Evaluate Clinical Supervision Models and Roles
Supervision Models
Supervision Model Discussion
It is important to understand that we see the world in a different way. As you go through this section, process if you are working with someone in supervision, what are the strengths and challenges of the supervisor and the supervisee seeing the world through the same or a different theoretical lens?
TYPES OF SUPERVISION ROLES
Educational Supervision: assessment of skills, evaluation of needs, provision of learning experiences, upgrading of knowledge and skills.
Administrative Supervision: monitoring work and workload, assuring work completion, quality and quantity control appropriate implementation of agency policies and procedures.
Supportive Supervision: providing support, understanding and assistance, understanding emotional needs. The supervisor provides employees with a supportive environment where they can enjoy high morale and job satisfaction.
Supervision Is An Intervention
Clinical supervision, teaching on-the-job with developmental conversations, regular feedback and the provision of a rapid response to issues as they arise.
To provide staff with a confidential, safe and supportive environment. To critically reflect on professional practice.
To improve quality patient services by improving mental health practice, by encouraging reflection on attitudes towards people with mental health problems and disorders, their family members and careers.
Improve self-awareness and taking responsibility for their clinical practice by adhering to a framework for clinical supervision.
To maintain the quality of the process of clinical supervision. Objectives of Clinical Supervision
To provide for the professional growth, and development of the clinical supervisee.
To provide protection for the welfare of the client so they are not harmed by the training supervisee
Monitoring the supervisee’s practice stays within the professional guidelines, gate keeping, teach, train, and empower
Promote the supervisee to become competent, independent clinicians who can carry out their goals, and be a positive influence on their clients.
Why do we need to learn so many theories?
Because how you normally address issues may not work for you,
and if so, THEN WHAT?
Psychotherapy Theory Models
Psychodynamic
Person-Centered
Cognitive-Behavioral
Systemic
Solution-Focused
Feminist
Psychodynamic
Psycho-dynamic supervision A psycho-dynamic supervisor would interpret the material being presented and use an awareness of the relationship dynamics between himself and the counselor in supervision as a means of supervising.
Supervisor is insightful regarding the supervisee. Links aspects of a counselor
May well be appropriate for a supervisors to change the focus of the session from 'supervision' to 'counseling'.
The situation may demand it - and we have what may be described as a ‘counseling interlude’.
Psycho-Dynamic Insight work with supervisees to enhance the quality of their interactions with clients. This does not entail moving beyond a supervisor's frame of reference.
Characteristics of Psychodynamic Supervision
Primary role-teacher -Motivated-Open, honest, aware of own strengths and weaknesses.
Self-reflecting, able to give and receive constructive feedback, empathies, supports, and challenge, internal review skills.
Having advanced knowledge of a variety of clinical methods and techniques. Able to reflect on one’s own supervising experience, what works and what did not, incorporate earlier learned experiences, and able to research as a student of supervision, and read, study supervision methods.
Second – Mentor-relationship building, New supervisees and also advanced clinicians all need support, Identifies weaknesses for improvement.
Advisor and consultation- challenging yet flexible, oversee the supervisee’s work, and counsel
For more understanding about the counter transference , an additional YouTube Video is provided as a resource
Person-Centered
Person-Centered Supervision assumes that the Supervisee has the ability to solve the problems at hand and grow as an effective clinician
Built on trust– Teaching and therapy
The supervisor acts as an experienced collaborator and provides an environment to allow supervisees to be open, not feel judged, and process the experience
Person- Centered
Rogers was the first to use transcripts and recorded interviews for supervision
Work toward Self-actualization
“I think my major goal is to help therapist to grow in self-confidence and to grow in the understanding of himself or herself, and to grow in the therapeutic process… Supervision for me becomes a modified form of therapeutic interview”
Carl Rogers
Cognitive-Behavioral
Cognitive Behavioral Supervision focuses on thoughts and behaviors of the supervisee. How the supervisee sees themselves as professional, and how they react to clients.
Techniques used by the Supervisor include agendas, reviewing last sessions, giving homework, and feedback using summary.
Teacher-Student style that is collaborative and direct.
