Evaluate Clinical Supervision Models and Roles

Clinical Supervision and Professional Development of

the Substance Abuse Counselor

Part 1

Overview of Part 1

Chapter 1: Information You Need To Know This chapter presents the basic information about clinical supervision in the substance abuse treatment field

and is organized as follows:

• Introduction (pp. 3–4)

• Central Principles of Clinical Supervision (pp. 5–6)

• Guidelines for New Supervisors (pp. 6–8)

• Models of Clinical Supervision (pp. 8–9)

• Developmental Stages of Counselors (pp. 9–10)

• Developmental Stages of Supervisors (pp. 10–11)

• Cultural and Contextual Factors (pp. 11–13)

• Ethical and Legal Issues (pp. 13–17)

• Monitoring Performance (pp. 17–20)

• Methods of Observation (pp. 20–24)

• Practical Issues in Clinical Supervision (pp. 24–29)

• Methods and Techniques of Clinical Supervision (pp. 30–32)

• Administrative Supervision (pp. 33–34)

• Resources (p. 34)

Chapter 2: Clinical Scenarios Showing How To Apply the Information This chapter presents several realistic clinical supervision scenarios that could take place in a substance abuse

treatment agency to demonstrate the material presented in chapter 1. Master Supervisor Notes are provided to

explain the thinking behind these actions. How­to Notes instruct supervisors on using a specific technique. The

scenarios should be useful to both counselors and supervisors.

Clinical Supervision and Professional Development  1

Chapter 1

Introduction Clinical supervision is emerging as the crucible in

which counselors acquire knowledge and skills for the

substance abuse treatment profession, providing a

bridge between the classroom and the clinic.

Supervision is necessary in the substance abuse

treatment field to improve client care, develop the

professionalism of clinical personnel, and impart and

maintain ethical standards in the field. In recent

years, especially in the substance abuse field, clinical

supervision has become the cornerstone of quality

improvement and assurance.

Your role and skill set as a clinical supervisor are dis­

tinct from those of counselor and administrator.

Quality clinical supervision is founded on a positive

supervisor–supervisee relationship that promotes

client welfare and the professional development of the

supervisee. You are a teacher, coach, consultant,

mentor, evaluator, and administrator; you provide

support, encouragement, and education to staff while

addressing an array of psychological, interpersonal,

physical, and spiritual issues of clients. Ultimately,

effective clinical supervision ensures that clients are

competently served. Supervision ensures that coun­

selors continue to increase their skills, which in turn

increases treatment effectiveness, client retention,

and staff satisfaction. The clinical supervisor also

serves as liaison between administrative and clinical

staff.

This TIP focuses primarily on the teaching, coaching,

consulting, and mentoring functions of clinical super­

visors. Supervision, like substance abuse counseling,

is a profession in its own right, with its own theories,

practices, and standards. The profession requires

knowledgeable, competent, and skillful individuals

who are appropriately credentialed both as counselors

and supervisors.

Definitions

This document builds on and makes frequent refer­

ence to CSAT’s Technical Assistance Publication

(TAP), Competencies for Substance Abuse Treatment

Clinical Supervision and Professional Development 

Clinical Supervisors (TAP 21­A; CSAT, 2007). The

clinical supervision competencies identify those

responsibilities and activities that define the work of

the clinical supervisor. This TIP provides guidelines

and tools for the effective delivery of clinical supervi­

sion in substance abuse treatment settings. TAP 21­A

is a companion volume to TAP 21, Addiction

Counseling Competencies (CSAT, 2006), which is

another useful tool in supervision.

The perspective of this TIP is informed by the follow­

ing definitions of supervision:

• “Supervision is a disciplined, tutorial process

wherein principles are transformed into practical

skills, with four overlapping foci: administrative,

evaluative, clinical, and supportive” (Powell &

Brodsky, 2004, p. 11). “Supervision is an interven­

tion provided by a senior member of a profession

to a more junior member or members. . . . This

relationship is evaluative, extends over time, and

has the simultaneous purposes of enhancing the

professional functioning of the more junior per­

son(s); monitoring the quality of professional serv­

ices offered to the clients that she, he, or they see;

and serving as a gatekeeper of those who are to

enter the particular profession” (Bernard &

Goodyear, 2004, p. 8).

• Supervision is “a social influence process that

occurs over time, in which the supervisor partici­

pates with supervisees to ensure quality of clinical

care. Effective supervisors observe, mentor, coach,

evaluate, inspire, and create an atmosphere that

promotes self­motivation, learning, and profession­

al development. They build teams, create cohesion,

resolve conflict, and shape agency culture, while

attending to ethical and diversity issues in all

aspects of the process. Such supervision is key to

both quality improvement and the successful

implementation of consensus­ and evidence­based

practices” (CSAT, 2007, p. 3).

Rationale

For hundreds of years, many professions have relied

on more senior colleagues to guide less experienced

professionals in their crafts. This is a new develop­

3

ment in the substance abuse field, as clinical supervi­

sion was only recently acknowledged as a discrete

process with its own concepts and approaches.

As a supervisor to the client, counselor, and organiza­

tion, the significance of your position is apparent in

the following statements:

• Organizations have an obligation to ensure quality

care and quality improvement of all personnel.

The first aim of clinical supervision is to ensure

quality services and to protect the welfare of

clients.

• Supervision is the right of all employees and has a

direct impact on workforce development and staff

and client retention.

• You oversee the clinical functions of staff and have

a legal and ethical responsibility to ensure quality

care to clients, the professional development of

counselors, and maintenance of program policies

and procedures.

• Clinical supervision is how counselors in the field

learn. In concert with classroom education, clinical

skills are acquired through practice, observation,

feedback, and implementation of the recommenda­

tions derived from clinical supervision.

Functions of a Clinical Supervisor

You, the clinical supervisor, wear several important

“hats.” You facilitate the integration of counselor self­

awareness, theoretical grounding, and development of

clinical knowledge and skills; and you improve func­

tional skills and professional practices. These roles

often overlap and are fluid within the context of the

supervisory relationship. Hence, the supervisor is in a

unique position as an advocate for the agency, the

counselor, and the client. You are the primary link

between administration and front line staff, inter­

preting and monitoring compliance with agency goals,

policies, and procedures and communicating staff and

client needs to administrators. Central to the supervi­

sor’s function is the alliance between the supervisor

and supervisee (Rigazio­DiGilio, 1997).

As shown in Figure 1, your roles as a clinical supervi­

sor in the context of the supervisory relationship

include:

• Teacher: Assist in the development of counseling

knowledge and skills by identifying learning

needs, determining counselor strengths, promot­

ing self­awareness, and transmitting knowledge

for practical use and professional growth.

Supervisors are teachers, trainers, and profes­

sional role models.

• Consultant: Bernard and Goodyear (2004) incor­

porate the supervisory consulting role of case con­

sultation and review, monitoring performance,

counseling the counselor regarding job perform­

ance, and assessing counselors. In this role, super­

visors also provide alternative case conceptualiza­

tions, oversight of counselor work to achieve mutu­

ally agreed upon goals, and professional gatekeep­

ing for the organization and discipline (e.g., recog­

nizing and addressing counselor impairment).

• Coach: In this supportive role, supervisors pro­

vide morale building, assess strengths and needs,

suggest varying clinical approaches, model, cheer­

lead, and prevent burnout. For entry­level coun­

selors, the supportive function is critical.

• Mentor/Role Model: The experienced supervisor

mentors and teaches the supervisee through role

modeling, facilitates the counselor’s overall profes­

sional development and sense of professional iden­

tity, and trains the next generation of supervisors.

Figure 1. Roles of the Clinical Supervisor

Part 1, Chapter 1 4

Central Principles of Clinical Supervision The Consensus Panel for this TIP has identified cen­

tral principles of clinical supervision. Although the

Panel recognizes that clinical supervision can initial­

ly be a costly undertaking for many financially

strapped programs, the Panel believes that ultimate­

ly clinical supervision is a cost­saving process.

Clinical supervision enhances the quality of client

care; improves efficiency of counselors in direct and

indirect services; increases workforce satisfaction,

professionalization, and retention (see vignette 8 in

chapter 2); and ensures that services provided to the

public uphold legal mandates and ethical standards

of the profession.

The central principles identified by the Consensus

Panel are:

1. Clinical supervision is an essential part of

all clinical programs. Clinical supervision is a

central organizing activity that integrates the

program mission, goals, and treatment philosophy

with clinical theory and evidence­based practices

(EBPs). The primary reasons for clinical supervi­

sion are to ensure (1) quality client care, and (2)

clinical staff continue professional development in

a systematic and planned manner. In substance

abuse treatment, clinical supervision is the pri­

mary means of determining the quality of care

provided.

2. Clinical supervision enhances staff reten­

tion and morale. Staff turnover and workforce

development are major concerns in the substance

abuse treatment field. Clinical supervision is a

primary means of improving workforce retention

and job satisfaction (see, for example, Roche,

Todd, & O’Connor, 2007).

3. Every clinician, regardless of level of skill

and experience, needs and has a right to

clinical supervision. In addition, supervisors

need and have a right to supervision of their

supervision. Supervision needs to be tailored to

the knowledge base, skills, experience, and

assignment of each counselor. All staff need

supervision, but the frequency and intensity of

the oversight and training will depend on the

role, skill level, and competence of the individual.

Clinical Supervision and Professional Development 

The benefits that come with years of experience

are enhanced by quality clinical supervision.

4. Clinical supervision needs the full support

of agency administrators. Just as treatment

programs want clients to be in an atmosphere of

growth and openness to new ideas, counselors

should be in an environment where learning and

professional development and opportunities are

valued and provided for all staff.

5. The supervisory relationship is the crucible

in which ethical practice is developed and

reinforced. The supervisor needs to model sound

ethical and legal practice in the supervisory rela­

tionship. This is where issues of ethical practice

arise and can be addressed. This is where ethical

practice is translated from a concept to a set of

behaviors. Through supervision, clinicians can

develop a process of ethical decisionmaking and

use this process as they encounter new situations.

6. Clinical supervision is a skill in and of itself

that has to be developed. Good counselors tend

to be promoted into supervisory positions with the

assumption that they have the requisite skills to

provide professional clinical supervision.

However, clinical supervisors need a different role

orientation toward both program and client goals

and a knowledge base to complement a new set of

skills. Programs need to increase their capacity to

develop good supervisors.

7. Clinical supervision in substance abuse

treatment most often requires balancing

administrative and clinical supervision

tasks. Sometimes these roles are complementary

and sometimes they conflict. Often the supervisor

feels caught between the two roles.

Administrators need to support the integration

and differentiation of the roles to promote the

efficacy of the clinical supervisor. (See Part 2.)

8. Culture and other contextual variables

influence the supervision process; supervi­

sors need to continually strive for cultural

competence. Supervisors require cultural com­

petence at several levels. Cultural competence

involves the counselor’s response to clients, the

supervisor’s response to counselors, and the pro­

gram’s response to the cultural needs of the

diverse community it serves. Since supervisors

are in a position to serve as catalysts for change,

they need to develop proficiency in addressing the

needs of diverse clients and personnel.

5

9. Successful implementation of EBPs requires

ongoing supervision. Supervisors have a role in

determining which specific EBPs are relevant for

an organization’s clients (Lindbloom, Ten Eyck, &

Gallon, 2005). Supervisors ensure that EBPs are

successfully integrated into ongoing programmat­

ic activities by training, encouraging, and moni­

toring counselors. Excellence in clinical supervi­

sion should provide greater adherence to the EBP

model. Because State funding agencies now often

require substance abuse treatment organizations

to provide EBPs, supervision becomes even more

important.

10. Supervisors have the responsibility to be

gatekeepers for the profession. Supervisors

are responsible for maintaining professional stan­

dards, recognizing and addressing impairment,

and safeguarding the welfare of clients. More

than anyone else in an agency, supervisors can

observe counselor behavior and respond promptly

to potential problems, including counseling some

individuals out of the field because they are ill­

suited to the profession. This “gatekeeping” func­

tion is especially important for supervisors who

act as field evaluators for practicum students

prior to their entering the profession. Finally,

supervisors also fulfill a gatekeeper role in per­

formance evaluation and in providing formal rec­

ommendations to training institutions and cre­

dentialing bodies.

11. Clinical supervision should involve direct

observation methods. Direct observation

should be the standard in the field because it is

one of the most effective ways of building skills,

monitoring counselor performance, and ensuring

quality care. Supervisors require training in

methods of direct observation, and administrators

need to provide resources for implementing direct

observation. Although small substance abuse

agencies might not have the resources for one­

way mirrors or videotaping equipment, other

direct observation methods can be employed (see

the section on methods of observation, pp. 20–24).

