clinical supervision primer for counselors and psychotherapists 2004-05© dr. jeffrey k. edwards...

Clinical SupervisionClinical SupervisionPrimerPrimer

for Counselors and for Counselors and PsychotherapistsPsychotherapists

2004-05©2004-05©

Dr. Jeffrey K. EdwardsProfessor

Family Counseling ProgramDepartment of Counselor Education

Northeastern Illinois University773-442-5541

The objectives of this course are to The objectives of this course are to help the participant: help the participant:

Acquire knowledge of supervision process Acquire knowledge of supervision process and skills from multiple domains and and skills from multiple domains and perspectives;perspectives;

Acquire knowledge of: the characteristics Acquire knowledge of: the characteristics of good and poor supervision;of good and poor supervision;

COURSE OBJECTIVESCOURSE OBJECTIVES

ObjectivesObjectives

Understand the three domains of clinical Understand the three domains of clinical supervision;supervision;

Understand the developmental stages of Understand the developmental stages of supervisees and appropriate supervision of supervisees and appropriate supervision of each;each;

Understand the developmental stages of Understand the developmental stages of becoming a clinical supervisor and what to becoming a clinical supervisor and what to expect of oneself during each stage;expect of oneself during each stage;

ObjectivesObjectives Understand the importance of practicing Understand the importance of practicing

ethical clinical supervision;ethical clinical supervision; Be familiar with several supervision Be familiar with several supervision

formats and methods;formats and methods; Learn how to help in developing self-Learn how to help in developing self-

sufficiency, self-efficacy and personal sufficiency, self-efficacy and personal agency of supervisees;agency of supervisees;

Reasons to study SupervisionReasons to study Supervision A study of 20,000 exit interviews found the

number one reason people leave jobs is "poor supervisory behavior." In other words: a bad boss!! Do you feel comfortable with your prospective boss' interpersonal and management style? Do you feel comfortable with your own? More important, how well do either of you serve as a mentor? Are you or your boss capable and interested in their/your growth? Will you or he or she make sure those under them/you have the training and resources to get the job done? Both you and your supervisees want a supervisor who is committed to success!

Psychotherapy Supervisor Psychotherapy Supervisor Development Scale*Development Scale*

Please circle the number that best describes how frequently you feel that each item describes you:

1 2 3 4 5 6 7___________________________________________________

never half the time always

My personal My personal experiencesexperiences

Who I am. Where I’ve been. How I’ve been trained. What I presently believe and practice

regarding clinical supervision.

Overview of Supervision: Overview of Supervision: Clinical Supervision started Clinical Supervision started

with with Psychoanalysis and the

medical model Watch one, do one, teach one Management and training.

Which one fits? Allen Hess, (1980) Psychotherapy

Supervision: Theory, Research and Practice. NY: Wiley

Supervision is......

From your point of view.

A Supervisor is...A Supervisor is...

In charge..? Responsible ? Knowledgeable ? Caring ? Evaluative? Sets goals?

Participants’ experience Participants’ experience with supervisionwith supervision

Good Supervision is: Bad Supervision is:

A Supervisor is...A Supervisor is...

Trainer or Instructor Consultant Counselor

Supervisor Domains

Discrimination Model. (Bernard, 1979).

Principles of ConsultationPrinciples of Consultation

A Triadic relationship (focuses on a third party) that may be an individual, organization,or a group within an organization.

It is not therapy! Consultants may be internal or external.

3. Counselor/therapist3. Counselor/therapist

Original clinical supervision – analysis Dealing with interface issues (transference

issues) What problems arise with this one??

– Informed consent– Possible dual relationship

Person of the Therapist Supervision.

Psychotherapy supervision is Psychotherapy supervision is important because it:important because it:

Provides supervisee with feedback from someone who is supposed to have more experience, and is objective.

Offers them guidance as to how to proceed when they are stuck;

Provides them with alternative views of the situation;

Psychotherapy supervision is Psychotherapy supervision is important because:important because:

Provides them with suggestions of case dynamics, treatment options, and gives them a “secure base” (Watkins, 2001) from which to operate.

Provides a quality control regarding care.

Theories of SupervisionTheories of Supervision

Developmental - Stoltenberg & Delworth, Systemic - Liddle, Bruenlin & Schwartz, Person of the therapist supervision - Aponte or

Atkinson Wu-wei - Edwards & Chen. But by and large there is NO universal theory of

supervision. Instead, the different models of counseling use

there own theory base, so......

