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Supervision Models Part I: How We Support and Care for Clinical Staff Bart Andrews, PhD CAPA Training Institute June 23, 2014.

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Presentation on theme: "Supervision Models Part I: How We Support and Care for Clinical Staff Bart Andrews, PhD CAPA Training Institute June 23, 2014."— Presentation transcript:

1 Supervision Models Part I: How We Support and Care for Clinical Staff Bart Andrews, PhD CAPA Training Institute June 23, 2014

2 Developmental Models There are 3 stages of supervisor and supervisee development: –Stage 1- Naïve Enthusiasm –Stage 2- Trials and Tribulations –Stage 3- Calm after the Storm Lets take a look at how these stages apply to my preparation.

3 Naïve Enthusiasm

4 Trials and Tribulations

5 Calm after Storm

6 Credit Where Credit Due “Powell is the man!”- David Patterson, June 17, 2014 BTW-why are there so many awesome Davids?

7 Understanding Change 30% of change is related to quality of relationship between client and counselor and/or counselor and supervisor 40% from extratherapeutic factors 15% is derived from hope/expectancy 15% specific to therapeutic technique

8 Relationship Drives EVERYTHING Better Clinical Supervision = Greater Job Satisfaction Better Clinical Supervision = Better Retention Better Clinical Supervision = Better Clinical Outcomes “...counselors view their supervisors as a primary resource for education, training, coaching, morale building and consultation,” (Powell and Brodsky, 2004).

9 The 4 ‘A’s’ of Supervision Available Accessible Able Affable Good supervision is largely a matter of caring for staff and mutually beneficial interdependency

10 Care Experiences What care have you received from a supervisor? What has a supervisor said (or not said) that has had the biggest impact on you? What has a supervisor done (or not done) that has had the biggest impact on you?

11 So What is a Model of Supervision?

12 Philosophy Continuum Insight: Process, Goals, Traits Experimentation Exploration Discovery Interpretation Self Development Life Enrichment Self Awareness Facilitative Client Driven Skill: Processes, Goals, Traits Acquiring new behaviors Action is the catalyst Problem resolution Symptom relief Skill development Problem oriented Directive Therapist Driven

13 9 Descriptive Dimensions Influential: Affective Vs Cognitive Symbolic:Latent Vs Manifest Structural:Reactive Vs Proactive Replicative:Parallel Vs Discrete Counselor TX:Related Vs Unrelated Information Gathering:Indirect Vs Direct Jurisdictional:Therapist Vs Supervisor Relationship:Facilitative Vs Hierarchical Strategy:Theory Vs Technique STAGES OF DEVELOPMENT ALWAYS RELEVANT

14 Psychodynamic Model Focus on the intrapersonal and interpersonal dynamics of the counselor in relation to ALL others Dynamic Awareness Goal: understanding dynamic contingencies: –Impact of past learning on current situations –Observing changes in the dynamic –Making therapeutic use of dynamic in counseling Goal is to refine supervisee’s mode of listening –Increase sensitivity to transference and countertransference –Awareness of drives and defense mechanisms

15 Assumptions Similarities in structure and dynamics of therapy and supervision- ISOMORPHIC RELATIONSHIPS Parallel processes between relationships Supervisor interprets this dynamic What is said and done is just the surface

16 Supervisor Kkills(sorry, Freudian slip) I meant Skills Listening Musing Suspension of judgment Tolerance for ambiguity Rejection of illusion Think confession for therapists!

