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The Clinical Supervisor, 32:244–259, 2013 Copyright © Taylor & Francis Group, LLC ISSN: 0732-5223 print/1545-231X online DOI: 10.1080/07325223.2013.851633

Address correspondence to Philip Clarke, Department of Counseling, Wake Forest University, P.O. Box 7406, Winston-Salem, NC 27109, USA. E-mail: [email protected]

The Motivational Supervisor: Motivational Interviewing As a Clinical

Supervision Approach

PHILIP B. CLARKE Wake Forest University, Winston-Salem, North Carolina, United States

AMANDA L. GIORDANO University of North Texas, Denton, Texas, United States

Motivational interviewing (MI) is an evidence-based clinical inter- vention used to elicit motivation for client behavior change. MI as a supervision style involves the same spirit, processes, and techniques used to cultivate supervisee development and change. This article describes the application of MI components to clinical supervision, detailing the processes of engaging, focusing, evoking, and planning. A case example depicting MI supervision is provided.

KEYWORDS motivational interviewing, clinical supervision, theory-based supervision

INTRODUCTION

Supervision is a fundamental component in counselor training and the pro- fessional development of beginning and experienced counselors. Supervisors assume a complex role that differs from teaching, consulting, or counseling (Bernard & Goodyear, 2004; Bordin, 1983) as they attend to supervisee growth and development as well as promote the welfare of clients. In this unique position, supervisors are charged with specific tasks such as fostering effective supervisory relationships, attending to supervisee anxiety and resistance, and proffering feedback.

A strong working alliance between supervisor and supervisee is an essential ingredient to the process of change. Bordin (1983) applied three

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aspects of the therapeutic working alliance to supervision, including mutu- ally agreed upon goals, understanding of each partner’s tasks, and the bond between partners. It is in and through the working alliance that the goals of supervision are reached (Bordin, 1983). Goals, however, can be blocked by supervisee anxiety and resistance (Borders & Brown, 2005; Jordan & Kelly, 2011; Pearson, 2000). Counselors experience anxiety about a number of aspects of the counseling process, such as competence, supervision, and preparation ( Jordan & Kelly, 2011) as well as navigating the dialectics of independence and dependence, and self, efficacy, and self-doubt (Ronnestad & Skovholt, 1993). Supervisee resistance refers to reactionary methods employed as means of protection from a variety of sources of anxiety in the supervisory relationship (Abernethy & Cook, 2011; Pearson, 2000). Borders (2009) suggests usinga subtle supervisory approach when navigating the obstacles of anxiety and resistance in supervision rather than a direct style that may invite defensiveness. According to the Association for Counselor Education and Supervision Best Practices in Clinical Supervision guidelines (2011), “the supervisor provides a balance of challenging and supportive feedback …” (p. 4). Researchers have found “task-oriented” supervision approaches characterized by specific objectives and feedback to significantly predict supervisee self-efficacy (Fernando & Hulse-Killacky, 2005).

The authors propose that motivational interviewing (MI) has the poten- tial to address these key tasks by providing a means to successfully foster strong supervisory relationships, address supervisee anxiety and resistance, as well as deliver feedback. Specifically, MI is “… designed to strengthen personal motivation and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion” (Miller & Rollnick, 2013, p. 29). This transtheo- retical counseling approach can be integrated into a supervisory model that combines key aspects of supervision into a unified framework for interacting and facilitating interventions with supervisees. Coupled with the evidence supporting the efficacy of MI in cultivating change, it is believed that moti- vational interviewing is well suited for implementation in supervision.

MOTIVATIONAL INTERVIEWING

Motivational interviewing (MI) is an evidence-based framework for facilitating behavior change that originated as an intervention for persons with alcohol issues by William Miller and Stephen Rollnick (Miller, 1983). Resolving ambiv- alence through evoking client arguments for changeis the target of MI. The ambivalent individual simultaneously holds reasons for and against change and MI counselors listen empathically with a focus on the client’s own rea- sons favoring change (Miller & Rollnick, 2013). The MI approach can be used as an independent counseling style, a precursor to another modality, or

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integrated within a different method or theoretical orientation (Hettema, Steele, & Miller, 2005). Brief motivational methods also provide a structure for offering feedback to clients in a manner consistent with the tenets of MI (Bien, Miller, & Tonigan, 1993; Ingersoll, Wagner, & Gharib, 2002). Furthermore, motivational enhancement therapy and brief motivational approaches are considered adaptations of MI for use in treatment studies, brief interventions, and varying roles of treatment (Burke, Arkowitz, & Dunn, 2002).

