Transcript The Contemporary Relational Supervisor Robert E. Lee and Thorana S. Nelson PowerPoint by Stephanie Seng and Toni Zimmerman, Colorado State University Copyright Taylor &

The Contemporary
Relational Supervisor
Robert E. Lee and Thorana S. Nelson
PowerPoint by Stephanie Seng and Toni Zimmerman, Colorado State University
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
1
PART I
Understanding the Supervising process: An Overview
Chapter 1 – Basic Ingredients in the Supervision Process
• Supervision is:
• An intervention provided by a more senior member of a profession to a
more junior member or members of that same profession. The
relationship is evaluative and hierarchical, extends over time, and has
the simultaneous purposes of enhancing the professional functioning of
the more junior person(s), monitoring the quality of professional services
offered to the clients that she, he, or they see, and serving as a
gatekeeper for those who are to enter the particular profession.
•
(Bernard & Goodyear, 2009, p. 7)
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
2
PART I – Understanding the Supervising process: An Overview
Chapter 1 – Basic Ingredients in the Supervision Process
• When becoming a couple and family therapist, you need
education, training, and supervision:
• CFT Education – Acquiring a knowledge base
• CFT Training – Acquiring skill in the application of this knowledge base
to therapeutic situations
• CFT Supervision – A training endeavor that follows some CFT education
and is dependent on a working alliance between the trainee and the
supervisor in pursuit of the trainee’s professional goals (Note: Education
can occur without such an alliance)
• CFT Supervision Training – Requires specialized training beyond
becoming a therapist that includes education and skill building related to
becoming a CFT supervisor
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
3
PART I – Understanding the Supervising process: An Overview
Chapter 1 – Basic Ingredients in the Supervision Process
• Differences between Supervision in CFT and Other Mental
Health Approaches
• Supervisors in CFT are more likely to attend to the values and beliefs
that trainees hold about couples and couples in therapy, including same
sex couples
• The therapeutic alliance in CFT is systemic and complex, requiring
supervision that discourages alliances that can be detrimental to the
couple relationship
• Therapists and supervisors of CFT must be comfortable with complex
emotional expressions that emerge in CFT
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
4
PART I – Understanding the Supervising process: An Overview
Chapter 1 – Basic Ingredients in the Supervision Process
• The full training system is a complex
environment of subsystems “with reciprocally
influencing domains of conceptualization and
action”
(Liddle, 1988, p. 154)
Clients
Therapist
s
Courts
System
Educational
institutions
Supervisors
Clinics
and
agencies
Mentors
• If supervisors are able to step back and observe themselves as living parts of the training
system, they may gain important insights into and leverage within training systems
• Interactional dynamics occur within, between, and among these subsystems and are
frequently related to each other
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
5
PART I – Understanding the Supervising process: An Overview
Chapter 1 – Basic Ingredients in the Supervision Process
• Paradigm of Systems Thinking
• As systems thinkers, we see the world as a complex of individuals and
their relationships with each other that are visible through interactions
• Within a system, change that occurs in one part reciprocally affects all
other parts and is, in turn, affected by those other parts
• System thinking in therapy and supervision includes awareness of
differences of values, attitudes, and ways of understanding the world
and the influence these have in professional work
• This matter goes beyond “cultural competency;” it must pervade CFT
education and training, and be attended to on a continual basis
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
6
PART I – Understanding the Supervising process: An Overview
Chapter 1 – Basic Ingredients in the Supervision Process
• CFT Supervisory Roles include:
•
•
•
•
Facilitator of growth of trainees as professionals
Teacher
Gatekeeper
Monitor administrative needs of institutions such as community,
accreditation and other regulatory bodies, and the professional field of
mental health therapy to ensure the community is protected from harm
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
7
PART I – Understanding the Supervising process: An Overview
Chapter 1 – Basic Ingredients in the Supervision Process
• Supervisor candidate’s first steps:
• Recognize own philosophies of supervision
• Rober (2010) suggests a process whereby new trainees attend to their “polyphony
of inner voices” through an exercise of self-awareness making trainees more
conversant in areas of concern:
•
•
•
•
Ideas about clients’ process (listening)
Processing what they hear (making sense of the client’s story)
Focusing on their own experiences related to the clients’ stories
Managing the therapeutic process
• Interview trainees to discover their philosophies and expectations
• Integrate ways of working and desired goals with those of the trainee Ask self “is this a good fit for the supervisor and trainee?”
• Establish agreed upon ground rules to work together (contract)
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
8
PART I – Understanding the Supervising process: An Overview
Chapter 1 – Basic Ingredients in the Supervision Process
• Interdependent Fundamentals of Supervision of Relational
Therapies
• Best context for positive learning is comprised of a consistent and
reasonable structure
• Best training is accomplished through an overt collaborative process
even when a supervisor must be directive
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
9
PART I – Understanding the Supervising process: An Overview
Chapter 1 – Basic Ingredients in the Supervision Process
• These fundamentals call for both hierarchical and collaborative
stances.
• A Safe Place to Be and Learn
• Health model instead of “deficit detecting”
• Trainees do not feel under a microscope, but also feel held safely so they do not harm
clients
• Trainees feel safe to make and discuss mistakes when environment is nonpathologizing
• Trainees feel safe to experiment
• Supervisory relationship is:
• Respectful, competency-based, task-oriented
• One of trust, openness, vulnerability, and commitment to quality training
• Formal and informal evaluation respects power differential
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
10
PART I – Understanding the Supervising process: An Overview
Chapter 1 – Basic Ingredients in the Supervision Process
• Ground rules for supervision require respect for self, place, and others
• Confidentiality: confidence that what is said in the supervision session stays there
• Attentive and respectful listening: honoring others by paying close attention to words,
body language, and cultivating awareness of individual diversity
• Alertness for micro-aggression: put-downs and scolding erode the working alliance
• Allowing trainees the “right to pass” giving them the space and time to think about what
is happening
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
11
PART I – Understanding the Supervising process: An Overview
Chapter 1 – Basic Ingredients in the Supervision Process
• Effective Supervision is Based on Shared Goals and a
Relationship to Sustain Those Goals
• Trainees and supervisors must have satisfactory relationships that
include agreement on goals and ways to reach the goals
• Primary focus of supervision must be on relationship between
supervisor and trainees
• The second but critical focus is to learn therapy skills
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
12
PART I – Understanding the Supervising process: An Overview
Chapter 1 – Basic Ingredients in the Supervision Process
• Supervision Must Cultivate Awareness of Individual and
Contextual differences
• Therapy and supervision education and professional life-long learning
goals should include attention to, acceptance of, and respect for
individual differences throughout treatment and training
• Two common errors CFTs can make:
• Arguing that fundamentally “everyone is the same”
• Reducing other to cultural stereotypes
• Individuals are unique combinations of influences, experiences, and
orientations that affect how they view the world and act within it
• Identity is dynamic and fluid through time and context, and it changes
according to where individuals are on the developmental trajectories of
their lives and the environments in which these lives are embedded
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
13
PART I – Understanding the Supervising process: An Overview
Chapter 1 – Basic Ingredients in the Supervision Process
• Theory and Transparency Form the Core of Responsible
Training and Therapy
• Theory- or philosophy-driven supervision
• Supervision’s theoretical underpinnings are developmental and dynamic
• Transparent supervision provides longer-lasting outcomes
• Explain and discuss what the therapist is doing and why
• Demonstrate and model (“This is how it can be done; This is how you can say
that”)
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
14
PART I – Understanding the Supervising process: An Overview
Chapter 1 – Basic Ingredients in the Supervision Process
• Supervision Must be Focused and Relational
• Three integrated developmental outcomes:
• Sophistication of family systems scholarship
• Socialization into the profession of CFT
• Cultivation of professional maturity
• Supervising from a systemic perspective – the client is the relationship
whether an individual, couple, family, or other
• Balancing directives with collaborative discussion
• The supervisor does not treat the client
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
15
PART I – Understanding the Supervising process: An Overview
Chapter 1 – Basic Ingredients in the Supervision Process
• Learning to Be a Therapist is a Developmental Process
• Initial stages begin with high level of didactic education
• With experience, trainees are given more space for the self of the
therapist to grow
• Near the end of supervision, supervisors engage in more mentoring
roles
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
16
Education and Training are Outcome Based
• At a minimum, beginners must learn central relational concepts; come
to recognize these concepts in clinical situations and in their own lives;
and be able to plan, implement, and evaluate interventions
• However, this narrow curriculum happens within
•
•
larger pedagogical mission organized around the
3 transcendental aspects of CFT training:
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
17
Namely:
• Family systems scholarship
• Socialization into the profession
• Cultivation of professional maturity
- Sophistication of family systems scholarship
- Socialization into the profession of CFT
- Cultivation of professional maturity
Learn
central
relational
concepts
Recognize
relational
concepts in
clinical work
Recognize
relational
concepts in
own lives
Be able to
plan,
implement,
and evaluate
interventions
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
18
Chapter 2 - Supervisory Relationships, Roles, and
Goals
• Supervisory Relationship
• Supervision is most effective when trainee and supervisor have a good
working alliance with common goals
• Swartz suggests reducing evaluative nature and focusing on four areas:
• Identity of trainee independent of specific performance or outcomes (mistakes are
ok)
• Trainee’s internal processes (what they are thinking)
• Interactions between therapists/clients and therapists/supervisors
• Big picture of therapy (not only micro-skills and specific interventions)
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
19
PART I – Understanding the Supervising process: An Overview
Chapter 2 - Supervisory Relationships, Roles, and Goals
• Therapist-client relationship is the synergism provided by shared goals
and enough of a relationship to support work toward these goals. This
extends to training, which will be enhanced if supervisors, trainees, and
client families agree in five areas:
•
•
•
•
•
Acceptance of each other
Theory
Technique
Proposed outcomes
Therapeutic bond
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
20
PART I – Understanding the Supervising process: An Overview
Chapter 2 - Supervisory Relationships, Roles, and Goals
• Components of the Supervisory Relationship
•
•
•
•
Accountability
Personal awareness
Trust
Power and authority
• Self of the Therapist/Self of the Supervisor
• Awareness of own legacies, family of origin factors, biases, unresolved issues, and
values
• Awareness of position in and dynamics of training system
• Trust
• Trainees trust supervisors to act in their best interest
• Supervisors trust trainees to be honest and forthcoming
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
21
PART I – Understanding the Supervising process: An Overview
Chapter 2 - Supervisory Relationships, Roles, and Goals
• Power and Hierarchy
• Make explicit
• Do not misuse
• Hierarchy and collaboration are not mutually exclusive
• Common Factors in Supervision to Manage Multiple Roles and Diverse
Obligations
• Schema developed by Morgan and Sprenkle (2007)
• Emphasis of supervision on clinical versus professional competence
• Focus on specific clinical issues versus general topics
• Directive versus collaborative relationship
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
22
PART I – Understanding the Supervising process: An Overview
Chapter 2 - Supervisory Relationships, Roles, and Goals
4 overlapping roles of supervisors that can be combined within a preferred supervisory
directive/collaborative style and the developmental phase of the trainee:
• Coach
• Specific competencies or skills, especially executive competencies
• Instruct, collaborate, and protect
• Teacher
• System concepts, concepts of various therapy approaches, appropriate integration
of interventions, and appropriate execution of interventions and case management
• Provides evaluation and feedback
• Administrator
• Agency/institutional requirements
• Help manage professional and personal time, write adequate case notes and
reports, and keep track of clinical and supervision hours
• Mentor
• Takes place later than earlier in trainee’s development
• Focuses more on professional development than clinical skills
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
23
PART I – Understanding the Supervising process: An Overview
Chapter 2 - Supervisory Relationships, Roles, and Goals
“Primary Directive”
• Parallel Process/Isomorphism
• Working relationship always comes first in supervision as in therapy
• Neglect of this aspect of supervision renders all other aspects ineffective
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
24
PART I – Understanding the Supervising process: An Overview
Chapter 2 - Supervisory Relationships, Roles, and Goals
• Other Important Supervisory Roles (ensuring adequate care, advocates,
gatekeepers)
• Working with an Impaired Therapist
• Being keenly aware of wellbeing of trainees and their ability to provide services to clients
• Emphasize importance of self-care and development of sense of self
• Creating a plan for managing client cases when therapist is impaired or compromised
• Supervisor Mentors (Supervision of Supervision)
• Supervisor candidates are required to receive mentoring as a part of training process.
