Fundamentals of MFT Supervision Ontario Association for Marriage and Family Therapy Toronto, ON June 12, 2019 (Day 1) Jeff Chang, Ph.D., R.Psych. Athabasca University & Calgary Family Therapy Centre jeffc@athabascau.ca

Relational Positions Professional mentor: Providing advice and support about: Further graduate education or continuing education Self-care and workload management Research vs. practitioner track Starting or enhancing a private practice Work-life balance

Vignette Dr. Kennedy, an MFT, had supervised Lana, a licensed counsellor, for eight years. Dr. Kennedy had supervised Lana as a licensure intern, and was her administrative supervisor at the family service agency where they both worked. Although they were still required to review cases, the vast majority of the time, Dr. Kennedy found that Lana’s clinical work was excellent, and Dr. Kennedy’s ideas were mostly enhancements of sound treatment plans that Lana developed on her own….

Vignette … Lately, the conversation had turned to Lana’s desire to return to school for a doctorate. They discussed what discipline (psychology, counselor education, or MFT) would provide the best fit for Lana, whether she wanted to seek a leadership position or an academic one after the completion of her degree, and various options of how she would balance family, work, and school.

Relational Positions Professional mentor: Discussion question: How does mentoring about issues broader than skills and techniques shift the supervisory relationship?

Relational Positions Advocate/system change agent: Advocating for policies, organizational structures, and clinical practices, etc., that make the delivery of services more effective.

Vignette Craig was contracted by a children’s mental health agency to provide clinical supervision to licensure interns and licensed clinicians. He found that, to a person, they felt overwhelmed with paper work and case management demands that they did not feel were useful. They were either working overtime (unpaid) to keep up, or dropping necessary documentation, thus exposing the agency to liability…

Vignette … Craig carefully worked his way into to position of trust with both the clinical staff and the senior management of the agency. He suggested some modest changes to reduce the duplication of forms, some small tokens of appreciation the agency could make to improve staff morale. He also explained to the clinical staff how documentation would help treatment consistency and were legally and ethically necessary.

Theory of Change Supervisor and supervisee must the clear about: Orienting question: “Is there a clash of ideas, or an ecology of ideas?” Supervisor and supervisee must the clear about: How clients change in counselling How supervisees change in supervision Not just counselling theory, but implicit beliefs and world view Almost all the time, the supervisor’s view is better elaborated than the supervisee’s view

Theory of Change The supervisor’s primary model of therapy will always “leak out.” Gregory Bateson: “Your epistemological slip is always showing” Not indoctrination, but clarification and deconstruction When theories are too divergent… The limits of competence Discussion question: What is the philosophy of your setting/you when it comes to theory of client change? Do you take a position of teaching or assimilating a supervisee’s theoretical approach, or accommodating it?

Vignette Lenora, a MFT master’s student, was quite taken with emotionally focused therapy (EFT), but became quite worried when she ended up being supervised by Consuelo, who was well-known for practicing narrative therapy. Lenora privately confided to a fellow student her worry that “narrative would be shoved down my throat.” Consuelo, who had an adequate understanding of EFT, invited Lenora to think in a way that was consistent with EFT’s assumptions and practice….

Vignette … to be “the best emotionally focused therapist you can be.” In supervision, Consuelo asked Lenora about “what EFT would guide you to do” in specific situations. She also invited to Lenora to deconstruct the discourses behind EFT’s assumptions. When Lenora was stuck and asked for help, Consuelo would often take a one-down position, apologizing for “only being able to think in narrative” before suggesting ideas. By the end of the school year, Lenora noted that Consuelo’s approach helped her to “really understand EFT and opened my eyes up to narrative.”

Therapist-Client- Supervisor System Orienting question: “What are the relational patterns affecting the supervision process? Larger context: agency, environment “Parallel process”: material from the therapeutic relationship replicates itself in supervision, thought to occur when the training analyst unconsciously identified with the patient and reenacts the patient's defensive behavior in supervision. “isomorphism” is a systemic reworking of the notion of parallel process, used mainly by family systems therapists: how family dynamics affect the therapy process

Therapist-Client- Supervisor System Isomorphism as an interventive stance: Liddle (1988). Isomorphic sequences are opportunities for intervention; supervisee can alter the sequence in supervision with the goal of altering the supervisee's in-session behavior accordingly.

Phase of Counsellor Development Orienting question: “Where is the supervisee in the journey? What are the supervisee’s developmental needs?” Themes and stages of counsellor development (Skovholt & Rønnestad, 1995; Rønnestad & Skovholt, 2003; see also see Goodyear, Wertheimer, Cypers, & Rosemond, Michelle, 2003). Eight dimensions: time period central task

Phase of Counsellor Development predominant affect sources of influence role and working style conceptual ideas learning process measures of effectiveness and satisfaction … Manifested differently in six distinct stages of counsellors’ careers.

Vignette Kendrick had been a licensed MFT for 24 years, and was employed by a family service agency. He had the idea that there was “nothing new under the sun” in the world of therapy. He had seen many trends and “flavors of the month” come and go since he entered graduate school almost 30 years earlier. In the last few years, Kendrick had reignited a passion for theatre – he had been in several high school and college productions -- and for the past three years was acting in community theatre….

Vignette … His studies of characters in plays in which he acted was melding with his clinical experience, and inviting him to think about his work in new ways. He frequently spoke in case review meetings about how a character he was getting ready to play helped him understand a particular client. His clinical director, Dr. Cohen, was a midcareer psychologist who practiced CBT, and initially did not understand where Kendrick was “coming from,” but knew Kendrick to be a sound, if somewhat unorthodox, therapist. Dr. Cohen listened carefully in case reviews, and was able to support Kendrick’s new direction in his clinical work.

Phase of Counsellor Development Meet in groups of three or four. Think of yourself at three stages in your work life: Upon completion of a practicum (graduate if relevant) Today Half-way in between Compare and contrast what you would have ideally desired from a supervisor at each of these times in your work like.

The Business of Supervision Supervision in private practice: Stand-alone supervision: JC/TM model Office-based supervision Offered as part of the practice organization. Provisionals vs. students Supervision in agencies Investing time to maximize services

Potentials Real world relevance Systemic: considers the context of which service delivery and supervision, culture, and the interactional patterns in which the client, counsellor, and supervisor participate Orienting and organizing supervision efforts -- remind supervisors to attend to, and weigh, multiple aspects of supervision at one time we have to walk, chew gum, breathe, look where we’re going, talk to the person we’re out walking with, and smell the flowers at the same time.

Potentials Transtheoretical and cross-disciplinary applicability Supervision as career-long process To clarify relationships of accountability, and thus provide a protective factor from inappropriate dual relationships and other ethical issues

Further Development Further feedback and conceptual development Piloting a training curriculum for supervisors (our program and interested community agencies) Evaluation of training Partnerships for research and conceptual development