Evaluate two models (explore their differences and similarities) of clinical supervision, and two roles of the clinical supervisor (Use the PowerPoint and read

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i-counseling.net Clinical Supervision: An Overview

Clinical Supervision: An Overview Edited by the Center for Credentialing & Education

Course Introduction

The general purpose of this course is to learn about the basic processes of clinical supervision. Completion of this course allows learners to become better consumers of supervision, more effective supervisors, and better able to evaluate involvement in the supervisory role. The information in this course is accumulated from several sources and years of clinical experience. CCE acknowledges the work of Bernard and Goodyear (1998) and the various ERIC contributions included in this course.

Learning Objectives

Upon completion of this course, you will • Understand the definition of clinical supervision. • Understand the scope and goals of clinical supervision. • Understand the basic process of effective clinical supervision • Interpret cultural issues in clinical supervision • Understand the process of group supervision • Understand basic legal and ethical issues as they relate to clinical supervision • Understand the purpose and need for evaluation in clinical supervision • Understand the implications of clinical supervision and standards of client care. • Understand basic clinical supervision theories. • Understand the basic mechanics associated with the management of clinical supervision including

administrative skills. • Understand the rationale and importance of matching the attributes of a clinical setting with those

of the supervisee (e.g., level of supervisee resistance). • Understand the differences between the “science” and “art” of clinical supervision.

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i-counseling.net Clinical Supervision: An Overview

Clinical Supervision: An Overview

Introduction Many mental health professionals will eventually find themselves in the role of clinical supervisor. Paramount issues for consideration include the supervisor’s clinical skill, the supervisor’s ability to impart this skill, and validating that the skill is being demonstrated by the supervisee.

Too many supervisors, particularly those of the academic ilk, are versed in the “science” portion of supervision, but not in the “art” part of supervision. In other words, they have minimal actual in-the-field experience, which transfers into the supervisee not learning essential real-world skills. Indeed, a few lauded theoretical supervisors have less experience than their former supervisees after the supervisee has been working for less than two years. The science part of supervision encompasses the formal theories and observations that have been confirmed or are confirmable. The art part of supervision entails the knowledge and accompanying skills that a professional accumulates over time (Bernard & Goodyear, 1998). Furthermore, university supervisors are often not held accountable for demonstrating that their supervisees can actually “do therapy or counseling.” This course’s conceptual framework is based on practical approaches to clinical supervision that hold the supervisee as well as the supervisor accountable within a mutually respected relationship.

Since counseling is dynamic and situations change from one moment to the next, the actual valence of “supervision as intervention” can be minimal. What supervision can do is provide a foundation on which the supervisee can make decisions about an intervention or counseling procedure. Conceptually, this course covers the fundamentals of effectively managing supervisees while at the same time remaining accountable to the welfare of the client – needless to say, a formidable task.

Supervision Defined A working definition of supervision might include: “An intervention provided by a more senior member of a profession to a more 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 more junior person(s), monitoring the quality of professional services offered to the client(s) she, he, or they see(s), and serving as a gatekeeper of those who are in the particular profession “ (Bernard & Goodyear, 1998, p. 6).

Other definitions include, “an intensive, interpersonally focused one-to-one relationship in which one person is designated to facilitate the development of therapeutic competence in the other person (Loganbill, Hardy, & Delworth, 1982, p. 4); and “an ongoing educational process in which one person in the role of the supervisee acquires appropriate professional behavior through an examination of the trainee’s professional activities” (Hart, 1982, p. 12).

In summary, supervision is an intensive educational process that facilitates the therapeutic competence of the supervisee over time. In order to emphasize client welfare, supervision is always provided by someone who possesses more experience (the expert) than the supervisee (the novice) and is skilled in the area in which the supervisee seeks supervision. Supervision is not counseling, but is a circumscribed set of skills that monitor the quality of the service provided by the supervisee. Supervision can be used to assess who is adequate at providing competent services to the public, and to obtain skills that facilitate certification and licensure.

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i-counseling.net Clinical Supervision: An Overview

In terms of a senior member providing supervision to a junior member, this is a relative term. An arguably better dichotomy is expert-novice. University supervisors with no more experience than their doctoral internships have been assigned to supervise seasoned therapists with years of experience who have returned to school to obtain a doctorate. (In fact, these non-traditional students provide a great service to universities since they often provide training for faculty). The senior/junior distinction is an artifact of university power hierarchies and is clearly not necessary in the definition of supervision. However, more experience is better than less experience when providing clinical supervision.

