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Clinical Supervision: A Competency-based Approach Based on Dr. Carol Falender’s January 2011 presentation to the VA Psychology Training Council Powerpoint.

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Presentation on theme: "Clinical Supervision: A Competency-based Approach Based on Dr. Carol Falender’s January 2011 presentation to the VA Psychology Training Council Powerpoint."— Presentation transcript:

1 Clinical Supervision: A Competency-based Approach Based on Dr. Carol Falender’s January 2011 presentation to the VA Psychology Training Council Powerpoint summary by Evelyn Sandeen, Ph.D., ABPP

2 Why do clinical supervision? Supervision is required for obtaining a degree and obtaining licensure Greater staff retention among clinicians who do supervision Less burnout among clinicians who do supervision Some research beginning to show positive impact of supervision on client outcomes (Bambling et al., 2006; Callahan et al., 2009)

3 Definition of Clinical Supervision Distinct professional activity Involves intention to develop science- informed practice in the trainee Collaborative, interpersonal process Involves observation (live, video, or audio) Involves feedback Facilitates trainee self-assessment

4 Definition, continued Facilitates the acquisition of knowledge and skills by – Instruction – Modeling – Collaborative problem-solving

5 Super-ordinate Values embedded in Clinical Supervision Integrity in relationships Ethical values-based practice Science-informed, evidence-based practice Appreciation of diversity – Diversity of client, of supervisee, and of supervisor

6 Pillars of Supervision Supervisory relationship alliance – Collaborative relationship – Respect essential – Transparency always desirable – Feedback—frequent and often-- essential Educational praxis – Tailoring learning strategies to the individual supervisee

7 Supervision vs. … Consultation – Consultation does not include the power differential that supervision does – Consultation does not bring the liability issues for the supervisor that supervision does Psychotherapy – Some techniques may overlap but domain of interest is starkly different Mentoring – Advocacy vs. evaluation

8 Definition of Competence Definition of competence in medicine: the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflections in daily practice for the benefit of the individual and community being served (Epstein & Hundert, 2002)

9 Definition of Competence APA definition: Performing tasks consistent with one’s professional qualifications, sensitive to individual and cultural differences, and anchored to evidence-based practice Competency Benchmarks in Professional Psychology (available on APA website)

10 Self-Evaluation and Meta-competence Self-rated competency is inversely related to other-rated competency (Kruger & Dunning, 1999; Dunning et al., 2003) The more fine-grained the self-assessment, the better the validity of the self-assessment Meta-competence is the ability to reflect on what we do not know and to compensate for that (refer, seek information, seek supervision/consultation or training)

11 Assessment of Competence in Professional Psychology Competency Toolkit (Kaslow et al., 2009) Provides information about and purposes for various assessment methods: 360-degree evaluation Rotation performance reviews Case presentation reviews Competency Evaluation Rating Forms Client/patient process and outcome data Consumer surveys Live or recorded performance ratings Objective Structured Clinical Examinations (OSCEs) Portfolios Record Reviews Simulations/Role plays Self-assessment Standardized client/patient interviews Structured oral examination Written examination

12 Steps in Competency-based Supervision First, make all steps transparent to the supervisee Step 1- Orientation to competency-based approach Step 2- Collaborative identification of competencies that will be focus of training Step 3- Development of the supervision contract Step 4- Formative evaluation—every session Step 5- Summative evaluations—at regular intervals

13 The Supervisory Alliance Supervisor must understand the difference between this alliance and the therapy alliance Supervisor has power over the supervisee Supervisor has responsibility to hold to professional standards and evaluate the supervisee Both therapy and supervisory alliances require respect and collaborative shared purpose

14 Development of the Supervisory Alliance Make the purpose and the expectations of supervision explicit (supervision contract may help here) Discuss similarities and differences between the client, the supervisee, and the supervisor each session Give and receive two-way feedback in an ongoing and frequent manner Measure the strength of the supervisory alliance (Appendix B in Falender and Shafranske, 2004) Clarify roles if supervisor has more than one role with supervisee

15 Development of the Supervisory Alliance, continued Identify relationship strain—This is the supervisor’s job – Change in supervisee behavior – Passive resistance – Spurious compliance – Hostility

16 Functions of the Supervisor in the Supervisory Relationship Identifying and Managing Countertransference – Help supervisee see emerging patterns – Give assignments to help balance out the countertransference – If this is resisted by supervisee, supervisor must state that working through countertransference is not optional, but is a mandate – Self-disclosure appropriate to understanding and working with countertransference should be expected and put in the supervision contract

17 Diversity Awareness Supervisor should start the process by disclosing his/her own matrix of personal multiple identities (biases, strengths, assumptions, background contributing to same) May invite supervisee to do the same without forcing Discuss how client’s diversity issues interact with the biases and assumptions of the supervisee and the supervisor

18 Providing Effective Feedback Feedback is more effective if it corresponds to self-assessment (using the Competency Benchmarks can promote shared language and behavioral goals) Feedback should be specific and behaviorally- linked Feedback should be close in time to the observation of the behavior (video or audio recording can be very useful here) Provide negative feedback in terms of plans, improvement, and goals

