Supervision

1. Supervision Jerrold Lee Shapiro, Ph.D. Professor and Chairman Santa Clara University

2. Supervisees complaints – exercise what complaints do you/ did you have about supervision? What do your supervisees have?

3. Common complaints • lack of constructive feedback • supervisors' criticisms were unfounded or inappropriate • failure to bring up sticky issues for fear of retaliation or perception that supervisors cannot handle them • all responsibility for conflict resolution fell on the supervisee • insufficient time to develop any relationship because of institutional demands

4. Progressive shift in Supervision • Responsibility for maintaining a professional relationship with supervisee and all clients • Formal contract re model, objectives, evaluation methods of supervision • Relational issues such as boundaries, multi-cultural issues and dual relationships

5. Goals of SupervisionHaynes, Corey, Moulton (2003) • Promoting supervisee growth thru teaching • Protecting welfare of client • Monitoring performance; gatekeeping rehabilitating impaired professionals/ trainees • Empowering supervisee to self-supervise as an independent professional

6. Supervisory Roles • Teacher (assessment, diagnosis, ethics, therapeutic approaches, theory, legal issues • Mentor guide, coach for career goals • Consultant – finding solutions, best treatment, helping supervisee problem solve and come to resolution • Counselor – not formal therapist, but helping focus on blocks within supervisee, counter-transference issues, cope with stress • Sounding Board (i.e. Tarasoff, suicide, court, minors – may require direct intervention

7. Supervisory Roles (cont.) • Administration– Policies and procedures of the institution, documentation, assist with beaurocracy, adherence to licensing regulations • Evaluation: Info to licensing boards, graduate programs etc • Documentation confidential record of each session • Empowerer

8. Responsibilities • You are responsible ethically and legally for actions taken by supervisee (Vicarious liability) • You must know of every case supervisee is seeing even if in separate location • Provide ongoing feedback (strengths and weaknesses) verbal and formal written • Monitor actions and decisions

9. Responsibilities • Documentation of sessions • Stay within scope of expertise • Due process for performance evals and procedures • Written contract • Monitor personal professional development

10. Responsibilities • Model effective problem solving for supervisees • Promote ethical knowledge and behavior • Promote knowledge and skills required to understand and work effectively with clients • Educate regarding crucial ethical issues especially within managed care or other third party system

11. Supervision as Relationship Centered Just as for therapy, successful supervision impossible when relationship is inadequate

12. The core of the supervision is the relationship • According to studies by Bernard and Goodyear (1998) , Holloway (1995) , and Bradley and Ladany (2001), productive supervision cannot occur when the relationship is inadequate

13. Supervision that focuses on the interaction among client, therapist, andsupervisor makes use of what is occurring in both the therapist-client relationship and the therapist-supervisor relationship.This enables the trainee to use his or her own experience of emotional difficulties in receiving help from the supervisor to facilitate understanding of the client's situation.

14. Parallel Process • Transfer of treatment from supervisor thru supervisee to client and vice versa • So relationship between any pair affects other pair • If the supervisory relationship mirrors the client relationship, the same kind of rapport building may be beneficial for effective supervision.

15. Jenna has a client (Jason) who is described as passive aggressive Every intervention with Jason is questioned and homework not followed Jenna is increasingly frustrated and begins to question her ability as a therapist Jenna is supervised by Mary Jenna seems particularly resistent to following recommendations regarding Jason She claims that nothing will work Mary cannot seem to find a way to get Jenna to try harder and focus on Jason’s resistence Parallel Process

16. The stuck place Jenna cannot understand why Mary wants to look at the supervisory relationship, but is willing to try. Jenna begins to see where what’s happening in the supervision is a replication of her therapy relationship with Jason Jenna focuses on the therapeutic relationship in session with Jason. Resistence is diminished Mary focuses on what’s happening in the supervisory relationship Jenna and Mary explore the resistence in the supervisory relationship They begin to see Jenna’s resistence as an unconscious manifestation of Jason’s resistence As they work on the resistence directly, it begins to diminish Parallel Process – Using the Supervisory relationship

