Clinical Supervisonis Preventing pitfalls and Perils

Clinical Supervisonis Preventing pitfalls and Perils

Clinical Supervision: The Issues and Pitfalls Michele D. Aluoch River of Life Professional Counseling LLC c.2013 Criteria for Supervising Counselors in Ohio Requirements for applying for a supervising counselor designation: minimum requirements after August 31, 2008. (a) Document a minimum of twenty-four hours of academic preparation or board approved continuing education coursework In counselor supervision training including training six hours in each area as follows: (i) Assessment, evaluation and remediation which includes initial, formative and summative assessment of supervisee knowledge, skills and selfawareness; components of evaluation e.g. evaluation criteria and

expectations, supervisory procedures, methods for monitoring (both direct and indirect observation) supervisee performance, formal and informal feedback mechanisms, and evaluation processes (both summative and formative), and processes and procedures for remediation of supervisee skills, knowledge, and personal effectiveness and self-awareness; Criteria for Supervising Counselors in Ohio (ii) Counselor development which includes models of supervision, learning models, stages of development and transitions in supervisee/supervisor development, knowledge and skills related to supervision intervention options, awareness of individual differences and learning styles of supervisor and supervisee, awareness and acknowledgement of cultural differences and multicultural competencies needed by supervisors, recognition of

relational dynamics in the supervisory relationship, and awareness of the developmental process of the supervisory relationship itself; (iii) Management and administration which includes organizational processes and procedures for recordkeeping, reporting, monitoring of supervisee's cases, collaboration, research and evaluation; agency or institutional policies and procedures for handling emergencies, case assignment and case management, roles and responsibilities of supervisors and supervisees, and expectations of supervisory process within the institution or agency; institutional processes for managing multiple roles of supervisors, and summative and formative evaluation processes Criteria for Supervising Counselors in Ohio (iv) Professional responsibilities which includes ethical and legal issues in

supervision includes dual relationships, competence, due process in evaluation, informed consent, types of supervisor liability, privileged communication, consultation, etc.; regulatory issues include Ohio laws governing the practice of counseling and counseling supervision, professional standards and credentialing processes in counseling, reimbursement eligibility and procedures, and related institutional or agency procedures. (b) The board shall waive the requirements in paragraphs (F)(1)(a)(i) to (F)(1) (a)(iv) and (F)(1)(e) of this rule for existing professional counselors and professional clinical counselors who apply prior to September 1, 2008 for the supervisory designation if they meet the other requirements of paragraph (F) of this rule. These applicants shall complete a minimum of ten hours of academic preparation or board approved continuing education coursework in counselor supervision training Criteria for Supervising Counselors in Ohio

(d) Each professional counselor shall obtain four thousand five hundred hours experience post licensure including, but not limited to, work in areas such as career counseling, personal growth, supervised diagnosis and treatment of mental and emotional disorders, etc. All supervision of diagnosis and treatment of mental and emotional disorders shall be per section 4757.21 of the Revised Code and rules 4757-15-01 and 4757-15-02 of the Administrative Code. (e) The fifteen hundred hours shall include at least one supervision of supervision experience. The professional clinical counselor in training shall work with the same supervisor for at least five hours learning the skills to become a supervisor. The professional clinical counselor in training shall work (as a supervisor-in-training) with the same supervisee (licensee who needs supervision) for a minimum of ten hours while learning from and working with a professional clinical counselor who has a supervising counselor designation. All supervision, and supervision of supervision addressed in this rule shall be faceto-face.

