination of client issues They are afraid that the relapse will be on their shoulders

40. STAGES of COUNSELOR DEVELOPMENT Level 1: continued The Supervision Focus: Exposure them to other orientations, models Encourage autonomy, risk taking Introduce ambiguity Balance anxiety, support & uncertainty by using structure & consistency Assist in conceptualizing Give them control Practice, practice, practice with direct observation of their work Build on their strengths Learn how they learn, so you can learn how to teach them

41. STAGES of COUNSELOR DEVELOPMENT Level 2: They like the adolescents their development shadows� they will push the envelope. They will challenge the supervisor�s authority, competency & qualifications. They will be client focused� What do you mean one size doesn�t fit all? Their self-awareness will fluctuate. They can become frustrated with difficult clients. They want both autonomy & dependence on their terms!

42. STAGES of COUNSELOR DEVELOPMENT Level 2: continued The Supervision Focus: Create a caseload that has the obvious & the difficult clients. Blending is good. Focus less on technique & more on theory(s). Do not be �thin skinned�, and � maintain the �chain of command�. Seek to move supervision to more of a �consultation-type� relationship. Teach alternatives & encourage independence. Supervision also includes counter-transference issues� so it may look like therapy from time to time. Do Not�Do Not� Do Not� become a supervisee�s therapist

43. STAGES of COUNSELOR DEVELOPMENT Level 3: The folks we �love to supervise� They know their own limits They may have doubts, but their doubts are not disabling They have a style that they are comfortable with Their counseling style is internal & spiritual They understand & thrive on caseload diversity They are ethically well developed They are relatively stable

44. STAGES of COUNSELOR DEVELOPMENT Level 3: Continued The Supervision Focus: Be facilitative & supportive. Treat supervisee as a colleague. Be a sounding board� a safe room. Share experience & self-disclosure. Use wisdom as opposed to knowledge. Strive to stimulate & push the Level 3 Counselor to grow. If you are not a Level 3 Counselor� do not supervise a Level 3 Counselor.

45. STAGES of SUPERVISOR DEVELOPMENT Level 1 Supervisors: Can be mechanical & overly structured Wants to be seen as an �expert�. Is highly motivated Wants supervisee to use the supervisor�s model Has trouble with Level 2 Counselors ( laugh here) A Level 1 Supervisor & a Level 2 counselor � �leads to divorce�

46. STAGES of SUPERVISOR DEVELOPMENT Level 2 Supervisors: Has a mixture of insight, confusion, supportiveness, conflict, anger & can withdraw from a supervisee Gets frustrated easily. Does not have Level 3 patience. Can be less objective; they need �to be right� They outgrow it� but the pace is not predictable Best fit: Level 1 Counselors Manageable Fit: Level 2 Counselors

47. STAGES of SUPERVISOR DEVELOPMENT Level 3 Supervisor: Works autonomously Has a good �sense of self� & supervisee Sets boundaries & roles Has preferred therapists. Generally a Level 3 Supervisor has a preferred counselor group. Some only work with Level 1 counselors, some are only comfortable with Level 2 counselors. We want to know� Do you think this is HEALTHY???

48. What To Expect In Supervision A Supervisor obtains information on what a supervisee is doing through: INDIRECT METHODS Written & verbal records Forms, files (including time clock or similar reports) Observe how the counselor interacts with staff. Most good treatment systems have some type of feedback/evaluation forms Remember� feedback has to be a two-way street!

49. What To Expect In Supervision Direct Supervision Methods One-Way Mirror Audio or Video Recordings Joint Sessions, co-facilitation of sessions Bug In The Ear (yes� wired!) Bug In The Eye* ( the TV is set-up behind the client & the camera is on the supervisor �who cues the counselor ) *We have our doubts� this counselor would have to be a great actor/reader & signer!

50. TO INTERVENE OR NOT?�What�s A Supervisor To Do? When a clinical supervisor observes a session, especially �live�, there is a natural tendency to want to INTERVENE. Powell writes that his rule for intervention is clear: INTERVENE ONLY WHEN IT IS AN OBVIOUS TEACHING MOMENT�or� IF THE WELFARE OF THE CONSUMER IS AT RISK. Which begs the question: What if the counselor is at risk!!! BEFORE INTERVENING ASK THESE QUESTIONS: Urgency? Consequences of now vs later Probability of unprompted action? Will the counselor do the right thing? Will the counselor know why the intervention is taking place & how will they use the data provided? Will the intervention create undue dependence? (Level of Counselor 1,2 or 3?)

