Supervision

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SUPERVISION

Copyright CDS Ventures, LLC 2006


WHAT SHAPES CLINICAL SUPERVISION
The theoretical model from which it is derived

(Therapy, Education)



THE PURPOSE OF SUPERVISION IS TO
Bring about change in the knowledge, skills and

behavior of another
Assist the counselor in self observing, self-

correcting, self reinforcing, and self soothing
Ensure counselors remaining in the field are

competent with regard to personal characteristics,
philosophical foundations, communication abilities,
counseling skills, administrative skills, and ethical
behaviors



DISCUSSION
It is our duty to ensure counselors remaining in the field

are competent with regard to
personal characteristics

philosophical foundations

communication abilities

counseling skills

administrative skills

ethical behaviors


For each of the above, identify 3 competencies in each
area, how you would assess them and ways you can
help supervisees enhance them.



FIVE MAIN COMPONENTS OF SUPERVISION
An experienced supervisor


Clients in clinical settings


A primary concern to “do no harm” with regard to

both the client and supervisee
Monitoring counselor performance through

observation
The goal of changing the counselors behavior




3 MAIN COMPONENTS OF SUPERVISION
Nurturance


Promote measurable development of skills and

competencies
Raise the level of accountability in counseling

services and programs



SUPERVISION HELPS THE COUNSELOR…
Understand himself/herself


Understand the process of counseling


Master the knowledge, skills and abilities of

counseling



SUPERVISION IS
A lifelong process of professional development,

affirming, internalizing and demonstrating a
professional self
A disciplined, tutorial process where principles are

translated to practice with 4 overlapping foci
Administrative

Evaluative

Clinical

Supportive


About people, their needs, concerns and growth




SUPERVISION IS DISCIPLINED MEANS
It is regularly scheduled, time limited with specific

agenda and expectations



SUPERVISION IS TUTORIAL MEANS
It involves individualized assessment, goals and

training plans



SUPERVISION IS A PROCESS MEANS
It is a relationship in which both parties work

together in an atmosphere of trust and respect



SUPERVISION TRANSLATES PRINCIPLES TO
PRACTICE
It teaches principles and how to use them

appropriately
It helps counselors identify what they did, why they

did it, when they would do it again

Discussion: How do you help counselors identify what they did, why they did it,
when they would do it again? (i.e. case studies, round tables, scenario based
training, group supervision etc.)



THE FOUR OVERLAPPING FOCI
Administrative


Evaluative


Clinical


Supportive




THE ADMINISTRATIVE FOCUS INVOLVES
Organizational management including hiring,

training, evaluating, etc.



THE EVALUATIVE FOCUS
Occurs in 2 main stages: goal setting and feedback


Should be proactive instead of always

reactive/corrective
Provides the supervisor opportunities to provide

praise and encouragement while assisting the
counselor in making necessary changes
Is consultative with a focus on the client


Discussion: What does it mean to have a proactive approach to evaluation?



3 ROADBLOCKS TO EFFECTIVE EVALUATION
Lack of supervisor skills in evaluating supervisee

performance (i.e. lack of understanding regarding
setting measurable goals/objectives)
Confusion about the compatibility of evaluation and

supervision
Anxiety evoking aspects of evaluation


Discussion: Discuss the major sources of anxiety for supervisees and methods
you have found useful to assist them



THE SUPPORTIVE FOCUS OF SUPERVISION
Providing hand-holding, cheerleading, morale

building, coaching and burnout prevention
Exploring supervisees’ feeling during the

counseling and supervision sessions
Facilitating supervisee self-exploration and growth


Assisting the supervisee in finding areas of success

in each hour of therapy

Discussion: Identify one way you accomplish each of the above tasks in your
supervision process.



SUPERVISION VS. COUNSELING MEANS
Supervision addresses counselor personal growth

issues as they relate to the material the client is
experiencing
Supervisors identify personal growth issues, but refer

the supervisee to a counselor to explore these issues in
depth
Supervision helps counselors identify ways they may

be acting out personal issues in the counseling session

Discussion: How do you differentiate the difference between supervision and
counseling and how do you negotiate that boundary on a regular basis.



THE BEST SUPERVISOR TEACHES
By example letting students watch you work




LEADERSHIP INVOLVES
Teaching, mentoring, coaching based in a set of

core values



10 PRINCIPLES FOR LEADERSHIP
Take full responsibility for the decisions you make
1.

Put subordinates wellbeing above your own
2.

Give subordinates full credit for successes
3.