Guidelines for New Supervisors Congratulations on your appointment as a supervisor!

By now you might be asking yourself a few questions:

What have I done? Was this a good career decision?

There are many changes ahead. If you have been pro­

moted from within, you’ll encounter even more hur­

dles and issues. First, it is important to face that

your life has changed. You might experience the loss

of friendship of peers. You might feel that you knew

what to do as a counselor, but feel totally lost with

your new responsibilities (see vignette 6 in chapter

2). You might feel less effective in your new role.

Supervision can be an emotionally draining experi­

ence, as you now have to work with more staff­related

interpersonal and human resources issues.

Before your promotion to clinical supervisor, you

might have felt confidence in your clinical skills. Now

you might feel unprepared and wonder if you need a

training course for your new role. If you feel this way,

you’re right. Although you are a good counselor, you

do not necessarily possess all the skills needed to be a

good supervisor. Your new role requires a new body of

knowledge and different skills, along with the ability

to use your clinical skills in a different way. Be confi­

dent that you will acquire these skills over time (see

the Resources section, p. 34) and that you made the

right decision to accept your new position.

Suggestions for new supervisors:

• Quickly learn the organization’s policies and pro­

cedures and human resources procedures (e.g., hir­

ing and firing, affirmative action requirements,

format for conducting meetings, giving feedback,

and making evaluations). Seek out this informa­

tion as soon as possible through the human

resources department or other resources within

the organization.

• Ask for a period of 3 months to allow you to learn

about your new role. During this period, do not

make any changes in policies and procedures but

use this time to find your managerial voice and

decisionmaking style.

• Take time to learn about your supervisees, their

career goals, interests, developmental objectives,

and perceived strengths.

• Work to establish a contractual relationship with

supervisees, with clear goals and methods of

supervision.

• Learn methods to help staff reduce stress, address

competing priorities, resolve staff conflict, and

other interpersonal issues in the workplace.

• Obtain training in supervisory procedures and

methods.

Part 1, Chapter 1 6

• Find a mentor, either internal or external to the

organization.

• Shadow a supervisor you respect who can help you

learn the ropes of your new job.

• Ask often and as many people as possible, “How

am I doing?” and “How can I improve my perform­

ance as a clinical supervisor?”

• Ask for regular, weekly meetings with your

administrator for training and instruction.

• Seek supervision of your supervision.

Problems and Resources As a supervisor, you may encounter a broad array of

issues and concerns, ranging from working within a

system that does not fully support clinical supervision

to working with resistant staff. A comment often

heard in supervision training sessions is “My boss

should be here to learn what is expected in supervi­

sion,” or “This will never work in my agency’s bureau­

cracy. They only support billable activities.” The work

setting is where you apply the principles and prac­

tices of supervision and where organizations are driv­

en by demands, such as financial solvency, profit,

census, accreditation, and concerns over litigation.

Therefore, you will need to be practical when begin­

ning your new role as a supervisor: determine how

you can make this work within your unique work

environment.

Working With Staff Who Are Resistant to Supervision Some of your supervisees may have been in the field

longer than you have and see no need for supervision.

Other counselors, having completed their graduate

training, do not believe they need further supervision,

especially not from a supervisor who might have less

formal academic education than they have. Other

resistance might come from ageism, sexism, racism,

or classism. Particular to the field of substance abuse

treatment may be the tension between those who

believe that recovery from substance abuse is neces­

sary for this counseling work and those who do not

believe this to be true.

In addressing resistance, you must be clear regarding

what your supervision program entails and must con­

sistently communicate your goals and expectations to

Clinical Supervision and Professional Development 

staff. To resolve defensiveness and engage your

supervisees, you must also honor the resistance and

acknowledge their concerns. Abandon trying to push

the supervisee too far, too fast. Resistance is an

expression of ambivalence about change and not a

personality defect of the counselor. Instead of arguing

with or exhorting staff, sympathize with their con­

cerns, saying, “I understand this is difficult. How are

we going to resolve these issues?”

When counselors respond defensively or reject direc­

tions from you, try to understand the origins of their

defensiveness and to address their resistance. Self­

disclosure by the supervisor about experiences as a

supervisee, when appropriately used, may be helpful

in dealing with defensive, anxious, fearful, or resist­

ant staff. Work to establish a healthy, positive super­

visory alliance with staff. Because many substance

abuse counselors have not been exposed to clinical

supervision, you may need to train and orient the

staff to the concept and why it is important for your

agency.

Things a New Supervisor Should Know Eight truths a beginning supervisor should commit to

memory are listed below:

1. The reason for supervision is to ensure quality

client care. As stated throughout this TIP, the

primary goal of clinical supervision is to protect

the welfare of the client and ensure the integrity

of clinical services.

2. Supervision is all about the relationship. As in

counseling, developing the alliance between the

counselor and the supervisor is the key to good

supervision.

3. Culture and ethics influence all supervisory

interactions. Contextual factors, culture, race,

and ethnicity all affect the nature of the supervi­

sory relationship. Some models of supervision

(e.g., Holloway, 1995) have been built primarily

around the role of context and culture in shaping

supervision.

4. Be human and have a sense of humor. As role

models, you need to show that everyone makes

mistakes and can admit to and learn from these

mistakes.

7

5. Rely first on direct observation of your counselors

and give specific feedback. The best way to deter­

mine a counselor’s skills is to observe him or her

and to receive input from the clients about their

perceptions of the counseling relationship.

6. Have and practice a model of counseling and of

supervision; have a sense of purpose. Before you

can teach a supervisee knowledge and skills, you

must first know the philosophical and theoretical

foundations on which you, as a supervisor, stand.

Counselors need to know what they are going to

learn from you, based on your model of counseling

and supervision.

7. Make time to take care of yourself spiritually,

emotionally, mentally, and physically. Again, as

role models, counselors are watching your behav­

ior. Do you “walk the talk” of self­care?

8. You have a unique position as an advocate for the

agency, the counselor, and the client. As a super­

visor, you have a wonderful opportunity to assist

in the skill and professional development of your

staff, advocating for the best interests of the

supervisee, the client, and your organization.

Models of Clinical Supervision You may never have thought about your model of

supervision. However, it is a fundamental premise of

this TIP that you need to work from a defined model

of supervision and have a sense of purpose in your

oversight role. Four supervisory orientations seem

particularly relevant. They include:

• Competency­based models.

• Treatment­based models.

• Developmental approaches.

• Integrated models.

Competency­based models (e.g., microtraining,

the Discrimination Model [Bernard & Goodyear,

2004], and the Task­Oriented Model [Mead, 1990],

focus primarily on the skills and learning needs of

the supervisee and on setting goals that are specific,

measurable, attainable, realistic, and timely

(SMART). They construct and implement strategies

to accomplish these goals. The key strategies of com­

petency­based models include applying social learn­

ing principles (e.g., modeling role reversal, role play­

ing, and practice), using demonstrations, and using

various supervisory functions (teaching, consulting,

and counseling).

Treatment­based supervision models train to a

particular theoretical approach to counseling, incorpo­

rating EBPs into supervision and seeking fidelity and

adaptation to the theoretical model. Motivational

interviewing, cognitive–behavioral therapy, and psy­

chodynamic psychotherapy are three examples. These

models emphasize the counselor’s strengths, seek the

supervisee’s understanding of the theory and model

taught, and incorporate the approaches and tech­

niques of the model. The majority of these models

begin with articulating their treatment approach and

describing their supervision model, based upon that

approach.

Developmental models, such as Stoltenberg and

Delworth (1987), understand that each counselor goes

through different stages of development and recog­

nize that movement through these stages is not

always linear and can be affected by changes in

assignment, setting, and population served. (The

developmental stages of counselors and supervisors

are described in detail below).

Integrated models, including the Blended Model,

begin with the style of leadership and articulate a

model of treatment, incorporate descriptive dimen­

sions of supervision (see below), and address contex­

tual and developmental dimensions into supervision.

They address both skill and competency development

and affective issues, based on the unique needs of

the supervisee and supervisor. Finally, integrated

models seek to incorporate EBPs into counseling and

supervision.

In all models of supervision, it is helpful to identify

culturally or contextually centered models or

approaches and find ways of tailoring the models to

specific cultural and diversity factors. Issues to con­

sider are:

• Explicitly addressing diversity of supervisees (e.g.,

race, ethnicity, gender, age, sexual orientation)

and the specific factors associated with these types

of diversity;

• Explicitly involving supervisees’ concerns related

to particular client diversity (e.g., those whose cul­

ture, gender, sexual orientation, and other attrib­

utes differ from those of the supervisee) and

addressing specific factors associated with these

types of diversity; and

Part 1, Chapter 1 8

• Explicitly addressing supervisees’ issues related to

effectively navigating services in intercultural

communities and effectively networking with

agencies and institutions.

It is important to identify your model of counseling

and your beliefs about change, and to articulate a

workable approach to supervision that fits the model

of counseling you use. Theories are conceptual frame­

works that enable you to make sense of and organize

your counseling and supervision and to focus on the

most salient aspects of a counselor’s practice. You

may find some of the questions below to be relevant

to both supervision and counseling. The answers to

these questions influence both how you supervise and

how the counselors you supervise work:

• What are your beliefs about how people change in

both treatment and clinical supervision?

• What factors are important in treatment and clini­

cal supervision?

• What universal principles apply in supervision

and counseling and which are unique to clinical

supervision?

• What conceptual frameworks of counseling do you

use (for instance, cognitive–behavioral therapy,

12­Step facilitation, psychodynamic, behavioral)?

• What are the key variables that affect outcomes?

(Campbell, 2000)

According to Bernard and Goodyear (2004) and

Powell and Brodsky (2004),the qualities of a good

model of clinical supervision are:

• Rooted in the individual, beginning with the

supervisor’s self, style, and approach to leadership.

• Precise, clear, and consistent.

• Comprehensive, using current scientific and evi­

dence­based practices.

• Operational and practical, providing specific con­

cepts and practices in clear, useful, and measura­

ble terms.

• Outcome­oriented to improve counselor compe­

tence; make work manageable; create a sense of

mastery and growth for the counselor; and address

the needs of the organization, the supervisor, the

supervisee, and the client.

Finally, it is imperative to recognize that, whatever

model you adopt, it needs to be rooted in the learning

and developmental needs of the supervisee, the spe­

cific needs of the clients they serve, the goals of the

agency in which you work, and in the ethical and

legal boundaries of practice. These four variables

define the context in which effective supervision can

take place.

Developmental Stages of Counselors Counselors are at different stages of professional

development. Thus, regardless of the model of super­

vision you choose, you must take into account the

supervisee’s level of training, experience, and profi­

ciency. Different supervisory approaches are appro­

priate for counselors at different stages of develop­

ment. An understanding of the supervisee’s (and

supervisor’s) developmental needs is an essential

ingredient for any model of supervision.

Various paradigms or classifications of developmental

stages of clinicians have been developed (Ivey, 1997;

Rigazio­DiGilio, 1997; Skolvolt & Ronnestrand, 1992;

Todd and Storn, 1997). This TIP has adopted the

Integrated Developmental Model (IDM) of

Stoltenberg, McNeill, and Delworth (1998) (see figure

2, p. 10). This schema uses a three­stage approach.

The three stages of development have different char­

acteristics and appropriate supervisory methods.

Further application of the IDM to the substance

abuse field is needed. (For additional information, see

Anderson, 2001.)

It is important to keep in mind several general cau­

tions and principles about counselor development,

including:

• There is a beginning but not an end point for

learning clinical skills; be careful of counselors

who think they “know it all.”

• Take into account the individual learning styles

and personalities of your supervisees and fit the

supervisory approach to the developmental stage

of each counselor.

• There is a logical sequence to development,

although it is not always predictable or rigid; some

counselors may have been in the field for years but

remain at an early stage of professional develop­

ment, whereas others may progress quickly

through the stages.

Clinical Supervision and Professional Development  9

• Counselors at an advanced developmental level

have different learning needs and require different

supervisory approaches from those at Level 1; and

• The developmental level can be applied for differ­

ent aspects of a counselor’s overall competence

(e.g., Level 2 mastery for individual counseling

and Level 1 for couples counseling).