Bernard and Goodyear (1998) have asserted that a good supervisor does not necessarily need to be an effective therapist since a supervisor’ main function is to oversee and guide the efforts of the supervisee. They use the analogy that a good athlete does not a coach make. But, most coaches, who were not particularly good athletes, have at least played the game. In contrast, some supervisors, again at the university level, have only played the game long enough to complete their internships and obtain a supervisory job at the university level. Herein is one of the reasons for a lack of credibility in the public and professional eye. In fact, some supervisors who lack real-world experience even write books about supervision and indicate in this scholarly work that practical experience is not necessary. However, not all is lost. “Super-visors,” even those with little clinical experience, can provide a perspective to the supervisee that is removed from the actual supervision. It is antiseptic, and anecdotal, but here lies its value in such cases: supervision is not an intervention, in the classical sense. The supervisee provides the counseling, which may be influenced or directed by the supervisor. Supervision does not have to be provided by members of the same profession. In fact, many doctoral level supervisees in the counseling profession are supervised by individuals who identify with another helping profession (e.g., psychology, social work, psychiatry).

Models of Clinical Supervision Theories of supervision, according to Bernard & Goodyear (1998), include theories that extend directly from theories of psychotherapy. Likely to be adhered to by less experienced university supervisors, it is inevitable that most supervisors utilize psychotherapy theories to some extent. Psychotherapy theories used in supervision include psychodynamic theory or the working alliance model, parallel process or the mirroring of the therapist/ client relationship within the supervisor/supervisee relationship; person-centered or a focus on the supervisor’s trust in the supervisee’s ability to be a clinician in a non-controlling, nondirective environment based on mutual trust; cognitive –behavioral based on learning models that focus on behaviors and their consequences; and systemic. Some supervisor educators have defined particular schools of systems therapy as being non- egalitarian and even manipulative. Depending on the type of focus, this might be true. But, this is a myopic view of the systemic school of therapy and supervision, and exemplifies a lack of understanding more than a true definition.

Reciprocal relationships, recursive modeling and family dynamics also have influenced supervision theory. Narrative approaches posit that clients have developed stories or narratives about themselves and their lives that serve as a method for organizing their past and influencing their future. Family therapists have been using narrative approaches for some time. Another model describes the therapist serving as a story editor. Supervisors using these methods, assist the supervisee in developing narratives or personal stories about doing therapy, in general, and specifically stories about their clients (Bernard & Goodyear, 1998).

Developmental Models Developmental theories of supervision are based on the change process of the supervisee over time. The focus is primarily on the supervisee’s development, but sometimes to the exclusion of the client’s well-being.

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i-counseling.net Clinical Supervision: An Overview

Supervisees move through stages during training that are qualitatively different from one another; each stage requires a different supervisory environment (Chagnon & Russell, 1995). This model would indicate that supervisors should not supervise beyond their own level of development, and requires that supervisors not engage in supervisory functions beyond their experience and level of competency. The problem here is that in university settings, professors are not subject to “checks and balances” regarding their level of supervision, and furthermore, might even be “protected or sheltered” by academic policies or rank. Likewise, in clinical settings, a supervisee could be the “only show in town” and is subject to “seat of the pants” supervision.

The Littrell, Lee-Borden & Lorenz model is a four-stage model that emphasizes relationship building, teaching/ counselor role, collegial role, and self-supervision.

The Stoltenberg Model is a four level model that emphasizes dependency on the supervisor, the dependency- autonomy conflict, increased autonomy and mutual sharing, and “master counseling.” The Stoltenberg and Delworth model proposes three structures for supervisee training: awareness of self and others, motivation towards the developmental process, and some amount of dependency or autonomy. The Loganbill, Hardy & Delworth model is based on eight professional issues such as competence, direction, motivation, and ethics through three stages, namely stagnation, confusion, and integration. Although this theory appears to be very thorough, its actual usefulness in clinical settings is limited.

The Skovholt and Ronnestad model emphasizes therapist development over the lifespan. This eight-stage model identifies 20 themes that characterize therapist development over time. Overall, developmental models have empirical support, but also are criticized for being too simplistic (Russell et al., 1984).

Social & Eclectic Models Social role models of supervision emphasize role behaviors of supervisors including teacher, counselor, therapist, facilitator, case reviewer, and consultant. Other activities include monitoring, evaluating, modeling, and supporting.