Take risks when they are in the best interest of the
4.
organization or the client
Protect, support, defend subordinates to senior
5.
management



LEADERSHIP CONT…
Take a personal interest in the welfare of your staff
6.

Make decisions promptly
7.

Be a teacher
8.

Do not play favorites
9.

Do not give orders just to show who is boss
10.



BOTTOM UP MANAGEMENT MEANS
Participation in the decision making process is

spread throughout the corporation
A leader is a servant first


Supports, instead of directing, the teams that

design and implement the tasks



SIX MAJOR STAKEHOLDERS
Employees


Customers


Vendors


Competitors


Community


Owners




4 PRINCIPLES OF THE NEW ORGANIZATION
Networked systems


Servant leadership


Participatory management


Stakeholder involvement




TRAITS OF AN EFFECTIVE SUPERVISOR
The 4 “A’s”
 Available

 Accessible

 Able

 Affable

Discussion: In what ways are you available, accessible, able and affable? How
could you improve in any of these areas?



ANSWER THE FOLLOWING QUESTIONS
How do I believe change occurs

What are the crucial variables in training and

supervision
How do I measure success in supervision

How do I contribute to that success

What learning objectives do I have for supervision

What techniques will I apply to ensure learning

objectives are met

Discussion: Answer each of the above questions



MODELS OF SUPERVISION LAYERS
Philosophical foundation


Descriptive dimensions


The supervisor’s and supervisee’s stage of

development
Contextual factors including personal

characteristics and setting/environment



THE PHILOSOPHICAL LAYER
Basic beliefs about how we know what we

know, what motivates people and how people
change



TEN DESCRIPTIVE DIMENSIONS
Influential

Symbolic

Structural

Replicative

Counselor in treatment

Information gathering

Jurisdictional

Relationship

Strategy




INFLUENTIAL
Determines whether the client and supervisee are

influenced at an affective or cognitive level



SYMBOLIC
Deals with whether latent or manifest content is

addressed in counseling and supervision



STRUCTURAL
Describes whether therapy and supervision are

spontaneous or planned



REPLICATIVE
Refers to the extent to which the supervisor sees

observed interactions as representations of
isomorphic processes



COUNSELOR IN TREATMENT
Has to do with whether training and personal

therapy are viewed as related or unrelated activities



INFORMATION GATHERING
Contrasts indirect methods of obtaining information

with direct observation of therapy sessions



JURISDICIONAL
Concerns who is responsible for client care




RELATIONSHIP
Determines whether the counselor or supervisor

functions at the facilitative or hierarchical role with
respect to the client or supervisee



STRATEGY
Highlights the teaching of theory versus technique

in supervision



THE STAGE OF DEVELOPMENT LAYER
Includes not only the development of the

supervisee but the supervisor not only as a
clinician, but also as a supervisor



THE CONTEXTUAL FACTORS LAYER
5 Categories

Training


Philosophy


demographic characteristics of supervisor supervisee

and clients
Setting


Clinical issues




DEVELOPMENTAL APPROACH
The supervisor provides:
 Nonjudgmental support
 Uses a counseling, therapeutic approach
addressing feelings thoughts and actions that may
impede the supervisees professional performance
 Is consultative with self-evaluation an exploration
 Employs self supervision



STRUCTURES UNDERLYING DEVELOPMENT
Autonomy


Self and other awareness


Motivation




Counselor Level 1 “Forming”

Characterized by: high dependence on others, lack of self and

other awareness, categorical thinking, high motivation and
commitment to work
Plagued by feelings of anxiety and driven by the desire to do it

right
And formulate clinical concepts on the basis of a single aspect

of the client history
Practice by formulas such as “All clients in early recovery are

__________quot;



CONT…
Do not know how to formulate treatment plans


Cannot visualize and articulate therapeutic process from

intake through intervention to termination
The supervisor environment is one that encourages

autonomy of providing instruction support and modeling
within a structured setting
The primary responsibility of supervisors for level 1

counselors is to protect client needs at all times while
encouraging risk-taking by the counselor
To facilitate growth a supervisor should introduce the counselor

to ambiguity and conflict
It is imperative that supervisors working with level 1 counselors

take into account the supervisees learning style



Counselor Level 2 quot;Stormingquot;

Realizing that cannot save the world, level two counselors

become frustrated by their inability to solve difficult problems
Characterized by: vacillating between autonomy and

dependence, more self-aware of self and others, and
consistently motivated
Although level 2 counselors have more skills and tools, they

often do not know which tools to use with which client or why
Often vacillates between rejecting advice and assistance to

desperately wanting to be comforted and protected
Level 2 counselors can empathize excessively with the client