51. TO INTERVENE OR NOT?�WHAT�S A SUPERVISOR TO DO? What questions to ask (continued): Will the intervention skew the therapeutic event? Interventions should be limited to important moments. How many is too many�too few? Interventions should not minimize or undermine the credibility of the counselor being observed... Use positive language. The counselor should always be given �veto power� over the intervention from the supervisor� unless the session is truly destructive to the client.

52. THE BEST (?) METHODS OF SUPERVISION Munson (1999) ranked the most useful to the least useful methods of supervision, as practiced among social work supervisors. Here is what he found: Co-facilitation (this goes for group work also) �Bug In The Ear�(some agencies must have time & $) One Way Mirror Video Tapes Audio Tapes Process Recordings Case Discussion What about caseloads & time management? Does your work setting support quality supervision?

53. ADVANTAGES/DISADVATAGES of INDIVIDUAL SUPERVISION Advantages: Confidentiality is less likely to be compromised The counselor often feels safer & more comfortable There is more time to focus on the individual counselor The supervisory relationship is more likely to grow into one that is trusting, more honest & deeper. Disadvantages: Expensive & time consuming Increased chance of collusion between counselor & supervisor More chance that supervisor will overlook an issue or a problem Supervisor may only care about �their special agenda� Relationship can become too cozy, self-promoting Greater pressure on the supervisor when dealing with difficult counselors

54. ADVANTAGES/DISADVANTAGES of GROUP CLINICAL SUPERVISION Advantages: Economic use of time, money, expertise Decreases isolation among staff, learning others have difficult cases The group learns from each other Provides a wider range of experiences�mixes gender, age, race Provides opportunities for role playing, simulations & trying different strategies Disadvantages: Each counselor receives less individual time For new &/or intimidated counselors, group supervision can be scary Exposes shortcomings to a larger group, thus it can be very threatening Confidentiality can become a matter of concern Group supervision could look/sound like �a dysfunctional family�

55. CONTENT of CLINICAL SUPERVISION Supervision begins with basic �helping skills�: Attending, paraphrasing, summarizing, reflection of feelings & especially probing, confrontation & use of self disclosure in therapy Carl Rogers with Muscles!?! Affective qualities such as: empathy; genuineness; concreteness; & respect for clients Differential diagnosis skills�particularly regarding assessing co-occurring disorders Transference, counter-transference & counter resistance� Counter-transference is not harmful Key is to address counselor�s unresolved issues Understand what is a healthy/unhealthy response to a situation The key to counter transference is counselor self-understanding

56. PHYSICAL TOUCH IN COUNSELING The SA field, with it�s roots in �chummy, joyful anonymous groups� features lots of touching/hugging. As the SA field attracts more �non-recovering professionals� this issue has been/will be discussed & debated. The Bottom Line: If It Feels The Least Bit Uncomfortable�DON�T DO IT! If It Feels Comfortable�MAKE SURE YOU KNOW WHY! 59% of the CD counselors studied: hugged, kissed or affectionately touched their clients. Powell considers this a �startling & disturbing figure.� Lee Silverstein once said, �When we touch all of our patients the same, then we know it is therapeutically supportive.� Powell says this is a good rule to follow. A Tuscaloosa Psychiatrist was accused of �exploiting both male & female clients.� Do you think he touched them all the same way?

57. DISCLOSURE IN COUNSELING Do nothing in private that you wouldn�t do in public. Supervisor over sight: Self-Disclosure Rules: Counselor to Client. Does the counselor�s self-disclosure help the client? Has the client�s profile been considered when self-disclosing? Is there any current, unresolved issue(s) for the counselor? Has the counselor received informed consent from the client for this disclosure? (Isn�t Self-Disclosure Most Often Spontaneous?) What are the possible consequences of this self-disclosure? How often does the counselor self-disclose to clients? Aren�t AA, NA etc all about self-disclosure? How do we balance professional rigors with the foundations of our values, beliefs & traditions?

58. Physical Touch In Counseling Policies regarding touching by counselors should be clear. To achieve safety Touching should only be used sparingly & carefully As a form of greeting With the client�s permission As a therapeutic intervention, with clearly intended purposes When it meets client�s needs To establish trust It should be avoided if it raises difficult transference issues, if the client has a history of unresolved boundary issues (what about the counselors history?), or it creates either discomfort for the counselors &/or the client Does a supervisor ever suggest that a supervisee seek �help� to resolve issues like these?

