Transcript The Contextual-Functional Model of Clinical Supervision

Developing Your Unique Approach to
Clinical Supervision: The ContextualFunctional Meta-Framework
American Mental Health Counselors’
Association, Orlando, FL
Jeff Chang, Ph.D, R.Psych.
Assistant Professor
Graduate Centre for Applied Psychology
Athabasca University
[email protected]
Calgary, Alberta, Canada
Questions
Show of hands:
 currently supervising?
 consider yourself a new-ish supervisor?
 consider yourself an experienced
supervisor?
 had a course in supervision?
 read a book on supervision?
Think About
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Your “best” supervisee/supervision experience
Your “worst” supervisee/supervision experience
Constrains (formal and informal) of your
setting/context
Your biggest strength as a supervisor
Your biggest weakness as a supervisor
How this presentation can help
Your best hopes for this presentation
The Contextual-Functional MetaFramework: Developing Your Unique
Approach to Clinical Supervision
Developed inductively over 20 years of
supervision practice in different contexts,
supervising supervisees of different
theoretical orientations, experience levels,
and disciplines
Definition of Supervision
Definition of supervision:
Sustained, purposeful interaction between a more
proficient practitioner and a less proficient
practitioner undertaken to support the clinical and
professional development of the latter, and
directly and indirectly improve clinical
effectiveness.
 Supervision is a core competency in doctoral
programs in professional psychology, counseling,
MFT
 I assert that one cannot be a fully effective clinician
if one does not master basic administrative tasks
Definition of Supervision
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This definition assumes that clinical and
administrative supervision cannot be separated.
Tromski-Klingshirn & Davis (2007): Supervisees
generally did not experience it as problematic
when clinical and administrative supervision are
conducted by the same person.
Those who did mainly said it was a function of
the person.
Policies are ethical or accountability needs,
operationalized.
Standing on the Shoulders of…
I’ve been influenced by several approaches to
supervision and therapist development. These
provided ideas that I have used with more or less
utility, and that have stimulated reflection.
Developmental/stage models:
 Most prominent (IDM) (Stoltenberg, 2005) has
focused largely on the student and pre-licensure
years
 Three developmental stages in pre-licensed
therapists, and a “Integrated” level that aggregates
a wide range of career stages.
Standing on the Shoulders of…
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Summerill (1998) found that supervisors do
pretty much the same thing with all supervisees
irrespective of supervisees’ purported
developmental stage.
Themes and stages of counsellor development
(Skovholt & Rønnestad, 1995; Rønnestad &
Skovholt, 2003; see also see Goodyear,
Wertheimer, Cypers, & Rosemond, 2003).
Take-away: supervisees have different needs
over time.
Standing on the Shoulders of…
Discrimination Model (Bernard, 1997)


Intervention, conceptualization, and personalization skills
Teacher, counselor, consultant
Parsimonious
 Implicitly geared toward the student and
prelicensure years
Systemic Approach to Supervision (Holloway, 1995)
 Tasks: counseling skill, case conceptualization,
professional role, emotional awareness, selfevaluation
 Functions: monitoring/evaluating,
instructing/advising, modeling, consulting,
supporting/sharing

Standing on the Shoulders of…
addresses the complexity of supervision, and
administrative/organizational context
Common factors approach:
 Lambropolis (2002); Morgan & Sprenkle (2007)
 The latter make three key distinctions:
 Clinical competence vs. professional competence
(emphasis)
 Idiosyncratic vs. general (needs of supervisee or
profession)
 Collaborative vs. directive (relationship)