CBT Continued
Strategic, focus on technical mastery ex. How to challenge negative self talk
Goal oriented for each supervision session
Uses role play and imagery for examples of behavioral strategies
For more understanding about the Cognitive Behavioral Model , an additional YouTube Video is provided as a resource
Systemic Supervision
The understanding of systems that interact with each other is the premise of the supervision. It is a team approached model that is
Active- Supervisor is involved with client session
Directive- provides open discussions about session
Collaborative- Uses reflective teams to observe sessions for a team approach feedback
Systemic Continued
High engagement with supervisee as a directory, consultant role
Transcript session
Focus on relationships and interventions of presenting issues
Make connections with the client/family and society
High focus on Observations of session
Focus on the supervisee’s position within a broader system
Uses same techniques as therapy to apply to supervisee-Family of origin exploration, and strategic interventions
Solution-Focused
Focuses on the present solutions to a problem.
Supervisors lead by asking questions (curious inquirer), addressing strengths, resources, and skills. For example, “How did you manage that situation?”
Goal is to enhance confidence and skill, and reduce anxiety of supervisee.
The supervisor should help the supervisee to draw on his or her own resources, Use active listening, focus on the solution and that there are more than one solution. Supervisors provide encouragement, focus on supervisees’ strengths and successes rather than faults;
Relationship is collegial
Feminist theory
Assumes that one’s experiences is a reflection of societal expectations, views, and the dominant values
View Mental Health Disorders are viewed as a consequence of oppression
Oppose the DSM
Supervisors focus on the power differentials
Focus on the understanding of privilege, and empowerment
Developmental Models (brief overview)
Rønnestad and Skovholt
The Integrated Developmental Model
Process Models
Developmental Models
Development Model of Clinical Supervision advocates that supervisors match the structure, and style of supervision to the clinicians level of development. As the supervisee grows, and develops, the supervisory methods are adjusted to fit the skill level, and confidence of supervisee.
rønnestad skovholt supervision model
An evidence based supervision model based on understanding the need of the supervisee depending on the supervisee’s experience level:
The Lay Helper- Up to a Bachelors Level
The Beginning Phase-1st year grad student
The Advanced Student Phase-In Clinicals
Novice- 1st position after grad school
Experienced- Post licensed
Senior- 20 yrs plus
rønnestad skovholt supervision model Cont.
The Integrated Developmental Model
This model depicts the developmental levels of both clinicians and supervisors according to 3 basic structures
Autonomy – the ability to make independent decisions, the degree of supervision required, and self-confidence.
Self and Other Awareness – fears, anxieties, and uncertainties, and how certain behaviors affect the client and others.
Motivation – process of counseling, desire to help others, and learning of strengths and weaknesses.
Integrated Developmental Model
IDM Domains
1. Intervention skills competence
2. Assessment techniques
3. Interpersonal assessment
4. Client conceptualization
5. Individual differences
6. Theoretical orientation
7. Treatment plans and goals
8. Professional ethics
For more understanding about the Integrated Developmental model, an additional YouTube Video is provided as a resource
Process Models-Loganbill, Hardy, & Delworth
Focus is on the world, the self, and the Supervisor–
Based on 8 Professional Issues
Competence, direction, motivation, ethics, emotional awareness, autonomy, theoretical identity, and respect for others’ diversity/views.
Requires assessment in the professional issues in each of the 3 stages. Making a complex 24 positional assessment.
Three Stages
Stagnation –Unaware of deficits, black and white thinking, dependent, lack of motivation
Confusion – Liberated from rigid perceptions, more cognitively aware, frustrated with supervisor
Integration- accurately based self-aware, increased cognitive awareness, realistic view of supervisor, able to take more responsibility for self.
Social Role Models (brief Overview)
Social Role Model specifies that the supervisor act and perform certain roles, tasks, and functions that take into account behaviors, beliefs, and attitudes that the supervisee is expected to follow
Discrimination Model
Hawkins and Shohet Model
SAS
Discrimination Model
Supervisors will tailor their responses to the particular supervisee’s needs (thus the name Discrimination) Supervisors Focus on supervisees’:
1. Conceptualization skills include the supervisee’s ability to make some sense of the information that the client is presenting, to identify themes that occur in counseling, and to discriminate what is essential information from what is nonessential. These are mainly conceptualization skills that fall under assessment.