Since its inception, MI has been applied across a variety of clients pre- senting concerns ranging from eating disorders management (Wilson & Schlam, 2004) to suicide prevention (Zerler, 2008). The effectiveness of MI has been supported by many empirical pursuits (Lundahl & Burke, 2009). For example, a meta-analysis examining the efficacy of MI interventions revealed MI to be superior to advice-giving or brief interventions whether utilized by persons in the medical or mental health fields (Rubak, Sandbaek, Lauritzen, & Christensen, 2005). Moreover, the positive effects of MI approaches on behavior change with addictions and lifestyle intervention populations seem to remain over time as evidenced by a meta-analysis of 97 studies with assess- ments ranging from 3 months to 1 year after the intervention (Lundahl, Kunz, Brownell, Tollefson, & Burke, 2010). Adaptations of MI also yield noteworthy effect sizes such asreductions in drinking frequency (d = .35) and drug use (d = .56), and increased positive lifestyle changes (d = .53) (Burke, Dunn, Atkins, & Phelps, 2004). On the whole, MI has an evidence base supporting its effectiveness and mechanisms of change.

MI Training and Supervision

The efficacy of MI as a clinical intervention to promote client change prompt- edan exploration of the literature regarding MI training processes. The devel- opment of the Motivational Interviewing Step: Supervisory Tools for Enhancing Proficiency (MIA:STEP), a standardized manual for training clinicians in MI, represents a significant advancement in the field (Martino et  al., 2006). In addition, Miller and Moyers (2006) identified eight stages necessary for the acquisition of MI including learning the MI spirit, active listening, and respond- ing to client statements regarding change. Authors of several empirical articles examined the training and supervision of counselors learning to implement MI as a counseling intervention (Madson, Loignon,& Lane, 2009; Miller, Yahne, Moyers, Martinez, & Pirritano, 2004; Mitcheson, Bhavsar, & McCambridge, 2009). For example, Miller and colleagues (2004) completed a comprehensive analysis of MI pedagogy comparing the efficacy of several experimental MI training experiences on participants’ abilities to use MI. The researchers con- cluded that learning to use MI through self-directed study using training materials resulted in minimal MI attainment, workshops produced learning of MI that declined over time, and longitudinal supervision centered on continued education of MI engendered long-term retention of MI.

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Contrary to the quantity of literature examining MI training practices, few researchers have explored implementing MI into the supervisory relationship. The goal of the aforementioned studies was to aid supervisees in the effective application of MI rather than employ MI strategies with the purpose of evoking supervisee motivations for change. However, Madson, Bullock, Speed, and Hodges (2008) integrated “MI as a supervisory style” with addictions counselors (p. 350). The authors described the use of MI techniques within the supervisory roles of educator, supporter, consultant, and evaluator with counselors. Yet this application of MI was limited to use within role-based supervision with addictions counselors rather as theory- based supervision that incorporates solely MI in its principles and practices with counselors in general. Clarke and Giordano (2013) referenced the use of MI as a means to address cases of parallel process among supervisees. This appears to be the first application of MI as a general supervisory approach to foster supervisee change processes. The focus of the article, however, was related to the specific supervisory pitfall of parallel process. The authors seek to expand this line of research by presenting MI as a theory-based supervisory approach that provides a framework for the major supervisory processes of building the working alliance, eliciting supervisee motivation for change, and delivering feedback.

Before applying the MI spirit and various elements of MI to the super- visory process, it is important to note that there are times when the MI supervisor must take a directive approach. Similar to situations that require MI counselors to take a more prescriptive style, such as when the client is in danger of harming himself or herself or others (Miller & Rollnick, 2013), there also are times when the MI supervisor must assume an authoritative stance for the good of the supervisee. Also, if safety or ethical issues emerge, supervisors are charged with fulfilling their responsibilities promptly and decidedly. Therefore, the following sections describe the utilization of MI in developmentally appropriate supervisory situations in which it is fitting to elicit motivation from the supervisee to support lasting change.

