Transcript Supervision of Interns and Beginning Counselors

Supervision of Mental
Health Counseling
Interns
On line training for field supervisors
Clinical Mental Health Counseling
Program
Fall 08
Reflections on supervisory
experiences
Answer the following questions for yourself
about your own supervision experiences
Your Supervision Experiences
What kind of supervision did you get:
As an intern
 As a beginning counselor
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What was most helpful or least helpful
What do you do that is the same as your
supervisor
What do you do that is different
Definitions of supervision at your
work place
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What is your understanding of the
supervisory relationship
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Is supervision expected to be clinical,
administrative or both
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How well prepared do you feel to fulfill
this role (roles)
Why we need training
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Supervision skills similar but not identical to
counseling skills
Supervising without training gives message
that “any good counselor will be good
supervisor”
Supervisory training provides supervisor with
framework to conduct and evaluate
effectiveness of the supervision
Definition of Clinical
Supervision
(Bernard and Goodyear, 2004)
An intervention provided by a more
senior member of a profession to a
more junior member or members of
that same profession
Definition cont.
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Relationship is:
evaluative
extends over time
Simultaneous purposes of:
enhancing professional functioning
monitoring quality
gate keeping for the profession
How do you rate your skills
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Evaluation of supervisees
Enhancement of supervisees skills
Monitoring of supervisees counseling
relationships
Preventing incompetent, unethical or
harmful counselors from practicing
Safeguarding well being of client
Basic elements of supervisor
competence
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Understand the roles and functions of a
supervisor
Organize the supervisory experience
Be aware of the ethical and legal
considerations in the relationship
Have a working model of supervisory
process and work within that model to
develop effective supervisory relationship
Roles and Functions of the
Supervisor
Supervisor as teacher
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evaluate observed counseling session
interactions
Identify effective and ineffective interventions
Teach demonstrate or model intervention
techniques
Explain rationale behind specific strategies
Interpret significant events in counseling
sessions
Roles and Functions
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Identify issues of class, culture and
ethnicity in counseling session
Educate and provide resources for
supervisee to learn about effects of class,
culture, etc in counseling relationships
Model awareness and sensitivity to these
issues in supervision
Roles and Functions
Supervisor as Counselor
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Explore supervisee’s feelings during counseling or
supervision session
Explore supervisee’s feelings about specific
techniques and interventions
Facilitate supervisee’s self exploration of confidence
or concerns in sessions
Help supervisee define personal growth areas
Provide opportunities for supervisees to process own
affect or defenses
Roles and Functions
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Help supervisee identify his/her
values base, cultural background and
social awareness
Explore the possible effect of these
on supervisee’s counseling style and
effectiveness
Roles and Functions
Supervisor as Consultant
 Provide alternative interventions and/or
conceptualizations for trainee use
 Encourage brainstorming of strategies and
interventions
 Encourage discussion of client problems,
motivations, etc
 Solicit feedback from supervisee as to effectiveness
of session
 Ask supervisee to structure the session
(Bernard and Goodyear, 2004)
Roles and Functions
Supervisor as evaluator
 Provide regular and systematic feedback and
evaluation
 Provide information to graduate school
programs, prospective employers, licensing
boards and professional associations
 Provide references when requested by
licensing board or another agency
Roles and Functions
Supervisor as Administrator
 Monitor supervisees’ adherence to policies and
procedures of the agency
 Monitor legal and ethical matters and
documentation of client sessions
 Help supervisee navigate bureaucracies
 Monitor supervisees’ adherence to reporting
laws
 Monitor confidentiality of records
Roles and functions case study
A client arrived for her appointment wearing a
distinctive coat. The therapist remarked on its
bright and beautiful colors. At the end of the
day, the therapist returned home to find a box
with an identical coat on her doorstep. The
note said the client had made a big effort to
find the identical coat as a way to say thank
you for all the help she had received.
M. L. Nelson (October, 2002). How to be a lousy supervisor: Lessons from the research.
Paper presented at the convention of the Association for Counselor Educa tion and
Supervision, Park City, UT. Reprinted with permission.