Standing on the Shoulders of…
Model-based approaches
 Using ideas from one’s chosen model of
therapy has historically been an intuitivelysupported modus operandi
 Have had their historical moment, this has
passed.
 Don’t reflect typical community practice;
most of our supervisees don’t come to
learn a specific (“my”) model, little
development in last 15 years.
Standing on the Shoulders of…
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Watkins (1995b, p. 570): “Psychotherapy-based
models of supervision have generally shown…
stability over the last 25-30 years, with… no truly
new therapy-based theories of supervision
emerging and… existing therapy-based theories
showing limited changes or revisions….”
One exception is the narrative approach to
training and supervision (Winslade, Crocket,
Monk, & Drewery, 2000).
Competency profiles:
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MFT:
 Nelson, Chenail, Alexander, et al. (2007).
Psychology:
 Kaslow, Grus, Campbell, Fouad, Hatcher, & Rodolfa
(2009); Rodolfa, Bent, Eisman, Nelson, Rehm, &
Ritchie (2005)
Counseling:
 CACREP (2009)
 Task Group for Counsellor Regulation in British
Columbia (2007)
The Meta-Framework

Orienting to six factors that I believe form the basis
of supervision:
 We
attend to these six factors, explicitly, or implicitly
already. It would be better if we attended to these
factors intentionally.
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Clarity and intentionality of functions
Premise: Clarify how you will operationalize each of
these six factors and you will have your personal
approach to supervision
To paraphrase Steve de Shazer:
“I’m not here to teach you how to supervise. You’re
already doing it. I’m here to help you be comfortable
with, and understand what you’re doing.”
The Model
Administrative
Context
Culture Infused
Supervisory
Working Alliance
Functions
Theory of
Change
The CounselorClient
Supervisor
System
Phase of
Counsellor
Development
“To whom do I
owe my
allegiance”
“Can the
Supervisory
Relationship
support the
intervention?”
“When should I do
what?
“Is there a clash
of ideas, or
an ecology
of ideas?”
“What are the
relational patterns
that affect the
supervision
process?
“Where is the
supervisee in the
journey?”
o
Supervisory
working alliance
Primary functions
o
Clinical
educator
o
Ethics/risk
management
consultant
o
Skill
development
coach
o
Catalyst
o
Professional
gate-keeper
o
Admin
supervisor
o
Professional
mentor
o
Advocate/
system change
agent
o
Personal
supporter
o
o
o
o
o
o
o
AGS
Commission
Model
With whom
have I
contracted?
Who is
paying the
bill?
What do they
expect me to
do?
Is what I’m
doing fall
within my
primary
commission?
o
o
“Stages of
Change”
Visitor,
Complainant,
Customer
o
How does
the
supervisee’s
theory of
change and
the
supervisor’s
theory of
change
mesh – or
not?
Typically,
supervisor’s
theory of
change is
better
elaborated.
Isomorphism
Skovholt &
Ronnestad’s
themes and
stages of
counsellor
development
Six Factors
 Administrative Context
 Culture Infused Supervisory Working
Alliance
 Functions
 Theory of Change
 The Therapist-Client Supervisor System
 Stage of Therapist Development
Administrative Context
Orienting question: “To whom do I owe my
allegiance?”
 AGS Commission Model (Salamon, Grevelius, &
Andersson, 1993)
commission > hypothetical commission
 Primary commission vs. secondary commission
 Secondary commissions must fall within the primary
commission
 With whom have I contracted?
 Who is paying the bill?
 What do they expect me to do?
 Does what I’m doing fall within my primary
commission?
 Presented
Administrative Context
The AGS Commission Model impacts these areas:
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Contracting for supervision goals
Informed consent
Confidentiality
Varying levels of vulnerability
A disclosure of interest
While we, as supervisors, are always concerned
with the development of supervisees, we must keep
in mind where our primary allegiance lies
Vignette
Keenan, a predoctoral intern in clinical psychology,
was doing a rotation in a forensic assessment unit,
where he was being trained to conduct assessments
to ascertain if an accused is competent to stand trial,
or make recommendations on sentencing. He felt his
therapeutic skills were not being well-used, wanted to
do more to develop them. He asked his supervisor, Dr.
Law, if he could begin some therapy groups. She told
him that that was outside of the mandate of the unit,
but she would be happy to work with him to apply his
therapeutic skills like engagement and questioning to
his assessment work.
Administrative Context
Discussion question: Consider a situation in
which a supervisee required correction, or
even dismissal. How did you balance your
obligation to the supervisee, the
profession, and your employer?
Culture Infused Supervisory Working
Alliance
Orienting question: “Can the supervisory relationship
support the intervention?”
 Conceptualizing the working alliance:
 SFT’s ideas of “visiting,” “complainant,” and
“customer” relationships… working alliance is the
manifestation of an interactional pattern
 Prochaska and di Clemente’s Transtheoretical
Model of Change (stages of change)
 Obtain feedback on the working alliance
Discussion question: Reflect on a supervisee
whose motivation was uneven. How did you
“hook” his/her motivation? How did you learn
what the supervisee was motivated for?
Vignette
Lawrence, a clinical social worker, was supervising
several licensure interns in a family service
agency, using a combination of live supervision
from behind a one-way mirror, and case
consultation. He noticed that one of his
supervisees, Anna, seemed to be simply nodding
and agreeing with him a great deal, but did not
seem to be engaged in the content of his
feedback….
Vignette