Theories of SupervisionTheories of Supervision

Client centered supervisors stress empathy, and modeling

Cognitive supervisors stress cognition Systemic supervisors stress systems Etc., etc., etc!!

Heath & Storm Heath & Storm

Supervisors need to prove their usefulness to those they supervise, if they are to be effective - respect for those they supervisee.

Use your theory of Cx, and your theory of Supervision.

Strategies, Models and Strategies, Models and TechniquesTechniques

Interpersonal Process Recall Review of taped interviews

– Supervisor listens and provides feedback later

– Supervisor and Supervisee both listen to selected sections.

Review of Video tapes Live supervision either by one way mirror, televised

observation, or by supervisor sitting in on sessions. Group Supervision Peer supervision

All forms Counseling/Psychotherapy All forms Counseling/Psychotherapy supervision, however, seems to have supervision, however, seems to have

some similarities:some similarities:

An intervention that is provided by a senior member of a profession to a junior member or members of that same profession. This relationship is evaluative, extends over time, and has the simultaneous purposes of enhancing the professional functioning of the junior member(s), monitoring the quality of professional services offered to the clients she, he, or they see(s), and serving as a gatekeeper for those who are entering the particular profession. (Bernard and Goodyear, 1992, p.4)

All forms Counseling/Psychotherapy All forms Counseling/Psychotherapy supervision, however, seems to have supervision, however, seems to have

some similarities:some similarities:

According to Watkins (2002), this means that supervision has as components:

A relationship Evaluation Extends over time Enhances professional functioning Monitors quality of professional service Serves as gate keeper.

Counseling/Psychotherapy supervision Counseling/Psychotherapy supervision factors of supervision functioning:factors of supervision functioning:

Foci of supervision – professional, organizational, assessment/planning, implementation/intervention/evaluation, and personal factors;

Format of supervision – individually or group, face to face, or over phone.

Techniques – facilitative, supportive, confrontive, conceptual, problem solving, etc. (Watkins, 2002)

Developmental Stages of Developmental Stages of CounselorsCounselors

Development is Organic - “Importance is not placed on events or combinations of events as much as on the transformation of these events into meaningful information, which is then incorporated into prior knowledge. The developing person is viewed as emerging and moving towards a goal or end state” (Stoltenberg & Delworth, 1988, p. 4-5).

Developmental Stages of Developmental Stages of CounselorsCounselors

Level One - The beginning of the Journey

Level Two -Trial and Tribulations

Level Three - Challenges and Growth


dependent on supervisor, imitative lacking self-awarenesscategorical thinking, with limited experience


high motivation to do wellhigh anxiety channeled to hard work

focused on skill acquisitionhighly dependent on supervision


Supervision Environment 1. provide structure to keep anxiety low, 2. provide positive feedback regarding counselor’s abilities, 3. focus on data rather than on supervisee

Nancy’s PlightNancy’s Plight

Video

Level Two -Trial and Tribulation

fluctuating motivation, striving for independence, becoming more self-assertive and less imitative.

dependency/autonomy conflict

confusion stage


Supervisee’s skills, strengths and weaknesses are becoming evident.

Beginning awareness that this is not a job for the faint of heart


Realization that there is more to counseling than technique.

not all cases respond as hoped for, even with good skill level usage

Professional Ethics relates


Awareness of the limitations of counseling process with certain clients

The horrors of cases begin to become toxic

Taking cases home emotionally


Autonomy is increasedsupervisee may not seek opinions or advise of supervisor

May even resist discussion of cases -


Supervision EnvironmentHighly autonomous, little structure

Blend of client types is important

Supportive environmentConsultative,


Supervision Environment

Focus on theory and application Alternative views of clients Broadening repertoire of theory and

technique Focus on relationship, both with client, and

isomorphicly in supervision. Confrontation and interface issues are more

a part of supervision now.


Supervision Environment Less inclined to take the supervisors

word without critically evaluating suggestions as applied to clients.

Supervisory relationship is less hierarchical, and this should be supported.

Marilyn sees the worst.Marilyn sees the worst.

Video

Level Three - Challenge and Growth

Personal sense of counselor identity and self-confidence.

Motivation more stable Autonomy is not threatened Self- and other awareness is

heightened. A second-order shift has occurred.

Able to be with the client, yet not be drawn in. Able to pull back and evaluate.


Generally aware of their own strengths and weaknesses.

Can think of individual differences of clients.

Understand ethics and professional perspective.