Criteria for Supervising Counselors in Ohio (2) All supervising counselors shall maintain supervising counselor status by obtaining six hours of counselor professional standards committee approved continuing professional education in supervision. Three of the required six hours may be met through a minimum of six hours of peer supervision, which shall address one or more core supervision content requirements and shall be with other licensed mental health providers, and shall be documented as such, including participants' names, topics discussed and dates met. (3) Professional clinical counselors engaged in training supervision shall be called "supervising counselors" per paragraph (Q)(9) of rule 4757-3-01 of the Administrative Code. They shall have adequate training, knowledge, and skill to render competent clinical supervision and shall meet the criteria for work and training supervision as defined in paragraphs (A)(1) and (A)(2) of this rule. Professional counselors engaged in training supervision shall be called "supervising counselors" per paragraph (Q)(8) of rule 4757-3-01 of the Administrative Code. They shall have adequate training, knowledge,

and skill to render competent non-clinical supervision and shall meet the criteria for training supervision as defined in paragraph (A)(1) of his rule and shall not supervise the diagnosis and treatment of mental and emotional disorders. General Board Rules Regarding Supervisors Supervisor/supervisee relationship must be board approved in advance Roles and scope of practice are specifically delineated Start and end dates are delineated Supervisor/supervisee only have supervision in areas of specified competence Not a family member or relative Requires documentation of supervisor/supervisee interactions Reports co-signed by the supervisor

No more than 6 supervisees per clinical supervisor General Board Rules Regarding Supervisors Clients of supervisee can pay but only to the agency Supervisee openly acknowledges with clients the rules and limits of supervision Disclosure to clients of supervisee status No reports, forms, or paperwork disseminated without review of supervisor and his/her signature Filling in of training agreements is the supervisees responsibility 30 day board notice of changes of supervisors or any other changes in agreement Only counting hours of supervision by a designated supervising counselor

General Board Rules Regarding Supervisors A distinct period of training and practicum and internship from a CACREP accredited school Degree in area of licensure What Clinical Supervisors Do Training: One on one Face to face Instructive and didactic 1 hour per 20 hours Goals: 1) skill development

2) skill building By an independently licensed professional pre approved by the board What Clinical Supervisors Do Training (Continued): Facilitating skills for initial session, ongoing evaluation, and termination Teaching how to conceptualize clients according to various theoretical frameworks Increasing supervisee awareness of personal client variables (e.g. age, dev. Level, maturity, cultural/ethical issues) Demonstrating problem solving in client dilemmas Teaching job details/role expectations (e.g. Community mental health agency, private practice)

What Clinical Supervisors Do Training Continued: Developing an individual professional identity Offering emotional support/process variables Assisting the supervisee in awareness of types of clients that push their buttons Collaborating as a consultant to assist in problem solving What Clinical Supervisors Do Clinical and Professional Skills The work of therapy and associated tasks Deals with Dx/Tx of DSM disorders

Thorough psychosocial assessment Ongoing goal and treatment planning Evidence based practice Requires informed consent What Clinical Supervisors Do Professional Development continued: 1) Building awareness of symptomolgy for various DSM disorders 2) Assisting in evaluating for co-morbid conditions of differential diagnosis 3) Facilitating discussion of the implications of giving clients various diagnoses 4) Developing a model for treating the diagnosed condition(s) with an appropriate standard of care 5) Developing a way to periodically assess/review client treatment

goals and to modify as needed- improving client care What Clinical Supervisors Do Personal Professional Development of Supervisee Assessing and promoting personal and professional goals consistent with agency standards and ethical behaviors Leading and guiding supervisees to become more adept at using their skills and improving their ability to practice independently What Clinical Supervisors Do

Case review and conceptualizationMethods discussed later What Clinical Supervisors Do Evaluation School Evaluation Board evaluation of supervisee May include evaluation of supervisor or process Methods of Evaluation Methods of Evaluation Advantages Disadvantages

Self Report used often, readily Accepted, time efficient requires some level of insight, seen through eyes of the beholder, nonverbal cues missed, better with experienced supervisees, tends to be only as good as what is reported Process Notes

Used often, readily accepted, something you are supposed to observe anyway, quality control, ensures consistency in documentation Time consuming, notes often miss the essence of the session, better for advanced supervisees Methods of Evaluation Audiotaping Advantages