59. Physical Touch In Counseling � To feel attraction is not unethical. Rather it is unethical not to address the attraction in supervision.� Pope & Bajt (1988) Studies of boundary & sexual violations in counseling have demonstrated a progressive pattern of behavior on the part of the counselor, from contact to eventual violation & sexual misconduct. It is the clinical supervisors obligation to watch for this pattern as it develops, & to intervene before a boundary violation occurs: As a supervisor are you prepared to discuss these issues? Counselor �neutrality� decreases� Sessions become more �social�� The client is treated as �special�� The counselor�s self disclosure increases� Gentle touch begins & leads to embrace�

60. Physical Touch In Counseling The counselor manipulates transference to build a strong bond with the client. The counselor may make statements such as� �Oh your spouse sounds like they are unresponsive to you. I am sure there are those who would be more responsive to you, especially someone as good looking as you are.� OR � Wasn�t it a lucky break that we got to sit together at the AA meeting last night? Sitting with you made that meeting special for me.� Do the participants have any similair tales to share?Do the participants have any similair tales to share?

61. Physical Touch In Counseling Extra Sessions Begin Sessions are scheduled at the end of the day & run longer� or a client�s �schedule� is accommodated & the counselor stays late & alone The counselor stops billing the client & the size of the notes shrink The counselor & client have social time together, begin openly dating It must be clearly understood that it is expected & required that counselors seek self understanding, insight & counseling for themselves as needed. Supervisors, armed with facts, are expected to talk about these issues. (Don't forget, sometimes people do fall in love!)

62. TOP REASONS FOR BEING SUED Sexual impropriety (20%) Incorrect Tx (14%) Breach of confidentiality (7%) Incorrect diagnosis (7%) Assorted others (over 50%)

63. Problems & Concerns In Supervision The goal of supervision is to help a person be a better worker not necessarily a better person. A Clinical Supervisor�s most important tasks are protecting the consumer & to ensure the highest quality of service delivery. You are not their therapist. If therapy &/or treatment is called for� it should be received at another agency.

64. Problems & Concerns In Supervision What a counselor does in their private life is none of your business unless it interferes in some way with client care or service delivery. Supervising often looks & sounds like therapy. Why not, isn�t it what you are? Your counselor skills will spill over. You are going to need to follow policy to� limit the spillage. Policy is your protection. Under what circumstances might supervision look like therapy? When harm may be done to a client, it is important for the Supervisor to assess the Counselor�s limits/blind spots in order to protect the client�s welfare & care.

65. Problems & Concerns in Supervision Supervision can look like therapy when a supervisee has transitory issues, impacting on the delivery of services. When the Supervisor teaches the Counselor emotional awareness & parallel processes. This according to Holloway. When events are so intense that it is impossible for the supervisor not to respond. Can you think of any such �intense events�? If you think you are �drifting into therapy�� always ask the following question: � What does this have to do with the client?�

66. Traits of an Effective Supervisor Powell�s Prerequisite traits: Clinical skills & competencies: Your clinical experience is the single most important qualification to be a supervisor. Powell�s advice: Always keep a caseload, it keeps you connected to staff & reminds them why you became a supervisor in the first place. Passion: Supervisors must remain passionate about what they do. Stay involved & committed: It will be inspirational for those you serve & supervise. Have fun, have friends, spend time with your family, exercise, eat well, nurture your spiritual life. Have things that you believe in and do these things with fire & urgency. Take risks in the pursuit of a fulfilled life. Martin Luther King Jr said , �Life without risk isn�t worth living.� You can always do better, don�t settle.

67. Traits Of An Effective Supervisor The strongest traits of a Supervisor ought to be: A willingness & ability to teach (& learn) Good communication & listening skills A sense of fairness Well organized Clinical skills

68. ORGANIZATIONAL RESPONSE Competent well thought of CLINICANS don�t necessarily make competent well thought of SUPERVISORS. Promotion to a supervisory position as a reward can be harmful to an agency, its staff & its clients. Pay clinicians because they are worth it, don�t assume that good clinicians will be good supervisors.

