Clinical Supervision & Problem Gambling Counseling Loreen Rugle, Ph.D., NCGCII, BACC Program Director Program DirectorMDProblemgambling.com Problem Gambling Helpline Maryland Center of Excellence On Problem Gambling With deep appreciation to Joanna Franklin and David Powell

Clinical Supervision What are the goals of supervision? What are the goals of supervision? What are the similarities and differences between good supervision and good therapy? What are the similarities and differences between good supervision and good therapy?

Clinical Supervision Personal experiences with supervision: Personal experiences with supervision: How did you feel in your first supervision? How did you feel in your first supervision? Most Valuable? What made it valuable? Most Valuable? What made it valuable? Worst Experience? What made it difficult? Worst Experience? What made it difficult?

The Supervisory Process The Supervisory Process Establishment of a supportive, consultative relationship. Focus: Gambling Treatment. Establishment of a supportive, consultative relationship. Focus: Gambling Treatment. Establishment of a safe environment for learning and growth as a counselor Establishment of a safe environment for learning and growth as a counselor Clinical Supervision & Problem Gambling Counseling

The Supervisory Process The Supervisory Process Most direct level of responsibility is to the supervisee and ensuring this individual’s professional development. Most direct level of responsibility is to the supervisee and ensuring this individual’s professional development. Involved dual goals of education and evaluation Involved dual goals of education and evaluation Clinical Supervision & Problem Gambling Counseling

The Supervisory Process The Supervisory Process Obligation for the welfare and treatment of the client Obligation for the welfare and treatment of the client To ensure that no harm is done To ensure that no harm is done And that constructive, appropriate treatment is provided to the client And that constructive, appropriate treatment is provided to the client Lesser indirect obligations to the reputation and the effectiveness of either the institution or the profession Lesser indirect obligations to the reputation and the effectiveness of either the institution or the profession Clinical Supervision & Problem Gambling Counseling

Why Supervision Matters Raises standards of care Raises standards of care Keeps Current Keeps Current Provides Feedback Provides Feedback Reinforces Good Work Reinforces Good Work Mentors/trains Mentors/trains Assures Fidelity Assures Fidelity Helps Prevent Burnout Helps Prevent Burnout Increases Job Satisfaction/Retention Increases Job Satisfaction/Retention

Motivational Cycle Precontemplation Contemplation Action Maintenance Lapse or Relapse Planning Supervisor Therapist

Roadblocks to Good Supervision Roadblocks to Good Supervision Tries to just directly translate addiction treatment into gambling treatment Tries to just directly translate addiction treatment into gambling treatment “all addictions are the same, I’ve done addictions for years, how different can it be…” “all addictions are the same, I’ve done addictions for years, how different can it be…” Clinical Supervision & Problem Gambling Counseling

Supervision: Why Bother “You know one if you see one” --- Director of Substance Abuse Treatment Program, Detroit VA 11

What’s the Difference

Problem Gambling Counseling can Be a Lonely Business

Evidence Based Practices Require Ongoing Supervision

Ethics and Supervision Boundaries Confidentiality Incorrect treatment Incorrect diagnosis When in doubt be human

Roadblocks to Good Supervision Roadblocks to Good Supervision Unrealistic expectations: Counselors always “have it all together” Unrealistic expectations: Counselors always “have it all together” Can create an environment of denial Can create an environment of denial Cause counselors to hide problems Cause counselors to hide problems Prevent other team members from intervening Prevent other team members from intervening Clinical Supervision & Problem Gambling Counseling

Roadblocks to Good Supervision Roadblocks to Good Supervision “I should know it all” – less likely to ask questions, “I should know it all” – less likely to ask questions, Or ask for help Or ask for help When they do ask, they ask for answers When they do ask, they ask for answers Hide lack of knowledge Hide lack of knowledge Clinical Supervision & Problem Gambling Counseling

18 In the beginner's mind there are many possibilities, but in the expert's there are few. - Shunryu Suzuki 18

CAUTIONS CAUTIONS Counseling gambling clients is a stressful job Counseling gambling clients is a stressful job Higher caseloads, long hours, poor training and inadequate supervision are common challenges for today’s clinical staff and supervisors Higher caseloads, long hours, poor training and inadequate supervision are common challenges for today’s clinical staff and supervisors As demands increase and resources decrease the counselor is caught in the middle As demands increase and resources decrease the counselor is caught in the middle Dedicated counselors often put their needs on hold to meet the needs of their clients. Dedicated counselors often put their needs on hold to meet the needs of their clients. This eventually leads directly to………………………. Clinical Supervision & Problem Gambling Counseling

BURNOUT BURNOUT Many counselors believe they need to do it all, and manage excessive workloads. Many counselors believe they need to do it all, and manage excessive workloads. Warning signs of burnout are seen as lack of competence. Warning signs of burnout are seen as lack of competence. Proactive or prevention of burnout includes: Proactive or prevention of burnout includes:SUPERVISION Clinical Supervision & Problem Gambling Counseling

Developmental Models of Supervision Counseling supervisees pass through a series of identifiable, sequential hierarchical stages Counseling supervisees pass through a series of identifiable, sequential hierarchical stages Different supervisee needs exist across the different stages of development Different supervisee needs exist across the different stages of development Counseling supervisors should vary their supervision to match the needs of their supervisees. Counseling supervisors should vary their supervision to match the needs of their supervisees.

Developmental Process Knowledge Knowledge Skills Skills Theory Theory Awareness Awareness Understanding Understanding Analysis and Comparison Analysis and Comparison Synthesis and Integration Synthesis and Integration

Facilitating Reflective Thinking Reflective Thinking: Reflective Thinking: The active, ongoing examination of the theories, beliefs, and assumptions that contribute to counselors’ understanding of client issues and guide their choices for clinical interventions. The practice through which counselors continually examine the therapeutic process in increasing levels of complex understanding and evaluation

Facilitating Reflective Thinking Reflective Thinking: Reflective Thinking: Thoughtful reflective processing occurs when the counselor is: 1. Actively attending to information received from the client 2. Applying theoretical knowledge to the situation 3. Deciding on optimal interventions

We all have our blind spots Supervision helps see the bigger picture

28 Oriented to Change Oriented to Acceptance Unwavering Centeredness Benevolent Demandingness NurturingCompassionate Flexibility Linehan, 1993

As supervision improves so does Job satisfaction

Creating Environment for Growth What environment is most likely to facilitate growth and change? What environment is most likely to facilitate growth and change?

32 Supervisory Perspective To be or to do? To be or to do? Mirror principle Mirror principle A healing relationship begins with the therapist’s (and supervisor’s) healthy relationship with him/herself A healing relationship begins with the therapist’s (and supervisor’s) healthy relationship with him/herself Self-Awareness Self-Awareness Reflection on one’s motivation Reflection on one’s motivation Reflection on one’s belief system Reflection on one’s belief system Reflection on one’s limits Reflection on one’s limits Reflection on the role of spirituality in one’s life and work Reflection on the role of spirituality in one’s life and work Self-Acceptance Self-Acceptance

33 Supervisory Mindfulness Skills Acceptance Acceptance Nonjudgmental Nonjudgmental Observant (self and others) Observant (self and others) Reflective Listening Reflective Listening Awareness (self and others) Awareness (self and others) Relaxed alertness Relaxed alertness Understanding Understanding Compassionate communication Compassionate communication

34 Supervisory Mindfulness Skills Persistence Persistence Patience Patience Belief in efficacy of supervision Belief in efficacy of supervision Mindful risk taking Mindful risk taking

Thank You