MI SPIRIT IN SUPERVISION

MI is grounded in a spirit that is essential to employing the MI style, princi- ples, and techniques (Miller & Rose, 2009). The spirit of MI used in clinical settings also is applicable and effective in supervisory relationships. The MI spirit consists of four components: partnership, acceptance, compassion, and evocation (Miller & Rollnick, 2013). The term partnership provides a mantra that the helper is not to impose solutions upon the client; rather, goals are developed and pursued collaboratively. The MI counselor’s primary action is guiding more than directing or following (Miller & Rollnick, 2013). Partnership

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can apply even to those situations in which the supervisor is teaching new clinical skill. By following the formula elicit-provide-elicit, supervisors can inquire as to what the supervisee would like to learn, provide information regarding the skill, and elicit the supervisee’s reaction (Miller & Rollnick, 2013; Rollnick, Butler, Kinnersley, Gregory, & Mash, 2010). In this way, the MI supervisor creates a spirit of collaboration allowing the supervisee to feel both supported and autonomous, an optimal environment for professional growth.

A spirit of acceptance is derived from the humanistic principles of abso- lute worth, accurate empathy, autonomy, and affirmation (Miller & Rollnick, 2013). In summation, MI counselors embody the notion that persons are best served when they are listened to, validated, and affirmed, for who they are, what they want, and where they want to be in life (Miller & Moyers, 2006). This is relevant to supervision, particularly in addressing supervisee anxiety. By communicating that the supervisee has absolute worth, validating his or her emotional experiences, identifying and affirming strengths, and support- ing supervisee autonomy through the developmental process, supervisors create an optimal atmosphere diffuse anxiety.

A spirit of compassion guides the MI counselor to work selflessly and not utilize the approach to manipulate clients into counselor-directed change (Miller & Rollnick, 2013). Similarly, the MI supervisor’s job is not to train per- sons to counsel in the exact manner of the supervisor. Instead, a spirit of compassion drives the supervisor to work for the good of the supervisee and the client, rather than fulfilling a supervisor’s need to be needed. Furthermore, compassion informs the MI supervisor of the anxiety-provoking and vulner- able nature of learning and developing one’s skills and that persons arrive at supervision seeking well-intended support. Finally, the fourth element of the spirit of MI, evocation, refers to eliciting the client’s own assets and motiva- tion for change. Supervisees possess a multitude of abilities that will enable them to navigate ambivalence and struggles with clients and their own personal and professional development. Following the MI spirit of evocation, supervisors will listen for strength-based change language regarding super- visees’ self-awareness, client conceptualization, and intervention skills (Miller & Rollnick, 2013). Overall, when supervisors embody the spirit of MI, they create an accepting environment for developing the working alliance and inviting supervisees to explore and resolve ambivalence regarding their goals.

MI PROCESSES IN SUPERVISION

Emerging out of the spirit of MI are four processes that intentionally facilitate the process of increasing motivation for change among clients (Miller & Rollnick, 2013). The processes of engaging, focusing, evoking, and planning

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are useful for creating a person-centered style that can be incorporated throughout supervision. Rather than conceptualizing the processes as stages to be worked through linearly, they are best conceptualized as building blocks. Once a process is implemented, it is sustained throughout the counseling or supervisory relationship.

Engaging

The engaging process involves establishing rapport and meeting clients with an MI spirit through active, open-minded, and nonjudgmental listening, and affirming the client’s strengths and desires (Miller & Rollnick, 2013). Engaging is particularly important in MI supervision given research that supervisees report more positive supervision experiences when they perceive their supervisors as more empathetic (Britt & Gleaves, 2011). If engaging is con- ceptualized as the engine of the change process, OARS would be the gaso- line. OARS, an acronym referring to open questions, affirming, reflective lis- tening, and summarizing, encompasses the practical “how-to” skills used to engage clients and supervisees (Miller & Rollnick, 2013; Rosengren, 2009). With regard to supervision, open questions are utilized in forming a super- visee-centered working relationship by allowing supervisees to provide elaborate responses inviting reflection rather than short answers. Affirmations are supervisor statements in which he or she offers an observation about a supervisee’s strength by highlighting a specific positive attribute or skill. An MI supervisor might state, for example, “I really appreciate your attentive- ness to multiple perspectives when we discuss stressors that are affecting your client’s life.”