Figure 2. Counselor Developmental Model

Developmental Level Characteristics Supervision Skills

Development Needs Techniques

Level 1 • Focuses on self • Anxious, uncertain • Preoccupied with per-

forming the right way • Overconfident of skills • Overgeneralizes • Overuses a skill • Gap between conceptu-

alization, goals, and interventions

• Ethics underdeveloped

• Provide structure and minimize anxiety

• Supportive, address strengths first, then weaknesses

• Suggest approaches • Start connecting theory

to treatment

• Observation • Skills training • Role playing • Readings • Group supervision • Closely monitor clients

Level 2 • Focuses less on self and more on client

• Confused, frustrated with complexity of coun- seling

• Overidentifies with client • Challenges authority • Lacks integration with

theoretical base • Overburdened • Ethics better understood

• Less structure provided, more autonomy encour- aged

• Supportive • Periodic suggestion of

approaches • Confront discrepancies • Introduce more alterna-

tive views • Process comments, high-

light countertransfer- ence

• Affective reactions to client and/or supervisor

• Observation • Role playing • Interpret dynamics • Group supervision • Reading

Level 3 • Focuses intently on client • High degree of empathic

skill • Objective third person

perspective • Integrative thinking and

approach • Highly responsible and

ethical counselor

• Supervisee directed • Focus on personal-pro-

fessional integration and career

• Supportive • Change agent

• Peer supervision • Group supervision • Reading

Source: Stoltenberg, Delworth, & McNeil, 1998

Developmental Stages of Supervisors Just as counselors go through stages of development,

so do supervisors. The developmental model present­

ed in figure 3 provides a framework to explain why

supervisors act as they do, depending on their devel­

opmental stage. It would be expected that someone

new to supervision would be at a Level 1 as a super­

visor. However, supervisors should be at least at the

second or third stage of counselor development. If a

newly appointed supervisor is still at Level 1 as a

Part 1, Chapter 1 10

counselor, he or she will have little to offer to more

seasoned supervisees.

Figure 3. Supervisor Developmental Model

Developmental Level

Characteristics To Increase Supervision Competence

Level 1 • Is anxious regarding role • Is naïve about assuming the role of supervisor • Is focused on doing the “right” thing • May overly respond as an “expert” • Is uncomfortable providing direct feedback

• Follow structure and formats • Design systems to increase organization of

supervision • Assign Level I counselors

Level 2 • Shows confusion and conflict • Sees supervision as complex and multidimen-

sional • Needs support to maintain motivation • Overfocused on counselor’s deficits and per-

ceived resistance • May fall back to being a therapist with the

counselor

• Provide active supervision of the supervi- sion

• Assign Level 1 counselors

Level 3 • Is highly motivated • Can provide an honest self-appraisal of

strengths and weaknesses as supervisor • Is comfortable with evaluation process • Provides thorough, objective feedback

• Comfortable with all levels

Source: Stoltenberg, Delworth, & McNeil, 1998

Cultural and Contextual Factors Culture is one of the major contextual factors that

influence supervisory interactions. Other contextual

variables include race, ethnicity, age, gender, disci­

pline, academic background, religious and spiritual

practices, sexual orientation, disability, and recovery

versus non­recovery status. The relevant variables

in the supervisory relationship occur in the context

of the supervisor, supervisee, client, and the setting

in which supervision occurs. More care should be

taken to:

• Identify the competencies necessary for substance

abuse counselors to work with diverse individuals

and navigate intercultural communities.

• Identify methods for supervisors to assist coun­

selors in developing these competencies.

• Provide evaluation criteria for supervisors to

determine whether their supervisees have met

minimal competency standards for effective and

relevant practice.

Models of supervision have been strongly influenced

by contextual variables and their influence on the

supervisory relationship and process, such as

Holloway’s Systems Model (1995) and Constantine’s

Multicultural Model (2003).

The competencies listed in TAP 21­A reflect the

importance of culture in supervision (CSAT, 2007).

The Counselor Development domain encourages self­

examination of attitudes toward culture and other

contextual variables. The Supervisory Alliance

domain promotes attention to these variables in the

supervisory relationship. (See also the planned TIP,

Improving Cultural Competence in Substance Abuse

Counseling [CSAT, in development b].)

Cultural competence “refers to the ability to honor

and respect the beliefs, language, interpersonal

styles, and behaviors of individuals and families

receiving services, as well as staff who are providing

such services. Cultural competence is a dynamic,

ongoing, developmental process that requires a com­

mitment and is achieved over time” (U.S. Department

Clinical Supervision and Professional Development  11

of Health and Human Services, 2003, p. 12). Culture

shapes belief systems, particularly concerning issues

related to mental health and substance abuse, as well

as the manifestation of symptoms, relational styles,

and coping patterns.

There are three levels of cultural consideration for

the supervisory process: the issue of the culture of

the client being served and the culture of the coun­

selor in supervision. Holloway (1995) emphasizes the

cultural issues of the agency, the geographic environ­

ment of the organization, and many other contextual

factors. Specifically, there are three important areas

in which cultural and contextual factors play a key

role in supervision: in building the supervisory rela­

tionship or working alliance, in addressing the spe­

cific needs of the client, and in building supervisee

competence and ability. It is your responsibility to

address your supervisees’ beliefs, attitudes, and bias­

es about cultural and contextual variables to advance

their professional development and promote quality

client care.

Becoming culturally competent and able to integrate

other contextual variables into supervision is a com­

plex, long­term process. Cross (1989) has identified

several stages on a continuum of becoming culturally

competent (see figure 4).

Figure 4. Continuum of Cultural Competence

Cultural Destructiveness Superiority of dominant culture and inferiority of other cultures; active discrimination

Cultural Incapacity Separate but equal treatment; passive discrimination

Cultural Blindness Sees all cultures and people as alike and equal; discrimination by ignoring culture

Cultural Openness (Sensitivity) Basic understanding and appreciation of importance of sociocultural factors in work with minority populations

Cultural Competence Capacity to work with more complex issues and cultural nuances

Cultural Proficiency Highest capacity for work with minority populations; a commitment to excellence and proactive effort

Source: Cross, 1989.

Although you may never have had specialized train­

ing in multicultural counseling, some of your super­

visees may have (see Constantine, 2003). Regardless,

it is your responsibility to help supervisees build on

the cultural competence skills they possess as well as

to focus on their cultural competence deficits. It is

important to initiate discussion of issues of culture,

race, gender, sexual orientation, and the like in

supervision to model the kinds of discussion you

would like counselors to have with their clients. If

these issues are not addressed in supervision, coun­

selors may come to believe that it is inappropriate to

discuss them with clients and have no idea how such

dialog might proceed. These discussions prevent mis­

understandings with supervisees based on cultural or

other factors. Another benefit from these discussions

is that counselors will eventually achieve some level

of comfort in talking about culture, race, ethnicity,

and diversity issues.

If you haven’t done it as a counselor, early in your

tenure as a supervisor you will want to examine your

culturally influenced values, attitudes, experiences,

and practices and to consider what effects they have

on your dealings with supervisees and clients.

Counselors should undergo a similar review as

preparation for when they have clients of a culture

different from their own. Some questions to keep in

mind are:

• What did you think when you saw the supervisee’s

last name?

Part 1, Chapter 1 12

• What did you think when the supervisee said his

or her culture is X, when yours is Y?

• How did you feel about this difference?

• What did you do in response to this difference?

Constantine (2003) suggests that supervisors can use

the following questions with supervisees:

• What demographic variables do you use to identify

yourself?

• What worldviews (e.g., values, assumptions, and

biases) do you bring to supervision based on your

cultural identities?

• What struggles and challenges have you faced

working with clients who were from different cul­

tures than your own?

Beyond self­examination, supervisors will want con­

tinuing education classes, workshops, and conferences

that address cultural competence and other contextu­

al factors. Community resources, such as community

leaders, elders, and healers can contribute to your

understanding of the culture your organization

serves. Finally, supervisors (and counselors) should

participate in multicultural activities, such as com­

munity events, discussion groups, religious festivals,

and other ceremonies.

The supervisory relationship includes an inherent

power differential, and it is important to pay atten­

tion to this disparity, particularly when the super­

visee and the supervisor are from different cultural

groups. A potential for the misuse of that power

exists at all times but especially when working with

supervisees and clients within multicultural contexts.

When the supervisee is from a minority population

and the supervisor is from a majority population, the

differential can be exaggerated. You will want to pre­

vent institutional discrimination from affecting the

quality of supervision. The same is true when the

supervisee is gay and the supervisor is heterosexual,

or the counselor is non­degreed and the supervisor

has an advanced degree, or a female supervisee with

a male supervisor, and so on. In the reverse situa­

tions, where the supervisor is from the minority

group and the supervisee from the majority group,

the difference should be discussed as well.

Clinical Supervision and Professional Development 

Ethical and Legal Issues You are the organization’s gatekeeper for ethical and

legal issues. First, you are responsible for upholding

the highest standards of ethical, legal, and moral

practices and for serving as a model of practice to

staff. Further, you should be aware of and respond to

ethical concerns. Part of your job is to help integrate

solutions to everyday legal and ethical issues into

clinical practice.

Some of the underlying assumptions of incorporating

ethical issues into clinical supervision include:

• Ethical decisionmaking is a continuous, active

process.

• Ethical standards are not a cookbook. They tell

you what to do, not always how.

• Each situation is unique. Therefore, it is impera­

tive that all personnel learn how to “think ethi­

cally” and how to make sound legal and ethical

decisions.

• The most complex ethical issues arise in the con­

text of two ethical behaviors that conflict; for

instance, when a counselor wants to respect the

privacy and confidentiality of a client, but it is in

the client’s best interest for the counselor to con­

tact someone else about his or her care.

• Therapy is conducted by fallible beings; people

make mistakes—hopefully, minor ones.

• Sometimes the answers to ethical and legal ques­

tions are elusive. Ask a dozen people, and you’ll

likely get twelve different points of view.

Helpful resources on legal and ethical issues for

supervisors include Beauchamp and Childress (2001);

Falvey (2002b); Gutheil and Brodsky (2008); Pope,

Sonne, and Greene (2006); and Reamer (2006).

Legal and ethical issues that are critical to clinical

supervisors include (1) vicarious liability (or respon­

deat superior), (2) dual relationships and boundary

concerns, (4) informed consent, (5) confidentiality,

and (6) supervisor ethics.

Direct Versus Vicarious Liability An important distinction needs to be made between

direct and vicarious liability. Direct liability of the

supervisor might include dereliction of supervisory

responsibility, such as “not making a reasonable

effort to supervise” (defined below).

13

In vicarious liability, a supervisor can be held liable

for damages incurred as a result of negligence in the

supervision process. Examples of negligence include

providing inappropriate advice to a counselor about a

client (for instance, discouraging a counselor from

conducting a suicide screen on a depressed client),

failure to listen carefully to a supervisee’s comments

about a client, and the assignment of clinical tasks to

inadequately trained counselors. The key legal ques­

tion is: “Did the supervisor conduct him­ or herself in

a way that would be reasonable for someone in his

position?” or “Did the supervisor make a reasonable

effort to supervise?” A generally accepted time stan­

dard for a “reasonable effort to supervise” in the

behavioral health field is 1 hour of supervision for

every 20–40 hours of clinical services. Of course,

other variables (such as the quality and content of

clinical supervision sessions) also play a role in a rea­

sonable effort to supervise.

Supervisory vulnerability increases when the coun­

selor has been assigned too many clients, when there

is no direct observation of a counselor’s clinical work,

when staff are inexperienced or poorly trained for

assigned tasks, and when a supervisor is not

involved or not available to aid the clinical staff. In

legal texts, vicarious liability is referred to as

“respondeat superior.”

Dual Relationships and Boundary Issues Dual relationships can occur at two levels: between

supervisors and supervisees and between counselors

and clients. You have a mandate to help your super­

visees recognize and manage boundary issues. A dual

relationship occurs in supervision when a supervisor

has a primary professional role with a supervisee

and, at an earlier time, simultaneously or later,

engages in another relationship with the supervisee

that transcends the professional relationship.

Examples of dual relationships in supervision include

providing therapy for a current or former supervisee,

developing an emotional relationship with a super­

visee or former supervisee, and becoming an

Alcoholics Anonymous sponsor for a former super­

visee. Obviously, there are varying degrees of harm

or potential harm that might occur as a result of dual

relationships, and some negative effects of dual rela­

tionships might not be apparent until later.

Therefore, firm, always­or­never rules aren’t applica­

ble. You have the responsibility of weighing with the

counselor the anticipated and unanticipated effects of

dual relationships, helping the supervisee’s self­

reflective awareness when boundaries become

blurred, when he or she is getting close to a dual rela­

tionship, or when he or she is crossing the line in the

clinical relationship.

