1. Supervision of Mental Health Counseling Interns
On line training for field supervisors
Clinical Mental Health Counseling Program
Fall 08

2. Reflections on supervisory experiences
Answer the following questions for yourself about your own supervision experiences

3. Your Supervision Experiences
What kind of supervision did you get:
As an intern
As a beginning counselor
What was most helpful or least helpful
What do you do that is the same as your supervisor
What do you do that is different

4. Definitions of supervision at your work place
What is your understanding of the supervisory relationship
Is supervision expected to be clinical, administrative or both
How well prepared do you feel to fulfill this role (roles)

5. Why we need training
Supervision skills similar but not identical to counseling skills
Supervising without training gives message that “any good counselor will be good supervisor”
Supervisory training provides supervisor with framework to conduct and evaluate effectiveness of the supervision

6. Definition of Clinical Supervision
(Bernard and Goodyear, 2004)
An intervention provided by a more senior member of a profession to a more junior member or members of that same profession

7. Definition cont. Relationship is: evaluative extends over time
Simultaneous purposes of:
enhancing professional functioning
monitoring quality
gate keeping for the profession

8. How do you rate your skills
Evaluation of supervisees
Enhancement of supervisees skills
Monitoring of supervisees counseling relationships
Preventing incompetent, unethical or harmful counselors from practicing
Safeguarding well being of client

9. Basic elements of supervisor competence
Understand the roles and functions of a supervisor
Organize the supervisory experience
Be aware of the ethical and legal considerations in the relationship
Have a working model of supervisory process and work within that model to develop effective supervisory relationship

10. Roles and Functions of the Supervisor
Supervisor as teacher
evaluate observed counseling session interactions
Identify effective and ineffective interventions
Teach demonstrate or model intervention techniques
Explain rationale behind specific strategies
Interpret significant events in counseling sessions

11. Roles and Functions
Identify issues of class, culture and ethnicity in counseling session
Educate and provide resources for supervisee to learn about effects of class, culture, etc in counseling relationships
Model awareness and sensitivity to these issues in supervision

12. Roles and Functions Supervisor as Counselor
Explore supervisee’s feelings during counseling or supervision session
Explore supervisee’s feelings about specific techniques and interventions
Facilitate supervisee’s self exploration of confidence or concerns in sessions
Help supervisee define personal growth areas
Provide opportunities for supervisees to process own affect or defenses

13. Roles and Functions
Help supervisee identify his/her values base, cultural background and social awareness
Explore the possible effect of these on supervisee’s counseling style and effectiveness

14. Roles and Functions Supervisor as Consultant
Provide alternative interventions and/or conceptualizations for trainee use
Encourage brainstorming of strategies and interventions
Encourage discussion of client problems, motivations, etc
Solicit feedback from supervisee as to effectiveness of session
Ask supervisee to structure the session
(Bernard and Goodyear, 2004)

15. Roles and Functions Supervisor as evaluator
Provide regular and systematic feedback and evaluation
Provide information to graduate school programs, prospective employers, licensing boards and professional associations
Provide references when requested by licensing board or another agency

16. Roles and Functions Supervisor as Administrator
Monitor supervisees’ adherence to policies and procedures of the agency
Monitor legal and ethical matters and documentation of client sessions
Help supervisee navigate bureaucracies
Monitor supervisees’ adherence to reporting laws
Monitor confidentiality of records

17. Roles and functions case study
A client arrived for her appointment wearing a distinctive coat. The therapist remarked on its bright and beautiful colors. At the end of the day, the therapist returned home to find a box with an identical coat on her doorstep. The note said the client had made a big effort to find the identical coat as a way to say thank you for all the help she had received.

18. Roles and functions case study
The clinician is your supervisee. She states that when trying to return the gift to the client, the client became distraught and said it felt like a rejection of her. The client asked the therapist to keep the coat at least until the next session and if the therapist still wanted to give it back, she would take it. The client stated that she could not return the coat because it was on sale.