Reflective listening is the MI counselor’s method of feeding back to the client the essence of the content, feeling, or meaning they detect in the cli- ent’s comments. A specific type of complex reflection used during engaging is the double-sided reflection, which is particularly effective at capturing a sense of ambivalence experienced by the client (Miller, 1995). When applied to the supervisory process in which a supervisee feels both excited and scared at the idea of working with clients with multiple traumas, the supervi- sor may reflect, “You’re feeling two ways about working with John. On one hand you’re concerned you might not be experienced enough to help this client, but on the other hand, you’re eager to work with clients who have endured trauma.”

Summarizing is the final OARS component and is, in essence, another form of complex reflection (Anstiss, 2009). When summarizing, the coun- selor amalgamates the key insights, topics, and themes from a segment of the counseling process (Miller & Rollnick, 2013). In MI supervision, summaries similarly capture key content, supervisee affect, meaning, and insight that are embedded in supervision material. In the third edition of the MI text, Miller and Rollnick (2013) described a fifth core skill in addition to OARS;

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informing and advising. Providing information and offering advice is done in the right quantities and only after attaining permission. This additional skill is particularly relevant to supervision as information and advice-giving is often appropriate and encouraged. The elicit-provide-elicit formula previously referenced is how Miller and Rollnick (2013) propose giving information or advice in an MI fashion.

Focusing

Focusing is the process of counselor and client co-constructing desired coun- seling outcomes with the intention of reaching clear treatment targets (Miller & Rollnick, 2013). Many times, supervisees are unclear as to appropriate supervision goals or may not be aware of counseling skills that need to improve. In these instances, the FRAMES model may be a useful supervisory intervention to focus the session.

Feedback is needed in several supervisory scenarios, including for- mative and summative evaluations that take place at the midpoint and conclusion of academic semesters, directive feedback when a supervisee needs to be instructed specifically how to proceed with a client, when a supervisee requests feedback, when the supervisor reviews tape sessions, or following live supervision. The FRAMES approach is an MI adaptation that couples features of MI with the delivery of feedback. FRAMES stands for feedback, responsibility, advice, menu of options, empathy, and self- efficacy (Bien et  al., 1993; Ingersoll et  al., 2002; Miller, 1999; Miller & Sanchez, 1994). This brief motivational approach, which has been used by medical doctors and mental health personnel in short-term helping situa- tions, is particularly useful when the provision of information in a direc- tive format is most effective (Britt, Hudson, & Blampied, 2004). When FRAMES is applied to counseling, feedback consists of offering informa- tion to the client based on formal and/or informal assessments of the presenting concern (Miller & Sanchez, 1994). In supervision, the supervi- sor offers her or his perspective on aspects of the supervisee’s perfor- mance (after asking the supervisee’s permission) and then invites the supervisee to process subsequent thoughts and feelings about the feed- back (Britt et al., 2004; Ingersoll et al., 2002). In the context of counseling, the FRAMES component of responsibility refers to emphasizing the auton- omy of the client in order to increase intrinsic motivation to change (Miller & Rollnick, 2013). The same principle applies in supervision in which the responsibility for integrating or not integrating the feedback is placed on the supervisee. For example, a supervisor may state, “As the one in the counseling room, you are tasked with choosing whether or not to implement my feedback when working with your client.”

Since FRAMES is a brief motivational approach, advice is used. When providing feedback, supervisors may offer suggestions (with permission) as

