Supervision Competency: Current Status and Future Trends

1. Supervision Competency: Current Status and Future Trends Presented at APPIC Membership Meeting, 2014 Carol Falender, Ph.D. www.cfalender.com

2. Current Status: Supervisors • Competence of the supervisor has been a “given” • Assumption that all supervisors ARE competent • Purely hierarchical supervision attenuates power differential with additive privilege of the supervisor • Feminist, humanist, psychodynamic, and and competency-based theorists have deconstructed the power differential and described a supervisory interpersonal, collaborative dialectic • Falender & Shafranske, 2004; Farber, 2010; Frawley-O’Dea & Sarnat, 2001; Porter & Vasquez, 1997)

3. Current Status: Supervisees • Competency-based replaces the implicit assumption of competence with explicit demonstration of competence • Since EPPP was never defined as a measure of competence (Schaffer, 2011), the task of ascertaining implicitly falls to the supervisor • Major focus has been on competence of the supervisee—tracking developmentally or at a fixed point • Supervisees receive no training or “role invocation” to be effective supervisees (Vespia et al., 2002; Falender & Shafranske, 2012)

4. Realities: Supervisor Competence • Emerging data on harmful supervision (e.g., Ellis et al., 2014) • Multiculturally incompetent supervision (e.g., Falender, Shafranske, & Falicov, 2014; Green & Dekkers, 2010; Jernigan et al., 2010; Singh & Chun 2010) • Power differential, privilege, oppression, and context diminish supervisee power

5. Momentum towards Competency-based Supervision • Supervisee Competence: • Benchmarks - Supervision • Fouad et al., 2009; Hatcher et al., 2013 • NCSPP Competencies –Management and Supervision • http://www.ncspp.info/DALof%20NCSPP%209-21-07.pdf • Training Trajectory • Health Service Psychology Blueprint (2013) • The Role of the Psychology Internship (D’Angelo, 2013) • Supervision • Board of Educational Affairs Supervision Guidelines • (In review, 2014)

6. Competency-based Supervision (2) • Across theories • (special issue edited by Farber & Kaslow, 2010 Psychotherapy: Theory, Research, Practice, Training • e.g., Psychodynamic, Cognitive, Humanistic, Family Systems • Internationally • e.g., Australia, U.K., New Zealand • (see Falender & Shafranske, 2014) • Process • Active and Experiential • (e.g., Bearman et al. 2013; Reiser & Milne, 2012)

7. Era of Competency-based Supervision and Training • Supervision as a distinct professional competency • What other aspect of psychology is practiced without specific training? • Consequence of lack of consensus on supervision as a distinct professional competency is a lack of supervision training and agreement on when training should occur • Ultimate result—no training until post-licensure if at all • When SHOULD training in supervision occur? • Accreditation standards—result in wide range of what comprises competence in supervision

8. Status of Supervision Training • Only about 40% of supervisees have received formal training in clinical supervision –content highly variable (electives, • >60 % among U.S. counseling grad students • About half of grad students report they received no coursework or no supervision training at all • About 60% of supervisors report they have had little or no supervision training

9. Most Pervasive Influence • When asked what is the major influence on your supervision experience—still the majority say their own personal experience of being supervised • Supervisees—Crook-Lyon et al., 2011 • This premise undermines the reality of supervision as a distinct professional competency Agreement that supervision is the major influence in development of the supervisee

10. Competency-based Supervision • Systematic, meta-theoretical approach addressing alliance, strains, diversity, personal factors, legal and ethical • Adoption of competencies frame and establishment of reliability among supervisors • Active, experiential process in supervision • Supervisee self-assesses and supervisor provides transparent ongoing assessment and feedback • Specific attention to strengths and areas in improvement—support and difficult discussions • Ongoing evaluation so it is never a surprise

11. Specific Goals and New Developments • Introduce (Draft) Guidelines for Supervision developed by the APA Board of Educational Affairs Task Force • Assist you in identifying specific steps and plans to take back to your setting regarding clinical supervision

12. Guidelines for Clinical Supervision in Health Service Psychology BEA Task Force of APA

13. Members of the Task Force Carol Falender, Chair; Beth Doll; Michael Ellis, Rodney K. Goodyear; Nadine Kaslow (liaison from the APA Board of Directors); Stephen McCutcheon; Marie Miville and; Celiane Rey-Casserly (liaison from BEA); APA Staff: Catherine Grus and Jan-Sheri Morris

14. Guidelines for Clinical Supervision in Health Service Psychologyaka Guidelines on Supervision (DRAFT) Health Service Psychology refers to: • “Psychologists are recognized as Health Service Providers if they are duly trained and experienced in the delivery of preventive, assessment, diagnostic and therapeutic intervention services relative to the psychological and physical health of consumers based on: 1) having completed scientific and professional training resulting in a doctoral degree in psychology; 2) having completed an internship and supervised experience in health care settings; and 3) having been licensed as psychologists at the independent practice level” (APA, 1996).