Rationale: To provide the novice supervisor a guide through developmental process of
becoming an AAMFT Approved Supervisor
• Should include contract, be confidential, focus on supervision (not therapy), and assist with
the process of applying for AAMFT Approved Supervisor designation
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
25
PART I – Understanding the Supervising process: An Overview
Chapter 2 - Supervisory Relationships, Roles, and Goals
• Pragmatics of Navigating Supervisory Roles
• Help trainees learn and avoiding doing therapy through them
• Establish clear boundaries through contracts, conversation, and rules
• Supervision Goals
• Negotiated between supervisors and trainees
• Guided by theoretical orientation, supervision philosophy, and developmental level of
trainee
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
26
PART I – Understanding the Supervising process: An Overview
Chapter 2 - Supervisory Relationships, Roles, and Goals
• Long-term Goals
• Chief goal is development of competent, confident, lawful, and ethical therapists
• Construed in a larger context of the self of the therapist, his/her philosophy or worldview in
general, and the values that the therapist-trainee holds dear
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
27
PART I – Understanding the Supervising process: An Overview
Chapter 2 - Supervisory Relationships, Roles, and Goals
• Long-term goals Include contextual, process and content goals:
• Contextual goals - Safe, clear, and flexible supervisory contexts
• Environment of mutual trust
• Flexibility as the trainee develops and situations arise
• Process goals - Focus on process rather than content and supervisors pay attention to
patterns of interaction
• Within and between clinical cases (both case and caseload levels)
• Between trainees and other professionals
• Within the trainee-supervisor relationship
• Within the entire training context
• Content goals - Content is also important at times
• When a therapist might benefit by learning about a certain clinical situation interactions
• When a supervisor’s expertise is clearly required for client wellbeing, e.g., suitability for
outpatient treatment; screening for and management of substance use; relationship
neglect, abuse, and violence; lethality toward self and others.
• When the trainee’s actions suggest something is interfering with either the clinical or
supervisory process such as power struggles with clients or between therapist and
supervisor
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
28
PART I – Understanding the Supervising process: An Overview
Chapter 2 - Supervisory Relationships, Roles, and Goals
• Other Long-term Goals
•
•
•
•
Developing competence in CFT
Developing theory-driven therapy
Evaluate trainees’ competence and development as clinical professionals
Gatekeeping (for the public and the profession)
• Short-term Goals
•
•
•
•
•
Establishing relationship
Clarifying theoretical approaches of trainee and supervisor
Establishing short and long-term goals
Clarifying roles
Establishing ground rules
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
29
PART I – Understanding the Supervising process: An Overview
Chapter 2 - Supervisory Relationships, Roles, and Goals
• Supervision and Therapy
• Acceptable and appropriate to explore aspects of trainee’s personal life as they impact CFT
• Unresolved personal issues that impact therapy negatively may benefit from therapy
• AAMFT Code of Ethics:
• 4.2 Marriage and family therapists do not provide therapy to current students or
supervisees
• 4.1 Marriage and family therapists who are in a supervisory role are aware of their
influential positions with respect to students and supervisees, and they avoid exploiting
the trust and dependency of such persons. Therapists, therefore, must make every
effort to avoid conditions and multiple relationships that could impair professional
objectivity or increase the risk of exploitation. When the risk of impairment or
exploitation exists due to conditions or multiple roles, therapists take appropriate
precautions.
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
30
Chapter 3- Getting Started: Readiness and
Procedures
• An overview of the supervisory roles; distinctions among
education, training, and experience; and participant diversity
• Discussion of developmental aspects of supervision; general
education and training requirements; training issues; and
fundamental processes of supervision
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
31
PART I – Understanding the Supervising process: An Overview
Chapter 3 – Getting Started: Readiness and Procedures
• Education, Training, and Experience
• Education transfers a body of knowledge
• Training teaches how to apply that knowledge to perform interventions
• Experience involves growth
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
32
PART I – Understanding the Supervising process: An Overview
Chapter 3 – Getting Started: Readiness and Procedures
• Participant Diversity
• Context, professional history, epistemology, attitudes about authority,
personal context, and unique life experience all influence both the
trainee and the supervisor
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
33
PART I – Understanding the Supervising process: An Overview
Chapter 3 – Getting Started: Readiness and Procedures
• Developmental Aspects of Supervision
• Beginners look for a big picture or overall perspective of what therapy is,
as opposed to fine detail, wanting and expecting a high degree of
direction.
• Beginners require an orientation to therapy
• More advanced trainees seek less direction and more support for
professional development and skill building
• Veteran therapists seek more consultative relationships
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
34
PART I – Understanding the Supervising process: An Overview
Chapter 3 – Getting Started: Readiness and Procedures
• Education and Training Requirements
• Teaching the basic tools of therapy
• Active listening
• Foremost foundational skill
• Sensitivity to relationship issues, affect management, and problem-solving
strategies
• Good interviewing skills
• Constructive goal setting – Observable, positive behaviors, in the here
and now, and within the clients’ means and control
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
35
PART I – Understanding the Supervising process: An Overview
Chapter 3 – Getting Started: Readiness and Procedures
• System Thinking is Foundational
• Systems is not:
• Medical model, which focuses on diagnoses and treats symptoms
• Psychological model, which focuses on personality traits
• Relational model does not see problems as residing within the individual
• Different social settings and relationships increase probability of desirable and
undesirable ideas, feelings, behaviors, and interactional dynamics
• Pursues the exception
• Seeing so-called traits as actually situation-specific rather than characterological or
pathological within an individual teaches the importance of context and reciprocity
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
36
PART I – Understanding the Supervising process: An Overview
Chapter 3 – Getting Started: Readiness and Procedures
• Important to assist trainees in being aware of essential systemic
concepts
• Supervisors may wish to construct a table of what they and others
consider essential systemic concepts that can be updated as needed
• System and cybernetic concepts: wholeness, homeostasis, negative and positive
feedback, first and second order change, circularity, recursivity, reciprocal
influence, open and closed systems, morphogenesis, equifinality
• Structure: System, subsystem, hierarchy, alliance, boundaries, triangles
• Tools for assessing systems: Active listening, circular questioning, multiple
realities, frames, exploration of diversity and context, co-construction
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
37
PART I – Understanding the Supervising process: An Overview
Chapter 3 – Getting Started: Readiness and Procedures
• Development of a Therapy Approach
• Beginners who stay with one theory and later expand report less
confusion
• Trainees need to learn to articulate their approaches and apply them to
clinical work
• Personal domain – personality factors, personal philosophy, family of origin, own
therapy, own marriages and relationships
• Professional domain – influence of undergraduate classes, graduate training,
clients, professional development, clinical experience and sophistication
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
38
PART I – Understanding the Supervising process: An Overview
Chapter 3 – Getting Started: Readiness and Procedures
• Pragmatics of Getting Started
• Screening: Readiness for supervised clinical experience
• Trainees must be able to remain in treatment room cognitively, emotionally, and
behaviorally
• Requires personal maturity, good boundaries, social judgment, self-observation, and
self-control
• Trainees must have foundational tools of relational therapy (general overview of
what therapy is, active listening skills, and understanding basic systems
constructs)
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
39
PART I – Understanding the Supervising process: An Overview
Chapter 3 – Getting Started: Readiness and Procedures
• Protections Necessary for Supervisors, Training Institutions, and
Communities
• Adequate documentation package protects supervisors, their trainees,
and the institutions in which training takes place
• Trainees should read, comprehend, and accept specifics of any and all
policies and procedures manuals and affirm understanding through
signature and dates
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
40
PART I – Understanding the Supervising process: An Overview
Chapter 3 – Getting Started: Readiness and Procedures
• Supervision contracts – written documents that specify expectations and obligations of both the
supervisors and their trainees. Should include (adopted from Bernard & Goodyear, 2009):
•
•
•
•
•
•
•
•
Supervisor’s background
Supervisor’s methods
Confidentiality policies
Financial issues and policies
Requirements for documentation of hours as well as clinical and supervision notes
Risks and benefits of supervision
Goals of supervision
Evaluation instruments and procedures
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
41
PART I – Understanding the Supervising process: An Overview
Chapter 3 – Getting Started: Readiness and Procedures
• Supervision contracts – written documents that specify expectations and obligations of both the
supervisors and their trainees. Should include (adopted from Bernard & Goodyear, 2009):
•
•
•
•
•
•
•
•
•
Duration of the contract and criteria for termination
Expectations for knowledge of state/provincial requirements and ethics codes
Supervisor’s responsibilities
