AN UNAVOIDABLE TENSION BETWEEN HOLDING AND ASSESSING

Clinical Supervision in an Educational Setting:

Dr Pól Dominic McCann

navitas.comacap.edu.au

Background

After 2.5 years working in supervision at ACAP, the main tension noted is that of mentor vs monitor

Presentation is based on conversations with supervisors and supervisees

Elisabeth Shaw’s 2013 paper Mentoring or Monitoring which indicates that this is widespread across the workforce

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What is supervision?

Milne (2007) says is in neither therapy nor mentoring – but he takes a very positivist approach and how do you categorise such subjective interactions?

It’s not counselling – but some students will merge the two

Gilbert (2001, p. 200) claims it is naive to believe ‘the proposition that the practices of reflection and clinical supervision are separate and different from processes of surveillance’

Some supervisors say it never happens; others say it does but they contain and redirect; others say they are distinct but there is a need to acknowledge POTT which cannot come about without the student being aware of how their history intersects with their practice

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ACAP Supervision: Overarching Aims Support the supervisee development: personally and

professionally

Challenge blindspots, skill deficiencies

Evaluate competence, empathy, self-awareness

Gatekeeping: ensuring graduates are ready to practice competently and ethically (McCann 2015)

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The tension is not confined to ACAP

Gilbert (2001, p. 201) Workplace supervision can be managerial rather than reflective

The added impost for training supervisors is that we must assess. And we have the third hat of pedagogy

So setting up a contract early in the term: bracket off expectations for each section

Developing the steps along the way: first assessment needs to focus on skills, less on formulation and conceptualisation

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The tension is not confined to ACAP Larger US psych colleges report boundary issues in

supervision which create issues and influences in grading supervisees

APA Ethics Code (APA, 2010) Beneficence and nonmaleficence; fidelity and responsibility; integrity; justice; and respect for people’s rights and dignity

PACFA (2015) 3.1Ethical principles of Counselling and Psychotherapy 3.2.1 Fidelity 3.2.2 Autonomy 3.2.3 Beneficence 3.2.4 Non-maleficence 3.2.5 Justice 3.2.6 Self-respect

These all impact on education and training (Erickson Cornish 2014).

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What we see at ACAP

An academically strong student

A student with good skills

A student who seems to be aware….

…can all fall apart in supervision, despite gatekeeping at several stages

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Impression management

The tension of grading

How to deliver feedback

Power imbalances

Boundaries

Gatekeeping

Themes to consider

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Impression management and political suicide

Are supervisees going to withhold scenarios in which they may appear less competent? (Shaw 2015)

Supervisor comment: ‘I feel like I’m getting a really watered down version of what's going on for them.’ She tells them ‘if your skills aren't there I have to do something about that but I try and build as much safety as I can’, within a fraught set-up, for someone to bring their innermost inadequacies’

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The tension of being graded: Students many not present their weaker moments as they

want to show their best side

Students are assessed by pass/fail in relation to their skills

And yet it is actually a strength to show vulnerabilities

‘It’s about balancing opposites’

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The uses of feedback Supervision should use ‘corrective feedback on the

supervisee’s performance, teaching, collaborative goal setting’ (Milne 2007, p. 439)

Sometimes in group: Can be directed at all, or to one – but it is really directed (indirectly) at the most vulnerable. ‘It’s crucial to work with group dynamics…. I try to catch those teachable moments’

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If too directive… …does supervision risk losing the ability to foster

collaborative knowledge? (Shaw) Is collaboration only viable when there is a graduate-level degree of experience?

Supervisors note that these dynamics occur (generally less frequently) with their private clients: ‘yes but, there’s a reason…’ And there is a need to ask them to look at themselves first so even outside the educational setting, counselling is in the periphery

Students, need to demonstrate skills; private supervision is more about a fluid set of criteria. POTT is critical aspect to both.

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Delivering feedback ‘How does one carry out a monitoring function that

generates anxiety, when trying to maintain a respectful, collaborative arrangement?’ (Shaw 2013, p.302)

Supervisor asks how it felt to get feedback. Then puts it to one side – does not want to keep repeating. About professionalism, being able to move on. So she will have a private conversation if they are upset

The difficulty of this: ‘it’s a very subjective thing, how counsellors need to be, rather than what counsellors to be doing. An educational institute can only assess the doing. It can’t assess the being, because this is so subjective’

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Where to give feedback? ‘I try and keep feedback in the group, because if the group

miss some of the feedback you have given outside of it, they’re not quite on track with what transpired’

Must be aware of not shaming, especially for directive feedback. This may be delivered privately: Or a combination of both

‘[the marking criteria] brings structure to the subjectivity of supervision’

So while grading is seen as a negative in some contexts, the structure of grids assists by removing personality influences

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Boundaries Supervision should not blur into providing counselling of

supervisees. Asking for personal insight into a client case is not about asking for self-analysis (McCann 2015)

Brown, Murdoch and Abels (2014, p. 274) note that ”departure from commonly accepted clinical practice that may, at times, be beneficial to the client, and at other times, neutral or even harmful

Shaw (2014, p. 302) notes that ‘primitive feelings’ emerge and create reactions for supervisors and supervisee – and self-censoring follows

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Gatekeeping Is this the right time for you to do this degree?

Students note that it is harder in the field compared to role plays – so we don’t know how they will react until they get onto placement

Supervisors can identify students of concern about from year one: how do we ethically manage students at risk?

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Gatekeeping: Do they need counselling? Some said it never comes up; others said it will but they

contain and redirect quickly

How do you not assess POTT without examining the supervisee's back story – one noted that she not get drawn in: errs on these side of boundary but ‘I would be derelict of my duty not to address this’

Cites example of student who did placement where she had been volunteering for 2 years – fearful of going outside her boundary. So this was brought to the student’s attention

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Integrative Development Model: Level 1 Motivation and anxiety are high

Seeking structure and guidance in regards to the ‘best’ approach

High-self-focus but limited self-awareness

Apprehensive about being evaluated/judged

Limited autonomy – they need structure and warm guidance from supervisor: some direct challenge is required (Stoltenberg, McNeill & Delworth 1998)

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References American Psychological Association. (2010, June). Ethical principles of psychologists and code

of conduct. Retrieved from http://www.apa.org/ethics/code/ accessed 29 August 2016

Brown, C., Murdock, N. L., & Abels, A. (2014). Ethical issues associated with training in university counseling centres. Training and education in professional psychology, 8(4), 269-276.

Erickson Cornish, J. A. (2014). Ethical issues in education and training. Training And Education In Professional Psychology, 8(4), 197-200

Gilbert, T. (2001). Reflective practice and clinical supervision: meticulous rituals of the confessional. Journal Of Advanced Nursing, 36(2), 199-205. 2648.2001.01960.x

McCann, P.D. (2015). Professional Development Presentation for clinical supervisors, ACAP

Milne, D. (2007). An empirical definition of clinical supervision British Journal of Clinical Psychology, 2007, Vol.46(4), pp.437-447

PACFA Code of Ethics retried from: http://www.pacfa.org.au/wp-content/uploads/2014/04/Interim-Code-of-Ethics-2015.pdf accessed 11 August 2016

Stoltenberg, C.D., McNeill, B. and Delworth, U. (1998) IDM Supervision: An Integrated Developmental Model of Supervising Counselors and Therapists. San Francisco: Jossey-Bass

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Questions and feedback