15. Health service psychology is inclusive of the specialties of clinical, counseling, and school psychology.

16. BEA Task Force Goal To capture optimal performance expectations for psychologists who supervise. It is based on the premise that supervisors a) strive to achieve competence in the provision of supervision and b) employ a competency-based, meta-theoretical approach to the supervision process. Competency-based and meta-theoretical refers to working within any theoretical or practice modality, systematically considering the growth of specific competencies in the development of competence.

17. Purpose • For supervisors, the Guidelines on Supervision provide a framework to inform the development of supervisors and to guide self-assessment regarding professional development needs. • For supervisees, the Guidelines on Supervision promote the delivery of competency-based supervision with the goal of supervisee competency development. • A goal of the Guidelines on Supervision is to provide assurance to regulators that supervision of students in education and training programs in health service psychology is provided with and places value on quality.

18. Guidelines Development: 2012-2014 • Task force convened March 2012 • Meetings via conference call late summer 2013 early spring 2013 • Reviewed relevant literature including guidelines from other organizations • Agreed on domains, prepared drafts • Face to face meeting May 2013 • Revised draft • Request for comments fall 2013 • Revised early 2014

19. Assumptions about Supervision • A distinct professional competency that requires formal education and training • Prioritizes the care of the client and the protection of the public • Focuses on the acquisition of competence by and the professional development of the supervisee • Requires supervisor competence in services being supervised • Is anchored in the evidence base related to supervision and the services being supervised • Occurs within a respectful and collaborative supervisory relationship • Entails responsibilities on the part of the supervisor and supervisee

20. Assumptions (2) • Intentionally infuses and integrates diversity in all aspects of professional practice • Is influenced by both professional and personal factors • Is conducted in adherence to ethical and legal standards • Uses a developmental and strengths based approach • Requires reflective practice and self assessment by the supervisor and supervisee • Incorporates bidirectional feedback • Includes evaluation of the supervisee’s acquisition of competencies • Serves a gatekeeping function for the profession • Is distinct from consultation, personal psychotherapy, and mentoring

21. Domains of the Supervision Guidelines Domain A: Supervisor Competence  Domain B: Diversity Domain C: Supervisory Relationship Domain D: Professionalism Domain E: Assessment/ Evaluation/ Feedback Domain F: Problems of Professional Competence Domain G: Ethical, Legal, and Regulatory Considerations

22. The Guidelines (DRAFT, 2014)

23. Supervisor Competence • Supervisors strive to be  competent  in  the psychological services provided to clients/patients by supervisees under their supervision and when supervising in areas in which they are less familiar they take reasonable steps to ensure the competence of their work and to protect others from harm. •  Supervisors seek to attain and maintain competence in the practice of supervision through formal education and training. • Supervisors endeavors to coordinate with other professionals responsible for the supervisee’s education and training to ensure communication and coordination of goals and expecatations. • Supervisors strive for diversity competence across populations and settings  (as defined in APA, 2003). • Supervisors using technology in supervision (including distance supervision), or when supervising care that incorporates technology, strive to be competent regarding its use.

24. Diversity • Supervisors strive to develop and maintain self-awareness regarding their diversity competence, which includes attitudes, knowledge, and skills. • Supervisors planfully strive to enhance their diversity competence to establish a respectful supervisory relationship and to facilitate the diversity competence of their supervisees. • Supervisors recognize the value of and pursue ongoing training in diversity competence as part of their professional development and life-long learning. • Supervisors aim to be knowledgeable about the effects of bias, prejudice, and stereotyping. When possible, supervisors model client/patient advocacy and model promoting change in organizations and communities in the best interest of their clients/patients. • Supervisors aspire to be familiar with the scholarly literature concerning diversity competence in supervision and training. Supervisors strive to be familiar with promising practices for navigating conflicts among personal and professional values in the interest of protecting the public.

25. Supervisory Relationship • Supervisors value and seek  to create and maintain a collaborative relationship that promotes the supervisees’ competence. •  Supervisors seek to specify the responsibilities and expectations of both parties in the supervisory relationship. Supervisors identify expected program competencies and performance standards, and assist the supervisee to formulate individual learning goals. • Supervisors aspire to review regularly the progress of the supervisee and the effectiveness of the supervisory relationship and address issues that arise.

26. Professionalism • Supervisors strive to model professionalism in their own comportment and interactions with others, and teach knowledge, skills, and attitudes associated with professionalism. • Supervisors are encouraged to provide ongoing formative and summative evaluation of supervisees’ progress toward meeting expectations for professionalism appropriate for each level of education and training.