Disadvantages can get real reactions of clients if they consent to this, direct results, more credible than self clients tend to be okay if they consent to this approach but supervisees may be nervous so may be somewhat inaccurate

report or process notes Planning Supervision supervisor & supervisee know objectives & what is being evaluated, very concrete, specific goals & teaching functions, supervisor can intervene to protect the welfare of the client supervisee may focus more on this to the

detriment of the previous or latter parts of the session which are equally Methods of Evaluation Advantages Disadvantages Videotape addition of nonverbal, allows for review of 1) content, 2) affective and

cognitive aspects, and 3) process relationship issues in the present bulk & supplies needed, overload of data re. each session, what to focus on?, can be intrusive Live Observation supervisor can immediately intervene, gives the full picture of things, both

supervisor and supervisee see the same thing, most flexibility w/regards to scheduling follow up supervision discomfort of supervisee or insecurity in real life setting with supervisor Methods of Evaluation Group Supervision

Advantages Disadvantages cost effective, can avoid dependence on supervisor, more comprehensive, increases conceptualization of issues by having to verbalize in the group, protective of ego of supervisees, trainee empathy (1.Suggestions for problem cases, 2. Discussions of ethical and professional issues, 3. Fights isolation, 4. Sharing information, 5. Exploring problematic feelings, attitudes, &

behaviors, 6. Modeling and learning techniques, 7.Stress management, 8. Burnout reduction, 9. Exposure to various theories should only be a supplement, not enough time for in depth work, may be unlikely to personally disclose too many variables if have to be involved in other inter-agency functions, may limit time for indiv. Supervision

Methods of Evaluation Live Supervision Advantages Disadvantanges Allows the supervisee to make adjustments as needed, can enhance CIT skills in the moment, helps supervisor have access to all information in the moment,

allows quicker learning than other approaches, can be used with more challenging cases, may encourage supervisee to take more risks because he or she knows the supervisor some may discourage total Supervisee spontaneity, risk

for dependence on the supervisor, supervisor may intervene too much so may not prepare CIT for having to make isolated decisions Methods of Evaluation Advantages Disadvantages Webcam

Can be accesed from any computer, Use times efficiently, Modest installation and operation costs, Can be stored or downloaded on a variety of media and watched later Concerns about anonymity and confidentiality, technical complications, Needs assurance that will be erased and unavailable to unauthorized staff

Cofacilitation and Modeling Supervisor and clinician jointly run a session, Allows supervisor to model techniques while observing the clinician, clinician sees how the supervisor would respond, Good aid for difficult clients Supervisor must be proficient in skills to be

able to help the supervisee, the client may perceive the supervisee as less proficiene than the supervisor Methods of Evaluation Role Playing Increases the learning process, provides the supervisor with direct observation

of skills, Builds perspective from differing theoretical points of view, Creates a safe way to try new skills Supervisee may feel on the spot, Supervisor may provide too much detailed info. At once Supervisee Prep For Supervision

What clients do I think most about? What feelings, thoughts, reactions come to mind? Am I uncertain in any areas about how to assist with client change? Do I know what to do but am unsure of how to implement? Are there any topics that are unfamiliar or uncomfortable? Supervisee Prep For Supervision

Think about all dynamics of the case: Presenting concerns Family of origin variables Cultural factors Unique personal variables Values and beliefs Goals Thoughts, feelings, and behaviors Previous involvement in therapies

Collateral info. What is not stated Group Supervision Up to 5 simultaneously 1) Facilitate various ways of conceptualizing cases 2) Assist supervisees in drawing on the various strengths/perspectives of each other 3) Foster supportive environment- similar issues, strengths, successes among supervisees Supervisee Perceptions (Lizzio, A., Stokes, L., & Wilson, K., 2005)

Facilitative Versus Didactic Approaches Facilitative emphasis on interaction between supervisor and supervisee - helping supervise develop own professional and personal style reflective practice consideration of alternative viewpoints mutual control process focused