17. Supervisory sessions serve as an indirect model for therapy sessions Supervisors serve as a model for therapists

18. Supervision Techniques • Role Playing • Role reversals • Demonstrations • Socratic Questioning

19. A-V Techniques • Using Audio tapes • Using one-way mirror • video tapes • observational techniques • ear bugs and telephones

20. Responding to needs of supervisees • Varies with treatment characteristics, supervisee and clinical issues involved • adapted to developmental level of trainees

21. In therapy In supervision What do you do to enhance a strong working alliance? Why are there differences and which ones are appropriate?

22. Ongoing maintenance of thealliance should be the supervisor's responsibility What distinguishes supervisory and therapeutic alliance is the evaluative component

23. Even with all the changes Supervision remains part education and part therapy The Relationship is the core

24. Supervision is not therapy • Because of the different contract • primarily because of the evaluative component • Informed consent is crucial in that realm

25. Case Study • Barbara is supervising a group of MFT interns. • Jan brings in a case of a 14 year old pregnant girl whom she is working with to have the baby and put it up for adoption. • Two other interns strongly believe that Jan is getting her personal values and those of her client’s confused. Barbara believes that Jan is right and is very much opposed to abortion. • When another intern recommends that Jan explore abortion with her client, the supervision becomes very tense. Barbara closes down the discussion by saying that Jan is operation in the best interests of her client.

26. Case Study Toni is a student in a MFT program. She has lately been expressing dissatisfaction with the direction of her supervision. She claims that her supervision is all didactic. Her supervision is primarily describing what she does and listening to her supervisor give advice about what to do next. How might you respond as the supervisor to Toni’s complaints? Is her dissatisfaction more than resistance?

27. Case Study Jenny is in her first practicum setting. At the beginning she confesses to her supervisor that she may not be ready for this. As you discuss it with her, three things become evident: 1) She has low self esteem 2) She is most concerned about harm she might do by inexperience 3) As far as you can tell, she is as well prepared as the better graduate students with whom you have worked in the past. She wants you to make a decision as to what she should do

28. Case Study Bill in a new practicum student working with teens in a halfway house. He has recently seen a demonstration of EMDR and sees it as a way to really help the patients. As a supervisor, you think Bill is seriously underrestimating the pathology of his clients and you think the technique is dangerous. Bill thinks your reticence is holding him back What do you do?

29. Case Study Jackie is seeing a couple, working with them on communication skills with apparent progress. Then she gets a late night call from the wife saying that they had a “knock down drag out” fight and her husband has walked out. Jackie was able to ascertain that the wife slapped the husband before he left. Despite Jackie’s best professional efforts, neither of them seems willing to return to therapy. Jackie is feeling devastated and discouraged. How do you approach her?

30. Case Study Lupe is an experienced psychologist, who has been working for several years with minority clients. She is seeking your supervision because she has recently been seeing a family, whose values make her work ineffective. The family is Samoan and they use a great deal of corporal punishment with their children. They claim that it is the Samoan way of childrearing. Lupe believes that their “discipline” approaches physical abuse, but is reticent to violate cultural standards. How would you work with Lupe?

31. Case Study Mel, a licensed therapist with 5 years experience is running a group under your supervision. It becomes clear to you that he has several patients in the group who would best be diagnosed as “Borderline Personality Disorder.” He doesn’t seem to have a grasp on the effect of their pathology on the group process. What are your options and approaches?

32. Case Study You are working at a community agency. Most of the clients are of a different ethnic group than yourself. Recently your supervisees are of the same ethnic group as the clients. You get the feeling that they are loathe to take in your recommendations because they see themselves as more tuned in culturally to the clients. How do you deal with this?

33. Case Study As an experienced therapist, you have seen many female clients over the years. One group with whom you feel very comfortable is battered women. Recently, one of your supervisees began a group for new fathers at the local hospital. The issues that are emerging seem atypical in your experience. What is your best option?