Presentation on theme: "The Evidence for Effective and Ineffective Supervision"— Presentation transcript:
1The Evidence for Effective and Ineffective Supervision Nicholas LadanyLoyola Marymount UniversityLos Angeles, CA+, benign, -
2Presentation Objectives Provide an up-to-date summary of the state of the research on clinical supervisionIdentify the common elements of ineffective supervisionIncrease knowledge about how to enhance clinical supervision and improve training in clinical supervision
3Elements of Effective Supervision (Ellis & Ladany, 1997; Ladany, 2005; Ladany & Inman, 2010) Attend to the Supervisory RelationshipApply Models of Supervision (e.g., Critical-Events Model)Attend to Unique Features of SupervisionEvaluativeEducativeInvoluntaryEngage in Role InductionDifferentiate Supervision from PsychotherapyAttend to Supervisee-focused and Client-focused OutcomesRecognize the importance of Covert ProcessesKeep abreast of Ethical and Legal IssuesOffer Evaluations that include Goal-Setting and FeedbackEnhance Multicultural CompetenceAttend to Parallel ProcessesTend to Administrative Responsibilities (e.g., note-taking, s’ee oversight)Consider Group Supervision and Peer Supervision as important adjunctsSecure Supervision Training
4Elements of Ineffective Supervision Not all supervision is rosySupervisees get harmedSupervision failures are a result of:Supervisor factorsSupervisee factorsDyadic factors(Ladany & Inman, in press; Ladany & Inman, 2008)
5Supervisor Factors Inclination to infantalize supervisees Incomplete or Incompetent evaluationToo positive --- GatekeepingNo valid or reliable instrumentsMulticulturally misguided (i.e.,racist, sexist, homophobic)Ethically challenged in relation to supervisionInadequate TrainingSupervisor specific trainingMisapplication of theory (unique features of supervision)
6Supervisee Factors Openness to learning Training in helping skills Receptivity to feedbackTraining in helping skillsCapacity to learn helping skillsCapacity for deep self-awarenessCapacity for knowledge acquisition (perhaps over-rated)
7Dyadic Factors Supervisory alliance Too much case discussion Over indulgence in client-focused outcomes
9Degree of Trainee Openness to Learning and Supervisor Competence Competence of SupervisorIncompetentNeutralCompetentActive Learner11.1%Passive LearnerIndifferent Learner
10A Critical Events-Based Model of Supervision Ladany, Friedlander, & Nelson (2005)The Supervisory Working AllianceMarkerTask EnvironmentConsists of Interaction SequencesResolutionSuccessful or Unsuccessful
11The Supervisory Working Alliance (Bordin, 1983) Mutual Agreement about the Goals of Supervisione.g., mastery of specific counseling skillse.g., understanding how the trainee’s personal issues influence work with clientsMutual Agreement about the Tasks of Supervisione.g., review counseling session tapese,g., trainee is responsible for initiating supervisory discussionEmotional BondMutual caring, liking, trusting
12Critical Events Remediating Skill Difficulties and Deficits Heightening Multicultural AwarenessNegotiating Role ConflictsWorking Through CountertransferenceManaging Sexual AttractionRepairing Gender-Related Misunderstandings & Missed UnderstandingsAddressing Problematic Supervisee Emotions and BehaviorsFacilitating Trainee InsightWorking Through Therapist Shame
13Markersupervisee’s statement, series of statements, or behavior signaling the need for a specific kind of help
14Task Environment Interaction Sequences Focus on the Supervisory Working AllianceNormalize ExperienceAttend to Parallel ProcessFocus on SkillFocus on Self-EfficacyExploration of FeelingsFocus on Supervisee’s DynamicsAssess KnowledgeFocus on EvaluationCase DiscussionFocus on Multicultural AwarenessFocus on CountertransferenceCareful of too much Case Review
15Resolution Self-Awareness Knowledge Skills Supervisory Alliance Continuum of Successful to Unsuccessful
19Assumptions about Supervision and Nondisclosure Supervisees ‘nondisclose’ more than they discloseSometimes what is not said is more important than what is said
20Nondisclosure Studies Ladany, Walker, Pate-Carolan, & Gray (in press); Banks & Ladany (2002); Ladany, Walker, & Melincoff (2001); Ladany & Melincoff (1999); Ladany & Lehrman-Waterman (1999); Ladany, Hill, Corbett, & Nutt (1996)Content of and reasons for nondisclosureSupervisee nondisclosure post multiple sessionsSupervisee nondisclosure post single session, longitudinallySupervisor nondisclosure post multiple sessionsNondisclosures in relation to supervision process and outcome variables
21Supervisee Nondisclosure Categories Negative Reactions to Supervisor (90%)Unpleasant, disapproving, or critical thoughts, feelings, or characterizations relating to the supervisorExamples:He is very rigid and narrow in theory and practiceI thought he had a big blind spot on how to help me in supervisionShe's disorganizedHe's obnoxiousReasons: Deference to the Supervisor, Impression Management, and Political Suicide