Supervision Environment 1.dependency and strengths need to be acknowledged and supported (sometimes even encouraged),

2. case accountability needs to be provided within this context


Supervision Environment Supervisee may be beyond formal, regular supervision but may seek help with specific cases. There is a need for supervision to advance past a single theoretical framework, broadening the supervisee’s repertoire. Focus should be on integration of all aspects of the counselor.

What research says about:What research says about:

Good Supervision is:

Self-reflective and self-monitoring of the emotional/interpersonal processes with supervisee;

Ability to identify with as well as observe experiences of supervisee and his/her clients’;

Poor Supervision is: Evidence of

psychopathology; Evidence of narcissistic

needs and vulnerability with excessive need to be liked or be in control.

Some novice supervisors who have not had training, or supervision of supervision.

What research says about:What research says about:

Good Supervision is:

Flexibility about theory, technical principles, and trainee’s learning style;

Respectful attitude, supportive and non-judgmental;

Humility toward knowledge, curiosity, relaxed and patient manor

Poor Supervision is: If you decide to get

supervision of your own supervision, find out what they know about the process of supervision, not just if they have advanced degrees or have supervised for a long time.

What research says about:What research says about: Good Supervision is:

Ability to convey principles and concepts with clarity;

Ability to think out loud in order to model clinical inference process;

Willingness to allow students to view supervisor’s own clinical work;

Poor Supervision is:

Isomorphic and Parallel Isomorphic and Parallel processes in supervision – processes in supervision –

Howard LiddleHoward Liddle

Isomorphism means identity or similarity of form," (Kerlinger, 1986, p. 395).

Parallel means : extending in the same direction, everywhere equidistant, and not meeting, or the development of similar new characters by two or more related organisms in response to similarity of environment -- called also parallel evolution

Isomorphic processes in Isomorphic processes in supervisionsupervision

The word comes from Iso - meaning same, and morph - meaning structure. Any two systems that are connected are said to have isomorphic properties when there is similarity between the two.

Isomorphy refers to that part of two or more structures that have a correspondence. As there is an interconnection between all systems that are interrelated, this correspondence has the potential of influence.

Isomorphic Isomorphic Client system

Therapist systemSupervisory system

Patterns of Interaction in Patterns of Interaction in SupervisionSupervision

1. Rapport-building. Both participants seek to structure a feeling of comfort in a context where work is being evaluated. Length of time is related to contexts of overt hierarchy, gender, familiarity with one another, and new or ongoing cases to talk about.

2. Getting down to work stage - “What would you like to focus on? Where Stuck?


3. Resolution of questions raised and options discussed. Case specific future directions and options, follow-up on past supervision sessions, asking questions regarding supervisee’s intentions. Often suggestions go un-heeded.

4. Wrapping-up - abbreviated period of chit-chat, and good-byes.


Research Implications During research they discovered that the process

increased the level of trust and collegiality between students and supervisors. Supervision can be enhanced by increasing vulnerability and collegiality.

Supervision can be relationship-focused and multi-hierarchical. The process appears to have much to do with the nature of the relationship.


Supervision can be multidirectional Clinical supervision might be best defined

as the joint monitoring of: 1) each supervisee’s current therapy cases,

2) growth of supervisee as a therapist, 3) the process of supervision, 4) the interaction between supervisor and supervisee.

Ethics in Clinical SupervisionEthics in Clinical Supervision

Codes of Ethics – practice within the boundaries of one’s competences.

Impaired Supervisee or supervisor.– 4.6 % of Psychologists report they have been

impaired at sometime during their career.

6% report alcohol excess, others have depression and other series impairments. Most are never confronted or asked to seek help.

Ethics in Clinical SupervisionEthics in Clinical Supervision Codes of Ethics – sexual attraction to clients also

applies here too, with regard to those we supervise and those of us who are supervising. Non exploitation of those under them. 17 % reported that they had sexual relationships with their supervisor, 1 out 4 women who obtained their doctorate had sexual relationships with their supervisor or teacher.

Tarasoff – the psychologist's supervisor, a psychiatrist was also found to be liable.

Need to maintain case records on supervisees.

Ethics in Clinical SupervisionEthics in Clinical Supervision

Informed Consent of supervisees. Direct liability – due to supervisees’

erroneous actions or omissions. Vicarious Liability – Courts assume that

supervisor is responsible for the conduct of the supervisee.

Knapp and Vandecreek (2001).