Trainee’s responsibilities
Supervision session content
Supervisor accessibility and contact information
Issues about which supervisors must be informed
Ethical considerations
Due process
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
42
PART I – Understanding the Supervising process: An Overview
Chapter 3 – Getting Started: Readiness and Procedures
• Supervision contracts essential areas from Thomas (2007):
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Supervisor’s background
Supervisory methods
Supervisor’s responsibilities and requirements
Trainee’s responsibilities
Potential supplemental requirements
Confidentiality policies
Documentation of supervision
Financial policies
Risks and benefits
Evaluation (criteria and process)
Complaint procedures and due process
Professional development goals
Endorsement
Duration and termination of the contract
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
43
PART I – Understanding the Supervising process: An Overview
Chapter 3 – Getting Started: Readiness and Procedures
• Documentation of Therapy Sessions
• Access to raw data for all trainees is critical and non-negotiable
• Comprehensive progress notes of therapy and supervision sessions
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
44
PART I – Understanding the Supervising process: An Overview
Chapter 3 – Getting Started: Readiness and Procedures
• Form of Supervision
• Accrediting and regulatory bodies specify kinds and amounts of supervision required
• Supervisors and institutions are held liable for alleged errors of their trainees
• Supervisors must have some means to see what their trainees are doing first hand
• Live supervision is most logical means, but often not practical
• When live is not an option, trainees must be strictly required to abide by the supervisors’
requirements for access to therapy data
• Supervisors should provide trainees with information about how data will be used:
• What the supervisor will be looking for in case notes and what kind of feedback to expect
• How the supervisor will supervise using a recording
• What will happen in live observation in the room, behind a one-way mirror, or viewed through
closed-circuit technology
• Information about live observation should include circumstances for calls into the therapy room or
requests for the therapist to leave the therapy room for consultation
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
45
PART I – Understanding the Supervising process: An Overview
Chapter 3 – Getting Started: Readiness and Procedures
• Fundamental Processes of Supervision
• Best when a systematic process is followed
• Supervision follows education – system concepts, CFT principles, basic
interviewing skills
• Five domains of goals and activities (Nelson & Johnson,1999)
• Conceptual, perceptual, executive, evaluative, professional
• Trainee begins with a knowledge base that includes basic concepts, gathers data
through interviewing and watching client families, and then uses those concepts
and perceptions to craft interventions in the therapy room
• Cultivation of professional skills are woven throughout the whole of supervision
• Next step with beginning trainees is to evaluate predetermined goals and criteria
for therapist skills and therapy outcomes
• Isomorphism –how the supervisor treats the trainee will influence how the trainee
treats clients
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
46
PART I – Understanding the Supervising process: An Overview
Chapter 3 – Getting Started: Readiness and Procedures
• Beneficial dynamics found in both supervision and therapy:
• Solid working alliance with mutual goals and a facilitating relationship
• Systems-based conceptualization of and communication about data, interventions,
and outcomes
• Sensitivity to and acceptance of multiple realities
• Characterized by climate of discovery, social relatedness, active listening, and
appreciation for others
• Continuous group and relationship processing
• Interventions related to issues at hand
• Good interviewing technique continually stressed and cultivated
• Mutual and effective goal setting
• Members assume appropriate responsibility for affects, beliefs, actions, and
change
• Appropriate boundaries
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
47
Chapter 4 - Screening, Contracts, Core Competencies, and
Evaluation
• Screening
• Evaluate trainees’ skills, competencies, and potential at beginning with
the purpose of:
• Determining whether supervisory relationship is appropriate and a good fit
• Determining what skills and competencies may require further development
• Discuss supervisor’s and trainee’s philosophies of therapy
• Determining if each is interested in singular or integrated approach
• Determining if there is a fit related to collaborative verses hierarchical style
• General fit with Relational Therapy
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
48
PART I – Understanding the Supervising process: An Overview
Chapter 4 – Screening, Contracts, Core Competencies, and Evaluation
• Values
• Must be able to accept if not share each other’s values
• Pragmatics
• Must agree upon expectations for supervision fees, schedules for meeting, the
format for supervision, setting goals, evaluating the supervision as well as the
trainee’s progress, and procedures for emergencies
• Includes expectations and requirements of the training setting, whether a graduate
program, agency, or licensure requirements
• Contracts
• Have about goals, procedures, and pragmatics of supervision in written form
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
49
PART I – Understanding the Supervising process: An Overview
Chapter 4 – Screening, Contracts, Core Competencies, and Evaluation
• Core Competencies are used for screening and supervising (discussed in more detail in
Chapter 8)
• Consists of six domains
•
•
•
•
•
•
Admission to Treatment
Clinical Assessment and diagnosis
Treatment Planning and Case management
Therapeutic Interventions
Legal Issues, Ethics and Standards
Research and Program Evaluation
• Domains are divided into subdomains
•
•
•
•
•
Conceptual Skills
Perceptual Skills
Executive Skills
Evaluative Skills
Professional Skills
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
50
PART I – Understanding the Supervising process: An Overview
Chapter 4 – Screening, Contracts, Core Competencies, and Evaluation
• Evaluation
• Formative (“along the way”)
•
•
•
•
•
•
Regular or irregular intervals
Keep supervision progress notes
Objective Structured Clinical Exercises
Outcome Management
Use Core Competencies to evaluate
Basic Skills Evaluation Device
• Summative (more formal with documentation at the end of a pre-determined
period)
• All formative methods can be used as summative methods
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
51
PART I – Understanding the Supervising process: An Overview
Chapter 4 – Screening, Contracts, Core Competencies, and Evaluation
• Evaluation of Supervision
•
•
•
•
Developed at the beginning of supervision
Based on criteria agreed upon between supervisors and trainees
Criteria related to supervision goals
Helps supervisors improve supervision and be more helpful to trainees
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
52
Part II
Relational Supervision Practices
Chapter 5 - A Closer Look Supervision Formats
• Individual and Group Approaches (advantages and disadvantages)
• Individual or Dyadic Supervision
• Individual
• Defined by COAMFTE and many states as one supervisor and one or two trainees
• Dyadic defined by authors as one supervisor and one trainee
• Strengths
• A personal and safe place for learning (maximizes attention on trainees)
• A haven (express doubts, vent emotions, refresh energies)
• Limitations
• Intense relationships and power differentials
• No escape or “pass”
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
53
PART II – Understanding the Supervising process: An Overview
Chapter 5 – A Closer Look Supervision Formats
• Group Supervision
• Keys to Good Group Supervision
•
•
•
•
Monitor and maintain group process carefully
Obtain mutual agreement on goals and strategies
Model good communication and interviewing skills
Identify barriers to constructive processes and devise plans to manage them
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
54
PART II – Understanding the Supervising process: An Overview
Chapter 5 – A Closer Look Supervision Formats
• Strengths
•
•
•
•
•
•
Economical
Direct and indirect learning
Shared expertise and support
A rich environment of learning
A social laboratory (members experience and are shaped by group process)
A haven
• Limitations
• Limited time and detailed continuity for one case or trainee
• Crises or enthusiastic members may override equitable parceling of time and
energy
• Potential lack of safety
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
55
PART II – Understanding the Supervising process: An Overview
Chapter 5 – A Closer Look Supervision Formats
• Live Approaches
• One-way mirror, closed-circuit viewing, co-therapy, sitting in room
• Keys to good live supervision
•
•
•
•
Begin with an understanding of isomorphism (parallel processes)
Actively listen, validate, and stay cognitively/emotionally connected to trainees
Process may be more influential than content
Don’t ask trainees to understand and do things beyond their professional
development
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
56
PART II – Understanding the Supervising process: An Overview
Chapter 5 – A Closer Look Supervision Formats
• No research to indicate live is better, but it does offer some advantages
(strengths)
•
•
•
•
•
•
•
Meets mandates for licensure
Parallels therapy being action-oriented and “here right now”
Allows therapist to experience shifts in therapy due to changes in their behavior/approach
Reassures supervisors that therapists are providing responsible, good-enough care
Offers comfort and emotional support
Provides opportunity to observe immediate effects of interventions
Provides opportunity for supervisors’ constructive observations to serve as an antidote to
trainees’ unrealistic goals, self-denigration, or expectations of blame
• Gives other trainees opportunity to observe and learn “on both sides of the mirror”
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
57
PART II – Understanding the Supervising process: An Overview
Chapter 5 – A Closer Look Supervision Formats
• Limitations
•
•
•
•
•
•
May contribute to performance anxiety
May impair view of a bigger clinical picture
May miss important issues or cues due to the lack of replay options
Requires unique facilities
Requires significant amount of time
May be complicated by power and hierarchy issues
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
58
PART II – Understanding the Supervising process: An Overview
Chapter 5 – A Closer Look Supervision Formats