19 Incorporating Process and Outcome Data into Supervision Review client outcome reports during supervision (Lambert & Hawkins, 2001) Review therapeutic alliance measures during supervision (e.g., Working Alliance Inventory, Hatcher & Gillaspy, 2006) Utilize satisfaction with supervision forms (Appendix K in Falender & Shafranske, 2004; reprinted from unpublished manuscript by Hall-Marley, 2001)

20 Ethics Supervisors should review the ethical principles related to the discipline of whomever they are supervising (Universal Declaration of Ethical Principles for Psychologists, 2008; APA Code of Ethics, 2002) Make a point to discuss ethics each supervisory session Supervisors should attend to potential ethical teaching points as they arise

21 Boundary Issues Distinction between boundary crossings vs. boundary violations Boundary crossings are unusual but can be planful and okay ethically Boundary violations are never okay Should discuss internet and social media issues with supervisees in terms of ethics

22 Boundary Issues, cont. Around 4% of psychology students experience sexual contact, pursuit or harrassment by supervisors/educators Attraction to clients—80% of practitioners admit to this during career yet supervisees rarely disclose this Attraction by client—help supervisee do functional analysis of the situation and respond appropriately

23 Liability Supervisors have two types of liability related to their supervisees – Direct Liability for negligent supervision we can control this by observing supervisee taking corrective action based on observation

24 Liability, continued Second type of Liability – Vicarious liability—liability for supervisee’s behavior Not under our control completely May be liable simply because of relationship with supervisee

25 Supervising the “problem supervisee” Competency issues around professional behavior often are what we mean by “problem supervisee” Papadakis et al. (2005) found correlation between unprofessional behavior in medical school and later discipline by state boards – First type of unprofessional behavior: Severely diminished capacity for self-improvement; failure to respond to feedback – Second type: Severe irresponsibility, unreliability, failure to followup

26 “Problem Supervisee” continued Other categories of problem supervisees: – Unable/unwilling to integrate professional standards into their behavior – Inability to acquire professional skills – Inability to control personal stress so that it interferes with professional functioning

27 Response to “Problem Supervisees” In all cases, must have and follow a remediation procedure Observation and feedback must begin early Remediation plan itself should be – Competency based – Items should be observable – Items should be measurable – Plan should have time limits – Examples of Remediation Plans are on VAPTC sharepoint site

28 Self-care Self-care is not a luxury; it is an ethical imperative Self-care options for psychologists to model for supervisees: – Vary work responsibilities – Use positive self-talk – Maintain personal/professional balance – Take vacation time

29 Self-care, continued – Maintain professional identity through CE, new professional tasks, organizations – Spirituality – Read literature – Have control over work responsibilities – Teach and supervise—protective activities to prevent burnout

30 References American Psychological Association (2002). Ethical Principles of Psychologists and Code of Conduct Bambling, M., King, R., Raue, P., Schweitzer, R & Lambert, W. (2006). Clinical supervision: Its influence on client-rated working alliance and client symptom reduction in the brief treatment of major depression. Psychotherapy Research, 16 (3), 317-331. Callahan, J.L., Almstrom, C. M., Swift, J. K., Borja, S. E., Heath, C.J. (2009). Exploring the contribution of supervisors to intervention outcomes. Training and Education in Professional Psychology, 3(2), 72-77. Dunning, D., Johnson, K., Ehrlinger, J., & Kruger, J. (2003). Why people fail to recognize their own incompetence. Current directions in Psychological Science, 12 (3), 83-87. Epstein, R.M., Hundert, E.M. (2002). Defining and assessing professional competence. Journal of the American Medical Association, 287(2), 226-235. Falender, C. A., Shafranske, E. P. (2004). Clinical Supervision: A Competency-based Approach. American Psychological Association, Washington, D.C. Hatcher, R. L., Lassiter, K.D. (2007). Initial training in professional psychology: The practicum competencies outline. Training and Education in Professional Psychology, 1 (1), 49-63. Hatcher, R.L., & Gillaspy, J.A. (2006). Development and validation of a revised short version of the working alliance inventory. Psychotherapy Research, 16 (1), 12-25.

31 References, Cont. Kaslow, N.J., Gurs, C.L., Campbell, L.F., Fouad, N.A., Hatcher, R.L., & Rodolfo, E.R. (2009). Competency assessment toolkit for professional psychology. Training and Education in Professional Psychology, 3 (4, Suppl), S27-S45. Kruger, J. & Dunning, D. (1999). Unskilled and unaware of it: How difficulties in recognizing one’s own incompetence lead to inflated self-assessment. Journal of Personality and Social Psychology, 77 (6), 1121-1134. Lambert, M.J., & Hawkins, E.J. (2001). Using information about patient progress in supervision: Are outcomes enhanced? Australian Psychologist, 36, 131- 138. Papadakis, M.A., Teherani, A, Banach, M.A., Knettler, T.R., Rattner, S.L., Stern, D.T., Veloski, J.J., & Hodgson, C.S. (2005). Disciplinary action by medical boards and prior behavior in medical school. New England Journal of Medicine, 353, 2673-2682. Universal Declaration of Ethical Principles for Psychologists. (2008). Available from the International Union of Psychological Science Web site:

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