Exploring dual relationship issues with counselors in

clinical supervision can raise its own professional

dilemmas. For instance, clinical supervision involves

unequal status, power, and expertise between a

supervisor and supervisee. Being the evaluator of a

counselor’s performance and gatekeeper for training

programs or credentialing bodies also might involve a

dual relationship. Further, supervision can have ther­

apy­like qualities as you explore countertransferen­

tial issues with supervisees, and there is an expecta­

tion of professional growth and self­exploration. What

makes a dual relationship unethical in supervision is

the abusive use of power by either party, the likeli­

hood that the relationship will impair or injure the

supervisor’s or supervisee’s judgment, and the risk of

exploitation (see vignette 3 in chapter 2).

The most common basis for legal action against coun­

selors (20 percent of claims) and the most frequently

heard complaint by certification boards against coun­

selors (35 percent) is some form of boundary violation

or sexual impropriety (Falvey, 2002b). (See the dis­

cussion of transference and countertransference on

pp. 25–26.)

Codes of ethics for most professions clearly advise

that dual relationships between counselors and

clients should be avoided. Dual relationships between

counselors and supervisors are also a concern and are

addressed in the substance abuse counselor codes and

those of other professions as well. Problematic dual

relationships between supervisees and supervisors

might include intimate relationships (sexual and non­

sexual) and therapeutic relationships, wherein the

supervisor becomes the counselor’s therapist. Sexual

involvement between the supervisor and supervisee

can include sexual attraction, harassment, consensual

(but hidden) sexual relationships, or intimate roman­

tic relationships. Other common boundary issues

include asking the supervisee to do favors, providing

preferential treatment, socializing outside the work

setting, and using emotional abuse to enforce power.

Part 1, Chapter 1 14

It is imperative that all parties understand what con­

stitutes a dual relationship between supervisor and

supervisee and avoid these dual relationships. Sexual

relationships between supervisors and supervisees

and counselors and clients occur far more frequently

than one might realize (Falvey, 2002b). In many

States, they constitute a legal transgression as well

as an ethical violation.

The decision tree presented in figure 5 (p. 16) indi­

cates how a supervisor might manage a situation

where he or she is concerned about a possible ethical

or legal violation by a counselor.

Informed Consent Informed consent is key to protecting the counselor

and/or supervisor from legal concerns, requiring the

recipient of any service or intervention to be suffi­

ciently aware of what is to happen, and of the poten­

tial risks and alternative approaches, so that the per­

son can make an informed and intelligent decision

about participating in that service. The supervisor

must inform the supervisee about the process of

supervision, the feedback and evaluation criteria, and

other expectations of supervision. The supervision

contract should clearly spell out these issues.

Supervisors must ensure that the supervisee has

informed the client about the parameters of counsel­

ing and supervision (such as the use of live observa­

tion, video­ or audiotaping). A sample template for

informed consent is provided in Part 2, chapter 2

(p. 106).

Confidentiality In supervision, regardless of whether there is a writ­

ten or verbal contract between the supervisor and

supervisee, there is an implied contract and duty of

care because of the supervisor’s vicarious liability.

Informed consent and concerns for confidentiality

should occur at three levels: client consent to treat­

ment, client consent to supervision of the case, and

supervisee consent to supervision (Bernard &

Goodyear, 2004). In addition, there is an implied con­

sent and commitment to confidentiality by supervi­

sors to assume their supervisory responsibilities and

institutional consent to comply with legal and ethical

parameters of supervision. (See also the Code of

Ethics of the Association for Counselor Education and

Clinical Supervision and Professional Development 

Supervision [ACES], available online at

http://www.acesonline.net/ethical_guidelines.asp).

With informed consent and confidentiality comes a

duty not to disclose certain relational communication.

Limits of confidentiality of supervision session con­

tent should be stated in all organizational contracts

with training institutions and credentialing bodies.

Criteria for waiving client and supervisee privilege

should be stated in institutional policies and disci­

pline­specific codes of ethics and clarified by advice of

legal counsel and the courts. Because standards of

confidentiality are determined by State legal and leg­

islative systems, it is prudent for supervisors to con­

sult with an attorney to determine the State codes of

confidentiality and clinical privileging.

In the substance abuse treatment field, confidentiali­

ty for clients is clearly defined by Federal law: 42

CFR, Part 2 and the Health Insurance Portability

and Accountability Act (HIPAA). Key information is

available at http://www.hipaa.samhsa.gov. Super­

visors need to train counselors in confidentiality regu­

lations and to adequately document their supervision,

including discussions and directives, especially relat­

ing to duty­to­warn situations. Supervisors need to

ensure that counselors provide clients with appropri­

ate duty­to­warn information early in the counseling

process and inform clients of the limits of confiden­

tiality as part of the agency’s informed consent proce­

dures.

Under duty­to­warn requirements (e.g., child abuse,

suicidal or homicidal ideation), supervisors need to be

aware of and take action as soon as possible in situa­

tions in which confidentiality may need to be waived.

Organizations should have a policy stating how clini­

cal crises will be handled (Falvey, 2002b). What

mechanisms are in place for responding to crises? In

what timeframe will a supervisor be notified of a cri­

sis situation? Supervisors must document all discus­

sions with counselors concerning duty­to­warn and

crises. At the onset of supervision, supervisors should

ask counselors if there are any duty­to­warn issues of

which the supervisor should be informed.

New technology brings new confidentiality concerns.

Websites now dispense information about substance

abuse treatment and provide counseling services.

With the growth in online counseling and supervi­

sion, the following concerns emerge: (a) how to main­

15

Part 1, Chapter 1 16

tain confidentiality of information, (b) how to ensure

the competence and qualifications of counselors pro­

viding online services, and (c) how to establish report­

ing requirements and duty to warn when services are

conducted across State and international boundaries.

New standards will need to be written to address

these issues. (The National Board for Certified

Counselors has guidelines for counseling by Internet

at http://www.nbcc.org/AssetManagerFiles/ethics/

internetcounseling.pdf.)

Supervisor Ethics In general, supervisors adhere to the same standards

and ethics as substance abuse counselors with regard

to dual relationship and other boundary violations.

Supervisors will:

• Uphold the highest professional standards of the

field.

• Seek professional help (outside the work setting)

when personal issues interfere with their clinical

and/or supervisory functioning.

• Conduct themselves in a manner that models

and sets an example for agency mission, vision,

philosophy, wellness, recovery, and consumer

satisfaction.

• Reinforce zero tolerance for interactions that are

not professional, courteous, and compassionate.

• Treat supervisees, colleagues, peers, and clients

with dignity, respect, and honesty.

• Adhere to the standards and regulations of confi­

dentiality as dictated by the field. This applies

to the supervisory as well as the counseling

relationship.

Monitoring Performance The goal of supervision is to ensure quality care for

the client, which entails monitoring the clinical per­

formance of staff. Your first step is to educate super­

visees in what to expect from clinical supervision.

Once the functions of supervision are clear, you

should regularly evaluate the counselor’s progress in

meeting organizational and clinical goals as set

forth in an Individual Development Plan (IDP) (see

the section on IDPs below). As clients have an indi­

vidual treatment plan, counselors also need a plan

to promote skill development.

Clinical Supervision and Professional Development 

Behavioral Contracting in Supervision Among the first tasks in supervision is to establish a

contract for supervision that outlines realistic

accountability for both yourself and your supervisee.

The contract should be in writing and should include

the purpose, goals, and objectives of supervision; the

context in which supervision is provided; ethical and

institutional policies that guide supervision and clini­

cal practices; the criteria and methods of evaluation

and outcome measures; the duties and responsibili­

ties of the supervisor and supervisee; procedural con­

siderations (including the format for taping and

opportunities for live observation); and the super­

visee’s scope of practice and competence. The contract

for supervision should state the rewards for fulfill­

ment of the contract (such as clinical privileges or

increased compensation), the length of supervision

sessions, and sanctions for noncompliance by either

the supervisee or supervisor. The agreement should

be compatible with the developmental needs of the

supervisee and address the obstacles to progress (lack

of time, performance anxiety, resource limitations).

Once a behavioral contract has been established, the

next step is to develop an IDP.

Individual Development Plan The IDP is a detailed plan for supervision that

includes the goals that you and the counselor wish to

address over a certain time period (perhaps 3

months). Each of you should sign and keep a copy of

the IDP for your records. The goals are normally stat­

ed in terms of skills the counselor wishes to build or

professional resources the counselor wishes to devel­

op. These skills and resources are generally oriented

to the counselor’s job in the program or activities that

would help the counselor develop professionally. The

IDP should specify the timelines for change, the

observation methods that will be employed, expecta­

tions for the supervisee and the supervisor, the evalu­

ation procedures that will be employed, and the activ­

ities that will be expected to improve knowledge and

skills. An example of an IDP is provided in Part 2,

chapter 2 (p. 122).

As a supervisor, you should have your own IDP,

based on the supervisory competencies listed in TAP

21­A (CSAT, 2007), that addresses your training

17

goals. This IDP can be developed in cooperation with

your supervisor, or in external supervision, peer

input, academic advisement, or mentorship.

Evaluation of Counselors Supervision inherently involves evaluation, building

on a collaborative relationship between you and the

counselor. Evaluation may not be easy for some

supervisors. Although everyone wants to know how

they are doing, counselors are not always comfortable

asking for feedback. And, as most supervisors prefer

to be liked, you may have difficulty giving clear, con­

cise, and accurate evaluations to staff.

The two types of evaluation are formative and sum­

mative. A formative evaluation is an ongoing status

report of the counselor’s skill development, exploring

the questions “Are we addressing the skills or compe­

tencies you want to focus on?” and “How do we assess

your current knowledge and skills and areas for

growth and development?”

Summative evaluation is a more formal rating of the

counselor’s overall job performance, fitness for the

job, and job rating. It answers the question, “How

does the counselor measure up?” Typically, summa­

tive evaluations are done annually and focus on the

counselor’s overall strengths, limitations, and areas

for future improvement.

It should be acknowledged that supervision is inher­

ently an unequal relationship. In most cases, the

supervisor has positional power over the counselor.

Therefore, it is important to establish clarity of pur­

pose and a positive context for evaluation. Procedures

should be spelled out in advance, and the evaluation

process should be mutual, flexible, and continuous.

The evaluation process inevitably brings up super­

visee anxiety and defensiveness that need to be

addressed openly. It is also important to note that

each individual counselor will react differently to

feedback; some will be more open to the process than

others.

There has been considerable research on supervisory

evaluation, with these findings:

• The supervisee’s confidence and efficacy are corre­

lated with the quality and quantity of feedback the

supervisor gives to the supervisee (Bernard &

Goodyear, 2004).

• Ratings of skills are highly variable between

supervisors, and often the supervisor’s and super­

visee’s ratings differ or conflict (Eby, 2007).

• Good feedback is provided frequently, clearly, and

consistently and is SMART (specific, measurable,

attainable, realistic, and timely) (Powell &

Brodsky, 2004).

Direct observation of the counselor’s work is the

desired form of input for the supervisor. Although

direct observation has historically been the exception

in substance abuse counseling, ethical and legal con­

siderations and evidence support that direct observa­

tion as preferable. The least desirable feedback is

unannounced observation by supervisors followed by

vague, perfunctory, indirect, or hurtful delivery

(Powell & Brodsky, 2004).

Clients are often the best assessors of the skills of the

counselor. Supervisors should routinely seek input

from the clients as to the outcome of treatment. The

method of seeking input should be discussed in the

initial supervisory sessions and be part of the super­

vision contract. In a residential substance abuse

treatment program, you might regularly meet with

clients after sessions to discuss how they are doing,

how effective the counseling is, and the quality of the

therapeutic alliance with the counselor. (For exam­

ples of client satisfaction or input forms, search for

Client­Directed Outcome­Informed Treatment and

Training Materials at http://www.talkingcure.com.)

Before formative evaluations begin, methods of evalu­

ating performance should be discussed, clarified in

the initial sessions, and included in the initial con­

tract so that there will be no surprises. Formative

evaluations should focus on changeable behavior and,

whenever possible, be separate from the overall annu­

al performance appraisal process. To determine the

counselor’s skill development, you should use written

competency tools, direct observation, counselor self­

assessments, client evaluations, work samples (files

and charts), and peer assessments. Examples of work

samples and peer assessments can be found in

Bernard and Goodyear (2004), Powell and Brodsky

(2004), and Campbell (2000). It is important to

acknowledge that counselor evaluation is essentially

a subjective process involving supervisors’ opinions of

the counselors’ competence.