CONT…
Level 2 counselors progress in a cyclical rather than linear

fashion regressing at times to earlier developmental issues



Counselor Level 3 quot;Normingquot;

Involves establishing one's own therapy model and

normalizing that approach in a range of clinical situations
Characterized by: secure autonomy, awareness and

acceptance of self and others, stable motivation



Supervisors: Level 1 quot;Formingquot;

Displays a mechanistic approach


Place a strong expert role


Depends on own supervisor


Is moderately to highly structured


Is invested in trainees adopting their own model


Has trouble with level 2 counselors




Supervisors: Level 2 quot;Stormingquot;

Displays confusion, conflict issues


Sees supervision and counseling as more complex,

multidimensional
Has fluctuating motivation


Focuses on supervisee


Loses objectivity


Blames supervisee for supervisor’s problems




Supervisors: Level 3 quot;Normingquot;

Functions autonomously


Displays self and supervisee awareness


Differentiates boundaries and roles


Able to supervise at all times


Prefers to work with a certain level of counselor




THE PSYCHODYNAMIC APPROACH
Regard supervision is a therapeutic process focusing

on the intrapersonal and interpersonal dynamics of the
counselor in relation to clients, colleagues, supervisors
and significant others
The goal is dynamic awareness which includes

understanding dynamic contingencies including past
learning experiences that reassert themselves and
present situations, observing changes in the dynamic,
and making therapeutic use of the dynamic in
counseling



CONT…
The primary methods of observation and the

psychodynamic model of supervision are not
directed such as process notes, verbatim
reports, and oral presentations.
The psychodynamic approach focuses on the

affective dimension, latent content, is
reactive, observes parallel processes, uses
indirect methods of information
gathering, believe the therapist has
jurisdiction, form facilitative relationships and
focus heavily on theory instead of technique



PSYCHODYNAMIC APPROACH PHASES
Phase 1: Childhood: supervisor creates a safe

place for supervisee to explore new techniques
Phase 2: Adolescence: alternating between

exploration into new areas and retreating to the
safety of home
Phase 3: Adulthood: mutual interdependence

between supervisor and supervisee built on the
foundation of basic universal values such as faith,
hope, love, peace and respect



THE SKILLS MODEL OF SUPERVISION
Three Basic Tenets

Counselors must learn the appropriate skills and

extinguish inappropriate behaviors
Supervision assists counselors in developing and

assimilating specific skills
Counselor knowledge and skill should be formulated in

behavioral terms



THE SKILLS MODEL OF SUPERVISION
Establishing a relationship between supervisee and

supervisor is a dynamic component of the learning
process
Supervision begins by asking what one needs to

learn to be an affective counselor
The next step is to set realistic, measurable, and

timely supervision goals that enhance the
supervisees motivation



SKILLS METHODS
Skills monitoring is an ongoing process that helps the

counselor identify appropriate professional performance
Role-playing and simulation techniques are used to

practice new skills
Micro training breaks down a specific skill into well-

defined measurable categories, and enabling the
counselor to acquire skills in small steps
Other behaviorally based techniques contribute to skills-

training as well
What the counselor learns in one context is generalized

to other contexts



CONT…
Identifies categories of necessary tasks that are not theory

specific which apply across the board, regardless of whether
one is psychodynamic, behavioral, or skill based in
orientation
Is characterized by an emphasis on the cognitive aspects,

manifests contents, is proactive, believes relationships are
to streets, uses direct methods of information gathering, the
jurisdiction to the supervisor, is hierarchical and technique
oriented



THE SYSTEM'S MODEL OF SUPERVISION
The primary focus is on a larger whole, or systems

which is defined as an integrated and related set of
components or subsystems organized for the
purpose of obtaining of specific objectives



THE STRUCTURAL MODEL OF SUPERVISION
Examines the organizational structure of the family

is the primary source of the family's problems,
impeding a clear flow of information and decision
making



THE STRATEGIC MODEL OF SUPERVISION
Looks for strategies functions and meanings and

family interactions
The therapist generates new strategies and skills

for the family to resolve the problem
behaviors, focusing on the function of the symptom
Technical skills are taught with a view toward the

development of the conceptual framework, giving
the supervisee a method of thinking and not a
model of therapy



