One Head, Many Hats: The Clinical Supervisor

1. Jennifer Smith, LPC Central Virginia Community Services October 5, 2011 One Head, Many Hats: The Clinical Supervisor

2. Goals of the Presentation 1. Increase knowledge about clinical supervision practice. 2. Increase knowledge about ethical, legal, and professional identity issues as a clinical supervisor. 3. Develop a professional development plan which includes practicing according to a supervisory theory.

3. Definitions of Supervision �Supervision is a disciplined, tutorial process wherein principles are transformed into practical skills, with four overlapping foci: administrative, evaluative, clinical, and supportive� (Powell & Brodsky, 2004) �Supervision is an intervention provided by a senior member of a profession to a more junior member or members.. This relationship is evaluative, 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 of those who are to enter the particular profession� (Bernard & Goodyear, 2004)

4. Functions of a Clinical Supervisor Teacher Consultant (Bernard and Goodyear) Coach Mentor/Role Model

5. Small Group Discussion With regard to your experience as a supervisee, describe a positive supervisory experience. 1. What behaviors/statements of the supervisor made it a positive experience? 2. What was your role in having it be a positive experience? 3. What difference did the experience make in your work with clients? With the supervisory relationship? With regard to your experience as a supervisee, describe a negative supervisory experience. 1. What behaviors/statements of the supervisor made it a negative experience? 2. What was your role in having it be a negative experience? 3. What difference did the experience make in your work with clients? With the supervisory relationship? How did what you needed in supervision change over time?

6. Central Principles of Clinical Supervision 1. Clinical supervision is an essential part of all clinical programs. 2. Clinical supervision enhances staff retention and morale. 3. Every clinician, regardless of skill and experience, needs and has a right to clinical supervision. In addition, supervisors need and have a right to supervision of their supervision.

7. Central Principles - continued 4. Clinical supervision needs the full support of agency administrators. 5. The supervisory relationship is the crucible in which the ethical practice is developed and reinforced.

8. Central Principles of Clinical Supervision - Continued 6. Clinical supervision is a skill in and of itself that has to be developed. 7. Clinical supervision in substance abuse treatment most often requires balancing administrative and clinical supervision tasks. 8. Culture and other contextual variables influence the supervision process; supervisors need to continually strive for cultural competence.

9. Central Principles - continued 9. Successful implementation of EBPs requires ongoing supervision. 10. Supervisors have the responsibility to be the gatekeepers for the profession. 11. Clinical supervision should involve direct observation methods.

10. Models of Clinical Supervision Competency-based models Treatment-based supervision models/Orientation-specific models Developmental models Integrated models

11. Psychotherapy-Based Supervision Models Psychodynamic Approach to Supervision (Frawley-O�Dea & Sarnat, 2001) Cognitive-Behavioral Supervision (Rosenbarum & Ronen, 1998) Person-Centered Supervision (Freeman, 1992; Tudor & Worrall, 2004) Psychotherapy �based approaches to supervision are rooted in the major theoretical schools of counseling Tends to be the supervisor�s theory of psychotherapy and counseling

12. Psychotherapy-Based Supervision Difference between supervision and therapy (Bernard, 1992) � Supervision is more educational (instructional and evaluative) then therapeutic Strengths of Psychotherapy-Based Supervision- Acknowledges interpersonal dynamics in the supervisory and counseling relationships Emphasizes the supervisory working alliance Described as a relational bond because of the shared goals and tasks (Bordin, 1979; 1983)

13. Strengths (continued) Behavioral approach utilizes: Modeling Role-playing Feedback Reinforcement Individualized goal-setting and Evaluation

14. Limitations Client safety could be jeopardized when training needs are emphasized over skill assessment and monitoring of client cases (Davenport, 1992) Overemphasis on supervisees� personal insight and the possible blurring of supervision and counseling (Bradley & Gould, 2001) Behavioral approach might emphasize skill acquisition while the supervisee as a person is ignored; limit or ignore the importance of affect and cognitions Cognitive approach might overemphasize thought patterns, fail to pay attention to feelings Person-centered approach while providing the supervisee with warmth and empathy, may leave little room for incorporating instruction and evaluation (Pearce, 2006)