69. Training of Counselors Training should touch on, at a minimum, the following topics: The ability to appear compassionate Understanding the therapeutic alliance & forming it quickly Knowing how to decipher what the client wants Learning how to offer the consumer ways to find meaningful answers that will help them live as they were created to live. Some call this �purpose� How to identify which client needs 10 sessions, who needs 20 & how many need an anchor for a long-long-time Localized knowledge of the resources available in their home community Learning how to explain feelings & obstacles associated with change Learning to inspire the client to seek control of their life

70. Legal & Ethical Issues Earlier we discussed �physical touch�. That is one aspect of the legal & ethical issues that we face as Clinical Supervisors. Remember unethical � isn�t necessarily illegal. A Clinical Supervisor has legal liability for the actions of a Counselor under their supervision if � the Supervisor has the ability to initiate, change or terminate the treatment of the client. The supervisor therefore has a legal responsibility to make a �reasonable effort to supervise�, generally seen as 1 hour of documented supervision for every 20 hours of client contact . The key ethical legal issue faced in supervision is Respondent Superior, vicarious liability� which means the Supervisor may be held liable for damages occasioned by the negligence of a supervisee, solely as a result of the supervisory relationship.

71. DOCUMENTATION IF IT ISN�T IN WRITING� IT DOESN�T EXIST! Document No Less Than� WHEN you meet (date, time, amount of time) WHAT was discussed ( client issue, strategy, etc.) WHAT the supervisee is to do as next steps REMEDIES to problems WHEN will you meet again (follow up/follow thru) HAS Email & Internet impacted documentation?

72. Legal & Ethical Issues At every supervision session do you ask your counselor: Since our last meeting has anything happened that might put you in a different light with any clients/patients? Are there concerns you have about any of your clients/patients? Are any clients/patients dangerous or suicidal? Have you failed to maintain client/patient confidentiality in any way? Is there anything a client/patient shared with you that gives you �a duty to warn�?

73. Legal & Ethical Issues A Supervisor must: Have a clearly defined frequency of supervision, especially regarding high-risk cases Are You Available for Hallway Consultations? Have a consistent format for supervisees to describe & conceptualize problems Carefully review treatment plans, especially crisis management contingencies Document their feedback/directives & maintain a written summary of recommendations Directly observe the supervisee�s clinical & administrative work

74. Supervisory Competence Courts in particular have defined a �standard of care & practice in supervision� as a result of malpractice cases by accepting the testimony of experts in the field. Does the supervisor � have the skills to perform the requisite supervisory functions? make �an adequate effort� to supervise? �Adequate� is defined by the profession or discipline. Most often defined as 1 hour of supervision for every 20 hours of client contact or approximately 1 hour of supervision per week per full-time therapist & the agency have a formalized process for providing feedback & (ongoing) evaluations to counselors. teach the tenets & legal and ethical standards of the profession? maintain adequate documentation of the supervision of the supervision process?

75. Supervisory Competence Court rulings have pointed to several common legal & ethical errors that occur in supervision. Confusing supervision with �case management� Focusing on client�s needs rather than the Supervisee�s development Relying on the Supervisor�s clinical skills in supervision, thereby turning supervision into therapy with a Supervisee. Adopting a laissez-faire attitude with supervision, hence it occurring on a sporadic basis Conducting quasi-casual case conferences & crisis-management supervision Using one�s supervisory power inappropriately.

76. Supervisory Accountability The legal criterion for malpractice is a breach of duty, that is, of one�s fiduciary responsibility to protect the welfare of another. Although only two percent of psychotherapeutic malpractice claims in 1998 were due to a failure to supervise a counselor, there is growing concern that supervisors are to be held accountable for the actions of their supervisees. Vicarious liability occurs when damage to a client results from a dereliction in carrying out one�s supervisory responsibility for the supervisee�s work, from giving inappropriate advice to the supervisee to the detriment of the client from failing to listen carefully to the supervisee�s report about a client, or from assigning tasks to a counselor who was not up the demands of the task!

77. Supervisory Accountability Confidentiality & Its Limits: Breaches of confidentiality are one of the top 5 charges in successful lawsuits against psychotherapists. In Roe vs. the State Board of Psychology (1995) the court ruled that it was the Supervisor�s responsibility to train the Supervisee in the limits of confidentiality. Tarasoff vs. Regents of the University of California has been used as the standard for duty to warn. Pesce vs. J.Sterling Morton High School (1987) lays out guidelines for mandatory child abuse reporting. The 2003 implementation of the HIPPA standards established new guidelines that limit confidentiality. A competent supervisor is conversant in HIPPA!