19. Roles and Functions Case Study
What are the main issues in this situation
What supervisory roles will be most useful to you in addressing these issues
How do you see yourself structuring the feedback you will give
What personal concerns may be raised for you by this situation
(Fall and Sutton, 2004)

20. Models of Supervision Three main types of supervision models:
Psychotherapy based models
Developmental models
Social Role models

21. Models Psychotherapy based models
Based on the use of specific theories of psychotherapy.
Putney, Worthington, and McCullough (1992) concluded that style or role of the supervisor is influenced by the supervisor's theoretical orientation in these models

22. Models Developmental models Two basic underlying assumptions:
(a) Student counselor/supervisee moves toward competence in a series of stages
(b) each student counselor/supervisee's developmental stage requires qualitatively different supervision environment if most favorable professional growth is to occur
(Chagnon & Russell, 1995).

23. Models Social role models
Focus on roles that supervisors engage in during supervision.
Primary range of roles includes:
administrator
counselor
consultant
evaluator
teacher
(Bernard, 1979; Carroll, 1996; Holloway, 1995; Williams, 1995).

24. Stoltenberg’s Developmental Model
Views training process as sequence of identifiable stages through which trainee progresses
Provides a conceptual framework for supervisor and supervisee

25. Stoltenberg’s model Four Stages of Development : Dependent
Dependent-autonomous
Conditional dependency
Integrated

26. Dependent Stage Supervisee: Lacks confidence
Needs support and direction
Needs opportunity to explore
Feelings and become more self aware
May be anxious about performance and evaluation

27. Dependent-autonomous stage
Supervisee:
Moves away from imitating supervisor and initiates new behaviors
May become overconfident or overwhelmed
Level of motivation may fluctuate
May express stress due to lack of confidence and wanting to appear competent

28. Conditional Dependency
Supervisee:
Checks in with supervisor if she/he runs into difficulty
Strong clinical skills
Establishes personal style and uses multiple approaches
May depend on supervisor as peer or colleague

29. Integrated stage Supervisee: Capable of independent practice
Aware of personal limitations
Interested in process of counseling
Comfortable with interdependent/collaborative approach
Seeks peer supervision

30. Bernard’s Discrimination Model
Three basic roles for supervisors:
Teacher
Counselor
Evaluator
Four main foci for supervision:
Intervention
Conceptualization
Personalization
Professional Behaviors

31. Teacher role
Determine what is critical for the student counselors/supervisees to learn
Give information, instruction, and guidance
Evaluate student counselors/supervisees
Give regular verbal and written feedback of strengths and areas for growth.

32. Counselor role
Help student counselors/supervisees focus on interpersonal and intrapersonal interactions.
Especially important when helping student counselors/supervisees conduct a self-evaluation

33. Consultant role
Student counselor/supervisee and supervisor relate as colleagues
Exchange ideas about interventions, goals, and treatment plans.

34. The four foci Intervention focuses on: Conceptualization focuses on:
What the supervisee is doing in the session
that is observable by the supervisor
Conceptualization focuses on:
How the supervisee understands what is happening in the session
Personalization focuses on:
Supervisee’s style and ability to mange transference and countertransference

35. Interaction of role and focus
When determining what role will be prominent at any one time during supervision, it is helpful to consider the purpose, or goal, of the role and how it fits with the focus of the supervision at that point

36. Supervisor behavior In any given situation, the supervisor is:
Assessing supervisee’s developmental stage
Assessing need for a particular focus
choosing an appropriate role to address that focus
Making an intervention around a particular focus using skills appropriate to the chosen role

37. Case studies - the Developmental and Discrimination Models
Identify the role the counselor plays
The main focus discussed in the vignette
Your assessment of the development stage or stages that would fit well with the supervisor’s approach
How effective you think this supervisor’s approach is
How would you change what they’re doing

38. Case 1
Dr. Snyder believes her role as a supervisor is to provide monitoring and direction for her supervisees. She keeps a close watch on them as she wants to make sure they are not being given too much responsibility. She puts a lot of time and energy into her supervisees. Her supervisees benefit from seeing her work but not from doing the work themselves and many do not feel confident about their clinical work

39. Case 2
Mr. Lee meets weekly with his supervisees and has clearly defined goals for supervision. He gives feedback on a regular basis and has a reputation for being direct. Mr. Lee is a highly skilled clinician and often gives advice about how to work with clients.