2. Process skills refer to the observable activity of the supervisee. Process is probably a poor phrase to use, since processes can also refer to the internal realities of the clinician, or the examination and analysis of internal realities.
3. Personalization skills include the contributions of the supervisee as an individual. This incorporates aspects of the person such as their personality, cultural background, sensitivity towards others, and sense of humor.
For more understanding about the Discrimination model, an additional YouTube Video is provided as a resource
Roles and Aspects of this Model -teacher
The Discrimination Model identifies three roles that the supervisor needs to adopt in order to facilitate the development of the clinician: teacher, counselor, and consultant.
The teacher role is taken by the supervisor to determine what is the necessary skill and knowledge base required for the supervisee in order to become more proficient. 5 activities encompassing the teacher role are:
1. Evaluate observed counseling session interactions.
2. Identify appropriate interventions.
3. Teach, demonstrate, or model intervention techniques.
4. Explain the rationale behind specific strategies and/or interventions.
5. Interpret significant events in the counseling sessions.
Roles and Aspects of this Model -counselor
The counselor role is taken by the supervisor when interpersonal or intrapersonal realities of the supervisee are addressed. 5 activities encompassing the counselor role are:
Explore supervisee feelings during counseling session or supervision session.
Explore supervisee feelings concerning specific technique and/or interventions.
Facilitate trainee self-exploration of confidence and/or worries in the counseling session.
Help the supervisee define personal competencies and areas for growth.
Provide opportunities for trainees to process their own feelings or defense.
Roles and Aspects of this Model-consultant
The role of consultant occurs when the supervisor allows for a more collegial, less hierarchical atmosphere, allowing the supervisee to share responsibility for his/her learning. In short, it is the development of autonomy for the supervisee. 5 activities encompassing the teacher role are:
Provide alternative interventions and/or conceptualizations for the supervisee.
Encourage supervisee brainstorming of strategies and/or interventions.
Encourage supervisee discussion of client problems and motivations.
Solicit and attempt to satisfy supervisee needs during the supervision session.
Allow the supervisee to structure the supervision sessions.
Hawkins and Shohet Model
Supervision focuses on the client, therapist, and supervisor in a Five Factor model
Role of the Supervisor
Developmental Stage of the supervisee
Counseling orientation of the supervisee and supervisor
Contract between supervisee and supervisor
Setting/Modality
Has a 25 task Matrix of functioning for specific information.
The systems Model -Halloway (SAS)
System Model emphasize on a learning alliance between the supervisor, and the supervisee. This alliance is based the relationship that is developed between the supervisor, and the supervisee
The purpose of the Systems Approach is to provide a framework and a language based on the empirical, conceptual, and practical knowledge to guide the supervisory process.
Systems Model (SAS)
The supervisor designs specific tasks and teaching tactics related the supervisee’s professional development. The SAS model has five specific goals:
The goal of supervision is to provide an opportunity for the supervisee to learn a broad spectrum of professional attitudes, knowledge, and skills in an effective and supportive manner.
Successful supervision occurs within the context of a complex professional relationship that is ongoing and mutually involving.
The supervisory relationship is the primary context for facilitating the involvement of the learning in reaching the goals of supervision. The essential nature of this interpersonal process bestows power to both members as the form the relationship.
For the supervisor, both the content and process of supervision become an integral part of the design of instructional approaches within the relationship.
As the supervisor teaches, the trainee is further empowered by acquiring the skills and knowledge of the professional work, and gaining knowledge through experiencing and articulating interpersonal situations.
The Supervisory relationship is divided into 3 sections: 1) interpersonal structure of the 2) phases of the relationship and 3) supervisory
The phases of the relationship are subdivided into three parts: 1) beginning phase; 2) mature phase; and 3) terminating phase.
The tasks of supervision are the professional knowledge necessary for the clinician to perform. Categories of teaching skills for supervisees include: 1) counseling skills; 2) case conceptualization; 3) professional role; 4) emotional awareness; and 5) self-evaluation.