… Wondering if he was fitting his supervision
practice with her needs, he asked her directly how
she experienced their supervisory alliance. She
replied, “It’s funny you should mention that. I’ve
been a little frustrated with supervision lately – you
are always so positive, and I need some concrete
ideas about what to do a lot of the time.” Lawrence
and Anna went on to renegotiate their supervision
contract, based on specific skill development
needs, including when she would find a call-in
during live supervision helpful.
Culture Infused Supervisory Working
Alliance
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“Culture-Infused Counselling” approach (Arthur
& Collins, 2010) urges counsellors to:
 Be culturally self-aware.
 Appreciate the cultural identity of supervisees
 Develop a culturally competent working alliance
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In this model, culture is not a theoretical
abstraction; the rubber meets the road in the
supervisory relationship
An ecology of ideas (beliefs and world view) and
interaction between supervisor and supervisee
Vignette
Dr. Khalil is a Jordanian-Canadian Muslim MFT
supervising Kelly, a master’s practicum student. At
their initial meeting, Dr. Khalil stood up, placed his
hand over his heart, and graciously bowed toward
Kelly. He explained that it is contrary to his
religious convictions to shake hands with women,
and that his gesture is a way for him to express his
respect for women. This opened a conversation
about how they each position themselves
culturally, and conceptualize gender in their
respective approaches to therapy.
Functions
Orienting question: “When should I do what?”
 Some functions will not be used with some
supervisees: determined by context.
 Morgan & Sprenkle’s (2007) three key distinctions:
 Clinical competence vs. professional competence
(emphasis)
 Idiosyncratic vs. general (needs of supervisee or
profession)
 Collaborative vs. directive (relationship)
 Not a bad way to think about things, but finer
distinctions are required to ensure that supervisors
are clear as to where their primary allegiance lies
Functions
Clinical educator:
 Teaching concepts and theories (conceptual skills;
Tomm & Wright, 1979)
 Assisting supervisees to clarify their theories of
counselling and them to make their practice
consistent with their theory
 Challenging supervisees’ assumptions,
deconstructing supervisees’ theories
 Teaching supervisees to “know what to look for”
(perceptual skills; Tomm & Wright, 1979)
 Utilizing ideas outside of “therapy” – art, literature,
philosophy
Discussion question: What are some of your best
practices to encourage theoretical clarity in your
supervisees?
Vignette
Leo, a student in Dr. Jessup’s internship seminar, was
a risk of failing because he could not articulate his
theory. An addictions counsellor for 25 years before
entering a Master’s program, he denigrated the need
to identify a theory, proclaiming that he “just wanted to
help people.” Rather than “just buying into an
established theory,” Leo marched to the beat of his
own drum. He seemed unable to connect his clinical
work, which seemed to be quite effective when he
showed his videos in class, to any coherent way of
thinking….
Vignette
… Dr. Jessup saw Leo’s promise and thought he was
a sensitive, effective, and intuitive counselor, but could
not pass him in the internship seminar unless Leo
articulated a coherent approach to counselling. He
challenged Leo to develop the “Leo Smith model.” Dr.
Jessup supported Leo to figure out, inductively, “why
he was doing what, when” in his sessions via
videotape review and live supervision. He was able to
articulate a coherent approach to counseling, and
even sheepishly admitted that he was “a cross
between CBT and reality therapy, with a little bit of
inner child work thrown in” by the end of the internship.
Functions
Ethics/Risk Management Consultant
 Supporting the application of ethical principles in
practice
 Moving beginning supervisees from “ethics as a
theoretical abstraction” to applied practice
outcomes.
 Supporting novice supervisees from a fear-based
perspective to a realistic outlook.
 Warning supervisees of risky situations
 Moving supervisees from a risk management,
defensive practice outlook to an aspirational
outlook
Discussion question: How do ethical the dilemmas
your supervisees face change as they develop?
Functions
Skill Development Coach:
 Demonstrating and giving feedback on
supervisee skills (executive skills; Tomm &
Wright, 1979):
 Generic (e.g., attending, questioning, reflecting,
summarizing, information-giving, structuring)
 Model-specific: How to use generic skills in the
service of the specific procedures in accord with a
theory of counselling
 Encouraging self-observation of skills
development
Discussion question: What are some favorite ways
to teach and/or model specific skills?
Vignette
Kelsey is a Master’s student in counselling who
has previously worked as a rehabilitation worker,
developing behavior management plans for
children diagnosed with autism. She had had
extensive training in applied behavior analysis.
She was pleased to have obtained a practicum in
a local clinic that was well known for solutionfocused training. Her supervisor, Liz, found that
Kelsey’s skill at asking for specific behavioral
descriptions and sequences could be easily
transferred to the process of shaping her solutionfocused questioning skills.
Functions
Catalyst:
 Tracking patterns of supervisee response to particular
client situations (“countertransference”).
 Raising these patterns with the supervisee
 Supporting the supervisee to find the correct (for
him/her) way to manage the issue
 The supervisee’s view will depend on the theory of
counselling he/she espouses, and personal
beliefs/values