40. Case 3
Ms. Adams sees supervisees as junior colleagues who should be functioning independently. She learned through the “sink” or “swim” method and that worked well for her, so she sees no reason that it won’t work well for her supervisees.

41. Common questions in supervision
What to do:
When there is conflict
When your supervisee is not prepared for supervision
When your supervisee fails to follow policies or supervisor recommendations
When your supervisee is attracted to a client
When you are attracted to a supervisee

42. Major Legal and Ethical Issues in Supervision
1. Due Process.
2. Informed Consents.
3. Dual Relationships.
4. Competencies
5. Confidentiality

43. Due Process
A legal term for a procedure that ensures that “notice and hearing must be given before an important right is taken away”.

44. Due Process Substantive due process
States that criteria and procedures that govern training programs MUST be applied consistently and fairly.

45. Due Process Procedural due process:
Student or supervisee must be appraised of academic and performance requirements and program regulations
Receive notice of any deficiencies
Be evaluated regularly
Have the opportunity to be heard if their deficiencies have led to a change in status

46. Case Study
Hannah is in a master’s program in mental health counseling. She has completed 10 courses in the program and is currently in practicum. Hannah has received a great deal of formative feedback throughout the practicum indicating that she had many areas that needed improvement. At the conclusion of the practicum, Hannah’s instructor a assigns Hannah a grade of F for the course. At this time, Hannah is informed that a failing grade in the practicum is grounds for dismissal from the program. Hannah is told that she may retake the practicum one time, but that the faculty is not optimistic that she will improve enough to receive a B or better, a condition for her continuing in the program. Although Hannah knew that she was not doing as well in the practicum as some others, she had no awareness that she was in danger of being terminated from the program until the final evaluation. It is likely that Hannah will take the advice of the faculty and will discontinue the training program at this time.

47. Case Study Have Hannah’s due process rights been protected?
How vulnerable is her practicum instructor and the program if she should decide to challenge their decision?
Even if Hannah does not appeal, what are the potential systemic implications of such a process?
Even though there is no ill will evident in the action of the faculty and no indication that their decision was capricious or arbitrary, did the process that they followed adequately protect the student and was it legally defensible?

48. Informed Consent
A concept handed down from the medical profession that states that all patients must be informed of any risks that a recommended treatment carries and also be advised of the alternative treatments available

49. Informed Consent Supervisors have three levels of responsibility:
To determine that clients have been informed by the supervisee of the parameters of treatment
Ascertain that clients are aware of parameters of supervision that will effect them
To provide informed consent for supervisee concerning his/her rights , expectations and responsibilities

50. Informed consent with supervisees
It is essential that supervisees understand and agree to the procedures of supervision
BEFORE it begins and at any time when it requires a change.

51. Informed Consent Types of information that trainees need are:
Choices of supervisor
The form of supervision
The time that will be allotted for supervision.

52. Informed Consent The expectations of the supervisor.
The type of documentation that the supervisor requires

53. Case Study
Latoya is in her pre-doctoral internship, working with substance abusing clients. In supervision she shares that one client in particular has been “getting to her” most likely because some of the client’s situation is so similar to Latoya’s past. Latoya’s supervisor immediately suggests that Latoya receive counseling regarding this issue. When Latoya says that she believes her past therapy was sufficient and that she would prefer to view the situation as a supervision one, her supervisor states that she will only continue to work with Latoya if she commits to counseling.