22Supervisee Nondisclosure Categories Personal IssuesThoughts about the self, experiences, or problems in the context of the individual's life that may or may not be known in public contexts such as the supervision setting.Examples:Wondered what teachers and students reactions would be if I revealed that I am BisexualSpecific family crisisI have not told my supervisor that I'm pregnantReason: Too Personal
23Supervisee Nondisclosure Categories Clinical MistakesThoughts related to perceived errors or inadequacy as a counselorExamples:I sometimes feel I made a mistake in a session and wait till next session to try to "correct" itFeeling like I hadn't checked out all the symptoms of a disorder with a clientI think I sometimes confuse my clients with interventions that are not at the client's level of understandingReason: Impression Management
24Supervisee Nondisclosure Categories Evaluation ConcernsUncertainty or uneasiness about the supervisor's assessment(s) of the SuperviseeExamples:I do not know whether my supervisor's evaluation of me is generally positive or negativeI wonder how my supervisor will evaluate meWorry that she will not give a good letter of recommendation
25Supervisee Nondisclosure Categories Negative Reactions to ClientUnpleasant, disapproving, or critical thoughts, feelings, or characterizations relating to the clientExamples:Some clients appear physically threateningAnger toward client for bringing up his racist/ chauvinistic feelings / thoughtsOne of my clients has poor personal hygiene which leads to negative reactions in meGetting frustrated when clients don't show and don't cancelThat sometimes I'm bored
26Supervisee Nondisclosure Categories Client-Counselor Attraction IssuesThoughts or feelings about the client and/or counselor appearing or feeling drawn to or interested in the other person in a sexual or physical senseExamples:Sexual attraction to a female clientFound a male client attractive, reminded me of type of guys I used to likeFeeling attractedSexual feelings toward a clientReason: ?
27Supervisee Nondisclosure Categories Supervisor AppearanceComments, thoughts, or feelings about the supervisor's external imageExamples:He wears clothes out of the 70'sShe seems so off the wall as far as dress, language, etc.Disapprove of dress habitsI like his silver belt buckle and general style of dress
28Supervisee Nondisclosure Categories Supervisee-Supervisor Attraction IssuesThoughts or feelings about the Supervisee and/or supervisor appearing or feeling drawn to or interested in the other person in a sexual or physical senseExamples:At one point I felt some attraction for my supervisorBeing attracted to his balance of power and sensibility and this translating to a physical attractionI think my supervisor is very attractive and also brilliant
29Supervisor Nondisclosure Categories Negative Reactions to Supervisee’s Counseling & Professional Performance (74%)Negative thoughts and feelings regarding the Supervisee’s clinical and professional skills.Examples:She has personal agendas that interfere with non-biased counselingSelf disclosure should have been absolutely avoided in that case.Reasons: Supervisee will Discover When Developmentally Ready and Addressed Indirectly
30Supervisor Nondisclosure Categories Supervisor Personal IssuesIssues related to the self and the supervisor’s personal life and experiencesExamples:Didn’t want to meet for supervision due to terminally ill relative that I needed to attend toIntern at one point shared that she was clinically depressed. I did not share that I had ever been clinically depressedProblems my daughter had at schoolReasons: Irrelevant to the goals and tasks of supervision
31Supervisor Nondisclosure Categories Negative Reactions to Supervisee’s Supervision PerformanceNegative thoughts and feelings about the Supervisee’s reactions in supervision such as the Supervisee not listening to supervisor instructions, or problems in supervision due to the Supervisee.Examples:He takes whatever I say in supervision and incorporates it into what he “feeds back” by the end of the hourAre you really going to try that technique or are you just appeasing me?That I am angry that he has canceled many of our sessionsI wish she would bring in a tape for us to listen to
32Supervisor Nondisclosure Categories Negative Supervisor Self-EfficacyConcerns about own performance as a supervisor. Concerns about self-efficacy as a supervisor and thoughts about the Supervisee’s perceptions of him or herExamples:Wonder if she questions my credibility because of age differencesThat I may not be as helpful or astute as she may wishInitially, I experienced anxiety and tension when interacting with my SuperviseeReason: Supervisor’s Own Issue
33Supervisor Nondisclosure Categories Supervisee AppearanceThoughts about the way the Supervisee dresses and looks, as well as personal habits that the supervisor noticesExamples:Gosh her clothes are nice they look expensiveHow can an intern afford this wardrobe? I’m jealous;Why do you always wear the same clothes?