Discussion question: How can we nudge at
supervisees’ “blind spots” without bashing them over
the head?
Vignette
Sandy is a divorced 46-year-old MFT working in a
community counselling agency. She has young
adult children and a mother in failing health, who
was struggling to stay in her own home. Sandy
referred to herself as a “sandwich generation”
woman, and spent many hours supporting her
mother’s independence. Her supervisor, Carol,
knew of her personal circumstances….
Vignette
… At one of their regular supervision sessions, Sandy
mentioned to Carol that her work with Amy, who had a
similar life circumstance, but had moved her widowed
father into a nursing home, was not going well. Sandy
admitted she thought Amy had not tried hard enough
to keep her father at home. They seemed to be talking
in circles. Carol wondered whether the therapeutic
impasse was related to Sandy’s personal situation.
She gingerly self-disclosed how she felt stuck, or less
than objective, occasionally at different points in her
life journey, and asked if this might be behind Sandy’s
therapeutic impasse with Amy.
Functions
Professional gatekeeper:
 Entering, formative, and summative evaluation
 Monitoring and giving feedback to supervisees re:
educational program policies and licensing
requirements
 Reporting to educational programs and licensing
boards
 Resolving performance issues, if present
 Out-counselling supervisees unsuitable for the
profession
Discussion question: Have you ever had to outcounsel a supervisee? Describe the experience.
Functions
Organizational/administrative supervisor:
 Ensuring compliance with policies and procedures
 Addressing performance issues, if present
 Policies are ethical or accountability needs,
operationalized.
 Supporting supervisees with time and workflow
management
 Clinical record-keeping and time management are
often the first indications of therapist impairment.
Discussion question: How is administrative
performance related to clinical competence?
Functions
Personal supporter
 Listening respectfully to events/struggles in
supervisees’ personal lives
 Providing personal support, within the bounds of
professional boundaries
 NOT THERAPY: performance vs. personal
Discussion question: When providing personal support
to a supervisee, what indicates to you that you
should make a referral for therapy?
Vignette
John, a pre-licensure psychologist in a private
practice, was uncharacteristically late getting
assessment reports completed. Most of these were
parenting assessments done at the request of the local
child protective service (CPS), necessitating
postponement of court dates. CPS workers were
calling John’s clinical supervisor and the owner of the
private practice, Dr. Kelly, to complain. When Dr. Kelly
asked John about this, he tearfully blurted out that his
wife had been having an extramarital affair, which
preoccupied him day and night. He felt unable to
concentrate on work, and profusely apologized for
letting things slip….
Vignette
… Dr. Kelly listened carefully and empathically to
John. Together, they negotiated a plan to manage the
incomplete and late work, and address the concerns of
the CPS workers, who were a prime referral source for
the practice. They also negotiated a reduction in
John’s workload so that he could manage adequately,
including John’s request to decline any marital therapy
cases from an EAP contract the practice served. Dr.
Kelly and John also discussed whether John required
a referral to therapy, and what modality (couple or
individual). Finally, Dr. Kelly recommended some
readings on therapist impairment.
Functions
Professional mentor:
 Providing advice and support about:
 Further graduate education or continuing
education
 Self-care and workload management
 Research vs. practitioner track
 Starting or enhancing a private practice
 Work-life balance
Vignette
Dr. Kennedy, an MFT, had supervised Lana, a
licensed counsellor, for eight years. Dr. Kennedy
had supervised Lana as a licensure intern, and
was her administrative supervisor at the family
service agency where they both worked. Although
they were still required to review cases, the vast
majority of the time, Dr. Kennedy found that Lana’s
clinical work was excellent, and Dr. Kennedy’s
ideas were mostly enhancements of sound
treatment plans that Lana developed on her
own….
Vignette
… Lately, the conversation had turned to Lana’s
desire to return to school for a doctorate. They
discussed what discipline (psychology, counselor
education, or MFT) would provide the best fit for
Lana, whether she wanted to seek a leadership
position or an academic one after the completion
of her degree, and various options of how she
would balance family, work, and school.
Functions
Advocate/system change agent:
 Advocating for policies, organizational
structures, and clinical practices, etc., that
make the delivery of services more effective.
Vignette
Craig was contracted by a children’s mental health
agency to provide clinical supervision to licensure
interns and licensed clinicians. He found that, to a
person, they felt overwhelmed with paper work and
case management demands that they did not feel
were useful. They were either working overtime
(unpaid) to keep up, or dropping necessary
documentation, thus exposing the agency to
liability…
Vignette
… Craig carefully worked his way into to position
of trust with both the clinical staff and the senior
management of the agency. He suggested some
modest changes to reduce the duplication of
forms, some small tokens of appreciation the
agency could make to improve staff morale. He
also explained to the clinical staff how
documentation would help treatment consistency
and were legally and ethically necessary.
Theory of Change
Orienting question: “Is there a clash of
ideas, or an ecology of ideas?”