Didactic teacher-controlled processes emphasizing instruction, advice, support, and guidance focus is on transmission of knowledge supervisor as expert supervisor with control of process based on the supervisors experiences to this point content focused

Supervisee Perceptions (Lizzio, A., Stokes, L., & Wilson, K., 2005) One of These Yields: higher supervisor ratings reduction in supervisee anxiety higher perception of supervision as effective Which approach do you think it is? Supervisee Perceptions of What A Supervisor Should Be (Pearson,Q.M., 2004) Availability and approachability Tracking and monitoring the students work

Providing regular and consistent feedback to the student Offering suggestions for improvement Restricting the relationship to supervision Offering suggestions regarding specific therapeutic situations Supervisee Perceptions of What A Supervisor Should Be (Pearson, Q.M., 2004)

Modeling and coaching Emotional support Reassurance Constructive positive feedback Supervisor Perceptions of What a Supervisee Should Be (Pearson,Q.M., 2004)

Psychological mindedness Openness Interest and Desire Motivation and initiative Enthusiasm and eagerness Dependability Interpersonal Curiosity Empathy Supervisor Perceptions of What a Supervisee Should Be (Pearson, Q.M., 2004) Willingness to risk

Intellectual openness Desire to accumulate professional knowledge Minimal defensiveness Introspection Receptivity to feedback Personal, clinical, and theoretical flexibility Supervisor Perceptions of What a Supervisee Should Be (Pearson, Q.M., 2004)

Willingness to grow Takes responsibility for his/her own behavior Actively participates in supervision sessions Respect for individual differences Understanding of how his/her own personal issues influence therapy Clinical Vs. Administrative Supervision Clinical- development of clinical skills, promoting client welfare, clinical assessment/intervention, individual or group, by independently licensed professional registered with the state board, supportive and educational Administrative- developing professional management skills for

functioning as part of a group or agency, goal: smooth organizational operations, focuses on case records, policies and procedures, accountability, hiring and firing/performance evaluation, increasing efficiency of output Key question- What are the benefits and concerns of being both a clinical supervisor and administrative supervisor according to supervisors and according to the supervisees? Client Rights re. Supervision Supervisors are to train supervisees to respect client rights and welfare of clients. Clients are made aware of the supervision statusfull disclosure Supervisees are not to communicate or give the impression in any way that they are actually licensed Records of supervision relationship should be

confidential and protected. Supervisors are responsible for supervisees actions. Client Rights re. Supervision Supervision should occur through regular one on one face to face meetings. Supervision should cover specific ongoing feedback. It should be clear between the supervisor and supervisee that they are not in a therapeutic relationship. Supervisors should have the freedom for honest evaluation including but not endorsing a supervisee for certification, licensure, or employment if good reason

Preventing Potential Pitfalls and Issues Interviewing Potential Supervisees Career Goals and Expectations Counseling Goals and Expectations Supervision Goals and Expectations Experiences to This Point/Expectations Preventing Potential Pitfalls and Issues Interviewing Potential Supervisees Areas For Further Training Theoretical Orientations Preferred Special Populations or Issues Preferred Supervision Experiences to this PointPros/Cons

Preventing Potential Pitfalls and Issues Supervisor Disclosure to Supervisee Work experiences Areas of expertise (disclosure statement) Areas of non-strengths Preferred theoretical orientations Special populations served Supervisory experience- preferred styles Expectations of time commitment- board rules, company policies, personal boundaries Preventing Potential Pitfalls and Issues Developing An Initial Supervision Agreement Board Agreement/ Pre-approval

Company contract Goals of Supervision Arrangement Populations/Scope of Practice Hours Expected- Direct, Indirect, Supervision Giving & Receiving Feedback Fee Agreement Sample Items in a Supervision Agreement This contract serves as verification and a description of the nature if the clinical supervision relationship between _______________________ (Supervisor) and ___________________ (Supervisee) for the time period beginning _______________________ and ending ______________________ .