• Retrospective Approaches
• Audio and Audiovisual Recordings
• Keys to good supervision
• Include clear policies about what should be recorded
• Ask for examples trainees feel good about as well as examples that help explore areas
for growth
• Use a variety of methods (discuss as therapy unfolds or stop and reflect on thoughts
and feelings)
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
59
PART II – Understanding the Supervising process: An Overview
Chapter 5 – A Closer Look Supervision Formats
• Strengths
•
•
•
•
•
•
•
•
•
Allows for distance supervision
Provides economies of time
Aids recall and corrects bias
Allows focus on only audio or only visual, and allows one to “freeze” moments
Allows trainees to see selves in action
Can focus selectively on parts of sessions that highlight special training or clinical concerns
Provides vicarious learning for other trainees
Teaches importance of iron-clad confidentiality procedures and processes
Can allow consultation over time if archived
• Limitations
• Can be awkward for trainees to inform clients sessions will be recorded
• Trainees may forget to record
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
60
PART II – Understanding the Supervising process: An Overview
Chapter 5 – A Closer Look Supervision Formats
• Case Presentations
• Based on verbatim session notes, structured progress notes, overall case summaries, unstructured verbal reports
• Strengths
•
•
•
•
•
•
•
Economical
Allows consideration within a larger clinical picture
Provides opportunity to explore self-of-the-therapist variables
Least intrusive
May lead to less performance anxiety
Teaches accurate case note writing
Requires trainees to pay attention to details and process and present rationale for interventions
• Limitations
•
•
•
•
Relies on trainees’ constructions of content and process
Dependent upon therapists’ writing and verbal skills
May be impacted on the amount of time between session and supervision
Requires creativity on part of supervisor to balance attention to theoretical development, skill training, and thoughts/feelings of trainees
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
61
PART II – Understanding the Supervising process: An Overview
Chapter 5 – A Closer Look Supervision Formats
• Contemporary Formats (electronically transmitted audiovisuals)
can include teleconferencing, telephone, web-based methods,
and so forth
• Strengths
• Accessibility for trainees who lack physical or financial resources to attend
supervision in person
• Better chance of fit between supervisor and trainee
• Limitations
• Ensuring confidentiality
• Securing required paperwork or recordings
• Managing emergencies
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
62
Chapter 6 - Approaches to Supervision
• Major Models of Therapy as Templates
• Historically, supervision was thought to mirror models of therapy that
trainees were learning
• Supervisors “taught” trainees how to do a specific form of therapy by
using that form of therapy as a format for teaching how to perform it
• Integrative
• Incorporates two or more approaches into one guiding philosophy of
supervision for each supervisor/trainee combination
• Difference between integrative and eclectic
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
63
PART II – Understanding the Supervising process: An Overview
Chapter 6 – Approaches to Supervision
• 3 types as identified by Morgan and Sprenkle (2007)
• Developmental
•
•
•
•
Trainees pass through predictable stages or phases of development as therapists
Beginning trainees need more directive and focused supervision
More advanced trainees benefit from discussing larger issues
Specific therapy model approaches can be applied within this approach
• Social-Role
• Focus on what supervisors do within different roles - teacher, consultant, mentor, etc.
• Various models attempt to match training situations with particular tasks and behaviors
• Other Approaches
• Goal or Skill Oriented – reflect outcome-based education
• Feminist-Influenced – can be manifested regardless of therapeutic approach in 2 ways
• Enhanced collaborative and egalitarian supervisory relationship
• Specific focus on ideas of gender equality, balance of power in relationships,
diversity, etc.
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
64
PART II – Understanding the Supervising process: An Overview
Chapter 6 – Approaches to Supervision
• Common Factors in Supervision
• All supervisor approaches can be identified in terms of supervisor’s
place along each of 3 dimensions
• Emphasis on clinical material versus professional development
• Specificity or focus on specific clinical case concerns versus more general therapy
concepts, philosophy, or context
• The nature of the supervisory relationship as collaborative versus hierarchical
• Important to understand how these approaches, factors, and dimensions
mesh in our supervision, and how they inform the decisions we make
and our actions
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
65
PART II – Understanding the Supervising process: An Overview
Chapter 6 – Approaches to Supervision
• Supervision Maps
• Rather than think about “models” of supervision, it may be more beneficial to
think about “maps” as a metaphor.
• Maps tend to have 2 points: Point A (where we are) and Point B (where we
hope to end up)
• Think of supervision with a beginning point A (which might be the beginning of
a supervisory relationship or an assessment of a trainee’s competence) and
ending point B (which might be the desired relationship at the end of
supervision or evidence of mastery of a set of competencies)
• You may use several different maps during the course of supervision
• Consider routes you want to take, factors that influence those routes, the best
kinds of vehicles for the routes, aspects of the terrain that are not well
represented on the maps
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
66
PART II – Understanding the Supervising process: An Overview
Chapter 6 – Approaches to Supervision
• Contextual-Functional Meta-Framework (Jeff Chang)
• Administrative Context: “To Whom do I Owe My Allegiance”
• Culture-Infused Supervisory Working Alliance: “Can Our Supervisory
Relationship Support the Intervention?”
• A Culture-Infused Approach (with culture defined broadly) that advocates reflection
on one’s cultural identity and that of the trainee to develop a culturally competent
working alliance
• The Working Alliance in Supervision (much like the therapeutic alliance) where
supervisory interventions fit with trainee receptivity
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
67
PART II – Understanding the Supervising process: An Overview
Chapter 6 – Approaches to Supervision
• Supervisory Roles: “When Should I Do What?”
•
•
•
•
•
•
•
•
•
Clinical educator
Skill development coach
Ethics/risk management consultant
Catalyst
Professional gatekeeper
Organizational/administrative supervisor
Personal supporter
Professional mentor
Advocate/system change agent
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
68
PART II – Understanding the Supervising process: An Overview
Chapter 6 – Approaches to Supervision
• Theory of change: “Is there a clash of Ideas, or an ecology of ideas?”
• Service delivery system – isomorphism: “What are the relational
patterns affecting the supervision process?”
• Phases of counselor development: “Where is the trainee in the journey?”
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
69
Chapter 7 - Effective Supervision
According to the Literature
• Evolutionary Look at Best Practices in Supervision
• Opinion (before 1990) – specified by major CFT theories
• Generic family therapy skills – based on trainees’ conceptual,
perceptual, and technical skills
• Professionalism – included increasing identification within the
profession; “professional self-confidence”; and a solid grounding in
ethics, law, and standards of practice
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
70
PART II – Understanding the Supervising process: An Overview
Chapter 7 – Effective Supervision According to the Literature
• Delphi Studies (1990-2000) – a systematic way to establish consensus among
experts in a topic or field in which in which expert participants “respond” to
each other in a series of surveys
• Content of Training
• National Exam Program
• Core Competencies
• Supervisory Processes
• Common beliefs derived from national sample of AAMFT Approved Supervisors
• Interactions with trainees are to be characterized by clear expectations with regard to
procedures, methods, and performance evaluation
• There must be a solid working alliance
• The supervisors’ attention should be distributed across details of case management, theory
and skills development, and the self of the therapist
• Common beliefs based on national sample of trainees that supervision is a safe
place with
• A sense of openness in the environment
• A focus on strengths while communicating respect, encouragement, and support
• Encouragement of personal growth issues and a willingness to confront blind spots and
resistances
• Conceptual and technical guidance and direction; supervisors offer useful conceptual
frameworks and practical skills
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
71
PART II – Understanding the Supervising process: An Overview
Chapter 7 – Effective Supervision According to the Literature
• Contemporary Research Initiatives
• Empirical validation of specific kinds of family therapy
• Exploration of generic factors thought to be common to all methods of psychotherapy
• Therapeutic or working alliance
• Observations and Opportunities for Research
• Ability of items that predict outcomes of therapy used is less a research question than
an entire program of systematic research
• The working alliance doesn’t focus on characteristics of either clients of therapists; it is
transactional
• A working alliance that can be defined by observable interactional characteristics might
be an excellent vehicle for training in meta-skills
• If a working alliance can be defined and observed, it might be useful in the supervisory
system
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
72
Chapter 8 - Supervision Based
on Core Competencies
• Developed in 2003 by AAMFT to provide a standard against
which therapists can be evaluated
• Core Competencies in CFT
• Five domains mastered in a developmental manner
• Not meant to be mastered at the time of graduation
• Subdomains within Core Competencies
• Conceptual Competencies – focuses on generic CFT cognitive skills
• System concepts - all things are connected and whole
• Patterns – target patterns for interventions to interrupt them
• Circular causality – circular not linear thinking
• Other – morphogenesis/morphostasis; open/closed systems; boundaries; process verses
content; complementarity, recursion and isomorphism, etc.