ADDICTIONS UNIQUE CHARACTERISTICS
Costs


Denial


Lack of a Consistent Pattern


Deleterious Consequences


Pervasive Effects




GOALS FOR ADDICTION TREATMENT
Detoxification


Dealing with patient denial


In overcoming guilt, shame, self blame, and other

destructive emotions
Establishing a healthy lifestyle and behaviors that

make it possible to maintain sobriety
Aftercare in a program of self-help and/or ongoing

therapy



OBJECTIVES FOR 12-STEP RECOVERY
Six Dimensions

Cognitive objectives mean that abusers must understand

how substance abuse has affected their life, how denial
and rationalizations contribute to continue drinking or
drug use despite negative consequences, and how the
negative consequences are connected with the alcoholic
drug abuse



CONT…
Emotional objectives include the need to

acknowledge feelings such as
anger, resentment, loneliness and deal with these
emotions in a way that minimizes relapse
Relationship objectives include understanding how

the substance abuse affects relationships with
people
Behavioral objectives include understanding how

substance abuse affects everything one does



Social objectives include the need to participate in

self-help programs and to reevaluate relationships
Spiritual objectives include the need to experience

hope that the addiction can be arrested, to believe
and trust in a power greater than oneself, and to
acknowledge one's own character defects and the
harm ones actions have caused



MINNESOTA MODEL PHILOSOPHY
Elements

Addicts can change their beliefs, attitudes, and behaviors


Alcoholism or addiction is a primary chronic, multifaceted

disease characterized by loss of control
Both long and short-term treatment goals are specified

including abstinence and a better lifestyle



ALCOHOL AND DRUG ABUSE MODEL (ADAM) OF
SUPERVISION
People have the ability to bring about change in

their lives with the assistance of a guide
People do not always know what is best for them,

and may be blinded by their resistance to, and
denial of the issues
The key to growth is mental insight and behavioral

change in the right amounts at a appropriate time
Change is constant and inevitable




Supervision the guidance to concentrate on what is

changeable
It is not necessary to no great deal about the cause

or function of a manifest problem to resolve it
There are many correct ways to view the world




DESCRIPTIVE DIMENSIONS OF THE ADAM
Influential: given the tendency of the field to attract

people with their own history of recovery, the
supervisor must attend to both cognitive and
affective issues at all stages of the counselor’s
development
Symbolic: emphasizes primarily manifest content,

being less concerned with historical information,
viewing the unconscious material as interesting but
nonessential to bringing about the desired
behavioral changes in client and supervisees



Structural: involves teaching the 12 core functions

with highly specific learning goals and explicit
supervisory activities
Replicative: Counselors behave in Supervision in a

manner parallel to clients in therapy
Counselor in treatment: therapy is not an essential

ingredient in the counselor supervision and it is
inappropriate for the supervisor to provide therapy



information gathering: varies from direct and indirect based

on counselor competency
jurisdictional: the responsibility for the welfare of the client

rests ultimately with the supervisor
relationships: nonhierarchical, consultative, facilitative


strategy: moves from technique to heavily theory based as

counselors increase competency



DISCUSSION
Which supervision model fits you best and why:

developmental, psychodynamic, skills, systems or
the alcohol and drug abuse model of supervision?



4 FACTORS THAT AFFECT CHANGE

Extra therapeutic factors which are all factors related

to client and not the actions of the therapist
Relationship factors, the single most significant issue

in the therapy outcome, including caring, empathy,
warmth, acceptance, mutual affirmation, and
encouragement of risk taking
Placebo factors, such as hope and expectancy


Technique factors, account for only 15% of

therapeutic change



WHAT COUNSELORS NEED TO LEARN
How to attend themselves to the client's feelings,

establish rapport, to demonstrate caring,
compassion, and empathy
How to find a collaborative instead of combative

metaphor for treatment
How to develop and monitor the therapeutic alliance

How to marshal and enhance the potential for

success through the use of social support networks,
community services and family and community
resources



How to avoid falling into conventional wisdom that when

treatment does not meet the desired outcome it is the
client's faults
How to promote the client sends a personal control and

empowerment
How to focus on the future and the client's ability to

overcome the past
How to engage in brief therapy




How to establish the affective qualities essential to

counseling before they are taught diagnostics
How to adapt a relationship to different clients and their

needs
The earlier change happens in treatment the more likely

will be a positive outcome
How to identify not what the person needs, but what the

person already has to work with
Help is when the mind is present in the heart, when

mind, body and spirit are integrated and when an
individual is at peace with his mind body and spirit even
if one of those elements is experiencing pain or suffering



