Transcript Progressive shift in Supervision

Supervision
Jerrold Lee Shapiro, Ph.D.
Professor and Chairman
Santa Clara University
Supervisees complaints – exercise
what complaints do you/ did you
have about supervision?
What do your supervisees have?
Common complaints
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lack of constructive feedback
supervisors' criticisms were unfounded
or inappropriate
failure to bring up sticky issues for fear
of retaliation or perception that
supervisors cannot handle them
all responsibility for conflict resolution
fell on the supervisee
insufficient time to develop any
relationship because of institutional
demands
Progressive shift in Supervision
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Responsibility for maintaining a
professional relationship with
supervisee and all clients
Formal contract re model,
objectives, evaluation methods
of supervision
Relational issues such as
boundaries, multi-cultural issues
and dual relationships
Goals of Supervision
Haynes, Corey, Moulton (2003)
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Promoting supervisee growth
thru teaching
Protecting welfare of client
Monitoring performance;
gatekeeping rehabilitating
impaired professionals/ trainees
Empowering supervisee to selfsupervise as an independent
professional
Supervisory Roles
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Teacher (assessment, diagnosis, ethics, therapeutic
approaches, theory, legal issues
Mentor guide, coach for career goals
Consultant – finding solutions, best treatment, helping
supervisee problem solve and come to resolution
Counselor – not formal therapist, but helping focus on blocks
within supervisee, counter-transference issues, cope with
stress
Sounding Board (i.e. Tarasoff, suicide, court, minors – may
require direct intervention
Supervisory Roles (cont.)
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Administration – Policies and procedures of the institution, documentation,
assist with beaurocracy, adherence to licensing regulations
Evaluation: Info to licensing boards, graduate programs etc
Documentation confidential record of each session
Empowerer
Responsibilities
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You are responsible ethically
and legally for actions taken by
supervisee (Vicarious liability)
You must know of every case
supervisee is seeing even if in
separate location
Provide ongoing feedback
(strengths and weaknesses)
verbal and formal written
Monitor actions and decisions
Responsibilities
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Documentation of sessions
Stay within scope of expertise
Due process for performance
evals and procedures
Written contract
Monitor personal professional
development
Responsibilities
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Model effective problem solving
for supervisees
Promote ethical knowledge and
behavior
Promote knowledge and skills
required to understand and work
effectively with clients
Educate regarding crucial
ethical issues especially within
managed care or other third
party system
Supervision as Relationship Centered
Just as for therapy, successful
supervision impossible when
relationship is inadequate
The core of the supervision is the relationship
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According to studies by Bernard and Goodyear (1998) , Holloway
(1995) , and Bradley and Ladany (2001), productive supervision
cannot occur when the relationship is inadequate
Supervision that focuses on the interaction
among client, therapist, and
supervisor makes use of what is occurring
in both the therapist-client relationship and
the therapist-supervisor relationship.
This enables the trainee to use his or her
own experience of emotional difficulties in
receiving help from the supervisor to
facilitate understanding of the client's
situation.
Parallel Process
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Transfer of treatment from supervisor thru supervisee to
client and vice versa
So relationship between any pair affects other pair
If the supervisory relationship mirrors the client
relationship, the same kind of rapport building may be
beneficial for effective supervision.
Parallel Process
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Jenna has a client (Jason)
who is described as
passive aggressive
Every intervention with
Jason is questioned and
homework not followed
Jenna is increasingly
frustrated and begins to
question her ability as a
therapist
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Jenna is supervised by Mary
Jenna seems particularly resistent
to following recommendations
regarding Jason
She claims that nothing will work
Mary cannot seem to find a way to
get Jenna to try harder and focus
on Jason’s resistence
Parallel Process –
Using the Supervisory relationship
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The stuck place
Jenna cannot understand
why Mary wants to look at
the supervisory
relationship, but is willing
to try.
Jenna begins to see where
what’s happening in the
supervision is a replication
of her therapy relationship
with Jason
Jenna focuses on the
therapeutic relationship in
session with Jason.
