CLINICAL SUPERVISION: PART II MODELS OF SUPERVISION STAGES OF DEVELOPMENT Cheryl Rugg, LCSW, ICS Cornerstone Counseling Services

Supervision Definition A fundamental premise of quality supervision is that you operate from a defined model of supervision just as we would have the supervisee operate from a model of counseling. Good clinicians make decisions under conditions of uncertainty. It is theory that enables this. This is also true for the clinical supervisor. The theory is your lens which helps to focus your attention. Bernard and Goodyear, 1998

Definition Supervision is an intervention provided by a more senior member of a profession to a more junior member of the same profession. This relationship is evaluative and hierarchical, extends over time, and Has the simultaneous purposes of enhancing the professional functioning of the more junior person(s); monitoring the quality of professional services offered to the clients that she, he, or they see; and serving as a gatekeeper for those are to enter the profession. Bernard and Goodyear, 2009

The Need for a Model of Clinical Supervision “The supervisor who is learning to venture out on his own or her own has, in the core model, a safe and certain “parent” to return to and look back upon when a steadying presence is needed. Beginning supervisors will inevitably lose their footing on occasion and need to know that when this happens they can fall back on and be guided by a tried and trusted model.” Wosket and Page, 2001

What Not to Do https://www.youtube.com/watch?v=Hf8mjMU5aJk

Four Supervisory Orientations Competency-based models Treatment-based models Developmental Approaches Integrated Models

Competency Based Models Focus on the skills and learning needs of the supervisee and on setting goals that are measurable, attainable, realistic and timely. Key strategies of supervision include modeling, role reversal, role playing and practice, demonstrations and using various supervisory functions such as teaching, counseling and consulting Microtraining Task-Orientated Model

Discrimination Model Reduces supervision to its’ basic tasks Show supervisees how to act and what needs to be focused on. Focus is on the supervisor's role as it relates to the supervisees development. Depending on the supervisees needs the supervisor acts as: Teacher Counselor Consultant

Focus of Supervision: Discrimination Model Supervisees’ counseling performance or process skills. Conceptualization skills or knowledge. Self-awareness or personalization Professional role skills and ethical behaviors.

Intervention Skills Discrimination Model What the supervisee is doing in the session; what is observable. Simple active listening skills. Understanding what the client is saying. Understanding the meaning of the behavior to the client.

Conceptualization Skills Discrimination Model Ability to make sense of the information the client is presenting. Identify themes and meanings. Discriminate what is essential from what is not. Formulate a way to understand the client. For example: The client has a heroine addiction. How does the counselor make sense of this as it exists in the particular client’s life.

Personalization Skills Discrimination Model Use of personal style while at the same time keeping therapy from being contaminated by personal issues and counter-transference. All the personal aspects the supervisee brings to his/her role as a counselor. Includes personality, cultural background, sensitivity toward others, sense of humor. In any given situation, how does the counselor personally make sense of the client? What personal experience has the supervisee with the specific situation?

Professional Behavior Discrimination Model Ethical behavior Legal issues Professional development Case management Record keeping

Discrimination Model Teacher Evaluate observed counseling Identify appropriate interventions Teach, demonstrate or model intervention techniques Explain the rationale behind interventions and strategies Interpret significant events in the counseling relationship

Discrimination Model Counselor Explore supervisee’s affective experience during counseling session or supervision session. Explore trainees feelings concerning specific interventions. Facilitate supervisee’s self-exploration of confidence and worries in the session. Help supervisee define personal competencies and areas of growth. Provide opportunities for trainees to process their own affect or defenses.

Discrimination Model Consultant Provide alternative interventions of strategies. Encourage supervisee brainstorming of interventions. Encourage discussion of client problems and motivation. Understand supervisee’s needs and attempt to satisfy them. Allow supervisee to structure the session.

Discrimination Model Example http://www.youtube.com/watch?v=7wOszCNcKR8

Developmental Models of Clinical Supervision Stoltenberg and Delworth (1987) Each counselor goes through different stages of development Movement through the stages is not always linear Movement can be influenced by setting and populations served

Developmental Model Describes developmental levels of clinicians and supervisors according to three domains: Autonomy – the ability to make independent decision, the degree of supervision required, and self- confidence Self and Other Awareness – fears, anxieties and uncertainties, how certain behaviors affect the client and others. Motivation – desire to help others and learning of strengths and weakness

Treatment-based Supervision Models Train to a specific theoretical approach Seeks to achieve fidelity and adaptation to an approach Emphasize the counselor’s strength Incorporate approaches and techniques of the model Motivational Interviewing, Cognitive Behavioral therapy and psychodynamic are examples

What Stage of Counselor Development is She In? http://www.youtube.com/watch?v=23AfQXWxXWw

Developmental Levels of Supervisors Someone new to supervision would be at a level 1. It is imperative that a new supervisor be at least at level 2 as a counselor and ideally at level 3.