78. Clinical Oversight: Dangerous Liaisons Court rulings have emphasized that supervisees must know: The qualifications of their Supervisor Critical patient information related to performance of their clinical duties The logistics of treatment Insurance reimbursement procedures Required record keeping The risks & benefits of alternatives to treatment

79. Clinical Oversight: Dangerous Liaisons Many courts have ruled that the Supervisor has the responsibility to oversee the counseling relationship between a Supervisee & a client. Ignorance of the nature of that relationship is no longer an acceptable excuse for a Supervisor. Monitor Supervisee�s cases The courts expect the Supervisor to confront the Supervisee about any allegations of impropriety Document recommendations & actions taken Supervisors must question client whenever feasible & clinically viable Place a critical incident report in the Supervisee�s file pending resolve Supervisors are expected to consult with colleagues Supervisors are expected to report the allegation to investigative services, state boards, & relevant ethics committees.

80. Clinical Oversight: Dangerous Liaisons Supervisors should meet the Supervisee�s clients whenever possible. Supervisors should have Supervisees review & sign the code of ethics of the counseling profession. Supervisors should regularly audiotape or videotape counseling sessions conducted by Supervisees & document all recommended actions. Direct observation of counselors in action is no longer a luxury.

81. Supervisory Contracting A contract between a Supervisor & a Counselor is strongly suggested. Indeed, as a guide to expectations contracting may help set the path of supervision: An individualized training plan for the Supervisee The schedule, format, duration, roles, responsibilities, goals & objectives of supervision Information on the Supervisor's training & model of supervision Emergency & crisis-management procedures, including the availability of 24/7 coverage in the event of a clinical emergency Clarification of roles of an academic supervisor (if any) A ratio of the number of clients to the number of supervision hours (see the 20 to 1 ratio) Formative, summary evaluations, disciplinary procedures, due process, rights of the supervisee & sanctions

82. Supervisee Selection, Assignments & Documentation It is imperative that the Supervisor protect the clients welfare by: Knowing the clinical competencies & limitations of their supervisees Assessing the complexity of client issues prior to assigning cases to a supervisee Determining whether the supervisee is adequately trained to assume the case Ensuring that the supervisee does not have too many cases to be able to provide proper services to clients Protecting the supervisee from having too many difficult-to-treat cases in their caseload Identifying & resolving learning & personal problems that may compromise the supervisee�s effectiveness Ensuring that there is sufficient supervision time for the cases assigned Have deep knowledge of the skills & history of the counselors hired

83. STUDY RESOURCES AVAILABLE from AADAA: Getting Ready To Test: Review/Preparation Manual for the Written Clinical Supervisor Exam Clinical Supervisor of Alcohol & Other Drug Abuse Counselors Role Delineation Study Addiction Counseling Competencies: the Knowledge, Skills & Attitudes of Professional Practice. Technical Assistance Pub (TAP) Series 21. DHHS Publication No. (SMA) 07-4243). 2006. Competencies for Substance Abuse Treatment Clinical Supervisors. TAP 21-A. DHHS Publication No. (SMA) 07-4243). 2007. CSAT Treatment Improvement Protocols (TIPS) www.kap.samhsa.gov/products/manuals/tips OPPORTUNITYISNOWHERE

84. DISCLAIMER Completion of this training does not imply that you have obtained mastery of the competencies needed for the position of Clinical Supervisor. Completion of this training does not imply that you are ready to successfully sit for the IC&RC,AODA, Inc. Clinical Supervisor written examination.

85. A FINAL WORD�OR THREE The exam is �an act of idealism�, developed by people just like you, who wrote questions about supervision as it should be. The contents of the exam is the foundation of our profession. The difference between your reality & the test�s assumptions can be frustrating & this may make studying & preparing difficult. STUDY FOR THE TEST � DO NOT DEBATE IT� YOU WILL LOOSE Immerse yourself in the �ideal�� sneak something you like into your daily practice � and as Powell says��TRUST YOUR SKILLS.� �and a very big THANK YOU for what you do! Sheldon L. Rosenzweig Carl Shantzis slrosenz@aol.com cshantzis@truvista.net

86. THAT�S ALL FOLKS!