Part 1, Chapter 1 18

Addressing Burnout and Compassion Fatigue Did you ever hear a counselor say, “I came into coun­

seling for the right reasons. At first I loved seeing

clients. But the longer I stay in the field, the harder

it is to care. The joy seems to have gone out of my job.

Should I get out of counseling as many of my col­

leagues are doing?” Most substance abuse counselors

come into the field with a strong sense of calling and

the desire to be of service to others, with a strong pull

to use their gifts and make themselves instruments of

service and healing. The substance abuse treatment

field risks losing many skilled and compassionate

healers when the life goes out of their work. Some

counselors simply withdraw, care less, or get out of

the field entirely. Most just complain or suffer in

silence. Given the caring and dedication that brings

counselors into the field, it is important for you to

help them address their questions and doubts. (See

Lambie, 2006, and Shoptaw, Stein, & Rawson, 2000.)

You can help counselors with self­care; help them

look within; become resilient again; and rediscover

what gives them joy, meaning, and hope in their

work. Counselors need time for reflection, to listen

again deeply and authentically. You can help them

redevelop their innate capacity for compassion, to be

an openhearted presence for others.

You can help counselors develop a life that does not

revolve around work. This has to be supported by the

organization’s culture and policies that allow for

appropriate use of time off and self­care without pun­

ishment. Aid them by encouraging them to take

earned leave and to take “mental health” days when

they are feeling tired and burned out. Remind staff to

spend time with family and friends, exercise, relax,

read, or pursue other life­giving interests.

It is important for the clinical supervisor to normalize

the counselor’s reactions to stress and compassion

fatigue in the workplace as a natural part of being an

empathic and compassionate person and not an indi­

vidual failing or pathology. (See Burke, Carruth, &

Prichard, 2006.)

Rest is good; self­care is important. Everyone needs

times of relaxation and recreation. Often, a month

after a refreshing vacation you lose whatever gain

you made. Instead, longer term gain comes from find­

ing what brings you peace and joy. It is not enough

Clinical Supervision and Professional Development 

for you to help counselors understand “how” to coun­

sel, you can also help them with the “why.” Why are

they in this field? What gives them meaning and pur­

pose at work? When all is said and done, when coun­

selors have seen their last client, how do they want to

be remembered? What do they want said about them

as counselors? Usually, counselors’ responses to this

question are fairly simple: “I want to be thought of as

a caring, compassionate person, a skilled helper.”

These are important spiritual questions that you can

discuss with your supervisees.

Other suggestions include:

• Help staff identify what is happening within the

organization that might be contributing to their

stress and learn how to address the situation in a

way that is productive to the client, the counselor,

and the organization.

• Get training in identifying the signs of primary

stress reactions, secondary trauma, compassion

fatigue, vicarious traumatization, and burnout.

Help staff match up self­care tools to specifically

address each of these experiences.

• Support staff in advocating for organizational

change when appropriate and feasible as part of

your role as liaison between administration and

clinical staff.

• Assist staff in adopting lifestyle changes to

increase their emotional resilience by reconnecting

to their world (family, friends, sponsors, mentors),

spending time alone for self­reflection, and form­

ing habits that re­energize them.

• Help them eliminate the “what ifs” and negative

self­talk. Help them let go of their idealism that

they can save the world.

• If possible in the current work environment, set

parameters on their work by helping them adhere

to scheduled time off, keep lunch time personal,

set reasonable deadlines for work completion, and

keep work away from personal time.

• Teach and support generally positive work habits.

Some counselors lack basic organizational, team­

work, phone, and time management skills (ending

sessions on time and scheduling to allow for docu­

mentation). The development of these skills helps

to reduce the daily wear that erodes well­being

and contributes to burnout.

• Ask them “When was the last time you had fun?”

“When was the last time you felt fully alive?”

Suggest they write a list of things about their job

19

about which they are grateful. List five people

they care about and love. List five accomplish­

ments in their professional life. Ask “Where do you

want to be in your professional life in 5 years?”

You have a fiduciary responsibility given you by

clients to ensure counselors are healthy and whole. It

is your responsibility to aid counselors in addressing

their fatigue and burnout.

Gatekeeping Functions In monitoring counselor performance, an important

and often difficult supervisory task is managing prob­

lem staff or those individuals who should not be coun­

selors. This is the gatekeeping function. Part of the

dilemma is that most likely you were first trained as

a counselor, and your values lie within that domain.

You were taught to acknowledge and work with indi­

vidual limitations, always respecting the individual’s

goals and needs. However, you also carry a responsi­

bility to maintain the quality of the profession and to

protect the welfare of clients. Thus, you are charged

with the task of assessing the counselor for fitness for

duty and have an obligation to uphold the standards

of the profession.

Experience, credentials, and academic performance

are not the same as clinical competence. In addition

to technical counseling skills, many important thera­

peutic qualities affect the outcome of counseling,

including insight, respect, genuineness, concreteness,

and empathy. Research consistently demonstrates

that personal characteristics of counselors are highly

predictive of client outcome (Herman, 1993, Hubble,

Duncan & Miller, 1999). The essential questions are:

Who should or should not be a counselor? What

behaviors or attitudes are unacceptable? How would a

clinical supervisor address these issues in supervi­

sion?

Unacceptable behavior might include actions hurtful

to the client, boundary violations with clients or pro­

gram standards, illegal behavior, significant psychi­

atric impairment, consistent lack of self­awareness,

inability to adhere to professional codes of ethics, or

consistent demonstration of attitudes that are not

conducive to work with clients in substance abuse

treatment. You will want to have a model and policies

and procedures in place when disciplinary action is

undertaken with an impaired counselor. For example,

progressive disciplinary policies clearly state the pro­

cedures to follow when impairment is identified.

Consultation with the organization’s attorney and

familiarity with State case law are important. It is

advisable for the agency to be familiar with and have

contact with your State impaired counselor organiza­

tion, if it exists.

How impaired must a counselor be before disciplinary

action is needed? Clear job descriptions and state­

ments of scope of practice and competence are impor­

tant when facing an impaired counselor. How tired or

distressed can a counselor be before a supervisor

takes the counselor off­line for these or similar rea­

sons? You need administrative support with such

interventions and to identify approaches to managing

worn­out counselors. The Consensus Panel recom­

mends that your organization have an employee

assistance program (EAP) in place so you can refer

staff outside the agency. It is also important for you

to learn the distinction between a supervisory refer­

ral and a self­referral. Self­referral may include a

recommendation by the supervisor, whereas a super­

visory referral usually occurs with a job performance

problem.

You will need to provide verbal and written evalua­

tions of the counselor’s performance and actions to

ensure that the staff member is aware of the behav­

iors that need to be addressed. Treat all supervisees

the same, following agency procedures and timelines.

Follow the organization’s progressive disciplinary

steps and document carefully what is said, how the

person responds, and what actions are recommended.

You can discuss organizational issues or barriers to

action with the supervisee (such as personnel policies

that might be exacerbating the employee’s issues).

Finally, it may be necessary for you to take the action

that is in the best interest of the clients and the pro­

fession, which might involve counseling your super­

visee out of the field.

Remember that the number one goal of a clinical

supervisor is to protect the welfare of the client,

which, at times, can mean enforcing the gatekeeping

function of supervision.

Methods of Observation It is important to observe counselors frequently over

an extended period of time. Supervisors in the sub­

stance abuse treatment field have traditionally relied

Part 1, Chapter 1 20

on indirect methods of supervision (process record­

ings, case notes, verbal reports by the supervisees,

and verbatims). However, the Consensus Panel rec­

ommends that supervisors use direct observation of

counselors through recording devices (such as video

and audio taping) and live observation of counseling

sessions, including one­way mirrors. Indirect methods

have significant drawbacks, including:

• A counselor will recall a session as he or she expe­

rienced it. If a counselor experiences a session pos­

itively or negatively, the report to the supervisor

will reflect that. The report is also affected by the

counselor’s level of skill and experience.

• The counselor’s report is affected by his or her

biases and distortions (both conscious and uncon­

scious). The report does not provide a thorough

sense of what really happened in the session

because it relies too heavily on the counselor’s

recall.

• Indirect methods include a time delay in

reporting.

• The supervisee may withhold clinical information

due to evaluation anxiety or naiveté.

Your understanding of the session will be improved

by direct observation of the counselor. Direct observa­

tion is much easier today, as a variety of technologi­

cal tools are available, including audio and videotap­

ing, remote audio devices, interactive videos, live

feeds, and even supervision through web­based cam­

eras.

Guidelines that apply to all methods of direct obser­

vation in supervision include:

• Simply by observing a counseling session, the

dynamics will change. You may change how both

the client and counselor act. You get a snapshot of

the sessions. Counselors will say, “it was not a

representative session.” Typically, if you observe

the counselor frequently, you will get a fairly accu­

rate picture of the counselor’s competencies.

• You and your supervisee must agree on procedures

for observation to determine why, when, and how

direct methods of observation will be used.

• The counselor should provide a context for the

session.

• The client should give written consent for observa­

tion and/or taping at intake, before beginning

counseling. Clients must know all the conditions of

Clinical Supervision and Professional Development 

their treatment before they consent to counseling.

Additionally, clients need to be notified of an

upcoming observation by a supervisor before the

observation occurs.

• Observations should be selected for review (includ­

ing a variety of sessions and clients, challenges,

and successes) because they provide teaching

moments. You should ask the supervisee to select

what cases he or she wishes you to observe and

explain why those cases were chosen. Direct obser­

vation should not be a weapon for criticism but a

constructive tool for learning: an opportunity for

the counselor to do things right and well, so that

positive feedback follows.

• When observing a session, you gain a wealth of

information about the counselor. Use this informa­

tion wisely, and provide gradual feedback, not a

litany of judgments and directives. Ask the salient

question, “What is the most important issue here

for us to address in supervision?”

• A supervisee might claim client resistance to

direct observation, saying, “It will make the client

nervous. The client does not want to be taped.”

However, “client resistance” is more likely to be

reported when the counselor is anxious about

being taped. It is important for you to gently and

respectfully address the supervisee’s resistance

while maintaining the position that direct obser­

vation is an integral component of his or her

supervision.

• Given the nature of the issues in drug and alco­

hol counseling, you and your supervisee need to

be sensitive to increased client anxiety about

direct observation because of the client’s fears

about job or legal repercussions, legal actions,

criminal behaviors, violence and abuse situa­

tions, and the like.

• Ideally, the supervisee should know at the outset

of employment that observation and/or taping

will be required as part of informed consent to

supervision.

In instances where there is overwhelming anxiety

regarding observation, you should pace the observa­

tion to reduce the anxiety, giving the counselor ade­

quate time for preparation. Often enough, counselors

will feel more comfortable with observation equip­

ment (such as a video camera or recording device)

rather than direct observation with the supervisor in

the room.

21

The choice of observation methods in a particular sit­

uation will depend on the need for an accurate sense

of counseling, the availability of equipment, the con­

text in which the supervision is provided, and the

counselor’s and your skill levels. A key factor in the

choice of methods might be the resistance of the coun­

selor to being observed. For some supervisors, direct

observation also puts the supervisor’s skills on the

line too, as they might be required to demonstrate or

model their clinical competencies.

Recorded Observation Audiotaped supervision has traditionally been a pri­

mary medium for supervisors and remains a vital

resource for therapy models such as motivational

interviewing. On the other hand, videotape supervi­

sion (VTS) is the primary method of direct observa­

tion in both the marriage and family therapy and

social work fields (Munson, 1993; Nichols, Nichols, &

Hardy, 1990). Video cameras are increasingly com­

monplace in professional settings. VTS is easy, acces­

sible, and inexpensive. However, it is also a complex,

powerful and dynamic tool, and one that can be chal­

lenging, threatening, anxiety­provoking, and hum­

bling. Several issues related to VTS are unique to the

substance abuse field:

• Many substance abuse counselors “grew up” in the

field without taping and may be resistant to the

medium;

• Many agencies operate on limited budgets and

administrators may see the expensive equipment

as prohibitive and unnecessary; and

• Many substance abuse supervisors have not been

trained in the use of videotape equipment or in VTS.