34Supervisor Nondisclosure Categories Positive Reactions to Supervisee’s Counseling and Professional PerformancePositive thoughts and feelings regarding the Supervisee’s clinical and professional skills. This includes positive thoughts about the Supervisee’s interventions in the counseling sessionExamples:She’s doing a great jobas a new professional, I don’t think I was nearly as comfortable asserting myselfHow enjoyable it is to work with the Supervisee
35Supervisor Nondisclosure Categories Attraction to SuperviseeThoughts or feelings about the Supervisee being physically appealingExamples:Strong sexual attraction to SuperviseeThat the Supervisee is attractive to meI find my Supervisee attractive
36Supervisor Self-Disclosure Categories Personal Information (73%)Supervisor self-discloses personal information about himself or herselfExamples:He told me about his separation and ultimate divorce from his wife earlier this yearHe said he was not able to co-lead a relationship group because of a current emotional state - recent break-upShe told me that although she wishes she had children, she is unable to have any
37Supervisor Self-Disclosure Categories Clinical and Training StrugglesSupervisor self-discloses situations in which he or she experienced difficulties with clients or in his or her own trainingExamples:Shared similar experience when he felt frightened and threatened by a clientWhen a client relapsed and attempted suicide, she said she questioned herself and wondered if she has done everything she could
38Supervisor Self-Disclosure Categories Successful/Positive Clinical And Training ExperiencesSupervisor self-discloses positive therapy outcomes, successes in own training and developmentExamples:My supervisor stated that for more than one year she had not had a client relapse and start using drugs again. She said that was the best record in the agencyTalked about successes working with couplesNo one challenged her in her training because she was so good
39Supervisor Self-Disclosure Categories Reactions to Supervisee’s ClientsSupervisor self-discloses her or his feelings about the supervisee’s clientsExamples:When one of my clients attempted suicide, she stated she also felt uncertain of herself and then she felt angry at him for regressing and harming himself and betraying her trustShared that her discomfort with a client I currently have would not allow her to provide nonbiased careIn some ways I come from the same background as these kids you are seeing (working class) but I managed through loans and scholarships to graduate with a Ph.D.; I did it, so can they!
40Supervisor Self-Disclosure Categories Dynamics at Training SiteSupervisor self-discloses interpersonal interactions at the training site and/or her or his reaction to these interactionsExamples:An observation about another senior staff member who tries to control me - she told of his attempts to do the same with her - we laughedAnother coworker felt he sexually harassed her. I felt he was observing my actions to see where I stood in this area
41Supervisor Self-Disclosure Categories Didactic MentoringInformation regarding how the supervisor might approach and/or work with the supervisee’s clients or training issuesExamples:He said he wanted to expose me to forensic psychology and competency evaluations, because he didn’t have that when he was in training and had to learn it on the jobI saw a client who was detained for child molestation, so he brought in a sample treatment plan to show how he worked with oneHow working with parents of clients is difficult and how to monitor your own feelings
42Supervisor Self-Disclosure Categories Supervisory RelationshipSupervisor self-discloses her or his perceptions of the supervisory relationshipExamples:She once told me how much she values our relationship and how much she's learned from me--a surprise, out of the blueI wasn’t very supportive of you and became a bit defensive yesterday
43Supervisor Self-Disclosure Categories Experiences of Being a SupervisorSupervisor self-discloses about her or his past or present experiences as a supervisorExamples:That she has been told by previous supervisees that she does not give enough positive feedbackShared that he had been criticized for being too accepting/not critical enough of supervisees
44Limitations Recall Limited depth of response U.S.-based samples Pre-degreed supervisees
45Future Theory and Research Directions Large sample post-session recall of nondisclosures (Mehr & Ladany, in preparation)Post-degreed superviseesInternational samples (e.g., Schröder & Gilbert Webb & Wheeler, 1998)Modes of supervision (e.g., group, peer)Process and outcome linkModels of self-disclosure
46Model for Supervisor Disclosure (Ladany & Walker, 2003) Categories of Self-DisclosurePersonal MaterialTherapy ExperiencesProfessional ExperiencesSupervisee’s ClientsSupervision ExperiencesPersonalization DimensionsDiscordant to CongruentNon-Intimate to IntimateIn Service of Supervisor to In Service of Supervisee
47Personal Material Self-Disclosure: The Uncontrollable Narcissist
48ConclusionsSometimes trainees keep a lot of important information from their supervisorsSometimes supervisors do not disclose things they should to their traineesSometimes supervisors disclose things to their trainees they shouldn’tIs there ever really “nothing to discuss in supervision?”