Sample Items in a Supervision Agreement Purposes, Goals, Objectives: Monitor and ensure welfare of clients seen by supervisee Promote development of supervisees professional identity and competence. Fulfill requirements for supervisees school and licensure requirements. Sample Items in a Supervision Agreement Context of supervision At least one clock hour of supervision face to face weekly Supplemental clock hours may also include a monthly

group supervision meeting Supervision will discuss cases conducted with children, adults, and families in an outpatient suburban setting. Supervision times will be prescheduled. Additional supervision times may be scheduled as needed. Sample Items in a Supervision Agreement Evaluation: Case notes, video or audiotape, live supervisions, cofacilitation or role plays may be used to evaluate supervisee ongoing performance. Specific feedback to the supervisee will focus on the supervisees demonstrated counseling skills and clinical documentation as well as knowledge of and

adherence to the technical and legal requirements Supervise will also be given the opportunity to evaluate the supervisor and the supervision process every three months. Sample Items in a Supervision Agreement Duties and responsibilities of the supervisor Examine clients presenting concerns and treatment plans for sessions Provide ongoing evaluation Sign off on all documentation Challenge inappropriate approaches or techniques in session or trough any aspect of practice. Intervene when clients are at risk Ensure ethical guidelines are upheld

Maintain weekly case notes of supervision Keep a copy of professional disclosure statement on the wall in the office where practicing Sample Items in a Supervision Agreement Duties and Responsibilities of Supervisee Uphold ethical guidelines Be prepared with notes, client files, associated tasks, school and board evaluations, and materials needed for ongoing in person supervision File training and agreements with school or board in a timely manner Complete case notes Consult with supervisor in conditions of uncertainty. Implement supervisor directives in subsequent sessions.

Keep a copy of professional disclosure statement noting supervision available on he wall in the office where practicing Sample Items in a Supervision Agreement Procedural Considerations: In the event there is something to discuss outside of regularly scheduled supervision sessions the supervisee may call the supervisor at (555) 555-5555 . No specific client info is to be communicated with supervisor, client directly, or outside sources via e mail due to confidentiality restrictions whatsoever. If supervisor is unavailable contact Ima Know It all, LPCC S at 555-555-5551. Sample Items in a Supervision

Agreement Terms of Contract Supervision hours are only to be recorded between the board approved supervisor and supervisee Supervision will be paid at a rate of $120 per hour from the supervisee directly to the supervisor. This contract is subject to revision at an time upon either the request of the supervisor or supervisee or agreement of both. We understand and agree to the aforementioned terms _______________________________ _______________________________ (Signatures) and Dates Qualities of Effective Supervisors Approachability High on Rogers process variables especially

empathy and support, genuineness Ability to give constructive criticism in a healthy, supportive manner rather than tearing down the individual Supported by modeling Issues to Target in Supervision (Loganbill, Hardy, and Delworth, 1982) 1) Competence- skill development, technique 2) Supervisee personal developmentAwareness of supervisee own issues, reactions, limitations & strengths, and how they affect clinical relationship 3)Supervisee sense of autonomy- Help supervisee learn to make appropriate clinical

decisions based on standards of care without having to check in on every detail Issues to Target in Supervision (Loganbill, Hardy, and Delworth, 1982) 4) Theoretical Framework- Identifying which theories respond to which issues better 5) Developing respect for the clinical relationship- not getting personal, judging or criticizing 6) Goal Formation/Achievement- Treatment planning, assessment of process, providing direction when needed, modifying goals as needed

Issues to Target in Supervision (Loganbill, Hardy, and Delworth, 1982) 7) Supervisee Self Assessment- Any areas of secondary gain for supervisee? 8) Professional Ethics- Awareness of and boundaries regarding ethical and professional dilemmas Developmental Stages of Supervisees I. Stagnation II. Confusion III. Integration