• Couple and family therapy approaches – understand many approaches
• Ethical and legal imperatives
• Competency in assessment, diagnosis, and evaluation
• Conceptual base
• Standardized assessment and diagnostic procedures
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
73
PART II – Understanding the Supervising process: An Overview
Chapter 8 – Supervision Based on Core Competencies
• Perceptual Competencies
• Tie conceptual competencies to actual therapy data
• Interactions with others, conversations, and contexts affect perceptions
• Knowledge or conceptual competency meets observations and become a different kind of
“knowledge” that applies uniquely to a particular situation
• Supervisor’s role is to continually evaluate trainee’s progress in connecting knowledge with
therapy information
• Executive Competencies
•
•
•
•
•
The “doing of therapy”
The biggest share of therapy competency domains
Interventions and beyond
Skills include interventions prescribed by singular approaches as well as integrated approaches
Supervisors focus on trainees’ goals rather than clinical content, but be aware of how knowledge
and perceptions fit into therapy approach
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
74
PART II – Understanding the Supervising process: An Overview
Chapter 8 – Supervision Based on Core Competencies
• Evaluative Competencies
• Two ways to conceptualize evaluation that overlap
• Evaluation of therapy
• Evaluation of self as a therapist
• Supervisory roles include and overlap with all categories
• Teachers help learn about assessment content and tools
• Coaches help gain skills along the way
• Mentors help situate skills within trainees’ own philosophies
• Administrators review work for completeness and accuracy
• Learning to evaluate oneself requires viewing self from outside the system
• Subjective
• Evaluation instruments
• Basic Skills Evaluation Device (Nelson & Johnson, 1999)
• Client feedback
• Informal
• Session Rating Scale or Outcome Rating Scale (Duncan, Miller, & Sparks, 2004)
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
75
PART II – Understanding the Supervising process: An Overview
Chapter 8 – Supervision Based on Core Competencies
• Professional Competencies
● Include a diverse set of behaviors: wearing appropriate attire, learning appropriate
touch, managing own feelings, interacting with other professionals, being
received
into the ranks of our field, keeping abreast of new knowledge
and requirements,
being active in professional organizations, helping with
legislative activities
● Fewest items associated with this domain, but success here often indicates
success in other domains
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
76
PART II – Understanding the Supervising process: An Overview
Chapter 8 – Supervision Based on Core Competencies
• Impaired participants (supervisors as well as trainees)
• Most literature related to inappropriate sexual behavior or substance misuse/abuse
• Also includes fatigue, illness, grief, life circumstance, family of origin triggers, inappropriate
boundaries
• Supervisor’s responsibility to help trainees learn signs of impaired judgment and act
accordingly
• Supervisors must appreciate extent of own reactions to trainees, situations, and institutional
structures
• Supervisors must stay informed about “best practices” of CFT
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
77
Chapter 9 – Tools: Supervising Manual-Based
Models
• Manualized interventions presuppose a detailed manual that states how
intervention must be done
• Viability of these interventions controversial
• Based on a requirement that once a regimen is established, it can be repeated
in additional settings in exactly the same way
• Interface between developer and clinician is the clinical supervisor
• Must be trained in procedures (often requires certification in program)
• Must adequately and consistently monitor and audit trainees
• Must also have confidence in the model
• Examples include:
• Emotionally Focused Therapy (Johnson, 2008)
• Multisystemic Therapy (Henggeler & Schaeffer, 2010)
• Functional Family Therapy (e.g., Sexton, 2009)
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
78
PART II – Understanding the Supervising process: An Overview
Chapter 9 – Tools: Supervising Manual-Based Models
• The Challenge of Executive- Micro- and Meta-Skills
• Critics of manualized interventions
• “Cookie cutter” approach doesn’t account for differences in clients, supervisors,
and trainees
• Definitions may not be valid from one culture to the next
• Evidence-based practice accounts for differences in clients, supervisors,
and trainees
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
79
PART II – Understanding the Supervising process: An Overview
Chapter 9 – Tools: Supervising Manual-Based Models
• Presence of executive, micro-, and meta- skills in unique combinations is at the
core of “prescriptive psychotherapy”
• May be the ultimate change agents in therapeutic interventions- more important than clinical
theory and diagnosis in facilitating change
• Executive skills
• Behaviors involved in the administration of an interview or intervention
• Includes time management, focus of attention, the intervention, delivery, processing, and
problem-solving within research-based approach
• Microskills
• The cornerstone of effective therapy or supervision and communication, often not taught in
intervention manuals, but can be vital to effective interventions
• Includes attending, questioning, clarifying, affirming, encouraging, summarizing, reframing, etc.,
and awareness by supervisors of what they do not know
• Metaskills
• The unique feeling qualities and attitudes that characterize effective therapists and supervisors
and facilitate their work
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
80
PART II – Understanding the Supervising process: An Overview
Chapter 9 – Tools: Supervising Manual-Based Models
• Guidelines for Ethical Practice
• Limitations of manualized treatments
• Meant to be carried out as written and often do not attend to within-diagnostic
group differences, including comorbidity
• Do not recognize importance of executive, meta-, and microskills
• May create false sense of confidence
• Supervisors need to develop executive, meta-, and microskills in
themselves, trainees, and the clinical setting
• Sometimes there may be a conflict with the apparent rigidity of a
manualized intervention
• Supervisors need to be led by their professional acumen
• Supervisors may need to consult with model developers or bring in external
sources
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
81
PART II – Understanding the Supervising process: An Overview
Chapter 9 – Tools: Supervising Manual-Based Models
• Probability of positive results is increased when:
• Supervisors are certified to teach and train the manualized intervention
• There is a well-constructed intervention manual that provides training, auditing,
and corrective mechanisms
• Requires consistent interplay between trainees and training staff managed by supervisors
• Requires administrative buy-in to the approach
• Trained therapists who hold allegiance to the approach
• Development of executive, meta-, and microskills
• Recognize cues that signal need for flexibility
• Requires self-observation, modeling, shaping, and positive social reinforcement
• Alertness for mismatch of manualized instructions with contextual factors
• Supervisors hold themselves to ethical guidelines for practice
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
82
Part III
Contextual Considerations
Chapter 10 - Contextual Aspects of Supervision
• Context influences people’s actions, thoughts, emotions, and
interactions
• Complexity of multiple realities is compounded by influence of
each party’s epistemology and language, meanings taken from
subcultural memberships in past and present, lessons taken
from past and present experiences, and supervisory needs and
wants
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
83
Part III – Contextual Considerations
Chapter 10 - Contextual Aspects of Supervision
• Culture, Setting, and Self permeate all aspects of the training system
• Overview
• Supervisors are aware of impact of contextual factors in their trainees’ lives
• Supervisors understand themselves as part of the supervisory context
• Historical Context
• Hare-Mustin’s 1978 article on feminism and family therapy ushered in an expanded way of
thinking about family dynamics that included social context
• McGoldrick and Giordano’s 1982 text encouraged therapists to recognize and consider the
broader contexts that influence individuals and families
• Sometimes mistakenly led to stereotypes of ethnicities
• Required “cultural humility”
• Today, systemic therapists understand cultural competence and cultural humility as
encircling the ecosystemic map of individuals and families at another level
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
84
Part III – Contextual Considerations
Chapter 10 - Contextual Aspects of Supervision
• Culture
• Defined as all the things in a particular context that impact the way one sees oneself:
one’s identity in that context, whether as part of the dominant group or at the margins
• “Cultural stew” (allows one to maintain identity while belonging and contributing to a group)
versus “melting pot”(discounts those at the margins as they blend in or assimilate and become
part of the larger group losing their individual identity)
• Also thought of as atmosphere helping to define what is considered to be important and expected
• The atmosphere is typically passed through family and group interaction
• One learns one’s “place” in the larger society and questions those who would move out or beyond their
appropriate “places” or roles
• Places and identities change in fluid and dynamic ways rather than characterological ways that relational
therapists and supervisors seek to respect rather than find a “true” identity
• Every interaction and discourse takes place among culturally diverse individuals
• Cultural Competence
• To expect and understand complexities of culture
• To keep complexities of culture at the forefront of analysis around clinical work and supervision
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
85
Part III – Contextual Considerations
Chapter 10 - Contextual Aspects of Supervision
• Cultural humility
• See people at the center of supervisory or clinical systems
• Be curious about a client’s or trainee’s situation, rather than “know” everything
about that situation
• Be self-reflective about one’s ideas and perceptions
• Be aware of own experiences, limitations, perspectives, biases, and prejudices
• Be aware of our positions in supervisory systems
• Seek to empower clients and trainees
• “Power with” rather than “power over”
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
86
Part III – Contextual Considerations
Chapter 10 - Contextual Aspects of Supervision
• Must concurrently consider interplay of four features: selves, context, social location, and
intersectionality of these factors
• Selves
• The Developing Selves of Trainees
•
•
Helping trainee identify among maturity level, family of origin position and role, training level, and clinical theory orientation and
determine related goals
Beginning trainees
• Require more focused and intense supervision that attends to clinical skills
•
Intermediate trainees
• May be working on clarifying personal philosophies of therapy or change, exploring ideas beyond early approaches, and
stretching selves clinically
• Requires supervision that holds them to standards while providing a safe place to explore
• Supervision may take on more philosophical tones of theory and approach and abstract ethical discussions
•
Advanced trainees
• Require a stance of watchful waiting
• Supervisors must be careful not to become complacent
• Supervision may take on more of a mentoring tone
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
87
Part III – Contextual Considerations
Chapter 10 - Contextual Aspects of Supervision
• Selves of Supervisors
• Awareness of and sensitivity to our own biases and prejudices affect our supervision
interactions in both conscious and unconscious ways
• Supervisors have much power over trainees because we have the ability and
responsibility of gatekeeping for the profession
• Supervisors must take this responsibility seriously when working with trainees who
are different from ourselves
• Supervisors must strive not to use power inappropriately
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
88
Part III – Contextual Considerations
Chapter 10 - Contextual Aspects of Supervision
• Social location
• Refers to a person’s place in society with respect to certain categories of identity
• Reflects a world view
• Affects what is perceived as acceptable or unacceptable in various situations and often is
stereotyped
• Expands the notion of diversity
• A social construction about who is at the center of society with more influence and privilege and
who is at the margins
• ADDRESSING: Age, Development, Disability, Religion, Ethnicity, Social Status, Sexual Orientation,
Indigenous heritage, National Origin, and Gender
• Intersectionality
• Awareness of more than one area of diversity at a time
• Much of the literature focuses on one or two aspects of diversity, but gives us ideas for
thinking about others dimensions and how the interact
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
89
Part III – Contextual Considerations
Chapter 10 - Contextual Aspects of Supervision
• Setting (where supervision takes place)
• All settings are “context” and each setting has its own culture of values,
practices, rules, and structure
• Settings can be empowering or oppressive, ossifying or creativityinducing
• Each setting provides its own overt and covert rules
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
90
Part III – Contextual Considerations
Chapter 10 - Contextual Aspects of Supervision
• Graduate Programs
•
•
•
•
The first training setting most trainees encounter
All are diverse and have their own culture
Supervisors must understand written, spoken, and unspoken rules
Include contexts such as classroom, on-site clinics, assistantships,
personal lives
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
91
Part III – Contextual Considerations
Chapter 10 - Contextual Aspects of Supervision
• Graduate Programs
• Outside supervisors
• Understand expectations and roles
• Be careful of potential triangulation with graduate programs and students
• Important factors
•
•
•
•
•
Awareness of politics of clinical leadership
Boundaries between setting and supervisor
Appropriate informed consent from clients
Access to clinical data
Attention to clear information about logistics such as place, time, and fees
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
92
Part III – Contextual Considerations
Chapter 10 - Contextual Aspects of Supervision
• Postgraduate Training
• May include more diversity than graduate programs
• Students often come from different fields
• Jurisdictional laws and rules affect training contexts
•
•
•
•
Titles may vary
Generally must complete graduate studies before having permission to practice
Some must take a national exam
Typically required to practice for a minimum number of years for a minimum number of hours
which must include couples, families, children, and individuals
• Typically face-to-face therapy
• Supervisors must meet rigorous AAMFT standards
• Coursework
• Mentoring (supervision of supervision)
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
93
Part III – Contextual Considerations
Chapter 10 - Contextual Aspects of Supervision
• Supervisory Practices
• Be conscious of the parameters of our involvement in each setting
• Be aware of our levels of liability in each setting
• Help our trainees understand our practices and requirements within that
context
• Keep clear boundaries among different roles
• Best practice is to have direct dialogue with trainees about the setting;
policies and procedures; various roles; our intentions within roles;
matters of sexuality, race, ethnicity, social class, etc.