Supervision thoughtsSupervision thoughts

You cannot work effectively without your supervisee/employee’s cooperation and goodwill!

People cooperate better when they feel their own best interests are at stake; growth and development.

Supervisee’s are stakeholders in the process.


People are motivated, not only by the possibility of wage earnings, but by intrinsic care and the knowledge that their immediate supervisors and administrators have their goodwill in mind.

Supervisees or employees work harder and more effectively, when they believe that they have a voice.


All of this happens better with the development and maintenance of positive relationships.

It is a supervisor/administrators responsibility to provide for positive growth and development.

Betsy – care of others

Supervising to Develop Self-Supervising to Develop Self-efficacy and Self-Reliance efficacy and Self-Reliance

Wu-Wei

Self-Efficacy in CounselingSelf-Efficacy in Counseling

Efficacy in dealing with the environment (or with a client) does not entail certain behaviors or simply knowing what to do. It involves “a generative capability in which component cognitive, social and behavioral skills must be organized into integrated courses of action to serve innumerable purposes’ Bandura, (1982).


Counseling Self-efficacy (CSE) is defined as one’s beliefs or judgments about her or his capabilities to effectively counsel a client in the near future. CSE beliefs are the primary causal determinant of effective counseling action, and effect choices of counselor responses, effort expenditure and persistence in the face of failures, and risk-taking behavior (Bandura, 1977).


Self-efficacy beliefs affect the mediating influences of other self-generated process, and which act collectively as personal agency that allows humans to both respond and proactive in an ever-changing environment. This allows counselors to use forethought to anticipate potential scenarios and prepare for them. They set goals for themselves and their clients based in part on forethought and in part on feedback (Larson & Daniels, 1998, p. 181). (Feedback loops)


CSE is highly correlated to the developmental stage of the counselor, however it is not linear, as the second stage may produce a lower correlation. Anxiety seems to lower CSE also.

The enhancement of CSE is based on Modeling, visual imagery and role playing.

So, what really counts in So, what really counts in counseling?counseling?

40% of outcome is related to the client

15% of outcome is related to technique

35% of outcome is related to the therapeutic relationship

The rest is related to extra ordinary factors

Supervision for Counselor Supervision for Counselor CompetencyCompetency

Focus on strengths Ask “narrative” questions, i.e., “when you did that, what

sort of things did you tell yourself? What did you do in this session that you really like? What would you do differently? Would you like to hear what I think? Knowing what you do know, what else do you think you might have done? As you reflect on how well you have come along, what thoughts and feelings do you have about your counseling?

What do you think “so-in-so” would have done?”

Preventing burnout in Preventing burnout in counselorscounselors

Self Care - Begin today to take steps toward self care Put the big rocks in first Limit case loads Vary case loads Don’t let the job be your life Dance, walk, do physical activities

SummarySummary

There is no one unified theory of supervision

Hierarchy seems to be a usual part, but the decrease of it adds to the relationship, hence effective supervision.

Where to get more Where to get more informationinformation

Syllabus and reference list is at: http://www.neiu.edu/jkedward/supervision.htp

References References

Bernard, J.M. (1979). Supervisory Training: A Discrimination Model. Counselor Education and Supervision, 19, 60-68.

Edwards, J.K., & Chen, M.W. (1999). Strength-Based Supervision: Frameworks, Current Practice and Future Directions: A Wu-wei Method. The Family Journal.

Larson, L.A., & Daniels, J. A. (1998). Review of the Counseling Self-Efficacy Literature. The Counseling Psychologist, 26, 179-218.

Keller, J.F., Protinsky, H.O., Lichtman, M., & Allen, K. (1996). The Process of Clinical Supervision: Direct Observation Research. The Clinical Supervisor, 14, 51-63.

Liddle, H.A., Bruenlin, D.C., & Schwartz, R.C. (1988). The Handbook of Family Therapy Supervision. New York: Guilford Press.

References References

Steward, R.J. (1998). Connecting Counselor Self-Efficacy and Supervisor Self-Efficacy: The Continued Search for Counseling Competence. The Counseling Psychologist, 26, 258-294.

Stoltenberg, C.D., & Delworth, U.D. (1987) Supervising Counselors and Therapists. San Francisco: Jossey Bass.

Watkins, C.E. (Ed.) (2001). Handbook of Psychotherapy Supervision.. New York: John Wiley & Sons, Inc.

clinical supervision primer for counselors and psychotherapists 2004-05© dr. jeffrey k. edwards...

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