Developmental Stages of Supervisees Stage One Unawareness of underlying issues Very black/white thinking Linear thinking-problem/solution, theoretical Low self concept High supervisor dependency Limited self awareness Supervisor = all knowing, all wise Developmental Stages of Supervisees Stage Two Instability, disorganization Realization of not having all the solutions

Fluctuations between I helped & I failed Still pretty dependent on supervision but more as a consultant Supervisee demonstrates more readiness for growth Developmental Stages of Supervisees Stage Three Flexibility Broader conceptualization and understanding Problems have many angles Sense of direction Sober judgment of both strengths & weaknesses

Systematic Training Program (Little, C., Packman, J., Simaby, M.H., & Maddux, C.D., 2005) Skills development Modeling Practicum

Internships Mastery Self monitoring Sober judgment of ones clinical abilities Theories of Supervision Types of Models Developmental- assisting the supervisee in maturing in developmental process Integrated- Supervisor is teacher and instructor, a training model, consulting when needed re. blind spots Orientation Specific- when supervisors role model a specific band of treatment

Developmental Considerations What level supervisee is at Early: support with minimal confrontation Advanced: skill building and complexities of clients Littrell, Lee-Borden, & Lorenz Model Supervisors match their roles to those needed by supervisees at any given time Move from shallow imitation to increasing self reliance Four Stages Stage One Supervisor as teacher and counselor

Setting goals and conditions for supervision May be determined by board, school requirements or agency contract Littrell, Lee-Borden, & Lorenz Model Stage Two Supervisors again act as both teacher and counselor Focus on assisting supervisee with skill deficits Stage Three Supervisor as collaborative consultant Move toward increased self monitoring and self judgment on the part of the supervisee

Littrell, Lee-Borden, & Lorenz Model Stage Four Distant consultants Collaborative between supervisor and supervisee More independence on the part of the supervisee Bernards Discrimination Model Three foci for supervision I) Intervention Skills Conducting diagnostic assessment interview Using skills like reflections, probes, restatements, summaries, and interpretations

Looking at nonverbals of the client Bernards Discrimination Model II) Conceptualization Skills Empathy with client communication Hearing client concerns Finding client themes Goal setting and modification for treatment

Matching goals with theoretical approaches Affirming client improvement and developing ongoing plan for sustaining gains Bernards Discrimination Model III) Personalization Skills Taking responsibility and direction for session outcomes Hearing feedback nondefensively- clients or supervisor Self analysis and monitoring Effectively combining personal style with client goals and treatment Developing an identity as a professional counselor

Integrated Approach to Supervision Nelson, Johnson & Thorngren Four Stages Nonsequential Ongoing I) Orientation Setting supervision responsibilities and goals Supervisors are counselors and teachers Integrated Approach to Supervision Nelson, Johnson & Thorngren II) Working How to do the work of counseling- diagnostic interviews, noting client behaviors and

nonverbals, diagnosis and treatment planning Skill development: strengths and weaknesses Combines all three foci areas of Bernards model Integrated Approach to Supervision Nelson, Johnson & Thorngren III) Transition Development trainings More independent thinking on the part of supervisees Cooperation and collaboration Less about teaching and specific answers

Integrated Approach to Supervision Nelson, Johnson & Thorngren IV) Integration Plan for ongoing program development and evaluation Self supervision- observing and adjusting as needed The Adlerian Model of Supervision Not necessarily sequential Process Oriented, Fluid Evaluation focused Goal Focused

Start with goals: supervisee, supervisor, client lifestyle, and expected outcomes Address development and modification of goals of these three Return to original schemas and goals when needed to see where things were supposed to be headed and/or to re-evaluate The Adlerian Model of Supervision Social Interest Supervisee and supervisor as team to benefit the client Evaluating counseling style and goals Includes evaluation in supervision

of supervisees lifestyle orientation and personal beliefs, values, and opinions as impacts The Adlerian Model of Supervision Style of Counseling Addresses how cases are conceptualized- whether goals are attainable, appropriateness of assumptions regarding counseling process or treatment, self concept as influencing counseling The Adlerian Model of Supervision