Supervisor and supervisee must the clear about:
 How
clients change in counselling
 How supervisees change in supervision
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
Not just counselling theory, but implicit beliefs
and world view
Almost all the time, the supervisor’s view is
better elaborated than the supervisee’s view
Theory of Change
The supervisor’s primary model of therapy will always
“leak out.”
 Gregory Bateson: “Your epistemological slip is always
showing”
 Not indoctrination, but clarification and deconstruction
 When theories are too divergent…
 The limits of competence
Discussion question: What is the philosophy of your
setting/you when it comes to theory of client change?
Do you take a position of teaching or assimilating a
supervisee’s theoretical approach, or accommodating
it?

Vignette
Lenora, a MFT master’s student, was quite taken
with emotionally focused therapy (EFT), but
became quite worried when she ended up being
supervised by Consuelo, who was well-known for
practicing narrative therapy. Lenora privately
confided to a fellow student her worry that
“narrative would be shoved down my throat.”
Consuelo, who had an adequate understanding of
EFT, invited Lenora to think in a way that was
consistent with EFT’s assumptions and practice….
Vignette
… to be “the best emotionally focused therapist
you can be.” In supervision, Consuelo asked
Lenora about “what EFT would guide you to do” in
specific situations. She also invited to Lenora to
deconstruct the discourses behind EFT’s
assumptions. When Lenora was stuck and asked
for help, Consuelo would often take a one-down
position, apologizing for “only being able to think in
narrative” before suggesting ideas. By the end of
the school year, Lenora noted that Consuelo’s
approach helped her to “really understand EFT
and opened my eyes up to narrative.”
The Service Delivery System
Orienting question: “What are the relational
patterns affecting the supervision process?
 Larger context: agency, environment
 “Parallel process”: material from the therapeutic
relationship replicates itself in supervision,
thought to occur when the training analyst
unconsciously identified with the patient and
reenacts the patient's defensive behavior in
supervision.
 “isomorphism” is a systemic reworking of the
notion of parallel process, used mainly by family
systems therapists: how family dynamics affect
the therapy process
Therapist-Client Supervisor System
Isomorphism as an interventive stance:
Liddle (1988).
 Isomorphic sequences are opportunities
for intervention; supervisee can alter the
sequence in supervision with the goal of
altering the supervisee's in-session
behavior accordingly.