Yet, VTS offers nearly unlimited potential for creative

use in staff development. To that end, you need train­

ing in how to use VTS effectively. The following are

guidelines for VTS:

• Clients must sign releases before taping. Most pro­

grams have a release form that the client signs on

admission (see Tool 19 in Part 2, chapter 2). The

supervisee informs the client that videotaping will

occur and reminds the client about the signed

release form. The release should specify that the

taping will be done exclusively for training purpos­

es and will be reviewed only by the counselor, the

supervisor, and other supervisees in group super­

vision. Permission will most likely be granted if

the request is made in a sensitive and appropriate

manner. It is critical to note that even if permis­

sion is initially given by the client, this permission

can be withdrawn. You cannot force compliance.

• The use and rationale for taping needs to be clear­

ly explained to clients. This will forestall a client’s

questioning as to why a particular session is being

taped.

• Risk­management considerations in today’s liti­

gious climate necessitate that tapes be erased

after the supervision session. Tapes can be admis­

sible as evidence in court as part of the clinical

record. Since all tapes should be erased after

supervision, this must be stated in agency policies.

If there are exceptions, those need to be described.

• Too often, supervisors watch long, uninterrupted

segments of tape with little direction or purpose.

To avoid this, you may want to ask your super­

visee to cue the tape to the segment he or she

wishes to address in supervision, focusing on the

goals established in the IDP. Having said this, lis­

tening only to segments selected by the counselor

can create some of the same disadvantages as self­

report: the counselor chooses selectively, even if

not consciously. The supervisor may occasionally

choose to watch entire sessions.

• You need to evaluate session flow, pacing, and

how counselors begin and end sessions.

Some clients may not be comfortable being videotaped

but may be more comfortable with audio taping.

Videotaping is not permitted in most prison settings

and EAP services. Videotaping may not be advisable

when treating patients with some diagnoses, such as

paranoia or some schizophrenic illnesses. In such

cases, either live observation or less intrusive meas­

ures, such as audio taping, may be preferred.

Live Observation With live observation you actually sit in on a counsel­

ing session with the supervisee and observe the ses­

sion first hand. The client will need to provide

informed consent before being observed. Although

one­way mirrors are not readily available at most

agencies, they are an alternative to actually sitting in

on the session. A videotape may also be used either

Part 1, Chapter 1 22

from behind the one­way mirror (with someone else

operating the videotaping equipment) or physically

located in the counseling room, with the supervisor

sitting in the session. This combination of mirror,

videotaping, and live observation may be the best of

all worlds, allowing for unobtrusive observation of a

session, immediate feedback to the supervisee, model­

ing by the supervisor (if appropriate), and a record of

the session for subsequent review in supervision. Live

supervision may involve some intervention by the

supervisor during the session.

Live observation is effective for the following reasons:

• It allows you to get a true picture of the counselor

in action.

• It gives you an opportunity to model techniques

during an actual session, thus serving as a role

model for both the counselor and the client.

• Should a session become countertherapeutic, you

can intervene for the well­being of the client.

• Counselors often say they feel supported when a

supervisor joins the session, and clients periodical­

ly say, “This is great! I got two for the price of

one.”

• It allows for specific and focused feedback.

• It is more efficient for understanding the counsel­

ing process.

• It helps connect the IDP to supervision.

To maximize the effectiveness of live observation,

supervisors must stay primarily in an observer role

so as to not usurp the leadership or undercut the

credibility and authority of the counselor.

Live observation has some disadvantages:

• It is time consuming.

• It can be intrusive and alter the dynamics of the

counseling session.

• It can be anxiety­provoking for all involved.

Some mandated clients may be particularly sensitive

to live observation. This becomes essentially a clinical

issue to be addressed by the counselor with the client.

Where is this anxiety coming from, how does it relate

to other anxieties and concerns, and how can it best

be addressed in counseling?

Supervisors differ on where they should sit in a live

Clinical Supervision and Professional Development 

observation session. Some suggest that the supervisor

sit so as to not interrupt or be involved in the session.

Others suggest that the supervisor sit in a position

that allows for inclusion in the counseling process.

Here are some guidelines for conducting live

observation:

• The counselor should always begin with informed

consent to remind the client about confidentiality.

Periodically, the counselor should begin the ses­

sion with a statement of confidentiality, reiterat­

ing the limits of confidentiality and the duty to

warn, to ensure that the client is reminded of

what is reportable by the supervisor and/or

counselor.

• While sitting outside the group (or an individual

session between counselor and client) may under­

mine the group process, it is a method selected by

some. Position yourself in a way that doesn’t inter­

rupt the counseling process. Sitting outside the

group undermines the human connection between

you, the counselor, and the client(s) and makes it

more awkward for you to make a comment, if you

have not been part of the process until then. For

individual or family sessions, it is also recom­

mended that the supervisor sit beside the coun­

selor to fully observe what is occurring in the

counseling session.

• The client should be informed about the process of

supervision and the supervisor’s role and goals,

essentially that the supervisor is there to observe

the counselor’s skills and not necessarily the

client.

• As preparation, the supervisor and supervisee

should briefly discuss the background of the ses­

sion, the salient issues the supervisee wishes to

focus on, and the plans for the session. The role of

the supervisor should be clearly stated and agreed

on before the session.

• You and the counselor may create criteria for

observation, so that specific feedback is provided

for specific areas of the session.

• Your comments during the session should be limit­

ed to lessen the risk of disrupting the flow or tak­

ing control of the session. Intervene only to protect

the welfare of the client (should something

adverse occur in the session) or if a moment criti­

cal to client welfare arises. In deciding to inter­

23

vene or not, consider these questions: What are

the consequences if I don’t intervene? What is the

probability that the supervisee will make the

intervention on his or her own or that my com­

ments will be successful? Will I create an undue

dependence on the part of clients or supervisee?

• Provide feedback to the counselor as soon as possi­

ble after the session. Ideally, the supervisor and

supervisee(s) should meet privately immediately

afterward, outlining the key points for discussion

and the agenda for the next supervision session,

based on the observation. Specific feedback is

essential; “You did a fine job” is not sufficient.

Instead, the supervisor might respond by saying,

“I particularly liked your comment about . . .” or

“What I observed about your behavior was . . .” or

“Keep doing more of . . . .”

Practical Issues in Clinical Supervision

Distinguishing Between Supervision and Therapy In facilitating professional development, one of the

critical issues is understanding and differentiating

between counseling the counselor and providing

supervision. In ensuring quality client care and facili­

tating professional counselor development, the

process of clinical supervision sometimes encroaches

on personal issues. The dividing line between therapy

and supervision is how the supervisee’s personal

issues and problems affect their work. The goal of

clinical supervision must always be to assist coun­

selors in becoming better clinicians, not seeking to

resolve their personal issues. Some of the major dif­

ferences between supervision and counseling are

summarized in figure 6.

Figure 6. Differences Between Supervision and Counseling

Clinical Supervision Administrative

Supervision Counseling

Purpose • Improved client care • Improved job perform-

ance

• Ensure compliance with agency and regulatory body's policies and pro- cedures

• Personal growth • Behavior changes • Better self-understand-

ing

Outcome • Enhanced proficiency in knowledge, skills, and attitudes essential to effective job perform- ance

• Consistent use of approved formats, poli- cies, and procedures

• Open-ended, based on client needs

Timeframe • Short-term and ongoing • Short-term and ongoing • Based on client needs

Agenda • Based on agency mission and counselor needs

• Based on agency needs • Based on client needs

Basic Process • Teaching/learning specif- ic skills, evaluating job performance, negotiat- ing learning objectives

• Clarifying agency expec- tations, policies and pro- cedures, ensuring com- pliance

• Behavioral, cognitive, and affective process including listening, exploring, teaching

Source: Adapted from Dixon, 2004

Part 1, Chapter 1 24

The boundary between counseling and clinical super­

vision may not always be clearly marked, for it is nec­

essary, at times, to explore supervisees’ limitations as

they deliver services to their clients. Address coun­

selors’ personal issues only in so far as they create

barriers or affect their performance. When personal

issues emerge, the key question you should ask the

supervisee is how does this affect the delivery of qual­

ity client care? What is the impact of this issue on the

client? What resources are you using to resolve this

issue outside of the counseling dyad? When personal

issues emerge that might interfere with quality care,

your role may be to transfer the case to a different

counselor. Most important, you should make a strong

case that the supervisee should seek outside counsel­

ing or therapy.

Problems related to countertransference (projecting

unresolved personal issues onto a client or super­

visee) often make for difficult therapeutic relation­

ships. The following are signs of countertransference

to look for:

• A feeling of loathing, anxiety, or dread at the

prospect of seeing a specific client or supervisee.

• Unexplained anger or rage at a particular client.

• Distaste for a particular client.

• Mistakes in scheduling clients, missed appoint­

ments.

• Forgetting client’s name, history.

• Drowsiness during a session or sessions ending

abruptly.

• Billing mistakes.

• Excessive socializing.

When countertransferential issues between counselor

and client arise, some of the important questions you,

as a supervisor, might explore with the counselor

include:

• How is this client affecting you? What feelings

does this client bring out in you? What is your

behavior toward the client in response to these

feelings? What is it about the substance abuse

behavior of this client that brings out a response

in you?

• What is happening now in your life, but more par­

ticularly between you and the client that might be

contributing to these feelings, and how does this

affect your counseling?

Clinical Supervision and Professional Development 

• In what ways can you address these issues in your

counseling?

• What strategies and coping skills can assist you in

your work with this client?

Transference and countertransference also occur in

the relationship between supervisee and supervisor.

Examples of supervisee transference include:

• The supervisee’s idealization of the supervisor.

• Distorted reactions to the supervisor based on the

supervisee’s reaction to the power dynamics of the

relationship.

• The supervisee’s need for acceptance by or

approval from an authority figure.

• The supervisee’s reaction to the supervisor’s estab­

lishing professional and social boundaries with the

supervisee.

Supervisor countertransference with supervisees is

another issue that needs to be considered. Categories

of supervisor countertransference include:

• The need for approval and acceptance as a knowl­

edgeable and competent supervisor.

• Unresolved personal conflicts of the supervisor

activated by the supervisory relationship.

• Reactions to individual supervisees, such as dis­

like or even disdain, whether the negative

response is “legitimate” or not. In a similar vein,

aggrandizing and idealizing some supervisees

(again, whether or not warranted) in comparison

to other supervisees.

• Sexual or romantic attraction to certain super­

visees.

• Cultural countertransference, such as catering to

or withdrawing from individuals of a specific cul­

tural background in a way that hinders the profes­

sional development of the counselor.

To understand these countertransference reactions

means recognizing clues (such as dislike of a super­

visee or romantic attraction), doing careful self­exam­

ination, personal counseling, and receiving supervi­

sion of your supervision. In some cases, it may be nec­

essary for you to request a transfer of supervisees

with whom you are experiencing countertransference,

if that countertransference hinders the counselor’s

professional development.

25

Finally, counselors will be more open to addressing

difficulties such as countertransference and compas­

sion fatigue with you if you communicate understand­

ing and awareness that these experiences are a nor­

mal part of being a counselor. Counselors should be

rewarded in performance evaluations for raising

these issues in supervision and demonstrating a will­

ingness to work on them as part of their professional

development.

Balancing Clinical and Administrative Functions In the typical substance abuse treatment agency, the

clinical supervisor may also be the administrative

supervisor, responsible for overseeing managerial

functions of the organization. Many organizations

cannot afford to hire two individuals for these tasks.

Hence, it is essential that you are aware of what role

you are playing and how to exercise the authority

given you by the administration. Texts on supervision

sometimes overlook the supervisor’s administrative

tasks, but supervisors structure staff work; evaluate

personnel for pay and promotions; define the scope of

clinical competence; perform tasks involving plan­

ning, organizing, coordinating, and delegating work;

select, hire, and fire personnel; and manage the

organization. Clinical supervisors are often responsi­

ble for overseeing the quality assurance and improve­

ment aspects of the agency and may also carry a case­

load. For most of you, juggling administrative and

clinical functions is a significant balancing act. Tips

for juggling these functions include:

• Try to be clear about the “hat you are wearing.”

Are you speaking from an administrative or clini­

cal perspective?

• Be aware of your own biases and values that may

be affecting your administrative opinions.

• Delegate the administrative functions that you

need not necessarily perform, such as human

resources, financial, or legal functions.

• Get input from others to be sure of your objectivity

and your perspective.

There may be some inherent problems with perform­

ing both functions, such as dual relationships.

Counselors may be cautious about acknowledging dif­

ficulties they face in counseling because these may

affect their performance evaluation or salary raises.