Style and Goal Reformation Helping supervisees to develop new and more productive counseling thoughts and behaviors Change ones to those that are more appropriate, empathic, and therapeutic for that specific situation and persons The Adlerian Model of Supervision Encouragement Looking at how the supervise will apply what has been learned to have improved therapeutic insight and outcomes in clinical

counseling Synergistic Model of Supervision (Ober, A.M., Granello, D.H., & Henfield, M.B., 2009) Balance of content and process orientation Developmental in nature (move from rigid assumptions and anxiety to flexibility and collaboration) for both supervisor and supervisee 3 critical elements: 1. Blooms Taxonomy 2. The Heuristic Model of Interpersonal Development and 3. Multicultural Competencies, individualized treatment

Synergistic Model of Supervision (Ober, A.M., Granello, D.H., & Henfield, M.B., 2009) Blooms Taxonomy Increasing cognitive complexities Cummulative levels Higher levels of tolerance for ambiguity

1. knowledge- recall 2. comprehension- demonstrating understanding 3. application- using the material in various situations 4. analysis- breaking down the material into parts 5. synthesis- integrating parts to from a new whole 6. evaluation- judging the material on the basis of defined criteria Synergistic Model of Supervision (Ober, A.M., Granello, D.H., & Henfield, M.B., 2009)

HMNID: Adaptation- conformity to certain stereotypes about clients Incongruence- challenging a persons beliefs, acceptance of some confusion and tension Exploration-Actively seeking out/working with differences Supervisor and supervisee may be on different levels Synergistic Model of Supervision (Ober, A.M., Granello, D.H., & Henfield, M.B., 2009 ) Multicultural Competencies Age, race, ethnicity, belief systems,

community, generation, soci-economic status, gender, sexual orientation, religion, values systems Synergistic Model of Supervision (Ober, A.M., Granello, D.H., & Henfield, M.B., 2009) Knowledge- What, when name, list define (Ex: Show evidence of__, Demonstrate knowledge of____, What do you know about ___?, Define ____.) Comprehension- summarize, describe, why, paraphrase, interpret (Ex. Describe what the research says about ___, Paraphrase the perceptions of two groups regarding the issue of ___., Why do you think a ___ approach may work better with ___ client than a ___ approach?)

Application- apply, demonstrate, construct, interpret, practice (Develop a plan for dealing with a client with ___, Demonstrate how the ___ technique could be applied to ___). Synergistic Model of Supervision (Ober, A.M., Granello, D.H., & Henfield, M.B., 2009) Analysis- analyze, compare, classify, contrast, experiment (Ex. Compare and contrast the assumptions of the following 2 techniques with regard to the role of client responsibility in the therapeutic process, Analyze the relationship between client resistence and early termination of counseling). Synthesis- create, combine, integrate, construct, summarize (Ex. Integrate the __ technique with a school-based program for students aged __., Hypothesize how solution-focused work may or may not work well with a lower socio-economic group with limited resources, education, and few

support systems.) Evaluation- appraise, assess, defend, critique (ex, Critique Dr. __s article on __ with respect to the 3 principles of empathy learned in class, Defend why a counselor may want to use a paradoxical intervention with a client presenting with __) Gestalt Supervision Groups (Melnick, J., & Fall, M., 2008) General principles: The present moment as encompassing the therapeutic experience and the future Expanding awareness- verbals and nonverbals Creative experiment (would you be willing to ?- e.g. the Gorilla girl)

Gestalt Supervision Groups Melnick, J., & Fall, M., 2008 Intrapsychic- within the supervisee Interpersonal- between 2 or more people Subgroup- looking at mini groups within the supervision group Group as a whole Computer-Based Supervision (Vaccaro, N., & Lambie, G.W., 2007)

Using technology to aid in supervision E- mail Computer-based teleconferencing Computer-assisted live supervision Videoconferencing IMing Computer-Based Supervision (Vaccaro, N., & Lambie, G.W., 2007)