Vignette
Andre was working as the clinical supervisor in an
employee assistance program (EAP). Once the
local factory, which was the EAP’s main corporate
client, closed, rumors were rife that the EAP would
be the next to go. The rumors and worry were
affecting client service. Andre raised the issue with
management, who gave him the unreassuring
news that lay-offs were likely. Armed with definitive
information, Andre could support the staff to hold it
together, support them to be present for clients,
and minimize the effects of the chaotic workplace
on client service.
Phase of Counsellor Development
Orienting question: “Where is the supervisee in the
journey? What are the supervisee’s
developmental needs?”
 Themes and stages of counsellor development
(Skovholt & Rønnestad, 1995; Rønnestad &
Skovholt, 2003; see also see Goodyear,
Wertheimer, Cypers, & Rosemond, Michelle,
2003).
Eight dimensions:
 time period
 central task
Stage of Counsellor Development
predominant affect
 sources of influence
 role and working style
 conceptual ideas
 learning process
 measures of effectiveness and satisfaction
… Manifested differently in six distinct stages of
counsellors’ careers.

Vignette
Kendrick had been a licensed MFT for 24 years,
and was employed by a family service agency. He
had the idea that there was “nothing new under the
sun” in the world of therapy. He had seen many
trends and “flavors of the month” come and go
since he entered graduate school almost 30 years
earlier. In the last few years, Kendrick had
reignited a passion for theatre – he had been in
several high school and college productions -- and
for the past three years was acting in community
theatre….
Vignette
… His studies of characters in plays in which he acted
was melding with his clinical experience, and inviting
him to think about his work in new ways. He frequently
spoke in case review meetings about how a character
he was getting ready to play helped him understand a
particular client. His clinical director, Dr. Cohen, was a
midcareer psychologist who practiced CBT, and
initially did not understand where Kendrick was
“coming from,” but knew Kendrick to be a sound, if
somewhat unorthodox, therapist. Dr. Cohen listened
carefully in case reviews, and was able to support
Kendrick’s new direction in his clinical work.
Potentials



Real world relevance
Systemic: considers the context of which service
delivery and supervision, culture, and the
interactional patterns in which the client,
counsellor, and supervisor participate
Orienting and organizing supervision efforts -remind supervisors to attend to, and weigh,
multiple aspects of supervision at one time
 we
have to walk, chew gum, breathe, look where
we’re going, talk to the person we’re out walking with,
and smell the flowers at the same time.
Potentials
Transtheoretical and cross-disciplinary
applicability
 Supervision as career-long process
 To clarify relationships of accountability,
and thus provide a protective factor from
inappropriate dual relationships and other
ethical issues

Further Development
Further feedback and conceptual
development
 Piloting a training curriculum for
supervisors (our program and interested
community agencies)
 Evaluation of training
 Partnerships for research and conceptual
development