49Assessing Evaluation Approaches What We KnowThe “germ theory” of psychotherapy training (Beutler, 1988) suggests students “catch” skills through exposure.Trainees are evaluated primarily qualitativelyMost supervisors use trainee self-report as a method to assess trainee performance, however, approximately half rely on audio or video recordings.
50What We KnowThe supervisor's general perceptions of the trainee may influence the trainee’s evaluation.Many supervisors may not be fulfilling their evaluation responsibilities adequately or ethically.Measures used to assess trainee competence are often outdated and, generally, psychometrically unsound (Ellis & Ladany, 1997; Ellis, D’Luiso, & Ladany, in press).
51Components of Assessing Trainee Evaluation Approaches Mode of CounselingIndividual, Group, Family, or CouplesDomain of Trainee BehaviorsCounseling or SupervisionCompetence AreaTheoretical Conceptualization, Helping Skills, Counseling Techniques, Professionalism, Multicultural Competence, Clinical Disorders, Assessment, Administration, Supervision Behaviors, Countertransference, Self-Evaluation
52Components of Assessing Trainee Evaluation Approaches (cont.) MethodTrainee Self-Report, Case Notes, Audiotape, Videotape, Live Supervision, Co-therapy, Role Play, Experiences in SupervisionProportion of CaseloadAll Clients, Subgroup of Clients, One ClientSegment of ExperienceEntire Training Experience, Part of Entire Training Experience, Specific Session, Segment of a Session
53Components of Assessing Trainee Evaluation Approaches (cont.) Time PeriodEarly, Middle, Late in Client TreatmentEarly, Middle, Late in Training ExperienceEvaluatorSupervisor, Clients, Peers, Objective RatersLevel of ProficiencyDemonstrated Skill, Comparison to Cohort Group
54Components of Assessing Trainee Evaluation Approaches (cont.) Reliability IssuesMeasurement Error, Supervisor Bias for Qualitative, Statistical for QuantitativeInterrater AgreementValidity IssuesConstruct ValidityFormatQuantitative vs. QualitativeStructured vs. Unstructured
55Example # 1 Evaluator: Supervisor Rate the competence of your trainee’s knowledge base on a 1 to 5 scale.Knowledge base is defined as “demonstrated good understanding of theories and research in psychology, human development, counseling/psychotherapy, assessment, and psychopathology.”
56Example # 2Assessment of a given area of competence based on the trainee’s developmental level.Task for Supervisor:Assess the developmental level of the trainee.Know the competence associated with the given developmental level of the trainee’s cohort group.Compare and contrast the trainee’s expressed competence to the associated developmental level.
57Example # 3Unclear, anti-therapeutic, or minimally relevant items, such astrainee’s personal grooming or appearancetrainee keeps client task-centeredtrainee maintains her or his office neat and orderlytrainee has a clear, well-defined set of values which he or she communicates in a therapeutic fashion.
58Effective Evaluation Strategies (Lehrman-Waterman & Ladany, 2001) Goal SettingA specific standard of proficiency on a task, which is to be accomplished within a specified time limitFeedbackThe supervisor verbally sharing her or his thoughts regarding the supervisee's progress on agreed upon goalsFormativeongoing, informal feedback that occurs throughout supervisionSummativesupervisor steps back and makes decisions regarding how well the supervisee is meeting the pre-established standards of performance
59Goal Setting Features of effective goal setting: Specific, explicit, and clearly wordedFeasible in regard to capacity, opportunity, and resourcesRequire the supervisee to "stretch" herself or himselfRelated to the task formulatedModifiable over timeMeasurableOrdered into priorityMutually agreed uponClarified early in the supervisory relationshipIdentify and set proficiency standards clearly
60Feedback Six key features of effective supervisor feedback: Systematic TimelyClearly understoodBalanced between positive and negative statementsComes from a credible sourceReciprocal
62Sample Evaluation 1 2 3 4 5 strongly neither agree strongly strongly neither agree stronglydisagree or disagree agreeUsing the above scale, rate the extent to which you believe this trainee exhibited each of the following skills:Attending and ListeningRestatementsOpen QuestionsReflections of FeelingsDemonstrate UnderstandingChallenge