15. Small Group Exercise Pair up with a partner and use the Cognitive-Behavioral Supervision approach with the following scenario: Supervisee completed his/her graduate work about a year ago and is employed by a local behavioral healthcare agency. This agency uses a CBT approach for working with substance abusing adults and adolescents. Your supervisee is struggling with how to get his clients to participate in role-plays during the counseling session, as the supervisee feels uncomfortable himself/herself with role-play. Supervisor � you are trained and certified in the CBT model�you are meeting with the supervisee during your weekly supervision meeting and this issue surfaces�

16. Developmental Models of Supervision Integrated Development Model (Stoltenberg, McNeill & Delworth, 1998) See handout

17. Friedman and Kaslow (1986) 6 Stages of Counselor Development Stage 1: Excitement and Anticipatory Anxiety Stage 2: Dependency and Identification Stage 3: Activity and Continued Dependency Stage 4: Exuberance and Taking Charge Stage 5: Identity and Independence Stage 6: Calm and Collegiality

18. Stage 1: Excitement and Anticipatory Anxiety Occurs before the supervisee actually begins seeing clients Overwhelmed by sense of awe Distressed by the duties and tasks that lie ahead As the supervisor you can: Reassure through the orientation process e.g. rules, regs, expectations Explore how it feels to be supervised Recall past good/bad supervisory experiences Present yourself as a reliable, credible, supportive resource

19. Stage 2: Dependency and Identification Period of high dependency Supervisee lacks a professional identity i.e. feels like a fraud Fears founded on their apparent lack of skill and experience Idealizes the supervisor Supervisees often adopt supervisor�s style and attitude Mimics the supervisor�s familiar phrases Supervisor is inundated in �how to� questions Fearful about being told they did something wrong Afraid of appearing foolish or na�ve Hides fears and mistakes

20. Supervisor�s Role in Stage 2 Warm and supportive without encouraging dependency Openly discusses her personal trials in the beginning Shares issues common to all new counselors (normalizes) Anticipates and plans strategies for predictable crises Screens out difficult clients Explains the role of constructive criticism in counselor development

21. Stage 3: Activity and Continued Dependency Counselor fluctuates between proficiency and dependency Clients have accepted the counselor as their counselor Frightens the counselor i.e. responsibility and emerging identity Counselor functions more independently Over and underestimates his/her abilities Struggling with case conceptualization and treatment planning Embarrassed to admit that she still needs help after all the training she has received

22. Supervisor in Stage 3 Frustrating time of uneven progress i.e. spurts of excellence following by simple mistakes May erroneously assume majority of work is done May underestimate potential dependency needs of the counselor

23. Stage 4: Exuberance and Taking Charge Finally counselor �buys in� Children and families start to improve as a result of her care Counselor discovers that counseling really works Formal training (theoretical) and work training (on the job) are integrated Time of more autonomy with the counselor and less bonding with the supervisor

24. Counselor in Stage 4 Begins to develop his/her style Recognizes counter-transference issues May enter into personal counseling during this period Develops rapport with clients Presents genuine empathy Fear is gone

25. Supervisor in Stage 4 Encourages independent thinking Gives supervisees opportunities to explore their strengths, creativity, potential Encourages supervisee to examine limitations Validates counselor�s emerging professional identity Furthers opportunities for professional development Recognizes that the counselor has not seen and done it all Frames all problems as normal development and dismisses importance

26. Stage 5: Identity and Independence Viewed as �professional adolescence� Time of separation and conflict with supervisor Counselor becomes too assertive and opinionated Supervisee: Bases decisions of her �clinical judgment� and internalized frame of reference May withhold information and seek peer consultation Begins to believe that her skills surpass the supervisor�s abilities in some ways Views her supervisor as �fallen from grace� or favored status

27. Supervisor in Stage5 Difficult time professionally Has to reinforce counselor�s developing autonomy Lacks critical information about the clients and is ultimately responsible for all the counselor�s decisions Reinforces the individuation process and affirms competence Is patient and non-defensive

28. Stage 6: Calm and Collegiality Supervisee�s rebelliousness subsides Counselor freely demonstrates the skills and abilities and.. Becomes a colleague Pursues supervision as a logical step in professional development May seek additional supervision as well Understands personal limitations and Addresses limitations through internal and external training opportunities Has developed and can rely on his/her professional style of counseling

29. Developmental Models of Supervision Ronnestad and Skovholt�s Model � 14 themes of counselor development Professional development involves an increasing higher-order integration of the professional self and the personal self. The focus of functioning shifts dramatically over time from internal to external to internal.