Integrative Model This model assumes that a counselor matures and becomes more self-confident and skilled over time resulting in shifts in: Awareness from self (“How am I doing?”) to client (”How is the client feeling?”) Dependence (“What should I do in this case?”) to autonomy, (“How is the therapeutic relationship progressing?”)

Integrative Model More than one theory and technique. Most frequently used model of supervision. More flexible. Requires research, practice, study and theorizing. Requires broad knowledge of approaches. Allows adapting supervision to the individual needs and theoretical orientation.

Integrated Models Integrated Developmental Model Describes counselor development as occurring through four stages. There is a beginning but not an end point for learning clinical skills. There is a logical sequence to development, although not always predictable and rigid. Some counselors remain in the field for years but remain at an early stage of professional development. Counselors at advanced levels have different learning needs and require different supervisory approaches.

Blended Model David Powell Alcohol and drug use disorders specific. Insight-oriented. Skills-oriented. Requires an understanding of the unique defining attributes of a problem for it to be conceptualized.

Philosophical Foundations Blended Model People have the ability to bring change in their lives with the assistance of a guide. Supervisees wishing to grow bring an openness to growth and a resistance to change. People do not always know what is best for them for they may be blinded by their resistance to and denial of the issues. Supervisee does not allow the individual to wander lost in the darkness until he finds his way out, nor does he dictate the precise direction. The key to growth is to blend insight and behavioral change in the right amounts at the right time. One step at a time and one day at a time are equally appropriate for clinical supervision. Supervisees are developing both behavior change and insight just as the AODA client is.

Foundations Blended Model Change is constant and variable. Just as a therapist looks for “windows of opportunity” so does the supervisor. The supervisor reinforces the inevitability of change in a progressive, developmental manner depending on the stage of growth of the supervisee. Supervisor focuses on what is changeable, avoiding entrenched characterological issues. Supervision works toward solutions and does not focus on supervisee problems. Latent content, unless it clearly detracts from the supervisee’s effectiveness is not relevant.

Foundations Blended Model There are many correct ways to view the world. The supervisor draws out the counselor’s curiosity, asking, “How do you want to change?” Supervisor offers alternatives and options for change. Timely blending of insight, guidance, and skill development that brings about lasting change.

Descriptive Dimensions Blended Model Influential-affective vs. cognitive-level 1 counselors need answers and skills, level 3 counselors are able to address transference and counter transference issues. Symbolic-latent vs. manifest- less emphasis on supervisee historical information and more emphasis on skill development. Structural- reactive vs. proactive-focus is on skill application and can become more flexible reflective of the supervisee’s capacity for insight and introspection

Descriptive Dimensions Blended Model Replicative- parallel process vs. discrete-rarely views the supervisee process with the supervisor as similar (parallel) to the counseling process. Counselor in Treatment- therapy is not an essential, the supervisor mindful of supervisee issues but does not make them a part of supervision. Information Gathering- direct observation of the supervisee in level 1 and 2 to insure AODA skill development, level 3 allows for more insight on the part of the supervisee

Descriptive Dimensions Blended Model Jurisdictional- responsibility over the client and the supervisee are with the supervisor Relationship- hierarchical level 1 and 2, facilitative level 3 Strategy- level 1 and 2 involve a great deal of teaching of skill, with maturity a level 3 supervisee can be exposed to theory

Themes of Counselor Development Over time professional’s theoretical perspective and professional roles become increasingly consistent with his or her values, beliefs, and personal life experiences. Later professionals gain a more confident and flexible style. Continuous self reflections is a prerequisite for optimal learning and development. Enthusiasm for professional growth maintains throughout the career. The cognitive map shifts; early supervisees rely on knowledge, later they shift to knowledge that is based upon their own experiences and self-reflections.

Themes Development is long, slow and erratic. Professional development is a life long process. Over time the early anxiety is mastered. Clients serve as primary teachers. Personal life influences professional functioning and development throughout the professional life. Growth occurs through contact with clients, supervisors, therapists, family and friends and younger colleagues.

Themes New counselors have strong affective reactions to their professional elders, from idealizing to de-valuing. Extensive experience with suffering contributes to heightened recognition, acceptance, and appreciation of human vulnerability. Realignment from Self as hero to Client as hero. “If these blows to the ego are processed and integrated into the therapists’ self-experience, they may contribute to the paradox of increased sense of confidence and competence, while feeling more humble and less powerful as a therapist.” Ronnestad and Skovholt, 2003

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