The five functions that the supervisor takes on while working with the supervisee are: 1) monitoring/evaluating; 2) instructing/advising; 3) modeling; 4) consulting; and 5) supporting/sharing.
Other Models
Competency-Based Models
Integrative Model
Blended Model
Interpersonal recall
Competency-Based Supervision
The critical role of supervision in a competency based models follows
1. The supervisor must have working knowledge of the specific evidence based treatment methodologies that they will be using with their supervisees.
2. In working with the supervisee, supervisors must help the supervisee in identifying the knowledge, skills, and values that form the basis of competency in a particular evidence based training (EBT).
3. Supervisors will then utilize specific learning strategies and evaluation procedures to sequentially build the supervisee’s skills appropriate to the supervisee’s clinical setting.
4. High quality competency based supervision requires direct observation of supervisee’s counseling, the use of performance feedback and individualized coaching, and the utilization of practice scenarios and role playing.
5. Feedback and coaching consists of discussing techniques utilized, skill when implementing strategies/techniques, and discussion of any strategies that are incompatible with the EBT.
Competency-Based Supervision
All models to supervision are intended to develop competence. A competency-based approach provides an explicit framework and method to initiate, develop, implement, and evaluate the processes and outcomes of supervision
believe personal traits, values, and pre- existing interpersonal competencies are some of the bases upon which the foundation of clinical expertise (and depending on these features clinical biases) are developed. –
Next, education and life experiences contributes to the acquisition of knowledge, skills, abilities and values that help to initially forge the conceptualizations and socialization to the profession. – Clinical training then provides the integrative learning experiences in which skills, abilities, knowledge and values interact, form learning trends, and with practice (under supervision or sometimes even without supervision), become clinical competencies.
Competencies are specific external standards of professional functioning (an acquisition of skills and understanding). – Central to a competency-based approach is the identification of learning goals and objectives that lead to the development of measurable competencies. – Competencies are developed through reflection, conceptualization, planning, practical experience and experimentation within a structured learning environment.
Blended Model-Specific to Substance abuse Supervisors
Philosophical Foundation of the Blended Model -1. People have the ability to bring about change in their lives with the assistance of a guide. 2. People do not always know what is best for them, for they may be blinded by their resistance to and denial of the issues. 3. The key to growth is to blend insight and behavioral change in the right amounts at the appropriate time. 4. Change is constant and inevitable. 5. In supervision, as in therapy, the guide concentrates on what is changeable 6. It is not necessary to know a great about the cause or function of a manifest problem to resolve it. 7. There are many ways to view the world.
Stage of Development -1– the supervisee’s (and supervisor’s) level of training, experience, knowledge and skill. 2. Contextual Factors – characteristics of the client, counselor, supervisor, and setting that affect the environment of supervision. • The Blended Model is a supervisory process that blends insight-oriented with skills-oriented approaches. Utilizes these foundations, along with it many descriptive dimensions in order to structure its view of clinical supervision when working with the substance abuse counselor.
Key components to the Blended Model of Supervision 1. When defining your approach to supervision you must begin with an awareness of your personality, your style of leadership and teaching, and your underlying issues. Thus your own self is the first level of development. 2. You must define your concept of health, your core philosophy of change. 3. The descriptive dimensions further defines your approach to supervision. 4. Contextual factors in which supervision is conducted shapes your approach to supervision (e.g., age, recovering/non-recovering, ethnicity, gender, educational background, etc.). 5. You determine the extent to which you will address affective and behavioral issues in supervision, based, in great measure, upon the stage of counselor development (and in this teacher’s opinion) and the strength of the working alliance.
Influential and Symbolic Dimensions -This dimension has the premise that supervisee’s are influenced both affectively and behaviorally, depending on the individual’s stage of development, needs, and cognitive abilities. • Beginning clinicians will look for basic helping skills, and advanced clinicians will address more theoretical, and interpersonal issues. Symbolic Dimension • The blended model emphasizes primarily manifest content, viewing the unconscious (or latent) symbolic material as interesting but nonessential to bringing about desired changes.