• Supervisors are encouraged to engage in practices that sensitize
themselves and their trainees to multiple aspects of social location that
affect clients, therapy, trainees, supervisors, supervision and
supervisory/training contexts
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
94
Part III – Contextual Considerations
Chapter 10 - Contextual Aspects of Supervision
• Helpful exercises
•
•
•
•
•
•
Describe situations in which felt oppressed, then privileged
Cultural genograms
Cultural Context Model using cultural circles
Daily journal of cultural critical events
Role playing
Laszloffy and Habekost course objectives
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
95
Chapter 11 - Legal Aspects of Relational
Supervision
• Organization of Laws and Regulations
• CFTs are regulated in all 50 states, Washington, D.C. and 2 Canadian
provinces
• Clinical Practice: Licensure or Certification
• Laws stipulate who can use the title and provide certain services (scope
of practice)
• Purpose of licensing laws is to protect public from harm, not build CFT
practices
• Licensing laws are typically very general
• Specificity comes through rules or regulations set forth by licensing or regulatory
boards
• Rules do not need legislative action to change
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
96
Part III – Contextual Considerations
Chapter 11 - Legal Aspects of Relational Supervision
• Other Laws
• Confidentiality
• The right of a client to determine what information is divulged in therapy to others
• Differs from privilege which refers to client’s right to determine what confidential information
is presented in court
• Safest way to be certain about acceptability of divulging information is by having a client
sign a release of information
•
•
•
•
People to whom information may go
Details about what information may or may not be released
Time frame or limit for releasing information
Written consent required from anyone who attended sessions even consultants or visitors
• Trainees’ clients must be informed that an exception to their right to confidentiality is the
supervisor
• Trainees’ also have right to have supervision conversations kept confidential
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
97
Part III – Contextual Considerations
Chapter 11 - Legal Aspects of Relational Supervision
• Duty to Report
• In most places, mental health professionals are required to report suspected abuse or
neglect of a child, vulnerable adult, or others who cannot take care of their own interests
(mandatory reporters)
• Duty or ability to talk about clients is limited to the report only
• Important to be aware of appropriate actions/intricacies of reporting
• Reports are generally made on suspicion of abuse; therapists and supervisors are not
investigators
• Trainees may need a significant amount of support (both technical and emotional) when
making first reports
• When conflict exists, supervisors who are licensed must adhere to the law and rules
• Trainees may need to report, even if they disagree with setting
• Important to record notes of the situation, the process used to make a decision, the ultimate
decision, and other thoughts
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
98
Part III – Contextual Considerations
Chapter 11 - Legal Aspects of Relational Supervision
• Duty to Warn or to Protect
• When there is good reason to believe clients are in danger of hurting themselves
or someone else
• Tarasoff
• California case that impacted duty to warn legislation
• Courts determined when there is an identifiable victim, clear intent, statement, and
means for imminent danger, therapists must act to protect – not just warn - the
intended victim
• State law varies and supervisors should be aware of specific state details
• Must use experience in general, experience with a particular client, and a thorough
understanding of laws to make good decisions
• Consulting can be helpful in difficult situations
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
99
Part III – Contextual Considerations
Chapter 11 - Legal Aspects of Relational Supervision
• Minors in Therapy
• State laws vary about limitations and requirements for seeing children in therapy
• AAMFT Code of Ethics (and many state laws) specifically forbids treating therapists from
doing evaluations for custody or visitation with therapy clients in situations of divorce or
separation
• Therapist and expert witness testimony are different and these two roles must be kept
separate
• Subpoenas
• A legal request or demand for information
• Typically a request for case notes and/or testimony regarding therapist’s professional
opinion about a client and what happened in therapy
• Cannot ignore
• Must give what is requested or ask an attorney’s help in quashing the subpoena
• Cannot give information without clients’ permission or an order from a judge
• Often therapists can provide summaries of pertinent information (supervision and clinical notes)
• Generally recommended to get advice from an attorney
• Trainees need guidance in the distinctions between facts and interpretations or opinions
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
100
Part III – Contextual Considerations
Chapter 11 - Legal Aspects of Relational Supervision
• Records
• Must be aware of requirements spelled out by some state/provincial regulations and third
party payers of what is required in client records
• Must know how to protect records and how they may be used in supervision
• All clinical records and recordings must be available to supervisors
• Must know laws and ethics rules around record storage
• How to store
• How long to store
• Plans for appropriate transfer or disposal in case we are incapacitated or die
• Should keep notes about what happens in supervision
•
•
•
•
•
Which cases discussed
What directives or suggestions were made and their rationale
How trainees responded
What general topics were discussed
Follow up to previous consultations, etc.
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
101
Part III – Contextual Considerations
Chapter 11 - Legal Aspects of Relational Supervision
• HIPAA
• Health Insurance Privacy and Accountability Act
• Developed to help protect private health information
• Department of Health and Human Services website with HIPAA information
(http://www.hhs.gov/ocr/privacy/index.html)
• Provides that psychotherapy notes may be kept separate from rest of
client’s medical record and it takes special efforts to get those notes
• Psychotherapy notes report on or analyze conversations with clients
• Do not include session length, medications, modalities and frequencies
of treatment, diagnosis or prognosis of client’s condition, or progress
notes
• http://psychcentral.com/lib/2006/psychotherapy-notes-and-hipaa
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
102
Part III – Contextual Considerations
Chapter 11 - Legal Aspects of Relational Supervision
• Authorization for Release of Information
• Only with written client permission
• Requires permission from everyone and anyone who attended any sessions of a
case
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
103
Part III – Contextual Considerations
Chapter 11 - Legal Aspects of Relational Supervision
• Summary
• Good supervisors help their trainees learn not only the details of laws
that affect the practice of therapy, but also the importance of being
aware of laws, knowing how to research them, and reviewing them
periodically
• Belonging to professional organizations is recommended
• Inform members about changes to laws and rules
• AAMFT members are eligible for free legal and ethics consultation
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
104
Chapter 12 - Ethical Considerations in Relational
Supervision
• Overview
•
•
•
•
Professional ethics often overlap with legal considerations
Ethics codes typically are found on professional organizations’ websites
Most recent AAMFT ethics code went into effect July 1, 2012
Ethics codes are based on 5 fundamental ethical principles
•
•
•
•
•
Autonomy (right of clients to make decisions for themselves)
Beneficence (to be helpful)
Nonmaleficence (to do no harm)
Fidelity (to keep promises)
Justice (to act fairly)
• Explicit knowledge of ethical practice is a fundamental outcome goal for
trainees
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
105
Part III – Contextual Considerations
Chapter 12 - Ethical Considerations in Relational Supervision
• Creating and Sustaining an Ethical Supervisory Climate
• Conceptual frameworks to organize thinking can be helpful
• Stoltenberg et al. (1998) framework suggests supervisors have 3 fundamental areas to
influence trainees within developmental factors of the trainee:
• The trainee’s cognitive awareness of self and other
• The trainee’s desire to change beliefs, feelings, and actions
• The trainee’s ability to maintain the first two on his/her own
• Supervisors’ first steps should be to aspire to inculcate the 5 ethical principles from
Overview on previous slide
• Developmental Lens
• All successful supervisors nurture, confront, interpret, direct, and otherwise promote change
• Must recognize trainees are diverse
• Address trainee’s developmental needs and how they intersect with supervisor’s
developmental needs
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
106
Part III – Contextual Considerations
Chapter 12 - Ethical Considerations in Relational Supervision
• Contextual Lenses
• Ethics should be a part of all graduate and postgraduate training both in the
abstract and as it relates to particular cases
• Important to understand what constitutes one’s own values and ethics and one’s own
perspective on what those concepts mean and how they apply in therapy and
supervision
• Ethics genogram can be used in supervision to help therapists understand the origins of
their ideas, morals, values, and behaviors in an intergenerational context that can then
be used to examine stances relative to professional ethical behavior
• Four ethical issues for supervisors
• The matter of hierarchy
• Whether to focus on trainees’ views about clinical models and clients or on technical
skills
• Ambiguity of concepts such as “good,” “appropriate,” and “adequate”
• Dilemmas related to various supervisory methods
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
107
Part III – Contextual Considerations
Chapter 12 - Ethical Considerations in Relational Supervision
• Common Ethical Domains – identifying possible ethical blind spots
• Supervision and power
• Supervisory power is multi-faceted and pervades CFT training
• Includes power to reward, coerce, direct, and influence in overt and covert ways
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
108
Part III – Contextual Considerations
Chapter 12 - Ethical Considerations in Relational Supervision
• Supervision and Multiple Relationships
• Ubiquitous
• Boundary crossings can parallel potential problems in therapy such as inappropriate
self-disclosure, requesting or granting favors, business and financial interactions that
are outside the supervision system and outside social interactions
• Dual relationships in supervision can also be beneficial
• AAMFT ethics code was revised to be more aspirational than proscriptive
• 3 themes that affect impact of multiple relationships (Aducci & Cole, 2011)
• The situation
• How much and in what way the relationship affects therapy
• How much therapists and clients (or supervisors) can be open with each other
about their relationships
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
109
Part III – Contextual Considerations
Chapter 12 - Ethical Considerations in Relational Supervision
• Exploitation is major concern
• Examples of potentially problematic multiple relationships
• Collegial (current and former trainees; other business relationships)
• Friendships
• Those in rural and small communities (neighbors, fellow members of organizations,
children are friends, etc.)