Resistence is diminished
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Mary focuses on what’s happening
in the supervisory relationship
Jenna and Mary explore the
resistence in the supervisory
relationship
They begin to see Jenna’s
resistence as an unconscious
manifestation of Jason’s
resistence
As they work on the resistence
directly, it begins to diminish
Supervisory sessions serve as an indirect
model for therapy sessions
Supervisors serve as a model for therapists
Supervision Techniques
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Role Playing
Role reversals
Demonstrations
Socratic Questioning
A-V Techniques
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Using Audio tapes
Using one-way mirror
video tapes
observational techniques
ear bugs and telephones
Responding to needs of supervisees
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Varies with treatment characteristics, supervisee and
clinical issues involved
adapted to developmental level of trainees
What do you do to enhance a strong
working alliance?
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In therapy
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In supervision
Why are there differences and
which ones are appropriate?
Ongoing maintenance of the
alliance should be the supervisor's responsibility
What distinguishes supervisory and therapeutic
alliance is the evaluative component
Even with all the changes
Supervision remains part education
and part therapy
The Relationship is the core
Supervision is not therapy
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Because of the different contract
primarily because of the
evaluative component
Informed consent is crucial in
that realm
Case Study
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Barbara is supervising a group of MFT interns.
Jan brings in a case of a 14 year old pregnant girl whom she is
working with to have the baby and put it up for adoption.
Two other interns strongly believe that Jan is getting her
personal values and those of her client’s confused. Barbara
believes that Jan is right and is very much opposed to abortion.
When another intern recommends that Jan explore abortion
with her client, the supervision becomes very tense. Barbara
closes down the discussion by saying that Jan is operation in
the best interests of her client.
Case Study
Toni is a student in a MFT program. She has lately been
expressing dissatisfaction with the direction of her
supervision. She claims that her supervision is all didactic.
Her supervision is primarily describing what she does and
listening to her supervisor give advice about what to do
next.
How might you respond as the supervisor to Toni’s
complaints?
Is her dissatisfaction more than resistance?
Case Study
Jenny is in her first practicum setting. At the beginning she
confesses to her supervisor that she may not be ready for this.
As you discuss it with her, three things become evident:
1) She has low self esteem
2) She is most concerned about harm she might do by
inexperience
3) As far as you can tell, she is as well prepared as the better
graduate students with whom you have worked in the past.
She wants you to make a decision as to what she should do
Case Study
Bill in a new practicum student working with teens in a
halfway house. He has recently seen a demonstration of
EMDR and sees it as a way to really help the patients.
As a supervisor, you think Bill is seriously underrestimating
the pathology of his clients and you think the technique is
dangerous.
Bill thinks your reticence is holding him back
What do you do?
Case Study
Jackie is seeing a couple, working with them on communication
skills with apparent progress. Then she gets a late night call from
the wife saying that they had a “knock down drag out” fight and
her husband has walked out.
Jackie was able to ascertain that the wife slapped the husband
before he left.
Despite Jackie’s best professional efforts, neither of them seems
willing to return to therapy.
Jackie is feeling devastated and discouraged.
How do you approach her?
Case Study
Lupe is an experienced psychologist, who has been
working for several years with minority clients.
She is seeking your supervision because she has recently
been seeing a family, whose values make her work
ineffective.
The family is Samoan and they use a great deal of corporal
punishment with their children. They claim that it is the
Samoan way of childrearing.
Lupe believes that their “discipline” approaches physical
abuse, but is reticent to violate cultural standards.
How would you work with Lupe?
Case Study
Mel, a licensed therapist with 5 years experience is running
a group under your supervision. It becomes clear to you
that he has several patients in the group who would best be
diagnosed as “Borderline Personality Disorder.”
He doesn’t seem to have a grasp on the effect of their
pathology on the group process.
What are your options and approaches?
Case Study
You are working at a community agency. Most of the clients
are of a different ethnic group than yourself.
Recently your supervisees are of the same ethnic group as
the clients.
You get the feeling that they are loathe to take in your
recommendations because they see themselves as more
tuned in culturally to the clients.
How do you deal with this?
Case Study
As an experienced therapist, you have seen many female
clients over the years. One group with whom you feel very
comfortable is battered women.
Recently, one of your supervisees began a group for new
fathers at the local hospital.
The issues that are emerging seem atypical in your
experience.
What is your best option?