Structural Dimension -This blended model emphasizes a very structured approach with beginning clinicians, emphasizing mastery in the 12 core functions. As the supervisee grows, the structural component shift from proactive (on the supervisor’s part) to reactive (on the supervisee’s part). The supervisee has increasing responsibility for directing the course of supervision (e.g., talking about burnout, or future personal growth issues).
Replicative Dimension - clinicians do behave in supervision in an isomorphic (parallel) manner to clients in therapy. However, in the blended model, this is rarely addressed … except as these issues interfere with clinical functioning. Clinician in Treatment • The blended model does not view therapy as an essential ingredient in the clinician’s supervision, and holds it to be inappropriate for the supervisor to provide such therapy.
Information Gathering Dimension -This is the belief that the supervisor must gain as much information as possible on the counseling style of early (level 1 and 2) clinicians. Direct observation is essential for this process. • As the clinician grows in three developmental structures (motivation, self and other awareness, and autonomy-independence), the supervisor can utilize more insight-oriented issues and thus utilize more indirect information gathering techniques.
Strategy Dimension • The blended model provides for the teaching of technique and theory, either simultaneously or in alternation, depending on the developmental level of the clinician. - Early clinicians may need the focus to be on the 12 core areas and therapeutic relationship techniques (e.g., active listening skills). - People skilled in other areas, such as marriage and family therapy, may need emphasis on the different models of recovery and intervention techniques unique to this field.
Jurisdictional Dimension • The blended model sees jurisdiction over the client and supervisee as resting ultimately with the supervisor, who cannot escape the ethical and legal implications of every supervisee and every client. Relationship Dimension • The blended model views the supervisory relationship as directive for early (level 1 and 2) clinicians. This relationship becomes less directive as the clinician gains experience.
The Journey Dimension – Does the supervisor concentrate on the process of deepening supervisees (Level 3’s who are going downward and inward for reflection and introspection). Or do supervisors concentrate on developing (Level 1’s growing upward and outward in their professional development). • The Internalization Dimension – Does the supervisor seek to aid the supervisee in developing wisdom and integrating therapeutic behaviors and attitudes (Level 3). Or do supervisors help to isolate external philosophies of the supervisee and help them understand the compartmentalization of these external philosophies as they affect their practice (Level 1).
The Listening Dimension – Does the supervisor listen with the heart (Level 3) or with the head (Level 1) • The Questioning Dimension – Does the supervisor pose questions (Level 3) or answers (Level 1).
Interpersonal Process Recall
The supervisor and supervisee view a prerecorded videotape of a counseling session together.
At any point in which either person believes that something of importance is happening on tape, the tape is stopped.
The supervisor does NOT adopt a teaching role and instruct the trainee about what might have been done.
Supervisor needs to allow the supervisee the psychological space to investigate internal processes to some resolution.
NO Matter your MODEL OR THEORY Effective Keys to Clinical Supervision
Support
Support Growth • Professional Development Plans • Strength Based Performance Appraisal Systems
Unite
Unite Your Team • Open door policy • Regular one-on-one supervisory meetings
Praise
Praise Others • Formal recognition systems • Informal compliments - Catching them doing things right Effective Keys to Clinical Supervision
Expect
Expect Excellence • Clear position descriptions • Regular feedback sessions with staff
Require
Require Accountability • Creating a culture where staff holds each other accountable • Creating a culture where staff holds themselves accountable
Value
Value What You Believe • Ensuring understanding and buy-in to a shared mission and vision • continuously reminding team of goals and desired outcomes Effective Keys to Clinical Supervision
Instill
Instill Independence • Appropriate delegation • Encouraging risk taking
Share
Share Continuously • Active listening • Being transparent
Optimize
Optimize Ownership • Participatory strategic planning sessions • Encouraging risk taking
Resources
Hodges, S. (2016). The Counseling Practicum and Internship Manual: A resource for graduate counseling students (2nd ed.). EBSCO: Ebook Collection. Printed on 04/5/17.
http://store.samhsa.gov/shin/content//SMA14-4435/SMA14-4435.pdf
http://www.marquette.edu/education/grad/documents/Brief-Summary-of-Supervision-Models.pdf
https://www.counseling.org/resources/library/ERIC%20Digests/94-08.pdf
http://www.i-counseling.net/pdfs/clinical_supervision_overview.pdf