• Shifts in Roles
• May be accompanied by intimidation, exploitation, and boundary violation
• Examples: supervisors look to trainees for reassurance, supervisor-trainee roles
become therapeutic, or supervisors and trainees become friends
• Burden to manage relationships and boundaries fall on the supervisor as the higher
person in the hierarchy
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
110
Part III – Contextual Considerations
Chapter 12 - Ethical Considerations in Relational Supervision
• Helping Trainees Develop Personal Ethical Decision-Making Models
• Legal statutes and ethical codes overlap and include many “gray areas”
• Laws and regulations are the “floor” (minimum standard)
• Aspirational ethical codes are the “ceiling” (higher standard)
• Therapy and supervision take place in the middle of the room
• Requires an emphasis on moral reasoning beyond legal and ethical standards
• Our individual principles are about value-informed choices in therapy and
supervision
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
111
Part III – Contextual Considerations
Chapter 12 - Ethical Considerations in Relational Supervision
• Supervisors and trainees can be invited to take a developmental journey of self
discovery by answering these questions:
• What do I presuppose about the nature and source of morals and ethics? What are my
taken-for-granted ideas about good and bad, right and wrong and how did I come to
these ideas?
• What kind of person do I want to be?
• What duties or obligations push me in certain directions? To what extent do the 5 ethical
principles play a role? To whom am I obligated, personally and professionally?
• What are the possible future consequences that might pull be in certain directions
• What are the contextual perspectives of all those who will be affected by my
professional decisions? Who are they?
• What are the qualities of the relationships in which I want to participate?
• What does a particular experience say about a specific situation?
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
112
Part III – Contextual Considerations
Chapter 12 - Ethical Considerations in Relational Supervision
• Development of explicit ethical decision-making models
• Zygmond and Borhem (1989) suggest a model based on Kitchener
• Begin with intuitive level (facts and ordinary moral sense)
• If answer is not apparent, proceed to critical-evaluative process that includes
consulting professional ethical rules and laws, ethical principles, and ethical theory
as they apply to clinical situations
• Includes a feminist perspective that equalizes power among participants
• At the end of this process a decision is made
• Including consultation with colleagues, attorneys, and/or the AAMFT ethics and legal
consultation services
• Consider leading trainees through mock situations
• Recommended to have ideas about how to recognize own impairment and a decisionmaking tree for addressing impairment issues
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
113
Part III – Contextual Considerations
Chapter 12 - Ethical Considerations in Relational Supervision
• Steps for supervisors that may be helpful in situations requiring ethical decision making
• Pay attention to my own discomfort (intuition) regarding facts of the situation
• Ask what personal and professional values apply to my thinking
• Review Informed Consents for Treatment or Supervisory Contracts to remember what I have
promised or required
• Review AAMFT code of ethics and relevant jurisdictional laws and regulations
• Consult with clients or trainees when appropriate
• Consult trusted colleagues
• Analyze based on ethical principles of autonomy, beneficence, nonmaleficence, fidelity, and
justice
• Determine course of action (if any)
• Document my actions and decision-making process
• Evaluate the process and its consequences
• Amend Informed Consents for Treatment or Supervisory Contracts as necessary
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
114
Part III – Contextual Considerations
Chapter 12 - Ethical Considerations in Relational Supervision
• Topics for Educating CFT Trainees
• Signs of Trouble
• Trainees must learn to recognize in selves and clients
• Supervisors must provide safe contexts for discussing
• Supervision Contracts
• One of the best ways to avoid misunderstandings or ethical dilemmas
• Both trainees and supervisors should have input
• Informed Consent for Treatment
• Trainees must realize the sacred privileged nature of therapy and need for clients
to fully understand implications and contracts they are entering into
• Supervisors should include elements of appropriate informed consent in education
of trainees
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
115
Part III – Contextual Considerations
Chapter 12 - Ethical Considerations in Relational Supervision
• Boundaries
• Understanding appropriate boundaries in supervision will help avoid
misunderstandings
• Trainees should be expected to bring up concerns and feel safe in doing so
• Impairment
• Trainees need to learn to recognize self-impairment and engage in self-care
• Examples include personal therapy, religion/meditation, family-time, vacations,
exercise, networks of therapists
• Situations for discussions
• Include in supervisory contract
• Include examples
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
116
Chapter 13 - Self of the Therapist, Self of the
Supervisor
• “Know your own stuff,” “know the trainees’ stuff”
• Lev Vygotsky (1986) observed we are not aware of our cultures until
something “bumps” against them
• Often, covert feelings must be made overt and examined in the tension
of experiencing and revealing them to others as an opportunity for
learning and growth
• Core, transcendental issue: addressing diversity as a means of
increasing the effectiveness of diverse training systems composed of
diverse individuals with diverse backgrounds in diverse contexts with
diverse clients
• Barriers to constructive training system interactions carry over into
clinical function and must be addressed from the beginning and
consistently throughout training process
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
117
Part III – Contextual Considerations
Chapter 13 - Self of the Therapist, Self of the Supervisor
• Addressing Self of the Professional as a Primary Goal of
Supervision
• Central to any potential collaboration are shared goals and enough of a
relationship to support work on them
• Most important dictum – “Always address your working relationship”
• Cannot, however, block steps required for client, other, and community safety
• Supervisors can be expected to take the lead
• 2 goals in group supervision setting
• To grow the group process in an experience of safe participation (application of the
“working alliance” rule)
• Help the group recognize whether a sensitivity or insensitivity has occurred and if
so, address it
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
118
Part III – Contextual Considerations
Chapter 13 - Self of the Therapist, Self of the Supervisor
• Activities to Raise Self-Awareness Outside of the Training
System
• The training system is just one of many systems in which the members
exist
• Commonly cited experiential approaches to self-awareness
•
•
•
•
•
•
•
Genogram exercises
Debriefing of clients about therapeutic experiences
Discuss responses to therapeutic or working alliance scales
Interpersonal Recall video technique shows promise
Cultural genogram
Self exploration questions processed in a group
The Critical Incidents Diary
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
119
Part III – Contextual Considerations
Chapter 13 - Self of the Therapist, Self of the Supervisor
• CFT Models Useful for Identifying and Exploring Self of the Professional
• Data suggest that few supervisors are informed by a singular major CFT
theoretical model
• Supervisors must be able to tolerate ideas and perspectives other than their
own while, at the same time, critically analyze their own and others’ views
• 3 common CFT models are popular for addressing barriers in supervision or
therapy
• Psychodynamic – transference or countertransference issues that distort the interaction or its
meaning are normative, experienced by everyone, exciting to discover, and liberating
• Video Recordings – trainees can look at selves in clinical setting to reflect on their thinking,
emotions, and behaviors, and discuss in a safe environment with their supervisor
• Constructivist – focus on the “belief”: the ideational ways in which individuals make sense of
things
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
120
Part III – Contextual Considerations
Chapter 13 - Self of the Therapist, Self of the Supervisor
• Supervisors’ and Trainees’ Self-Care
• Important to know one’s limits professionally and personally
• Important to know what to do (or not do) and when to do it to take care of oneself
• Resiliency
• A “synergistic collection of attributes of individuals and their groups that allows them to
(a) stand up to stress and (b) grow from it
• A process that mediates the interaction of individual and contextual attributes
• Members of a training system will benefit from appreciating what they as a group
already do well and exploring “growing edges”
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
121
Part IV
Trouble shooting and Writing a Personal Philosophy of
Supervision Paper
Chapter 14 - Troubleshooting and Pragmatics in the Relational Training
System
• Appreciating the Interpersonal Context of Training
• Supervisory environment
• Supervisory goals
• Develop an environment characterized by safety conducive to constructive openness
• Maintenance of this atmosphere in ways compatible with the needs of the entire training
system
• Supervisors should appreciate everyone’s uncertainty and their reactions to it
• Establish a safe context for discussing anything
• Appreciate multiple realities in the workplace
• Remain calm, non-defensive and promote exploration of thoughts and feelings in an
atmosphere of safety and openness
• Model openness to the diversity of experience and good interview techniques
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
122
Part IV: Trouble shooting and Writing a Personal Philosophy of Supervision
Chapter 14 - Troubleshooting and Pragmatics in the Relational Training System
• Multiple Roles
• Supervisors concurrently are teachers, mentors, and evaluative administrators
• Difficulties can arise when these roles conflict or boundaries are ambiguous
• Training systems are also embedded in larger environments
• “The Best Defense is a Good Offense”
• Prudence: When presented with facts, a jury of a supervisor’s peers should be able to agree
with the supervisor with regard to obligations and that the best tools available were used to
arrive at reasonable judgments and actions
• Essential supervisory structures
• Comprehensive introductory interview, preliminary systemic assessment of trainee’s skills and
understanding of therapy and supervision, and introduction to the supervisor’s philosophy and
administrative tools
• Essential tools used consistently: Written supervision contracts adequate observation supported
by documentation packages, and explicit evaluative processes and their consequences
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
123
Part IV: Trouble shooting and Writing a Personal Philosophy of Supervision
Chapter 14 - Troubleshooting and Pragmatics in the Relational Training System
• Systemic Assessment: The Training System in its Largest Environment
• Imber-Black’s (1988) classic text, Families and Larger Systems: A Family
Therapist’s Guide through the Labyrinth, encourages supervisors and therapists to
consider larger systems
• Do any areas of responsibility overlap?