SUPERVISORS NEED TO
Offer mystery, compassion, openness, and a

simple presence instead of answers or being the
expert
Learn contemplative listening which means being

receptive to visual, auditory, kinesthetic and
intuitive cues, without an agenda, and without a
compulsion to help
The most important phrases a supervisor can learn

are quot;I don't knowquot; and quot;I could be wrongquot;



The goal of Supervision should not be the separate

autonomy of the individual but the realization of
one's essential connection and relatedness to
something broader than the self



ESTABLISHING SUPERVISORY RELATIONSHIPS
Creating a contract involving mutually defined goals

for both parties that allow for realistic accountability
Establishing a working relationship which includes

laying groundwork of trust and respect
Assessing the counselor's clinical knowledge and

skills and training needs using standardized
instruments, transcripts and other methods of
observation
Setting learning goals for the supervision and a form

of supervision training plan



GOALS OF SUPERVISION SHOULD BE
Clearly stated, attainable, specific, measurable and

observable
In writing (individual development plan, IDP) and

agreed upon by the supervisor and supervisee
Contain specific action steps to bring about the

outcome
Contain specific procedures to evaluate the

outcome



INDIVIDUAL DEVELOPMENT PLANS
Include the following

Expectations for supervision including the model of

therapy, the number and types of patient to be seen, the
number and duration of supervision sessions, and the
techniques and interventions to be used
The counselor's experience and readiness for the

position including the counselor's base of knowledge and
his or her strengths and areas for growth



Procedures to be used to observe the counselor

and practice
Procedures to be used to determine the counselor's

reasoning, conceptualization, and decision-making
skills
Procedures to be used to evaluate the counselor

Procedures to be used to intervene to help the

counselor achieve supervision goals



ASSESS THE LEARNING ENVIRONMENT
Questions

Is there sufficient challenge in the learning environment

to keep the supervisee motivated
Is the theoretical or philosophical dissonance between

supervisor and supervisee manageable
Does the supervisee have the necessary knowledge and

skills to begin this process
Does the supervisee have sufficient personal

development self-esteem and sense of self-worth to
progress
What is the supervisee's investment in the learning

process



CONT…
Does the supervisee possess the basic and affective

qualities needed for counseling such as empathy warmth
and genuineness
Is the amount of support available to the supervisee

sufficient and proportional to the challenge
Are the goals and means of supervision clear and

understood by all parties



Are the evaluation criteria realistic, measurable, attainable,

accurate, relevant and clearly understood
To what extent can the supervisee process feedback


Is the supervisory environment conducive to risk taking


To what extent is the supervisor able to help the supervisee

integrate new techniques and skills
Is there a basis for terminating the supervision at the

appropriate time



MANAGING THE SUPERVISORY WORKLOAD
Everyone providing direct counseling services

should receive at least one hour of supervision per
week
Individual sessions should run approximately 1

hour and small group sessions should run
approximately 1 1/2 hours



CONT…
Supervisors should discuss with their supervisees

whether they are going to observe entire sessions,
parts of sessions, live sessions, or tapes
Peer group supervision can be used to manage

larger groups where level 3 counselors supervise
level 1 and 2 counselors and level 3 counselors
meet in a small group for supervision with the
supervisor



It is rarely possible to supervise more than 15

counselors without suffering an unacceptable level
of personal stress or deviation from professional
standards



METHODS OF OBSERVATION INCLUDE
Videotapes


Cofacilitation


One-way mirror supervision


Role playing




WORKING WITH VIDEOS
Clear goals must be set to determine why, when,

and how videotaped sessions will be conducted
Interactive processes recorded on tape should be

related to the actual counseling session, its goals,
and the memories of the session and the rationale
for the intervention should be explored



Tape segment should be selected for review

because they provide teaching moments not
pretexts for scoring critical points
The supervisor should provide gradual feedback,

not a litany of judgments, and allow time between
segments discuss and assimilate feedback
It is vital to have signed releases from patients prior

to taping



The day prior to taping the counselor should inform the

patient that the videotaping is planned for the next session
and provide the patient the opportunity to state that they do
not want to have the session taped
quot;Patient resistancequot; to videotaping is usually a projection of

the counselor's resistance
Tapes must be erased after the training sessions as they are

admissible as evidence in court. Further it is not enough to
just tape over the session material, a magnetic tape erasure
should be used