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to how supervisees can improve their skills, expand their conceptualization of clients, or engage in deeper levels of self-awareness. Next, co-constructing a menu of options occurs in counseling when the counselor and the client collectively brainstorm and expand a list of possible solutions to a present- ing issue (Bien et al., 1993). Applied to supervision, the goal is to increase internal motivation to change and supervisee empowerment by encouraging the supervisee to make a choice from several options. Counselors using FRAMES are empathic, validating, and reflective of the client and any change talk in order to reduce defensiveness and increase motivation (Miller, 1999). MI supervisors offer feedback with empathy, and work to convey under- standing of the supervisee’s experience both in the counseling session as well as in supervision. For example, a supervisor may say, “Working with this client must feel overwhelming at times, but it seems important to you to find ways to be most effective and attend to treatment goals.” Finally, fostering self-efficacy is critical in brief motivational counseling since making behav- ioral changes may provoke a client’s insecurity in his or her ability to make these changes. In supervision, the supervisor can support self-efficacy by providing encouragement, affirmation, asking the supervisee about previous counseling victories, and constructing a plan to increase confidence (Miller & Sanchez, 1994).

Thus, MI provides a means for both direct and indirect approaches to providing feedback in order to assist with focusing the supervision session (Madson et al., 2008). The motivational style of feedback delivery is consis- tent with the spirit of MI and maintains supervisee engagement during the process of focusing.

Evoking

The MI counselor’s goal during the evoking process “… is having the person voice the arguments for change” (Miller & Rollnick, 2013, p. 28). Evoking is a multifaceted method in which the counselor attends to and aids the client in elaborating on change talk. There are several types of client statements which constitute change talk. Expressing a desire to change, perceiving the ability to change, providing reasons for change, and describing a need to change are possible forms of change talk (Miller, 1999; Venner, Feldstein, & Tafoya, 2006). Each type of change talk is relevant to the context of supervi- sion. The following statements illustrate different types of change talk that could transpire in a supervision session:

• “I definitely want to feel more comfortable working with older adult cli- ents.” (desire);

• “I used to feel uncertain about using an empty chair technique with clients, but now that I have been taking some positive risks in my sessions, I feel more confident that I can do it.” (ability);

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• “I am not being helpful to my client if I continue to dominate the direction of my sessions with her. I am just replaying negative experiences she has outside of counseling.” (reasons)

• “I need to take supervision more seriously and must come prepared to discuss cases. It’s important for me to pass practicum.” (need for change)

MI supervisors must be prepared to recognize and respond to change talk at any point in the supervision process (Miller & Rollnick, 2013). As supervisors hear supervisees engage in change talk, it should be reflected, reiterated, and explored to elicit further motivation to change. In the event that supervisee change talk is not forthcoming, statements support- ing change also can be evoked by developing discrepancy, a notion based on cognitive dissonance (Miller & Rollnick, 2002, 2013). In the clinical setting, developing discrepancy entails fostering client reflection regard- ing how their actions are incongruent with their goals and values. A useful way to set the stage for developing discrepancy in the supervision setting is to establish clear, co-constructed supervision goals at the onset of the supervision experience. This allows supervisees to more easily identify incongruence between their behaviors and previously established goals.

Another means to assess ambivalence and evoke change talk is by using the importance ruler, an informal measure of the client’s perceived importance of change behaviors (Miller & Rollnick, 2013). With regard to the supervisory experience, the MI supervisor can ask supervisees to rate on a scale from 0 to 10 how important it is for her or him to change a target behavior. Follow-up questions such as “Why are you at a five and not a three?” or “What would it take for you to shift from a five to a six?” elicit change talk from the supervisee (Miller & Rollnick, 2013). The con- fidence ruler mirrors the importance rule by assessing for perceived con- fidence in making a change. Supervisees of all developmental levels expe- rience uncertainty, yet self-doubt is particularly present with beginning and intermediate counselors ( Jordan & Kelly, 2011; Ronnestad & Skovholt, 1993). Statements reflecting perceived belief in one’s ability to make a change are referred to as confidence talk (Miller & Rollnick, 2013). In addition to the confidence ruler, supervisors can elicit confidence talk from supervisees by reviewing past successes in order to identify strengths and skills. For example, a supervisor may comment, “If it’s okay with you, let’s talk about what you recently learned about yourself when you over- came your anxiety about working with suicidal clients, and how that might apply to this situation.”