Roles and functions case study
The clinician is your supervisee. She states that
when trying to return the gift to the client, the
client became distraught and said it felt like a
rejection of her. The client asked the therapist
to keep the coat at least until the next session
and if the therapist still wanted to give it back,
she would take it. The client stated that she
could not return the coat because it was on
sale.
Roles and Functions Case Study
What are the main issues in this situation
What supervisory roles will be most useful to
you in addressing these issues
How do you see yourself structuring the
feedback you will give
What personal concerns may be raised for you
by this situation
(Fall and Sutton, 2004)
Models of Supervision
Three main types of supervision models:
Psychotherapy based models
Developmental models
Social Role models
Models
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Psychotherapy based models
Based on the use of specific theories of
psychotherapy.
Putney, Worthington, and McCullough
(1992) concluded that style or role of the
supervisor is influenced by the supervisor's
theoretical orientation in these models
Models
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Developmental models
Two basic underlying assumptions:
(a) Student counselor/supervisee moves
toward competence in a series of stages
(b) each student counselor/supervisee's
developmental stage requires qualitatively
different supervision environment if most
favorable professional growth is to occur
(Chagnon & Russell, 1995).
Models
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Social role models
Focus on roles that supervisors engage in during
supervision.
Primary range of roles includes:
administrator
counselor
consultant
evaluator
teacher
(Bernard, 1979; Carroll, 1996; Holloway, 1995;
Williams, 1995).
Stoltenberg’s Developmental
Model
Views training process as sequence of
identifiable stages through which trainee
progresses
Provides a conceptual framework for supervisor
and supervisee
Stoltenberg’s model
Four Stages of Development :
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Dependent
Dependent-autonomous
Conditional dependency
Integrated
Dependent Stage
Supervisee:
 Lacks confidence
 Needs support and direction
 Needs opportunity to explore
 Feelings and become more self aware
 May be anxious about performance and
evaluation
Dependent-autonomous stage
Supervisee:
 Moves away from imitating supervisor and
initiates new behaviors
 May become overconfident or overwhelmed
 Level of motivation may fluctuate
 May express stress due to lack of confidence
and wanting to appear competent
Conditional Dependency
Supervisee:
 Checks in with supervisor if she/he runs into
difficulty
 Strong clinical skills
 Establishes personal style and uses multiple
approaches
 May depend on supervisor as peer or colleague
Integrated stage
Supervisee:
Capable of independent practice
Aware of personal limitations
Interested in process of counseling
Comfortable with interdependent/collaborative
approach
Seeks peer supervision
Bernard’s Discrimination Model
Three basic roles for supervisors:
Teacher
Counselor
Evaluator
Four main foci for supervision:
Intervention
Conceptualization
Personalization
Professional Behaviors
Teacher role
Determine what is critical for the student
counselors/supervisees to learn
Give information, instruction, and guidance
Evaluate student counselors/supervisees
Give regular verbal and written feedback of
strengths and areas for growth.
Counselor role
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Help student counselors/supervisees
focus on interpersonal and intrapersonal
interactions.
Especially important when helping
student counselors/supervisees conduct a
self-evaluation
Consultant role
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Student counselor/supervisee and
supervisor relate as colleagues
Exchange ideas about interventions,
goals, and treatment plans.
The four foci
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Intervention focuses on:
What the supervisee is doing in the session
that is observable by the supervisor
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Conceptualization focuses on:
How the supervisee understands what is
happening in the session
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Personalization focuses on:
Supervisee’s style and ability to mange transference
and countertransference
Interaction of role and focus
When determining what role will be
prominent at any one time during
supervision, it is helpful to consider the
purpose, or goal, of the role and how it
fits with the focus of the supervision at
that point
Supervisor behavior
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In any given situation, the supervisor is:
Assessing supervisee’s developmental
stage
Assessing need for a particular focus
choosing an appropriate role to address that
focus
Making an intervention around a particular
focus using skills appropriate to the chosen
role
Case studies - the Developmental
and Discrimination Models
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Identify the role the counselor plays
The main focus discussed in the vignette
Your assessment of the development stage or
stages that would fit well with the supervisor’s
approach
How effective you think this supervisor’s
approach is
How would you change what they’re doing
Case 1
Dr. Snyder believes her role as a supervisor is to
provide monitoring and direction for her
supervisees. She keeps a close watch on them
as she wants to make sure they are not being
given too much responsibility. She puts a lot
of time and energy into her supervisees. Her
supervisees benefit from seeing her work but
not from doing the work themselves and many
do not feel confident about their clinical work
Case 2
Mr. Lee meets weekly with his supervisees and
has clearly defined goals for supervision. He
gives feedback on a regular basis and has a
reputation for being direct. Mr. Lee is a highly
skilled clinician and often gives advice about
how to work with clients.