27. Assessment/Evaluation/Feedback • Ideally, assessment, evaluation, and feedback  occur within a collaborative supervisory relationship. Supervisors promote openness and transparency in feedback and assessment, by anchoring such in the competency development  of the supervisee. • A major supervisory responsibility is monitoring and providing feedback on supervisee performance. Live observation or review of recorded sessions is the preferred procedure. • Supervisors aspire to provide feedback that is direct, clear, and timely, behaviorally anchored, responsive to supervisees’ reactions, and mindful of the impact on the supervisory relationship. • Supervisors recognize the value of and support supervisee skill in self-assessment of competence and incorporate supervisee self-assessment into the evaluation process. • Supervisors seek feedback from their supervisees and others about the quality of the supervision they offer, and incorporate that feedback to improve their supervisory competence.

28. Professional Competence Problems • Supervisors understand and adhere both to the supervisory contract and to program, institutional, and legal policies and procedures related to performance evaluations. Supervisors strive to address performance problems directly. • Supervisors strive to identify potential performance problems promptly, communicate these to the supervisee, and take steps to address these in a timely manner allowing for opportunities to effect change. • Supervisors are competent in developing and implementing plans to remediate performance problems. • Supervisors are mindful of their role as gatekeeper and take appropriate and ethical action in response to supervisee performance problems.

29. Ethics, Legal, and Regulatory Considerations • Supervisors model ethical practice and decision making and conduct themselves in accord with the APA ethical guidelines, guidelines of any other applicable professional organizations, and relevant federal, state, provincial, and other jurisdictional laws and regulations. • Supervisors uphold their primary ethical and legal obligation to protect the welfare of the client/patient. • Supervisors serve as gatekeepers to the profession. Gatekeeping entails assessing supervisees’ suitability to enter and remain in the field. • Supervisors provide informed clear information about the expectations for and parameters of supervision to supervisees preferable in  the  form of a written supervisory contract. • Supervisors to maintain accurate and timely documentation of supervisee performance related to expectations for competency and professional  development.

30. Association of State and Provincial Psychology Boards Supervision Guidelines • Regulatory guidelines to inform thinking and regulation regarding supervision by State and Provincial Psychology Boards • Personal communication, Steve DeMers, 2014

31. APPLICATIONS OF BEA Supervision guidelines

32. Clarita began supervision with Dr. Tullson in September. She was delighted that he described his high level of competence in areas of substance abuse, theoretical approaches, and the diagnoses of many of the clients in the setting , and outlined his various areas of specialty. After that they launched right into discussing cases, and after a month or so Clarita reflected that she was not clear about his expectations for her for supervision. She was unsure why he addresses her as “Clara”. Typically, each week she would plan the hour to ensure each of her five cases was addressed systematically, but she was finding he tended to prefer to stay on one case for the entire hour…and often asked that they continue on that case for several weeks. She had inquired whether there was a way to address other cases, but he said, “all in time” and urged her not to be impatient. The intensive case discussions were highly theoretical and abstract. At the beginning of the third month, Clarita told Dr. Tullson they must focus on the child case she was seeing as she was worried about whether criteria were met for child abuse reporting. DrTullson responded that Clara was very perseverative and he was wondering about her own diagnosis.

33. How Could the Guidelines be Useful? • What are strengths of Dr. Tullson’s supervision? • What areas appear neglected? What legal issues are raised? • How could the guidelines lead him to strengthen his supervision? • Be specific

34. Aaron is a very technically competent supervisee and wants to use monitoring devices with his depressed client and have them be sent to his iPhone App from the client—he also wants to use a professional Facebook page to interact with that client through a social network.—and he is exploring other internet features and Apps to treat depression. The supervisor uses a flip cellphone.

35. Reactions?

36. Jin is a practicum student at a Counseling Center. When he began he had an elaborate orientation and the director outlined the extremely large number of students waiting for services, the high suicide risk, and the balance of serving more students and meeting the needs of those seen through the limited number of sessions available—4 to 6. Jin has been at the setting for six weeks, receiving mostly crisis cases and this week he told his supervisor that he feels the setting is presenting him an ethical challenge akin to unethical behavior—that he feels to see clients for such a brief time is highly unethical and he cannot bring himself to do that. His supervisor is stymied.

37. Implementation In Your Setting? • Please consider specific steps you would like to take to move towards implementation of the Supervision Guidelines? • Focus on one or two of the Guidelines sections • Or • Focus on implementation of the Entire Guidelines

38. How Could The BEA Guidelines Be Useful In Your Setting? • Identify strengths and “bright spots” in supervision practice in your setting • Consider issues that are difficult relating to A. Supervisor competence and lack of such B. Potential harm inflicted on clients and supervisees C. Issues across domains

39. Questions • How will these guidelines be useful to you? • How would you encourage dissemination? • What additional resources would be helpful for implementation? • Additional issues/ comments?

40. Information For This Presentation Is Based Upon: • Guidelines for Clinical Supervision in Health Service Psychology • A competency-based framework for supervision • Written by the Task Force on Supervision Guidelines • Convened by the Board of Education Affairs • Public comment period has closed, and it is scheduled to come before Council in August for approval as policy