MI supervisors also should attend to any supervisee sustain talk, or statements supporting no change, with intentional strategies to cultivate the return to change talk (Miller & Rollnick, 2013). Approaches such as straight reflections can be used to decrease supervisee defensiveness by validating

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their experience. Double-sided reflections are useful in that they first acknowl- edge the supervisee’s sustain talk and then link it to relevant change talk articulated by the supervisee earlier in supervision (e.g., “You’re frustrated that you have to be evaluated regularly on your counseling skills and you also desire to improve your intervention and conceptualization abilities”). Another response to sustain talk is coming alongside, which occurs when the supervisor speaks from the sustain talk side of ambivalence to elicit change talk from the supervisee. An example of this particular skill is pro- vided in the case vignette later in this article.

Planning

In the final MI process, planning, change talk shifts from language about the importance of change, to statements specifying change plans and incli- nations to change including commitment, activation, and taking steps (CAT) (Miller & Rollnick, 2013). Commitment language entails the client’s verbal pledge to change. Activation talk occurs when the client is nearing a com- mitment to change, but has not yet made a distinct vow to do so. Miller and Rollnick (2013) reported clients may make statements such as, “’I’m willing to …” or “I am ready to …” (p. 162). When clients express taking steps toward change, they describe specific aspects of their change plan.

When MI supervisors begin to hear this type of change talk, it signals readiness to begin constructing a change plan (Miller & Rollnick, 2013). OARS should be used to reflect and summarize CAT statements in order to solidify motivation toward accomplishing supervision goals. For example, upon hearing her supervisee commenting, “I have promised myself that I will use more reflections during my sessions” the supervisor replies, “You sound committed to improving your active listening skills. Let’s talk about some specific actions steps that will help you attain this goal.”Change plans in supervision may entail the submission of additional tapes for review, utilizing live supervision, developing a target number of demonstrated behaviors in the next counseling session, or role-playing particular skills in supervision. In accordance with the MI spirit, change plans are co-constructed by both the supervisor and supervisee in an environment of acceptance and compassion.

THE MI SUPERVISOR: A CASE EXAMPLE

The following case example depicts the use of MI as a supervisory approach. Although the transcript is fictional, it was constructed based on the work of the second author. In this example, the supervisee, Jessica, is in her second semester of internship at a general counseling practice serv- ing adult clients. One of Jessica’s goals for the semester is to be more authentic with her clients by relying on her in-session reactions and feel- ings to inform her work. The example is based on a supervision session

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following the submission of a tape in which Jessica is working with an adult male, Josh, who presents with a history of impulsivity, poor decision making, and emotional instability. Jessica has seen this client for several weeks and is frustrated with her work, stating that she feels lost and pow- erless in their sessions.

Sup: You sound weary when you talk about this particular client.

(Engaging; reflection)

Jessica: I am. I feel like he comes in, takes over, and I am just along for the ride. I am not sure what he needs and I get lost in his stories. But I don’t think there is anything I can do. He is so resistant. Sup: I am sure it is difficult to feel powerless in your counseling sessions. What is it like to get lost in his stories?

(Engaging; accurate empathy; open question)

Jessica: Well, I try to follow them … but sometimes they just don’t add up, you know? It is like he is exaggerating parts of them or maybe just making them up as he goes along … either way, I end up wondering whether or not they actually happened. Sup: You are doubting the truthfulness of what he is saying, yet you are unsure what to do about those doubts.

(Engaging; focusing; double-sided reflection)

Jessica: Exactly. I don’t want to be mean, but I just don’t believe him a lot of the time … but I don’t know what to do, so I just go along with him, feeling frustrated the whole ses- sion. I wish he would just be honest!

(Focusing; developing a clear topic of the supervi- sion session)

Sup: A part of you is afraid of offending the client, so you continue tracking his stories, and yet another part feels inauthentic as you appear to believe something you don’t.

(Evoking; double-sided re flection capturing both sides of ambivalence)

Jessica: Yeah, I guess inauthentic is the right word. I hadn’t really thought of it like that … but he makes me feel that way. I am doing what I need to do … and if he is dis- honest there is no changing that.

(Sustain talk)

Sup: So it may be that your client is respon- sible for making you disingenuous … and even now you are powerless to do anything about it.

(Evoking; coming along- side and speaking from the sustain talk perspec- tive to elicit change talk.)

Jessica: Well, I don’t know if I am powerless. It probably isn’t completely his fault. I guess there might be something I could be doing differently … .