The Hawkins and Shohet model is a social role model that focuses on the client, therapist, and supervisor over five factors: 1) role of the supervisor, 2) developmental stage of the trainee, 3) counseling orientation of the trainee and supervisor, 4) the contract between supervisor and trainee, and the 5) setting or modality. The Holloway model focuses on five tasks and five functions of the supervisor. This matrix of 25 task-function combinations suggests the role a supervisor might adhere to with a particular supervisee in a particular situation. Most advanced supervisors have used eclectic and intergenerationalist models to establish their own model. They might blend supervision models, develop relationship frameworks, consider the competence level of the trainee, and evaluate the outcomes of the supervision process.

The discrimination model has three supervisor foci, namely the trainee’s intervention, conceptualization skills, and personalization skills. This model also includes three roles of the supervisor including teacher, counselor, or consultant. This model is referred to as the discrimination model because it implies that the supervisor will tailor his or her responses as needed (Bernard, 1979).

The following information further describes models of clinical supervision including a further discussion of developmental approaches as well as integrated and orientation-specific models.

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i-counseling.net Clinical Supervision: An Overview

Models of Clinical Supervision

by George R. Liddick

Clinical supervision is the construction of individualized learning plans for supervisees working with clients. The systematic manner in which supervision is applied is called a "model." Both the Standards for Supervision (1990) and the Curriculum Guide for Counseling Supervision (Borders et al., 1991) identify knowledge of models as fundamental to ethical practice.

Supervision routines, beliefs, and practices began emerging as soon as therapists wished to train others (Leddick & Bernard, 1980). The focus of early training, however, was on the efficacy of the particular theory (e.g. behavioral, psychodynamic, or client-centered therapy). Supervision norms were typically conveyed indirectly during the rituals of an apprenticeship. As supervision became more purposeful, three types of models emerged. These were: (1) developmental models, (2) integrated models, and (3) orientation-specific models.

Developmental Models Underlying developmental models of supervision is the notion that we each are continuously growing, in fits and starts, in growth spurts and patterns. In combining our experience and hereditary predispositions we develop strengths and growth areas. The object is to maximize and identify growth needed for the future. Thus, it is typical to be continuously identifying new areas of growth in a life long learning process. Worthington (1987) reviewed developmental supervision models and noted patterns. Studies revealed the behavior of supervisors changed as supervisees gained experience, and the supervisory relationship also changed. There appeared to be a scientific basis for developmental trends and patterns in supervision.

Stoltenberg and Delworth (1987) described a developmental model with three levels of supervisees: beginning, intermediate, and advanced. Within each level the authors noted a trend to begin in a rigid, shallow, imitative way and move toward more competence, self-assurance, and self reliance for each level. Particular attention is paid to (1) self-and-other awareness, (2) motivation, and (3) autonomy. For example, typical development in beginning supervisees would find them relatively dependent on the supervisor to diagnose clients and establish plans for therapy. Intermediate supervisees would depend on supervisors for an understanding of difficult clients, but would chafe at suggestions about others. Resistance, avoidance, or conflict is typical of this stage, because supervisee self-concept is easily threatened. Advanced supervisees function independently, seek consultation when appropriate, and feel responsible for their correct and incorrect decisions.

Once you understand that these levels each include three processes (awareness, motivation, autonomy), Stoltenberg and Delworth (1987) then highlight content of eight growth areas for each supervisee. The eight areas are: intervention, skills competence, assessment techniques, interpersonal assessment, client conceptualization, individual differences, theoretical orientation, treatment goals and plans, and professional ethics. Helping supervisees identify their own strengths and growth areas enables them to be responsible for their life-long development as both therapists and supervisors.

Integrated Models Because many therapists view themselves as "eclectic," integrating several theories into a consistent practice,

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some models of supervision were designed to be employed with multiple therapeutic orientations. Bernard's (Bernard & Goodyear, 1992) Discrimination Model purports to be "a theoretical." It combines an attention to three supervisory roles with three areas of focus. Supervisors might take on a role of "teacher" when they directly lecture, instruct, and inform the supervisee. Supervisors may act as counselors when they assist supervisees in noticing their own "blind spots" or the manner in which they are unconsciously "hooked" by a client's issue. When supervisors relate as colleagues during co-therapy they might act in a "consultant" role. Each of the three roles is task specific for the purpose of identifying issues in supervision. Supervisors must be sensitive toward an unethical reliance on dual relationships. For example, the purpose of adopting a "counselor" role in supervision is the identification of unresolved issues clouding a therapeutic relationship. If these issues require ongoing counseling, supervisees should pursue that work with their own therapists.