Case 3
Ms. Adams sees supervisees as junior colleagues
who should be functioning independently. She
learned through the “sink” or “swim” method
and that worked well for her, so she sees no
reason that it won’t work well for her
supervisees.
Common questions in
supervision
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What to do:
When there is conflict
When your supervisee is not prepared for
supervision
When your supervisee fails to follow policies
or supervisor recommendations
When your supervisee is attracted to a client
When you are attracted to a supervisee
Major Legal and Ethical Issues in
Supervision
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1. Due Process.
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2. Informed Consents.
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3. Dual Relationships.
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4. Competencies
5. Confidentiality
Due Process
A legal term for a procedure that
ensures that “notice and hearing must
be given before an important right is
taken away”.
Due Process
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Substantive due process
States that criteria and
procedures that govern
training programs MUST be
applied consistently and
fairly.
Due Process
Procedural due process:
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Student or supervisee must be appraised
of academic and performance
requirements and program regulations
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Receive notice of any deficiencies
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Be evaluated regularly
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Have the opportunity to be heard if their
deficiencies have led to a change in status
Case Study
Hannah is in a master’s program in mental health counseling. She
has completed 10 courses in the program and is currently in
practicum. Hannah has received a great deal of formative
feedback throughout the practicum indicating that she had
many areas that needed improvement. At the conclusion of the
practicum, Hannah’s instructor a assigns Hannah a grade of F
for the course. At this time, Hannah is informed that a failing
grade in the practicum is grounds for dismissal from the
program. Hannah is told that she may retake the practicum one
time, but that the faculty is not optimistic that she will improve
enough to receive a B or better, a condition for her continuing
in the program. Although Hannah knew that she was not doing
as well in the practicum as some others, she had no awareness
that she was in danger of being terminated from the program
until the final evaluation. It is likely that Hannah will take the
advice of the faculty and will discontinue the training program
at this time.
Case Study
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Have Hannah’s due process rights been protected?
How vulnerable is her practicum instructor and the
program if she should decide to challenge their
decision?
Even if Hannah does not appeal, what are the
potential systemic implications of such a process?
Even though there is no ill will evident in the action
of the faculty and no indication that their decision
was capricious or arbitrary, did the process that they
followed adequately protect the student and was it
legally defensible?
Informed Consent
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A concept handed down from the medical
profession that states that all patients must be
informed of any risks that a recommended
treatment carries and also be advised of the
alternative treatments available
Informed Consent
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Supervisors have three levels of responsibility:
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To determine that clients have been informed by
the supervisee of the parameters of treatment
Ascertain that clients are aware of parameters of
supervision that will effect them
To provide informed consent for supervisee
concerning his/her rights , expectations and
responsibilities
Informed consent with
supervisees
It is essential that supervisees
understand and agree to the
procedures of supervision
BEFORE it begins and at any time
when it requires a change.
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Informed Consent
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Types of information that trainees need are:
 Choices of supervisor
 The form of supervision
 The time that will be allotted for
supervision.
Informed Consent
The expectations of the supervisor.
 The type of documentation that the
supervisor requires
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Case Study
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Latoya is in her pre-doctoral internship, working with
substance abusing clients. In supervision she shares
that one client in particular has been “getting to her”
most likely because some of the client’s situation is so
similar to Latoya’s past. Latoya’s supervisor
immediately suggests that Latoya receive counseling
regarding this issue. When Latoya says that she
believes her past therapy was sufficient and that she
would prefer to view the situation as a supervision
one, her supervisor states that she will only continue
to work with Latoya if she commits to counseling.