CREATIVE WAYS TO USE VIDEOTAPES
Running the tape and fast-forward to convey a

heightened image of the counselors and clients
body movements
Turn down the audio to try to fill in what is being

said on the basis of nonverbals
While reviewing the tape prior to supervision, the

supervisor might do voiceover dubbing questions
for the supervisee onto the tape



COFACILITATION CONSIDERATIONS
It is time-consuming


It is obtrusive and alters the dynamics of counseling


It can be anxiety provoking for both counselor and

client
If the session is not also videotaped, there is no

record of the session to review later



GUIDELINES FOR COFACILITATION
The supervisor should sit in the group or beside the

counselor in an individual counseling session
The supervisor should begin the session with a

pledge of confidentiality
Prior to the session the supervisor and supervisee

should briefly discuss the background of the
session, salient issues and plans for the session



CONT…
The supervisor should take notes during the

session as a means of recalling key issues to be
discussed later
The supervisors interventions during the session

should be limited to no more than three or four
comments
Feedback should be given to the counselors as

soon as possible after the session



CONT…
If a group session is led by two counselors to

supervisor should meet with the to supervisees
jointly
Cofacilitation should be used in conjunction with

videotaping whenever possible



GROUP SUPERVISION BENEFITS
It provides a cost-effective way of supervising more

people in the same time
It offers each counselor a reality testing of her

perceptions through peer validation
Learning is enhanced by diversity of people in the

group
Groups create a working alliance among

counselors that engenders a sense of
psychological safety



The group process facilitates learning by setting up a

microcosm of the larger social environment
Group disclosure enhances the potential for self-disclosure,

confrontation, and opportunities for growth
Empathy and sharing of interests are available to a greater

extent than in individual supervision
When the group works together over time personal growth

on the part of the individual members can be reinforced
possibly by the group's
Alternative clinical approaches and methods are available to

a far greater extent than a single supervisor can offer
The potential for critical feedback is greatly expanded




PROCESSES IN GROUP SUPERVISION
cohesiveness


a sense of we-ness


a shared frame of reference


tolerance of diverse opinions


movement toward common goals


like any group leader, the task of the supervisor is

to help the group identify its norms, and to model
appropriate qualities, behaviors, and skills



CASE PRESENTATIONS
Are useful in groups and individual supervision


Should be built around problems and solution-

oriented questions to be answered
Should move from client information to dynamics,

prognosis, and treatment plan
Allow the supervisor to observe the counselor's

actions, determine their impact on the client, assess
the counselor's clinical reasoning process, and help
the counselor improve treatment delivery



CASE PRESENTATION PROBLEMS
Too many presentations into short of a time


Focusing on a specific problem instead of giving a

case overview
Material is not contextualized


Supervisee dynamics interfere with free and open

discussion of the case
There are expectations for interventions beyond

the capabilities of the counselor



ROLE PLAYING IS…
An alternative to observing the clinician and an

actual counseling session
Ideal for practicing skills


An opportunity to learn-by-doing in a safe

environment and receive helpful feedback



FEEDBACK AND INTERVENTION
Can be triaged into three levels: immediate

intervention, non-immediate
intervention, suggestions



5 TYPES OF SUPERVISORY INTERVENTION
facilitative: bringing about discussion through

nondirective questions
confrontive: addresses specific action or behavior

and require the counselor to answer a question
about it
conceptual: contributes new information and a

different way of visualizing the case



CONT…
prescriptive: direct the counselor to respond in a

particular manner the next time a certain set of
circumstances occurs
catalytic: moves the process along by asking

provocative, or what if questions



FEEDBACK IS
Supervisor's response to the data presented


Supportive, challenging and pragmatic


Designed to bring about a positive change in the

professional life of the counselor



EFFECTIVE FEEDBACK

Is elicited rather than imposed


Is timely


Is communicated clearly, directly and with regard

to specific issues
Is constructive and descriptive rather than critical

or judgmental
Is directed toward changeable behavior


Is not used as a disciplinary weapon




CONT…
Constructive feedback is sandwiched between

positive feedback and/or recognition of work well
done



METHODS OF PROVIDING FEEDBACK
Trunking or breaking down information into

manageable bites
Providing nonthreatening but thought-provoking

were challenging questions
Sharing one's own experiences in concrete terms


Providing support and encouragement


Suggesting alternatives




EFFECTIVE CHALLENGES ARE
Tentative


Phrased with the tone of care and respect


Tied to reinforcement


Built upon steps which have already been

successfully accomplished
Focused on specific and concrete behaviors




TRANSFERENCE & COUNTERTRANSFERENCE

That transference reactions that may arise even from

the way they decorate their office
That not all emotional reactions to clients are

countertransference
That not all countertransference reaction to harmful


Of the difference between healthy personal or

therapeutic responses to clients and unhealthy
responses arising from the counselor's own
unresolved conflicts



