Developmental Supervision Using the IDM John Laux, Ph.D., PCC-s, LICDC School Psychology, Legal Specialties, & Counselor Education The University of Toledo

  Discriminate between Clinical Supervision & Developmental Supervision Understand the First Two Stages of Integrated Developmental Model of Supervision IDM

What is Supervision?

Supervision   over-seeing, looking over someone’s shoulder to check on them; and also ‘super’ in the sense of outstanding or special, helping someone to extend their professional skills and understanding.

 http://www.faculty.londondeanery.ac.uk/e-learning/supervision/what-is-supervision

Clinical & Developmental Supervision

 Clinical & Developmental Supervision Development ongoing professional learning  Clinical/performance clinical governance and standard setting.

 Clinical & Developmental Supervision Who does what?

• Clinical/performance supervision is the sole domain of the site supervisor • Developmental supervision is done by both the university supervisor and the site supervisor.

 Clinical & Developmental Supervision How to tell them apart: • Who is the focus?

 Answer the question, “Are we talking about the client/student or the supervisee?” • Example 1.

  I have a high no-show rate after the initial session. How do I increase my productivity?

Susan keeps missing appointments. How can I work to increase her motivation for counseling?

 Clinical & Developmental Supervision Client/student or supervisee?

• Example 2.

  Richard’s parents want to know how they can improve his study skills both at home and at school. What interventions do you suggest I recommend for these parents? I am not a parent. I feel comfortable working with students, but I am scared about meeting with parents and guardians.

 Clinical & Developmental Supervision Faculty and graduate assistants do not provide Clinical Supervision.

• Why not?

 So, what do faculty do during practicum and internship?

IDM Supervision  An Integrated Developmental Model of Supervision -Stoltenberg, McNeil & Delworth

3 Levels of Development  Level 1 Therapist (Practicum)  Level 2 Therapist (Internship-Newly Licensed Independence)  Level 3 Therapist (Independence on)

Overarching Structures    Self & Other Awareness Motivation Autonomy

Specific Domains         Intervention Skills Assessment Interpersonal Assessment Client Conceptualization Individual Differences Theoretical Orientation Treatment Plans & Goals Professional Ethics

So You’ve Agreed to Be A Site Supervisor

What Does the Typical Practicum Student Know?

Overarching Structures —Level 1  Self & Other Awareness • About whom is the student thinking upon entering the counseling room?

Overarching Structures —Level 1  Self & Other Awareness • Focus is on personal effectiveness, skills

Overarching Structures —Level 1 Anxiety/fear

Overarching Structures —Level 1  Concerned about supervisor’s evaluation.

Overarching Structures —Level 1  Motivation

Overarching Structures —Level 1  Motivation • Usually high. • Focused on going from beginner to expert.

• Want to move from anxiety to comfort.

• Want to learn the “best” theory, techniques or approaches.

Overarching Structures —Level 1  Autonomy • Heavily dependent on supervisor  What to do/say in session

Overarching Structures —Level 1  Autonomy • Heavily dependent on supervisor  How to use supervision

Level 1 Intervention Skills Competence    Want understandable set of skills in a structured framework they can imitate.

Latch on to an orientation & become a devotee (usually 1 st one they read or CBT) Every issue becomes a nail.

  Level 1 Assessment Techniques Tend to prefer interview methods or standardized methods. Have little critical skills. I.e., fail to consider client response set or motivation.

Level 1 Interpersonal Assessment  Use personal reactions as assessment tool & barometer of data received.

Level 1 Client Conceptualization  Focus is on specific aspects of clients’ story & exclude other relevant data.

 Tend to over- or under-pathologize.

Level 1 Individual Differences    to interpret clients’ MC via own cultural lenses.

Assume that if they have common traits then the client’s worldview is the same as their own. OR Assume that if they have dissimilar traits then the client’s worldview is the vastly different from their own.

Level 1 Theoretical Orientation  Seeking the one-truth. When found, become disciples.

Level 1 Treatment Planning    Difficult to conceptualize treatment from intake to discharge.

Focus is on keeping clients.

Tx planning may be general or cookie cutter/manualized.

Level 1 Treatment Planning  Focus is on keeping clients.

Tx planning may be general or cookie-cutter or manualized

Level 1 Professional Ethics   Rigid application & rote memorization.

Need guidance in interpreting and applying.

Supervising the Level 1 Therapist  Structure!!!!

• Both supervision & their clinical work.

Supervising the Level 1 Therapist  Break feedback down into manageable/observable chunks.

Supervising the Level 1 Therapist  Simplicity & slow speed.

Supervising the Level 1 Therapist  Encourage self-examination

Supervising the Level 1 Therapist  How?

• Observation • Skills training • Role plays • Readings • Group sup • Balance ambiguity • Create conflict • Cont. education

Supervising the Level 1 Therapist     Be supportive Be prescriptive Tie theory to diagnosis to treatment Initiate growth

Transitioning to Level 2  Practicum to Internship  100 hours (minimum) under their belt.

Transitioning to Level 2    Motivation: • may decrease for new approaches/techniques Autonomy: • may desire more than is warranted.

Awareness: • Begins to move toward client, away from self.

Overarching Structures —Level 2  Self & Other Awareness • Less on self, more on client via empathy • Potential for over-identification

Overarching Structures —Level 2  Vacillation between autonomy & dependency.

Overarching Structures —Level 2   Dependency/autonomy struggle affects motivation.

• Want independence but question self when in tough/new situations.

Evidence of struggle in supervision

Level 2 Intervention Skills Competence   More comfort w/wide range of intervention skills, but… Skills aren’t integrated w/theory.

 Level 2 Assessment Techniques Improvement in diagnostic criteria & assessment instruments, but…

Level 2 Interpersonal Assessment  Ability to be self-aware & monitor own cognitive/affective reactions is compromised due to over identification.

Level 2 Client Conceptualization  Case conceptualization is more complex but subject to over identification with client.

Level 2 Individual Differences   More willing to acknowledge influence of socio/cultural & environmental influences on behavior.

Vacillate between global one size fits all approaches and the idea that every client is unique.

Level 2 Theoretical Orientation  Less rigidly aligned with one theory willing to explore other theories.

Level 2 Treatment Planning  May lose sight of need for jointly formulating treatment plans with clients.

 http://www.youtube.com/watch?v=B YLMTvxOaeE

Level 2 Professional Ethics  Ethics better understood • May view as imposition or limitation on practice that could be violated & justified by exceptions.

Supervising the Level 2 Therapist  “Therapeutic Adolescence.” • Seek balance   between guidance and support.

between autonomy and challenge.

Supervising the Level 2 Therapist   Client Assignment: • Usually get more pathological clients who are less open to trying out newer sets of skills. Case assignment should be presenting problems in and out of trainee comfort zone.

Supervising the Level 2 Therapist  Interventions • Ongoing support & concern for supervisee development.

• Talk about own past difficulties.

• Prescriptive: provide multiple options & get supervisee input. Encourage autonomous choices. • Explain your rationale for your decisions.

Supervising the Level 2 Therapist  Interventions • Encourage alternate client case conceptualizations. • Encourage increased self-awareness of counter-transference & manipulations.