17 Developmental Stages Childhood –Space to play, home base –Bonding –Demarcating space Adolescence –Structure building –Work and play-experimentation –Conflict Adult –Internalized values –Identity settles –Transition to colleague

18 Descriptive Dimensions- Psychodynamic Influential: Affective Symbolic:Latent Structural:Reactive Replicative:Parallel Counselor TX:Related Information Gathering:Indirect+ Jurisdictional:Therapist+ Relationship:Facilitative Strategy:Theory+

19 Skills Model 3 Basic Tenets 1)Counselors must learn the appropriate skills and extinguish inappropriate behaviors 2)Supervision assists counselors in developing and assimilating specific skills 3)Counselor knowledge and skills should be formulated in behavioral terms

20 9 Methods of Skill Supervision 1.Establishing a Relationship between supervisee and supervisor is a dynamic component of the learning process –Focus is on skill acquisition via instruction and modelling 2.Supervision begins by asking what one needs to lean to be an effective counselor –Current skill level? What skills are needed? Task list? 3.Set realistic, measurable and timely goals to enhance motivation –Is this reminding anyone of SMART goals and MI?

21 Methods Continued 4.Modeling and reinforcement are basic tools –Two way modeling: supervisor to supervisee and back again 5.Skills monitoring is ongoing

22 6.Role Playing and Simulation 7.Microtraining-breaking down skills into small steps –Simulated session that is video taped –Supervisor provides feedback and re-demonstrates on tape 8.Other Techniques are added –Self management –Overt and covert stimulus control –Relaxation Training 9.Generalization of Skills –In what other situations might you use... Methods Continued

23 Task Oriented Model

24 Taking Supervision to Task Drawn from behavioral and computer science models Behavioral variables are manipulated to influence outcome of supervision By reinforcing the variables of counselor behavior, supervisor can train more effective counselors Not specific to any theoretical models Tasks and reinforcement/shaping can be applied to specific skills for whatever model or technique an agency is using

25 Direct Observation Direct viewing of work is key Modeling, feedback and programmed interventions Using live material for supervision

26 Hierarchical System/3 Levels/Parallel Activity Client level 1.Client database-what is going on with me 2.Client comes with set of hopes/goals 3.Make goals overt 4.Establish treatment plan 5.Put treatment in place 6.Goals met 7.Termination

27 Counselor Level 1.Preparation 2.Establish client data base/evaluation-what is going on with client 3.Determine goals 4.Develop treatment plans 5.Carry out treatment plans 6.Evaluate progress 7.Goals met 8.Termination procedures

28 Supervisor Level 1.Supervisor and Client Database-what is going on with them? A.Supervisor preparation task B.Determine supervisee’s preparation task 2.Determine Supervision goals 3.Supervision Plan A.Determine Assessment Procedures B.Determine Observation Procedures C.Present Supervision Plan 4.Observe Therapist A.Observe Delivery B.Observe Impact 5.Evaluate and Intervene A.Case file and assessment results B.Interview with Counselor 6.Determining Counselor Progress A.Update counselor database B.Determine need for additional training/supervision 7.End Supervision

29 Developmental Stages-Skills Apprentice –Motivated –Inwardly insecure/anxious –Eager to please Journeyman –Demonstrates some skill –Some challenging behavior –Starting to generalize Expert –Able to generalize across contexts –Mastered technical skills –Integrated personal model of therapy

30 Descriptive Dimensions-Skills Influential: Cognitive Symbolic:Manifest Structural:Proactive Replicative:Discrete Counselor TX:Unrelated Information Gathering:Direct Jurisdictional:Supervisor Relationship:Hierarchical Strategy:Technique

31 Descriptive Dimensions, Really? DynamicSkill Influential: AffectiveCognitive Symbolic:LatentManifest Structural:ReactiveProactive Replicative:ParallelDiscrete Counselor TX:RelatedUnrelated Information Gathering:Indirect+Direct Jurisdictional:Therapist+Supervisor Relationship:FacilitativeHierarchical Strategy:Theory+Technique

32 What’s Next: Blended Model Blended Model acknowledges that substance use providers need their own model Also called contemplative because it includes spiritual and faith based elements Recognizes that successful supervision BLENDS both insight and skill based models Philosophical model is evidence based AND consistent with substance use professionals training and agency goals COMING SOON TO A CAPA NEAR YOU

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