On the other hand, having separate clinical and

administrative supervisors can lead to inconsistent

messages about priorities, and the clinical supervi­

sor is not in the chain of command for disciplinary

purposes.

Finding the Time To Do Clinical Supervision Having read this far, you may be wondering, “Where

do I find the time to conduct clinical supervision as

described here? How can I do direct observation of

counselors within my limited time schedule?” Or,

“I work in an underfunded program with substance

abuse clients. I have way too many tasks to also

observe staff in counseling.”

One suggestion is to begin an implementation process

that involves adding components of a supervision

model one at a time. For example, scheduling super­

visory meetings with each counselor is a beginning

step. It is important to meet with each counselor on a

regular, scheduled basis to develop learning plans

and review professional development. Observations of

counselors in their work might be added next.

Another component might involve group supervision.

In group supervision, time can be maximized by

teaching and training counselors who have common

skill development needs.

As you develop a positive relationship with super­

visees based on cooperation and collaboration, the

anxiety associated with observation will decrease.

Counselors frequently enjoy the feedback and support

so much that they request observation of their work.

Observation can be brief. Rather than sitting in on a

full hour of group, spend 20 minutes in the observa­

tion and an additional 20 providing feedback to the

counselor.

Your choice of modality (individual, group, peer, etc.)

is influenced by several factors: supervisees’ learning

goals, their experience and developmental levels,

their learning styles, your goals for supervisees, your

theoretical orientation, and your own learning goals

for the supervisory process. To select a modality of

supervision (within your time constraints and those

of your supervisee), first pinpoint the immediate func­

tion of supervision, as different modalities fit differ­

ent functions. For example, a supervisor might wish

to conduct group supervision when the team is intact

and functioning well, and individual supervision

Part 1, Chapter 1 26

when specific skill development or countertransferen­

tial issues need additional attention. Given the vari­

ety of treatment environments in substance abuse

treatment (e.g., therapeutic communities, intensive

outpatient services, transitional living settings, cor­

rectional facilities) and varying time constraints on

supervisors, several alternatives to structure supervi­

sion are available.

Peer supervision is not hierarchical and does not

include a formal evaluation procedure, but offers a

means of accountability for counselors that they

might not have in other forms of supervision. Peer

supervision may be particularly significant among

well­trained, highly educated, and competent coun­

selors. Peer supervision is a growing medium, given

the clinical supervisors’ duties. Although peer super­

vision has received limited attention in literature, the

Consensus Panel believes it is a particularly effective

method, especially for small group practices and

agencies with limited funding for supervision. Peer

supervision groups can evolve from supervisor­led

groups or individual sessions to peer groups or can

begin as peer supervision. For peer supervision

groups offered within an agency, there may be some

history to overcome among the group members, such

as political entanglements, competitiveness, or per­

sonality concerns. (Bernard and Goodyear [2004] has

an extensive review of the process and the advan­

tages and disadvantages of peer supervision.)

Triadic supervision is a tutorial and mentoring rela­

tionship among three counselors. This model of

supervision involves three counselors who, on a

rotating basis, assume the roles of the supervisee,

the commentator, and the supervision session facili­

tator. Spice and Spice (1976) describe peer supervi­

sion with three supervisees getting together. In cur­

rent counseling literature, triadic supervision

involves two counselors with one supervisor. There is

very little empirical or conceptual literature on this

arrangement.

Individual supervision, where a supervisor works

with the supervisee in a one­to­one relationship, is

considered the cornerstone of professional skill

development. Individual supervision is the most

labor­intensive and time­consuming method for

supervision. Credentialing requirements in a partic­

ular discipline or graduate studies may mandate

individual supervision with a supervisor from the

same discipline.

Clinical Supervision and Professional Development 

Intensive supervision with selected counselors is help­

ful in working with a difficult client (such as one with

a history of violence), a client using substances unfa­

miliar to the counselor, or a highly resistant client.

Because of a variety of factors (credentialing require­

ments, skill deficits of some counselors, the need for

close clinical supervision), you may opt to focus, for

concentrated periods of time, on the needs of one or

two counselors as others participate in peer supervi­

sion. Although this is not necessarily a long­term

solution to the time constraints of a supervisor, inten­

sive supervision provides an opportunity to address

specific staffing needs while still providing a “reason­

able effort to supervise” all personnel.

Group clinical supervision is a frequently used and

efficient format for supervision, team building, and

staff growth. One supervisor assists counselor devel­

opment in a group of supervisee peers. The recom­

mended group size is four to six persons to allow for

frequent case presentations by each group member.

With this number of counselors, each person can

present a case every other month—an ideal situation,

especially when combined with individual and/or peer

supervision. The benefits of group supervision are

that it is cost­effective, members can test their per­

ceptions through peer validation, learning is

enhanced by the diversity of the group, it creates a

working alliance and improves teamwork, and it pro­

vides a microcosm of group process for participants.

Group supervision gives counselors a sense of com­

monality with others in the same situation. Because

the formats and goals differ, it is helpful to think

through why you are using a particular format.

(Examples of group formats with different goals can

be found in Borders and Brown, 2005, and Bernard &

Goodyear, 2004.)

Given the realities of the substance abuse treatment

field (limited funding, priorities competing for time,

counselors and supervisors without advanced aca­

demic training, and clients with pressing needs in a

brief­treatment environment), the plan described

below may be a useful structure for supervision. It is

based on a scenario where a supervisor oversees one

to five counselors. This plan is based on several

principles:

• All counselors, regardless of years of experience or

academic training, will receive at least 1 hour of

supervision for every 20 to 40 hours of clinical

practice.

27

• Direct observation is the backbone of a solid clini­

cal supervision model.

• Group supervision is a viable means of engaging

all staff in dialog, sharing ideas, and promoting

team cohesion.

With the formula diagramed below, each counselor

receives a minimum of 1 hour of group clinical super­

vision per week. Each week you will have 1 hour of

observation, 1 hour of individual supervision with one

of your supervisees, and 1 hour of group supervision

with five supervisees. Each week, one counselor will

be observed in an actual counseling session, followed

by an individual supervision session with you. If the

session is videotaped, the supervisee can be asked to

cue the tape to the segment of the session he or she

wishes to discuss with you. Afterwards, the observed

counselor presents this session in group clinical

supervision.

When it is a counselor’s week to be observed or taped

and meet for individual supervision, he or she will

receive 3 hours of supervision: 1 hour of direct obser­

vation, 1 hour of individual/one­on­one supervision,

and 1 hour of group supervision when he or she pres­

ents a case to the group. Over the course of months,

with vacation, holiday, and sick time, it should aver­

age out to approximately 1 hour of supervision per

counselor per week. Figure 7 shows this schedule.

Figure 7. Sample Clinical Supervision Schedule

Counselor Week 1 Week 2 Week 3 Week 4 Week 5

A

1 hour direct observation

1 hour individual supervision

1 hour group supervision of A’s case

(3 hours)

1 hour group 1 hour group 1 hour group 1 hour group

B 1 hour group 3 hour group 1 hour group 1 hour group 1 hour group

C 1 hour group 1 hour group 3 hour group 1 hour group 1 hour group

D 1 hour group 1 hour group 1 hour group 3 hour group 1 hour group

E 1 hour group 1 hour group 1 hour group 1 hour group 3 hour group

When you are working with a counselor who needs

special attention or who is functioning under specific

requirements for training or credentialing, 1 addition­

al hour per week can be allocated for this counselor,

increasing the total hours for clinical supervision to 4,

still a manageable amount of time.

Documenting Clinical Supervision Correct documentation and recordkeeping are essen­

tial aspects of supervision. Mechanisms must be in

place to demonstrate the accountability of your role.

(See Tools 10–12 in Part 2, chapter 2.) These systems

should document:

• Informal and formal evaluation procedures.

• Frequency of supervision, issues discussed, and

the content and outcome of sessions.

• Due process rights of supervisees (such as the

right to confidentiality and privacy, to informed

consent).

• Risk management issues (how to handle

crises, duty­to­warn situations, breaches of

confidentiality).

One comprehensive documentation system is Falvey’s

(2002a) Focused Risk Management Supervision

System (FoRMSS), which provides templates to

record emergency contact information, supervisee

profiles, a logging sheet for supervision, an initial

case review, supervision records, and a client termi­

nation form.

Supervisory documents and notes are open to man­

agement, administration, and human resources (HR)

personnel for performance appraisal and merit pay

increases and are admissible in court proceedings.

Supervision notes, especially those related to work

Part 1, Chapter 1 28

with clients, are kept separately and are intended for

the supervisor’s use in helping the counselor improve

clinical skills and monitor client care. It is imperative

to maintain accurate and complete notes on the

supervision. However, as discussed above, documen­

tation procedures for formative versus summative

evaluation of staff may vary. Typically, HR accesses

summative evaluations, and supervisory notes are

maintained as formative evaluations.

An example of a formative note by a supervisor might

be “The counselor responsibly discussed countertrans­

ferential issues occurring with a particular client and

was willing to take supervisory direction,” or “We

worked out an action plan, and I will follow this

closely.” This wording avoids concerns by the supervi­

sor and supervisee as to the confidentiality of super­

visory notes. From a legal perspective, the supervisor

needs to be specific about what was agreed on and a

timeframe for following up.

Structuring the Initial Supervision Sessions As discussed earlier, your first tasks in clinical super­

vision are to establish a behavioral contract, get to

know your supervisees, and outline the requirements

of supervision. Before the initial session, you should

send a supportive letter to the supervisee expressing

the agency’s desire to provide him or her with a quali­

ty clinical supervision experience. You might request

that the counselor give some thought to what he or

she would like to accomplish in supervision, what

skills to work on, and which core functions used in

the addiction counselor certification process he or she

feels most comfortable performing.

In the first few sessions, helpful practices include:

• Briefly describe your role as both administrative

and clinical supervisor (if appropriate) and discuss

these distinctions with the counselor.

• Briefly describe your model of counseling and

learn about the counselor’s frameworks and mod­

els for her or his counseling practice. For begin­

ning counselors this may mean helping them

define their model.

• Describe your model of supervision.

• State that disclosure of one’s supervisory training,

experience, and model is an ethical duty of clinical

supervisors.

Clinical Supervision and Professional Development 

• Discuss methods of supervision, the techniques to

be used, and the resources available to the super­

visee (e.g., agency inservice seminar, community

workshops, professional association memberships,

and professional development funds or training

opportunities).

• Explore the counselor’s goals for supervision and

his or her particular interests (and perhaps some

fears) in clinical supervision.

• Explain the differences between supervision and

therapy, establishing clear boundaries in this

relationship.

• Work to establish a climate of cooperation, collabo­

ration, trust, and safety.

• Create an opportunity for rating the counselor’s

knowledge and skills based on the competencies in

TAP 21 (CSAT, 2007).

• Explain the methods by which formative and sum­

mative evaluations will occur.

• Discuss the legal and ethical expectations and

responsibilities of supervision.

• Take time to decrease the anxiety associated with

being supervised and build a positive working

relationship.

It is important to determine the knowledge and skills,

learning style, and conceptual skills of your super­

visees, along with their suitability for the work set­

ting, motivation, self­awareness, and ability to func­

tion autonomously. A basic IDP for each supervisee

should emerge from the initial supervision sessions.

You and your supervisee need to assess the learning

environment of supervision by determining:

• Is there sufficient challenge to keep the supervisee

motivated?

• Are the theoretical differences between you and

the supervisee manageable?

• Are there limitations in the supervisee’s knowl­

edge and skills, personal development, self­effica­

cy, self­esteem, and investment in the job that

would limit the gains from supervision?

• Does the supervisee possess the affective qualities

(empathy, respect, genuineness, concreteness,

warmth) needed for the counseling profession?

• Are the goals, means of supervision, evaluation

criteria, and feedback process clearly understood

by the supervisee?

• Does the supervisory environment encourage and

allow risk taking?

29

Methods and Techniques of Clinical Supervision A number of methods and techniques are available

for clinical supervision, regardless of the modality

used. Methods include (as discussed previously) case

consultation, written activities such as verbatims and

process recordings, audio and videotaping, and live

observation. Techniques include modeling, skill

demonstrations, and role playing. (See descriptions of

these and other methods and techniques in Bernard

& Goodyear, 2004; Borders & Brown, 2005; Campbell,

2000; and Powell & Brodsky, 2004.) Figure 8 outlines

some of the methods and techniques of supervision,

as well as the advantages and disadvantages of each

method.