PHYSICAL CONTACT GUIDELINES

Physical contact for the client is justified only if it

is therapeutically supportive
Nothing that cannot be done in public should be

done in private
If you do something with one client, you should

be willing to do it with all clients



DETERMINING SKILL LEVELS
Supervisors should not assume a developmental

level based on the counselor's experience and
training
Supervisors should not assess counselor simply on

the basis of initial impressions
Supervisors should not determine developmental

level simply on the basis of performance in one or
two domains



Supervisors should use several sources of

information to assess counselor's development
including assessments by former supervisors,
measurements administered by the current
supervisor, counselor self-assessments, client
ratings, and work samples



COUNSELOR COMPETENCIES
6 Areas

Personal characteristics


Philosophical foundations


Communications


Counseling skills


Adjunctive or administrative activity


Ethical behaviors




SOURCES OF ANXIETY FOR SUPERVISEES

Beginner's quandary or the fear of the unknown


The spun glass theory that their clients are

delicate objects
Performance and approval anxiety


Dominance anxiety




DEALING WITH ANXIETY
Identify the supervisees anxious behaviors/defense

mechanisms
Assist the supervisee and recognizing and

exploring the cognitive pattern, and the needs of
expresses
Challenge the irrational beliefs with questions




CONT…
Assist the supervisee in constructing rational and

logical thoughts related to the anxiety or anger
Challenge the supervisee to take a behavioral risk

and try out the logical arguments
Ask the supervisee to write down the name of each

client and state what aspect of each case worries
him or her



BIASES AFFECTING SUPERVISION INCLUDE
Recency: remembering what happened last

week, not six months ago
Overemphasis on one factor as opposed to the

bigger picture
Unforgivingness leading to an inability to

acknowledge improvement
Prejudice based upon negative attributions


Favoritism




CONT…
Grouping or stereotyping


Indiscrimination, being either too approving or too

critical



PROTECTING AGAINST BIASES
By using standardized rating scales for all

employees
Creating behaviorally anchored rating scales for all

employees



EQS ARE
Effective questions


Open ended questions that ask what, and how

instead of why



OVERCOMING ROADBLOCKS INCLUDE
Solution-focused methods

Identifying previous times when a similar issue was

resolved or provided less of a problem
Using a miracle question to identify goals


Breaking goals down into smaller objectives


How have you been able not to have the problem bother

you in the past
Identifying exceptions to problems (i.e. When does this

problem not exist)



CONT…
Assisting the counselor in adopting a future

orientation
Cheerleading


Encouraging change to continue by highlighting

successes not errors



PREVENTING BURNOUT
Maintain adequate self and other awareness


Have a mentor and supervision of their supervision


Maintain some client load to stay in touch with the

very reason they went into counseling in the first
place
Seek extra counseling on personal issues interfere


Constantly strive towards personal growth




Ethical and Legal Concerns



MALPRACTICE PREVENTION
Providing high-quality clinical care grounded in

genuine empathy and alliance building
Avoiding dual relationships


Continuously maintaining some form of

supervision/consultation
Meticulous, high-quality documentation




DOCUMENTATION SHOULD
Date and times of supervision was provided


The names of those supervised


The general areas and clinical issues discussed


The names of the client discussed


The name or names of any person sought for

consultation on an issue



KEY BOUNDARIES
Sexual involvement with clients or supervisees is

prohibited
One does not supervise one's spouse


A supervisor should not act as a supervisees

therapist or counselor
A supervisor should not sponsor a supervisee in a

12 step or other self-help program
Supervisors and supervisees who are friends

should maintain boundaries carefully



DETERMINING ETHICAL VIOLATIONS
Is it legal


Is it balanced and fair to all concerned in the short

and long-term
How I feel about myself if my family, my colleagues

or the community knew



4 ETHICAL RESPONSIBILITIES OF SUPERVISEES

Uphold professional standards of practice


Recognize and deal with personal problems when

they interfere with clinical effectiveness
Treat the supervisor with respect and dignity