54. Case Study
Pauline is in her first month of employment at a residential center for alcoholic mothers. Most of her assignments have been what she considers “babysitting,” rather than any serious work with her charges. When she talks to her supervisor about this, she is informed that she will not be assigned a case load for the first 6 months and only then if she is perceived as “ready.” This is news to Pauline. She is frustrated because she turned down another job where she could have begun to work with kids immediately. Pauline is upset further because her husband has been notified by his firm that he will be transferred in 9 months to another location. Had Pauline known the conditions of her present position, she would not have accepted the job.

55. Case Study In each situation:
How egregious is the violation of the supervisees right to informed consent?
To what extent do institutional materials cover issues of informed consent for staff?
How might each situation have been handled to better address the rights of the supervisee?

56. Informed consents for Supervisors
Supervisors must also be afforded informed consent.
Need to be fully aware of the heavy responsibility, accountability and possible culpability involved in supervision.

57. Dual Relationships
Ethical standards for all MH disciplines strongly advise that dual relationships between therapist and clients be avoided.
It is the responsibility of the supervisor to be sure that supervisees understand the definition of dual relationships and avoid all such relations.

58. Dual Relationships
Defined as any relationships in addition to the professional one.
Dual relationships between supervisors and supervisees can be difficult to define and correct

59. Dual Relationships
Problematic dual relationships between supervisors and supervisees include:
Intimate relationships
Therapeutic relationships
Work relationships
Social relationships

60. Boundaries in Supervision
Boundary transgressions by trainees and beginning counselors are the second most common type of transgression
Second only to violations of confidentiality
These two categories account for 47% of all complaints made to monitoring bodies.

61. Boundary Issues
The best way to address ethical transgressions is preventive education and honest discussions between supervisors and supervisees on not only the possibility but also the probability of occasional sexual attraction to clients, supervisees and supervisors.

62. Boundary Issues
It is supervisors responsibility to raise questions on topic on a regular basis or be sure it is on the agenda for all supervision sessions.
Supervisors’ openness is vital in assisting supervisees manage intense feelings.

63. Supervisor competence
Attending to the best interest of the client and the supervisee simultaneously is the greatest clinical and ethical challenge of supervision.
Monitoring supervisee competence begins with the assumption that the supervisor is a knowledgeable clinician.

64. Supervision Competencies
Knowledge:
Of area being supervised
Of models, theories, modalities and research on supervision
Of professional development (how therapists develop)
Of ethics and legal issues specific to supervision

65. Supervision Competencies
Knowledge:
of assessment process
awareness and knowledge of diversity and its affects
Skills:
supervision modalities
relationship skills
sensitivity to multiple roles with supervisee

66. Supervision Competencies
Ability to provide effective formative and summative feedback
Ability to promote growth and self-assessment in trainees
Ability to conduct own self-assessment process
Ability to assess the learning needs and developmental level of the supervisee

67. Supervision Competencies
Ability to encourage and use evaluative feedback from the trainee
Teaching and didactic skills
Ability to set appropriate boundaries
Ability to seek consultation when supervisory issues are outside the domain of supervisory competence
Flexibility
Scientific thinking and the translation of scientific findings to practice throughout professional development

68. Supervision Competencies
Values
Responsibility for client and supervisee rests with the supervisor
Respectful
Responsible for sensitivity to diversity in all its forms
Balance between support and challenging
Empowering

69. Supervision Competencies
Social Context
Diversity
Ethical and legal issues
Developmental process
Knowledge of the immediate system in which supervision takes place
Awareness of the social/political context in which supervision takes place

70. Confidentiality in Supervision
Dimensions of confidentiality that the supervisor must safeguard:
The supervisee must keep confidential all client information except for the purposes of supervision.
The supervisee must also be informed that any discussions that take place IN supervision are also confidential.

71. Confidentiality
The supervisee has a right to privacy—
Supervisees must understand what will happen to information that they divulge in supervision.

72. The Supervisory Relationship
Goals
Tasks
Bonds

73. Working Alliance
Working Alliance
Goals
Tasks
Bonds