Figure 8. Methods and Techniques in Clinical Supervision

Description Advantages Disadvantages

Verbal Reports Verbal reports of clinical situations

Group discussion of clinical situations

• Informal • Time efficient • Often spontaneous in

response to clinical situation • Can hear counselor’s report,

what he or she includes, thus learn of the counselor’s awareness and perspective, what he or she wishes to report, contrasted with super- visory observations

• Sessions seen through eyes of beholder

• Nonverbal cues missed • Can drift into case manage-

ment, hence it is important to focus on the clinical nature of chart reviews, reports, etc., linking to the treatment plan and EBPs

Verbatim Reports Process recordings

Verbatim written record of a session or part of session

Declining method in the behavioral health field

• Helps track coordination and use of treatment plan with ongoing session

• Enhances conceptualization and writing skills

• Enhances recall and reflection skills

• Provides written documenta- tion of sessions

• Nonverbal cues missed • Self-report bias • Can be very tedious to write

and to read

Written/File Review

Review of the progress notes, charts, documenta- tion

• An important task of a super- visor to ensure compliance with accreditation standards for documentation

• Provides a method of quality control

• Ensures consistency of records and files

• Time consuming • Notes often miss the overall

quality and essence of the session

• Can drift into case manage- ment rather than clinical skills development

The context in which supervision is provided affects

how it is carried out. A critical issue is how to man­

age your supervisory workload and make a reason­

able effort to supervise. The contextual issues that

shape the techniques and methods of supervision

include:

• The allocation of time for supervision. If the 20:1

rule of client hours to supervision time is followed,

you will want to allocate sufficient time for super­

vision each week so that it is a high priority, regu­

larly scheduled activity.

• The unique conditions, limitations, and require­

ments of the agency. Some organizations may lack

the physical facilities or hardware to use videotap­

ing or to observe sessions. Some organizations

may be limited by confidentiality requirements,

Part 1, Chapter 1 30

Figure 8. Methods and Techniques in Clinical Supervision (continued)

Description Advantages Disadvantages

Case Consultation/ Case Management

Discussion of cases Brief case reviews

• Helps organize information, conceptualize problems, and decide on clinical interventions

• Examines issues (e.g., cross-cul- tural issues), integrates theory and technique, and promotes greater self-awareness

• An essential component of treatment planning

• The validity of self-report is dependent on counselor developmental level and the supervisor’s insightfulness

• Does not reflect broad range of clinical skills of the coun- selor

Direct Observation

The supervisor watches the session and may provide periodic but limited com- ments and/or suggestions to the clinician

• Allows teaching of basic skills while protecting quality of care

• Counselor can see and experi- ence positive change in session direction in the moment

• Allows supervisor to intervene when needed to protect the welfare of the client, if the ses- sion is not effective or is destructive to the client

• May create anxiety • Requires supervisor caution in

intervening so as to not take over the session or to create undue dependence for the counselor or client

• Can be seen as intrusive to the clinical process

• Time consuming

Audiotaping Audiotaping and review of a counseling session

• Technically easy and inexpen- sive

• Can explore general rapport, pace, and interventions

• Examines important relation- ship issues

• Unobtrusive medium • Can be listened to in clinical or

team meetings

• Counselor may feel anxious • Misses nonverbal cues • Poor sound quality often

occurs due to limits of tech- nology

Videotaping Videotaping and review of a counseling session

• A rich medium to review verbal and nonverbal information

• Provides documentation of clin- ical skills

• Can be viewed by the treat- ment team during group clini- cal supervision session

• Uses time efficiently • Can be used in conjunction

with direct observation • Can be used to suggest differ-

ent interventions • Allows for review of content,

affective and cognitive aspects, process relationship issues in the present

• Can be seen as intrusive to the clinical process

• Counselor may feel anxious and self-conscious, although this subsides with experience

• Technically more complicated • Requires training before

using • Can become part of the clini-

cal record and can be sub- poenaed (should be destroyed after review)

Clinical Supervision and Professional Development  31

Figure 8. Methods and Techniques in Clinical Supervision (continued)

Description Advantages Disadvantages

Webcam Internet supervision, syn- chronistic and asynchronis- tic

Teleconferencing

• Can be accessed from any com- puter

• Especially useful for remote and satellite facilities and loca- tions

• Uses time efficiently • Modest installation and opera-

tion costs • Can be stored or downloaded

on a variety of media, watched in any office, then erased

• Concerns about anonymity and confidentiality

• Can be viewed as invasive to the clinical process

• May increase client or coun- selor anxiety or self-con- sciousness

• Technically more complicated • Requires assurance that

downloads will be erased and unavailable to unauthorized staff

Cofacilitation and Modeling

Supervisor and counselor jointly run a counseling session

Supervisor demonstrates a specific technique while the counselor observes

This may be followed by roleplay with the coun- selor practicing the skill with time to process learn- ing and application

• Allows the supervisor to model techniques while observing the counselor

• Can be useful to the client (“two counselors for the price of one”)

• Supervisor must demonstrate proficiency in the skill and help the counselor incrementally integrate the learning

• Counselor sees how the super- visor might respond

• Supervisor incrementally shapes the counselor’s skill acquisition and monitors skill mastery

• Allows supervisor to aid coun- selor with difficult clients

• Supervisor must demonstrate proficiency in the skill and help the counselor incremen- tally integrate the learning

• The client may perceive coun- selor as less skilled than the supervisor

• Time consuming

Role Playing Role play a clinical situa- tion

• Enlivens the learning process • Provides the supervisor with

direct observation of skills • Helps counselor gain a differ-

ent perspective • Creates a safe environment for

the counselor to try new skills

• Counselor can be anxious • Supervisor must be mindful

of not overwhelming the counselor with information

Source: Adapted from Mattel, 2007.

such as working within a criminal justice system

where taping may be prohibited.

• The number of supervisees reporting to a supervi­

sor. It is difficult to provide the scope of supervi­

sion discussed in this TIP if a supervisor has more

than ten supervisees. In such a case, another

supervisor could be named or peer supervision

could be used for advanced staff.

• Clinical and management responsibilities of a

supervisor. Supervisors have varied responsibili­

ties, including administrative tasks, limiting the

amount of time available for clinical supervision.

Part 1, Chapter 1 32

Administrative Supervision As noted above, clinical and administrative supervi­

sion overlap in the real world. Most clinical supervi­

sors also have administrative responsibilities, includ­

ing team building, time management, addressing

agency policies and procedures, recordkeeping,

human resources management (hiring, firing, disci­

plining), performance appraisal, meeting manage­

ment, oversight of accreditation, maintenance of legal

and ethical standards, compliance with State and

Federal regulations, communications, overseeing staff

cultural competence issues, quality control and

improvement, budgetary and financial issues, prob­

lem solving, and documentation. Keeping up with

these duties is not an easy task!

This TIP addresses two of the most frequently voiced

concerns of supervisors: documentation and time

management. Supervisors say, “We are drowning in

paperwork. I don’t have the time to adequately docu­

ment my supervision as well,” and “How do I manage

my time so I can provide quality clinical supervision?”

Documentation for Administrative Purposes One of the most important administrative tasks of a

supervisor is that of documentation and recordkeep­

ing, especially of clinical supervision sessions.

Unquestionably, documentation is a crucial risk­man­

agement tool. Supervisory documentation can help

promote the growth and professional development of

the counselor (Munson, 1993). However, adequate

documentation is not a high priority in some organi­

zations. For example, when disciplinary action is

needed with an employee, your organization’s attor­

ney or human resources department will ask for the

paper trail, or documentation of prior performance

issues. If appropriate documentation to justify disci­

plinary action is missing from the employee’s record,

it may prove more difficult to conduct the appropriate

disciplinary action (See Falvey, 2002; Powell &

Brodsky, 2004.)

Documentation is no longer an option for supervisors.

It is a critical link between work performance and

service delivery. You have a legal and ethical require­

ment to evaluate and document counselor perform­

Clinical Supervision and Professional Development 

ance. A complete record is a useful and necessary

part of supervision. Records of supervision sessions

should include:

• The supervisor–supervisee contract, signed by

both parties.

• A brief summary of the supervisee’s experience,

training, and learning needs.

• The current IDP.

• A summary of all performance evaluations.

• Notations of all supervision sessions, including

cases discussed and significant decisions made.

• Notation of cancelled or missed supervision

sessions.

• Progressive discipline steps taken.

• Significant problems encountered in supervision

and how they were resolved.

• Supervisor’s clinical recommendations provided to

supervisees.

• Relevant case notes and impressions.

The following should not be included in a supervision

record:

• Disparaging remarks about staff or clients.

• Extraneous or sensitive supervisee information.

• Alterations in the record after the fact or prema­

ture destruction of supervision records.

• Illegible information and nonstandard

abbreviations.

Several authors have proposed a standardized format

for documentation of supervision, including Falvey

(2002b), Glenn and Serovich (1994), and Williams

(1994).

Time Management By some estimates, people waste about two hours

every day doing tasks that are not of high priority. In

your busy job, you may find yourself at the end of the

week with unfinished tasks or matters that have not

been tended to. Your choices? Stop performing some

tasks (often training or supervision) or take work

home and work longer days. In the long run, neither

of these choices is healthy or effective for your organi­

zation. Yet, being successful does not make you man­

age your time well. Managing your time well makes

you successful. Ask yourself these questions about

your priorities:

33

• Why am I doing this? What is the goal of this

activity?

• How can I best accomplish this task in the least

amount of time?

• What will happen if I choose not to do this?

It is wise to develop systems for managing time­

wasters such as endless meetings held without notes

or minutes, playing telephone or email tag, junk mail,

and so on. Effective supervisors find their times in

the day when they are most productive. Time man­

agement is essential if you are to set time aside and

dedicate it to supervisory tasks.

Resources The following are resources for supervision:

• Code of Ethics from the Association of Addictions

Professionals (NAADAC; http://naadac.org).

• International Certification & Reciprocity

Consortium’s Code of Ethics

(http://www.icrcaoda.org).

• Codes of ethics from professional groups such as

the American Association for Marriage and Family

Therapy (http://www.aamft.org), the American

Counseling Association

(http://www.counseling.org), the Association for

Counselor Education and Supervision

(http://www.acesonline.net), the American

Psychological Association (http://www.apa.org), the

National Association of Social Workers

(http://www.socialworkers.org), and the National

Board for Certified Counselors (NBCC;

http://www.nbcc.org).

• ACES Standards for Counseling Supervisors;

ACES Ethical Guidelines for Counseling

Supervisors

(http://www.acesonline.net/ethical_guidelines.asp);

and NBCC Standards for the Ethical Practice of

Clinical Supervision.

TAP 21­A provides detailed appendices of suggested

reading and other resources (CSAT, 2007).

Additionally, Part 3 of this document provides a liter­

ature review and bibliographies (available online only

at http://www.kap.samhsa.gov). The following are

examples of online classroom training programs in

clinical supervision in the substance abuse field:

• http://www.attcnetwork.org/midatlantic, Clinical

Supervision for Substance Abuse Treatment

Practitioners Series.

• http://www.attcnetwork.org/midatlantic,

Motivational Interviewing Assessment: Supervisory

Tools for Enhancing Proficiency.

• http://www.attcnetwork.org/northeast, Clinical

Supervision to Support the Implementation,

Fidelity and Sustaining Evidence­Based Practices.

• http://www.attcnetwork.org/northwestfrontier,

Clinical Supervision, Part 2: What Happens in

Good Supervision.

Other training programs are given in professional

graduate schools, such as New York University

School of Social Work; Smith College School for Social

Work; University of Nevada, Reno, Human and

Community Sciences; and Portland State University

Graduate School of Education.

For information about tools to measure counselor

competencies and supervisor self­assessment tools,

along with samples, see the following:

• David J. Powell and Archie Brodsky, Clinical

Supervision in Alcohol and Drug Abuse

Counseling, 2004.

• L. DiAnne Borders and Lori L. Brown, The New

Handbook of Counseling Supervision, 2005

• Jane M. Campbell, Becoming an Effective

Supervisor, 2000.

• Janet Elizabeth Falvey, Managing Clinical

Supervision: Ethical Practice and Legal Risk

Management, 2002.

• Carol A. Falender and Edward P. Shafranske,

Clinical Supervision: A Competency­Based

Approach, 2004.

• Cal D. Stoltenberg, Brian McNeill, and Ursula

Delworth, IDM Supervision: An Integrated

Developmental Model for Supervising Counselors

and Therapists, 1998.

34 Clinical Supervision and Professional Development   Part 1, Chapter 1