The Discrimination Model also highlights three areas of focus for skill building: process, conceptualization, and personalization. "Process" issues examine how communication is conveyed. For example, is the supervisee reflecting the client's emotion, did the supervisee reframe the situation, could the use of paradox help the client be less resistant? Conceptualization issues include how well supervisees can explain their application of a specific theory to a particular case — how well they see the big picture — as well as what reasons supervisees may have for what to do next. Personalization issues pertain to counselors' use of their persons in therapy, in order that all involved are nondefensively present in the relationship. For example, my usual body language might be intimidating to some clients, or you might not notice your client is physically attracted to you.

The Discrimination Model is primarily a training model. It assumes each of us now have habits of attending to some roles and issues mentioned above. When you identify your customary practice, you can then remind yourself of the other two categories. In this way, you choose interventions geared to the needs of the supervisee instead of your own preferences and learning style.

Orientation-Specific Models Counselors who adopt a particular brand of therapy (e.g. Adlerian, solution-focused, behavioral, etc.) oftentimes believe that the best "supervision" is true adherence to the mode of therapy. The situation is analogous to the sports enthusiast who believes the best future coach would be a person who excelled in the same sport at the high school, college, and professional levels. Ekstein and Wallerstein (cited in Leddick & Bernard, 1980) described psychoanalytic supervision as occurring in stages. During the opening stages the supervisee and supervisor eye each other for signs of expertise and weakness. This leads to each person attributing a degree of influence or authority to the other. The mid-stage is characterized by conflict, defensiveness, avoiding, or attacking. Resolution leads to a "working" stage for supervision. The last stage is characterized by a more silent supervisor encouraging supervisees in their growth toward independence.

Likewise, behavioral supervision views client problems as learning problems; therefore it requires two skills of the supervisee 1) identification of the problem, and (2) selection of the appropriate learning technique (Leddick & Bernard, 1980). Supervisees can participate as co-therapists to maximize modeling and increase the proximity of reinforcement. Supervisees also can engage in behavioral rehearsal prior to working with clients. Carl Rogers (cited in Leddick & Bernard, 1980) outlined a program of graduated experiences for supervision in client-centered therapy. Group therapy and a practicum were the core of these experiences. The most important aspect of supervision was modeling of the necessary and sufficient conditions of empathy, genuineness, and unconditional positive regard.

Systemic therapists argue that supervision should be therapy-based and theoretically consistent (McDaniel,

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i-counseling.net Clinical Supervision: An Overview

Weber, & McKeever, 1983). Therefore, if counseling is structural, supervision should provide clear boundaries between supervisor and therapist. Strategic supervisors could first encourage supervisees to change their behavior, then once behavior is altered, initiate discussions aimed at supervisee intuition.

Bernard and Goodyear (1992) summarized advantages and disadvantages of psychotherapy-based supervision models. When the supervisee and supervisor share the same orientation, modeling is maximized as the supervisor teaches — and theory is more integrated into training. But, when orientations clash, conflict or parallel process issues may predominate.

In summary, are the major models of supervision mutually exclusive, or do they share common ground? Models attend systematically to: a safe supervisory relationship, task-directed structure, methods addressing a variety of learning styles, multiple supervisory roles, and communication skills enhancing listening, analyzing, and elaboration. As with any model, a personal model of supervision will continue to grow, change, and transform as the supervisee gains experience and insight.

Management and Administration of the Supervision Process In academic settings, it is important that the supervisor carefully consider the site placement of each supervisee. The supervisee’s goals for the clinical internship will be useful in making this determination (Bernard & Goodyear, 1998). There should be a managerial plan for maintaining contacts with the supervisee’s site; these can be accomplished in person, online, by email, or by telephone. It is important that the site supervisor know when these contacts will occur and what method of contact will be used. It might be necessary for a university supervisor to become more involved in an internship placement under at least three conditions: 1) inconsistency in performance expectations of the supervisee, 2) incompatibility between expectations and the reality of the internship facility, and 3) inconsistency between expectations of the educational facility and the field site (Leonardelli & Gratz, 1985).

When considering an internship site, supervisors need a thorough agreement of understanding including all procedural considerations such as emergency contacts and means of evaluation. Furthermore, quality control needs to be consistently monitored by the faculty supervisor in university internship placements. For instance, all standards associated with accreditation, certification and/or licensure must be met (Bernard & Goodyear, 1998).