Case Study
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Pauline is in her first month of employment at a residential
center for alcoholic mothers. Most of her assignments have
been what she considers “babysitting,” rather than any serious
work with her charges. When she talks to her supervisor about
this, she is informed that she will not be assigned a case load
for the first 6 months and only then if she is perceived as
“ready.” This is news to Pauline. She is frustrated because she
turned down another job where she could have begun to work
with kids immediately. Pauline is upset further because her
husband has been notified by his firm that he will be
transferred in 9 months to another location. Had Pauline
known the conditions of her present position, she would not
have accepted the job.
Case Study
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In each situation:
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How egregious is the violation of the supervisees
right to informed consent?
To what extent do institutional materials cover
issues of informed consent for staff?
How might each situation have been handled to
better address the rights of the supervisee?
Informed consents for Supervisors
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Supervisors must also be afforded informed
consent.
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Need to be fully aware of the heavy
responsibility, accountability and possible
culpability involved in supervision.
Dual Relationships
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Ethical standards for all MH disciplines
strongly advise that dual relationships between
therapist and clients be avoided.
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It is the responsibility of the supervisor to be
sure that supervisees understand the definition
of dual relationships and avoid all such
relations.
Dual Relationships
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Defined as any relationships in addition to the
professional one.
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Dual relationships between supervisors and
supervisees can be difficult to define and
correct
Dual Relationships
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Problematic dual relationships between
supervisors and supervisees include:
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Intimate relationships
Therapeutic relationships
Work relationships
Social relationships
Boundaries in Supervision
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Boundary transgressions by trainees and
beginning counselors are the second most
common type of transgression
Second only to violations of confidentiality
These two categories account for 47% of all
complaints made to monitoring bodies.
Boundary Issues
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The best way to address ethical transgressions
is preventive education and honest discussions
between supervisors and supervisees on not
only the possibility but also the probability of
occasional sexual attraction to clients,
supervisees and supervisors.
Boundary Issues
It is supervisors responsibility to raise
questions on topic on a regular basis or be sure
it is on the agenda for all supervision sessions.
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Supervisors’ openness is vital in assisting
supervisees manage intense feelings.
Supervisor competence
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Attending to the best interest of the client and
the supervisee simultaneously is the greatest
clinical and ethical challenge of supervision.
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Monitoring supervisee competence begins with
the assumption that the supervisor is a
knowledgeable clinician.
Supervision Competencies
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Knowledge:
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Of area being supervised
Of models, theories, modalities and research on
supervision
Of professional development (how therapists
develop)
Of ethics and legal issues specific to supervision
Supervision Competencies
Knowledge:
of assessment process
awareness and knowledge of diversity and
its affects
Skills:
supervision modalities
relationship skills
sensitivity to multiple roles with supervisee
Supervision Competencies
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Ability to provide effective formative and
summative feedback
Ability to promote growth and self-assessment in
trainees
Ability to conduct own self-assessment process
Ability to assess the learning needs and
developmental level of the supervisee
Supervision Competencies
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Ability to encourage and use evaluative feedback from the
trainee
Teaching and didactic skills
Ability to set appropriate boundaries
Ability to seek consultation when supervisory issues are
outside the domain of supervisory competence
Flexibility
Scientific thinking and the translation of scientific findings
to practice throughout professional development
Supervision Competencies
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Values
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Responsibility for client and supervisee rests with
the supervisor
Respectful
Responsible for sensitivity to diversity in all its
forms
Balance between support and challenging
Empowering
Supervision Competencies
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Social Context
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Diversity
Ethical and legal issues
Developmental process
Knowledge of the immediate system in which
supervision takes place
Awareness of the social/political context in which
supervision takes place
Confidentiality in Supervision
Dimensions of confidentiality that the
supervisor must safeguard:
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The supervisee must keep confidential all client
information except for the purposes of supervision.
The supervisee must also be informed that any
discussions that take place IN supervision are also
confidential.
Confidentiality
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The supervisee has a right to privacy—
Supervisees must understand what will happen
to information that they divulge in supervision.
The Supervisory Relationship
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Goals
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Tasks
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Bonds
Working Alliance
Working Alliance
Goals
Tasks
Bonds