30. 14 Themes - Continued Continuous reflection is a prerequisite for optimal learning and professional development at all levels of experience. An intensive commitment to learn propels the developmental process

31. 14 Themes - Continued The cognitive map changes: Beginning practitioners rely on external expertise, seasoned practitioners rely on internal expertise. Professional development is long, slow, continuous process that can also be erratic. Professional development is a life-long process.

32. 14 Themes - Continued Many beginning practitioners experience much anxiety in their professional work. Over time, anxiety is mastered by most. Clients serve as a major source of influence and serve as primary teachers.

33. 14 Themes - Continued 10. Personal life influences professional functioning and development throughout the professional life span. Interpersonal sources of influence propel professional development more than �impersonal� sources of influence. New members of the field view professional elders and graduate training with strong affective reactions.

34. 14 Themes - Continued 13. Extensive experience with suffering contributes to heightened recognition, acceptance and appreciation of human variability. 14. For the practitioner there is a realignment from self as hero to client as hero.

35. Integrative Models of Supervision Technical eclecticism Bernard�s Discrimination Model Systems Approach

36. Discrimination Model (Bernard, 1997) Central assumption: Focus should be on the supervisee in the action of counseling Addresses 3 broad areas of supervisee development 1. Conceptual understanding 2. Mastery of intervention skills 3. Inter- and Intrapersonal dynamics

37. Discrimination Model (continued) Atheoretical and based on technical eclecticism Can be used effectively with different theories and models of therapy 3 Foci of Supervision and 3 Supervisor Roles

38. Foci of Supervision Intervention Skills Pertains to what the supervisor can observe the supervisee doing in the session Addresses the supervisee�s ability to skillfully deliver interventions e.g. pacing, engagement, empathy, etc. Conceptualization Skills How does the supervisee understand what it occurring in the session? Are patterns identified? How are interventions chosen? Personalization Skills Addresses the supervisee�s uniqueness as a counselor e.g. integration of personality, humor, culture, sensitivity to others, etc.

39. Supervisor Roles Teacher Teaching of skills, techniques, evaluating supervisee Counselor Role Facilitate trainee exploration of inter- and intrapersonal dynamics (feelings, worries, confidence level, etc.) Consultant Role Supervisee shares responsibility for learning and supervisor serves as a resource *Each role is used within each of the 3 foci. Maintain flexibility and resist habitual use of one role.

40. Group Supervision Types of Groups Staff Meetings Training Groups Peer Supervision Group Clinical Consultation Group Clinical Supervision

41. Advantages and Disadvantages Benefits Economy of time, money, expertise Vicarious learning Diversity of perspectives Emotional support/shared language between supervisees Increased comprehensive picture of supervisee Normalization of supervisee�s experiences Limitations Decreased 1:1 attention Confidentiality Group dynamics e.g. competition, scapegoating can hinder learning Inclusion of activities/techniques that appeal to most members Bernard and Goodyear (2009)

42. Group Supervision: A Conceptual Model Supervisor Style Authoritarian (supervision in the group, not with it) Participative (active group member) Cooperative (supervisor as facilitator) Stages of Group Development Forming (increasing comfort levels) Storming (power issues, competitiveness) Norming (what is expected of group members; initial, established structure monitored by supervisor) Performing (productive stage) Adjourning (evaluation)

43. Forming Contract? (minimizes potential role conflict and ambiguity) Frequency of meetings Attendance Manner of case presentations (supervisor present first?) Performing View case from various theoretical orientations Role play case with members taking on roles such as client, counselor, etc.