• Do any of the beliefs and expectations about roles for selves and others conflict?
• Are the goals that constitute “success” compatible with one another?
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
124
Part IV: Trouble shooting and Writing a Personal Philosophy of Supervision
Chapter 14 - Troubleshooting and Pragmatics in the Relational Training System
• Initial Interview
• A process - not an event - that begins to establish and test trusting relationship and
explores needs, expectations, and concerns of all parties in and out of room
• Trainees should be introduced to ethical codes and legal statutes at this time
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
125
Part IV: Trouble shooting and Writing a Personal Philosophy of Supervision
Chapter 14 - Troubleshooting and Pragmatics in the Relational Training System
• Three questions to be explored and documented
• What are the obligations to be met by each person?
• Provision of specified content
• Fulfillment of specific requirements
• Protection of reasonably identifiable victims
• To whom are the obligations owed?
• Clients and their significant others
• Supervisor and trainee
• Relevant social communities
• Training institutions
• Educational institutions
• Service-providing institutions
• Governmental regulatory bodies
• Professional organizations
• How will these obligations be audited and what reports will be made and to whom?
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
126
Part IV: Trouble shooting and Writing a Personal Philosophy of Supervision
Chapter 14 - Troubleshooting and Pragmatics in the Relational Training System
• Comprehensive Written Supervision Contract
• Provides structure to a relationship with a high degree of uncertainty
• Should be arrived at collaboratively and reviewed and signed by all parties
• Documentation Packages
• Mechanisms and criteria of evaluation should be agreed upon at beginning of supervision
• Supervision process notes
• Periodic evaluative and planning summaries
• Review and modification of supervision goals
• Final evaluative summary
• Evaluative Process and Its Consequences
• Range of consequences for negative evaluation
• Performance Improvement Plans
• Immediate termination with notification of appropriate authorities
• Supervision contracts may include specific clauses related to notification of others of premature
termination
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
127
Part IV: Trouble shooting and Writing a Personal Philosophy of Supervision
Chapter 14 - Troubleshooting and Pragmatics in the Relational Training System
• Addressing Difficulties
• Serious, immediate concerns must be quickly and clearly addressed
• Barriers to supervisory efficacy require a maintenance structure
• Important to think about own parts in difficulties
• Barriers can begin at any level of the training system and flow up and down
• Sensitive supervisors respond to both positive and negative ripples in the training
system
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
128
Part IV: Trouble shooting and Writing a Personal Philosophy of Supervision
Chapter 14 - Troubleshooting and Pragmatics in the Relational Training System
• Troubleshooting the Nuclear Subsystem:
Supervisor ↔Trainees↔ Clients
• The training system must have the capacity to observe itself (emphasis on system)
• Supervisors and trainees must agree that something is a potential barrier, then agree
that it is important enough to change
• Barrier must be made observable and auditable by both parties, and goals should consist of a
positive presentation
• Both parties must agree on methods of auditing and change that are realistic, focused on here
and now, and under their control
• Parties should agree to evidence indicating they are on the right track, document necessary
data, and explore all reciprocities
• Both parties should agree on a deadline for meeting performance goal or revisiting plan
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
129
Part IV: Trouble shooting and Writing a Personal Philosophy of Supervision
Chapter 14 - Troubleshooting and Pragmatics in the Relational Training System
• Conflict is often a result of perceptions of incompatible goals, scarce resources,
and/or interference in reaching certain goals
• Trainees identify conflict when supervisors are not invested in process or trainee,
are unwilling to own responsibility in difficulties, or are angry; when there is too
much work with too little supervision or power struggles
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
130
Part IV: Trouble shooting and Writing a Personal Philosophy of Supervision
Chapter 14 - Troubleshooting and Pragmatics in the Relational Training System
• Pragmatics: Facilitating Effective Supervision
• Dealing With Impasses
• Think systemically and recognize isomorphism
• Use a developmental model of training
• Unaddressed Issues
• Ignoring the elephant (systemic dynamics) in the room
• Systemic reciprocity may maintain barriers
• Must be a system-wide alertness for unaddressed issues resulting in insight-provoking questions
in a safe-enough environment
• Sexual attraction
• Ubiquitous and often not addressed well in training settings
• Must be proactive in discussions with trainees
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
131
Part IV: Trouble shooting and Writing a Personal Philosophy of Supervision
Chapter 14 - Troubleshooting and Pragmatics in the Relational Training System
• Solution-focused approaches are valuable for any supervisor as they
instill hope and a sense of wellbeing, empowerment, and direction
• Emergencies
• Prepare before an emergency occurs
• Create a checklist and assessment plan
• Allows for appropriate action when anxiety or stress is high
• Provides appropriate documentation for legal purposes
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
132
Part IV: Trouble shooting and Writing a Personal Philosophy of Supervision
Chapter 14 - Troubleshooting and Pragmatics in the Relational Training System
• Decisions about Handling Dysfunction or Deficiencies
•
•
•
•
•
Agree problem exists, limits professional efficacy, and has resisted attempts to fix
Invite individuals to co-create performance improvement plans
Agree to and document evidence of change and a time frame for reaching goals
Include language about due process
Potential consequences for inadequate or problematic behavior
• Increased supervision, decreased client load, decrease in certain kinds of clients,
coursework, therapy, and other potentially helpful measures
• Supervisors must be concerned only with barriers within clinical work
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
133
Part IV: Trouble shooting and Writing a Personal Philosophy of Supervision
Chapter 14 - Troubleshooting and Pragmatics in the Relational Training System
• Early Termination of Training Relationships
• Relationships must be terminated when trainees are so limited in cognitive,
affective, and/or behavioral flexibility that performance improvement plans are or
have been ineffectual
• Decision is best informed by a remediation plan; consultation with appropriate
neutral authority; and documentation specifying observable behaviors, probable
consequences, remedial interventions, and rationale for termination from training
or supervision
• Valuable to specify nonnegotiable prohibitions in training contracts
• Termination from supervision should occur when
• Individuals refuse to participate in developing or executing performance improvement
plans
• Performance improvement plans are not successful at removing significant barriers to
training and/or clinical ability, OR
• Individuals do not respect practice limitations, putting a segment of the clinical
population or training setting at risk
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
134
Chapter 15 - Developing the Personal Philosophy of
Supervision Paper
• AAMFT Approved Supervisor Designation Requirement
• Reflect on, consolidate and substantiate ideas to demonstrate familiarity with the
literature
• Meant to be highly personal including broad, philosophical ideas as well as specific
ideas
• AAMFT guidelines: 4 single-spaced pages or 1500 words exclusive of references or
appendices
• Content requirements: see rubric on page 187
• Process
•
•
•
•
•
Determine if a specific format is required by course instructor or supervision mentor
Choose a format and formulate ideas within each section
Keep case material to a minimum, using it briefly to illustrate ideas
Go back and forth from big picture to details
Maintain systemic perspective
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
135
Part IV: Trouble shooting and Writing a Personal Philosophy of Supervision
Chapter 15 - Developing Personal Philosophy of Supervision Paper
• Formats
• Use areas on rubric to organize the paper (page 187)
• Figley
• Description of personal supervision philosophy in summary form
• Demonstrated knowledge of current CFT supervision literature, which should be integrated
throughout the paper
• Demonstrated systemic orientation (e.g., describing supervision in relational terms and
context such as subsystem dynamics and isomorphism)
• Approach to therapy and how that informs approach to supervision in consistent and
congruent ways
• How contextual factors such as setting, trainee developmental level, family of origin, gender,
culture, and so forth are factored into philosophy
• Personal and professional influences on thinking
• A description of supervisory methods, namely the extent to which an informed systemic
approach guides preferences for individual and group supervision as well as live
observation, recordings, technology, and case consultation
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
136
Part IV: Trouble shooting and Writing a Personal Philosophy of Supervision
Chapter 15 - Developing Personal Philosophy of Supervision Paper
• Lee and Everett (2004)
• Supervisory roles and goals for both you and trainees, and therefore ground rules
for supervision
• Major CFT models that inform model
• Integration of models and approaches
• Developmental concerns – supervisor’s and trainees’
• Attention to contextual factors, personal and environmental (larger system
influences)
• Ethical and legal concerns
• Contractual and administrative concerns
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
137
Part IV: Trouble shooting and Writing a Personal Philosophy of Supervision
Chapter 15 - Developing Personal Philosophy of Supervision Paper
• Filling in the details
•
•
•
•
Visualize supervisory process step by step
Think about goals and roles
Incorporate personal experiences that guide philosophy
Consider idealized preferences versus reality
• Connecting therapy and supervision approaches
• Ratliff’s (2000) metaphor: cut flowers, potted plants, transplants, grafted plants, grown from seed integration
• Common mistakes to avoid
•
•
•
•
•
Omitting an area completely
Mentioning something, but not defining or explaining it
Not integrating systemic or contextual factors into other areas
Not including ideas about trainee development and isomorphism
Not integrating current literature throughout the paper or using citations accurately
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
138
Part IV: Trouble shooting and Writing a Personal Philosophy of Supervision
Chapter 15 - Developing Personal Philosophy of Supervision Paper
• Final Words
• Consider target audience (course instructor, supervision mentor, trainees,
supervisors)
• Use a clear outline of headings and subheadings
• Use proper grammar and punctuation
• Cite references throughout
• Follow instructor’s guidelines for formatting
Copyright Taylor & Francis. To be used with R. E. Lee, & T. S. Nelson (2013). The contemporary relational supervisor. New York: Routledge.
139