Treat information shared in supervision with the

highest degree of confidentiality



THE PRINCIPLE OF VICARIOUS LIABILITY
The supervisor assumes clinical responsibility for

the client just as much as if the client were under
his or her own personal care



COMMON LEGAL AND ETHICAL ERRORS
Confusing supervision with case management


Focusing on the client's needs rather than a

supervisee’s development
Relying on the supervisor's clinical skills in

supervision thereby turning supervision into therapy
Adopting lax attitude with supervision occurring on

a sporadic basis



CONT. . .
Conducting casual case conferences and crisis

management supervision
Using supervisory power inappropriately




SUPERVISOR ACCOUNTABILITY

Did the supervisor make a reasonable effort to

supervise including direct observation of
counselors in action
Was the supervisor competent to perform the

tasks of the supervisor



THE LEGAL CRITERION FOR MALPRACTICE IS

a breach of duty




CONFIDENTIALITY
Is one of the top five charges (and successful

suits) against therapists
Is regulated by HIPAA

Must be spelled out in a notice of privacy

practices given to all new patients
May be waived under certain circumstances

including
Examination by the federal government as it

relates to terrorist activity
Imminent threat of harm to self or others




NONDISCLOSURE BY SUPERVISEES
Is reported by 97% of supervisees


Should be addressed in the supervision contract




SUPERVISION CONTRACT
Components

An individualized training plan for the supervisee


The schedule

format, duration, roles, responsibilities, goals and
objectives of supervision
Information on the supervisor's training and model of

supervision
Emergency and crisis management procedures including

the availability of 24-hour coverage in the event of a
clinical emergency
Clarification of the roles of an academic supervisor




CONT…
The ratio of the number of clients to the number of

supervision hours
Formative and summative evaluation procedures


Disciplinary procedures, due process, rights of the

supervisee, and sanctions



HOW SUPERVISORS PROTECT THE CLIENT
Knowing the clinical competencies and limitations

of the supervisees
Assessing the complexity of client issues prior to

assigning a case to a supervisee
Determining whether the supervisee is adequately

trained to assume the case
Ensuring the supervisees do not have too many

cases



CONT…
Protecting the supervisee from having too many

difficult to treat cases
Identifying and resolving learning and personal

problems that may compromise the supervisees
effectiveness
Ensuring that there is sufficient supervision time for

the cases assigned



CONTEXTUAL FACTORS IN SUPERVISION
Involve identifying stereotypes that inhibit learning

and prevent people from seeing the uniqueness of
each individual
Requires the supervisor to actively engage the

supervisee in exploration of how their beliefs and
stereotypes are affecting treatment and developing
strategies for working through them



5 WAYS OF MAXIMIZING CONTEXTUAL FACTORS

Context can be used to create and deepen the attachment

between client and counselor, supervisee and supervisor
They can be used to promote and enhance competency, or

support and challenge
They can be used to enhance manageability, and identify

which information collected is irrelevant
They can be used to differentiate among the universal,

transcultural, culture specific, and idiosyncratic behaviors of
all parties
They can be used to provide a relativistic framework for

assessment and intervention



GENDER AND ETHNICITY IN SUPERVISION
Shape belief systems about what constitutes

mental illness, the manifestation of symptoms,
defensive styles, and patterns of coping
Impact verbal and nonverbal communication

Introduce different values with regard to

relationships, connectedness and
structure/concreteness
Impact help-seeking patterns in the way people use

and respond to treatment



STARTING A SUPERVISION PROGRAM

Requires a realistic view of what can be achieved

within a particular working environment
Must be broken down into specific steps that can

be implemented sequentially or in a nonlinear
manner
May need to begin by implementing a supervision

program with a small group of supervisees
Should encourage resistant staff to become

educated about the value of supervision



COUNSELOR IMPAIRMENT
5 Stages

Compulsive overwork


A change in behavior and attitudes


Onset of crises and a progressive deterioration of job

performance
General immobilization and quot;if onlyquot;

thinking, daydreaming, and tardiness
Confusion and overreaction to supervisor's

recommendations as well if any real or imagined criticism



CONT…
Depression, apathy, cynicism, laziness, and lack of

cooperation
Discipline and termination




SUPERVISOR RESPONSIBILITIES & COUNSELOR IMPAIRMENT

Early identification and referral for counseling


Consultation and decision about how sick the counselor

can be before he's taken off-line
Awareness that a person must have two years without

abuse of substances before returning to alcohol and
drug abuse counseling
Requirements to notify the counselor's professional

credentialing organization when there is a violation of
ethical codes including substance impairment



SUMMARY

There are a host of ways to supervise and issues to

be considered in counseling and supervision.
By engaging in and providing regular supervision

we maintain the welfare of our clients and our
profession.


Supervision

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