Similarly, it is critically important in university internship experiences that the site supervisor understand what type of supervisee attributes would best fit the placement. For example, if the site supervisor uses a particular type of counseling theory regarding the change process, it is important that this be clearly communicated with a prospective supervisee (Olsen & Stern, 1990).

Administration of supervision should always be planned, not done “as you go.” A plan will include time allocations, organizational issues, resources, and activities. A critical managerial responsibility is matching the supervision to the specific needs of the supervisee. This might sound obvious, but all too often this is not the case in university settings where the needs of the professor appear to be paramount. Furthermore, it is important to keep good supervision records for instructional as well as legal reasons (Bernard & Goodyear, 1998).

Munson (1993) recommended the following outline for supervision records:

1) If required, a supervision contract

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i-counseling.net Clinical Supervision: An Overview

2) A brief statement of the needs, training and supervision experience of the supervisee 3) A summary of all performance evaluations 4) Notation of all supervisory sessions 5) Cancelled or missed appointments 6) Notation of cases discussed and significant decisions 7) Significant problems, if any, in the supervision and how they were resolved, or whether they

remain unresolved and why.

The management and administration of supervision and the training of new professionals should be taken as seriously as performing counseling. Since there are very few models concerning the professional development of supervisors, it is important to continue to seek consultation and professional development activities. It is important to obtain professional and personal support, know yourself, stay informed, get feedback, and go slowly (Bernard & Goodyear, 1998).

Supervisors-in-training often have substantial life and professional experience to assist them with becoming clinical supervisors and managing the process. Three important areas for supervisor training include theoretical models, supervision research, and ethical and professional issues. Reading supervision classics such as Searles (1955) and Stoltenberg (1981) will expose supervisors-in-training to some of the original work in this discipline and provide suggestions for the management of the supervision process.

Unfortunately, the best intentions of any supervisor can be weakened by poor managerial and administrative skills. To be a good manager, it is imperative that supervision guards against burnout. Taking good care of self is paramount in effective administration of all that occurs during clinical internship and work-related supervision.

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i-counseling.net Clinical Supervision: An Overview

Administrative Skills in Counseling Supervision

by Patricia Henderson

The administrator of a supervision program is the person ultimately responsible for the quality of supervision provided and the effectiveness of supervisory staff. Conceptually, the supervision "program" includes not only the staff of supervisors, but also the activities they do, outcomes they strive to help their supervisees achieve, materials and resources they use, and means by which the activities, outcomes, and staff performance are evaluated. Administrators of supervision programs include school system, central office-based guidance directors who administer the supervision activities of campus-based counseling department heads; counselor- owners of private practices with multiple counselor supervisors; heads of counselor education departments with multiple faculty members supervising intern and practicum students; and counselor educators responsible for field-site practicum and internship supervisors of their students.

Program Management Administrators provide leadership and direction to supervision programs by developing and upholding the program mission and the goals of supervision. To ensure effective implementation of the program (and the related counseling activities), administrators must know and be able to articulate for the staff and others the purpose, value, and goals of supervision, including its contribution to the quality of the counseling program. Essential here are knowledge of and commitment to the professional standards of counseling performance, ethics (American Counseling Association, 1988), and supervision (Dye & Borders, 1990), as well as the relevant legal standards. Administrators must be able to articulate how supervision relates to performance evaluation and to other professional development activities. They need to be able to facilitate the establishment of program priorities and to assist counselors and/or supervisors in establishing relevant objectives which not only will maintain the program, but also cause its improvement.

Administrators need to help supervisors be clear about the priority of supervision in relation to other aspects of their jobs. Supervisors of school or agency counseling departments with multiple counselors often have counseling caseloads in addition to supervision responsibilities. Counselor educators often carry teaching or advisement responsibilities in addition to supervising practicum and internship students.

Administrators not only are accountable for the provision of high quality supervision, they also are accountable for resultant improvement in the performance of supervisees/counselors, and ultimately for assuring effective treatment for clients. Based on their evaluations of supervisors' competence, administrators have a responsibility to match supervisors and counselors for optimum professional development, and for establishing efficient systems for matching counselors and clients for optimum personal development. They also must be able to develop, with supervisors, the system for monitoring client progress. Establishing systems that are not burdensome to the staff is often a challenge to the administrator. Writing sk

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