(Beginning of change talk)

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Sup: I hear you acknowledging that your role in this relationship is also important and your contribution does impact what hap- pens in session … that sounds empowering. [Jessica nods in agreement.] You know, as you talk about this client, I can’t help but think of your supervision goals, particularly the one around relying on your in-session reactions.

(Evoking; reflection; developing discrepancy between present behavior and goals)

Jessica: [sigh] I wasn’t even thinking about that goal, but now that you bring this up I guess it really does apply. I have a lot of in- session reactions with this client … I don’t even know what to do with them, but I’d like to do something to be more authentic.

(Change talk [desire])

Sup: So you have been aware of your feel- ings and reactions in session, yet you are unsure how to utilize them in a therapeutic way … and you would like that to be different.

(Evoking; reflecting change talk to encourage elaboration)

Jessica: Right. As of now, I just sit there and stew … and the session goes nowhere … . I don’t want to keep doing that.

(Change talk [desire])

Sup: Let me ask you Jessica, on a scale from 0 to 10, with 10 being extremely high, how important is it for you to use your in-session reactions to inform your work and be more authentic with your client?

(Evoking; importance ruler)

Jessica: Well, I guess like an 8 or 9. I don’t want to continue to leave each session frus- trated, and I honestly don’t think I am help- ing him very much by pretending I believe his stories.

(Change talk [desire and reasons for change])

Sup: So it is very important for you to make a change. I wonder, how confident do you feel that you could make this change in your clinical work? Let’s use the same scale, from 0 to 10.

(Evoking; confidence ruler)

Jessica: I don’t know … like a 3 or something. Sup: Okay, so it is important to you, but you really aren’t sure you would be able to do things differently even if you tried. I wonder, why is this rating a 3 and not a 1?

(Evoking; follow-up questions to elicit change talk)

Jessica: Well, I guess I don’t feel completely incapable. I mean, I’ve learned new things before … .

(Confidence talk)

Sup: What is coming to mind? (Evoking; open question)

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Jessica: Last semester I didn’t think I could reflect meaning … but after we worked on it for a while I was actually able to start doing it in session.

(Confidence talk; review- ing past success)

Sup: So you identified an area for growth, practiced it in supervision, and felt confident to try it out in session. What else?

(Evoking; reflection; open-ended question)

Jessica: Well … I guess I also learned how to do a suicide assessment. I used to be terri- fied of a client having suicidal ideations, but now I think I can do an okay job responding to that … .

(Supervisee responds with additional confidence talk)

As the session continues, the supervisor and Jessica discuss how she was able to implement changes in her clinical work in the past and, through this dialogue, increase her confidence level with regard to the present area of change. Next, they begin the planning process by constructing a menu of options as to how Jessica might proceed with her client. Jessica chooses among the options and decides to stop the client when she begins to doubt his truth- fulness and gently share her reaction using the statement, “Let me pause you for a moment because I am feeling a bit confused …” and identify the discrep- ancy in the story. Thus by utilizing MI, the supervisor is able to facilitate the resolution of Jessica’s ambivalence by eliciting her own motivations for change.

CONCLUSION

MI supervision is a pragmatic approach for guiding the structure and pro- cesses of effective supervision. The MI spirit creates an accepting, collabora- tive, and compassionate atmosphere for supervisees to uncover their own reasons for change. The MI processes provide a framework for supervision with corresponding interventions that emphasize key components of super- vision. MI supervision is versatile in that the approach can be integrated with role-based supervision models such as the discrimination model (similar to Madson and colleagues [2008]) or with other theory-based supervision such as solution-focused supervision (Pearson, 2006). Moreover, the case example demonstrates how MI supervision can invoke techniques to be implemented in specific supervisory situations. An added benefit of MI supervision is the modeling of humanistic principles and MI interventions by the supervisor that counselors can then utilize with their own clients. Research is needed to determine whether MI supervision yields improved outcomes regarding skill development, anxiety and resistance, and satisfaction with supervision with supervisees at various stages of clinical development. A limitation of MI supervision is the absence of a framework for matching interventions to supervisee developmental level. To address this, researchers might consider

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incorporating developmental models such as the Integrative Developmental Model (Stoltenberg & McNeill, 2009) with MI supervision.

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