Issues: Confidentiality Disclaimers Liability Technological competencies Boundaries With Supervisees Adhere to general, professional, ethical standards Reduce likelihood of exploitation Never- sexual relationships or sexual harassment Honest credit/citation to sources No supervision by a relative Honest evaluation to board, even if it means a person is not

necessarily recommended for licensure Regular follow-ups initiated and evaluations: two way Ethical Considerations in Supervision Vicarious responsibility Due process afforded supervisee Receiving informed consent (both supervision relationship and trainee/client relationship) Avoiding dual relationships Competency areas of supervisor and supervisee Confidentiality of client issues and supervision issues Common Ethical Concerns with Supervisees (Worthington, Tan & Poulin- 2002)

Intentional nondisclosure of important information (97.2%): clinical mistakes, personal problems, negative reactions by clients, countertransference, sexual attraction to clients Mismanagement of case records- inadequate record keeping (esp. cases of abuse, custody, homocide, hospitalization) Operating at an inappropriate level of autonomy Common Ethical Concerns with Supervisees (Worthington, Tan & Poulin- 2002) Failure to address personal issues Inappropriate methods of managing conflict with supervisors: gossip, damaging supervisors reputation, policies and rules violations, forging

documentation, adjusting hours on forms Two most common reasons: I want to avoid confrontation & I feel ashamed of my mistakes. Asking The Supervisor For Help Have a specific outlined agreement Besides board agreement and clinical supervision contract know how to approach in non traditional situations Ask supervisor how he/she prefers to he approached. Think ahead about your questions or concerns.

Asking The Supervisor For Help Can you give me some ideas about how to avoid giving advice when clients keep asking? Would you mind reviewing this paperwork? Where can I find resources on ____ topic? Can you help explore the _____ feeling I have about this situation? My client reminds me of ___. How can I work with that? Asking The Supervisor For Help Can we discuss options of treatment with this client with _____ issues?

How can I build trust and rapport with this challenging client? I do not know why I am stuck about ___. Can you maybe give me some guidance? I think I may have not documented this correctly. Can you rev it with me? What should I have done? I am not sure if I handled a potential ethical situation correctly. Could I have your guidance? Helping Supervisees Self Evaluate What are you actively doing to build trust with your clients? How do you engage ion therapeutic partnership? How do you confront clients when necessary? How are you assisting clients in taking responsibility

for their behaviors? Change? What things do you say or do to instill hope and build a healthy future orientation? How are you helping clients generalize skills outside of session? Supervisors Self Evaluation How am I contributing to problems? How is the supervisee contributing to problems? What is working? Not working? How can we reframe this situation into an opportunity for growth? Danger Signals

Flattery Seductive behavior Frequent desire to discuss sexual issues Complaints of loneliness Overdependence Physical Familiarity Gift giving

Danger Signals Thoughts of counselor/client/supervisor/supervisee between sessions Comparing the counselor/client/supervisor/supervisee to your spouse Fantasies about the counselor/client/supervisor/supervisee Seeing the other person as special Excuses to extend contact with the other Desire to disclose personal things Danger Signals A strong sense that the other is responding

to you distinctly different from others in the same situation Defensiveness to feedback Mirroring or feeling the same way the clients present- paralell process Sources of Threats For Supervisees 1) Evaluation anxiety 2) Performance anxiety 3) Personal problems or internal conflicts 4) Deficits in the supervisory relationship 5) Fear of negative consequences for trying new or risky counseling interventions 6) Power Imbalances

Reducing Sense of Threat

Restructuring feedback Reframing vulnerability as an opportunity for growth Assessing strengths Building support systems Increasing the ratio of positive to negative feedback Modifying supervision style Noting things which produce defensive reactions Noting performance and approval demands Supervisee Resistance Supervise perception of threat Attempts to slow down the process of counseling and supervision A response to non helpful supervision

Supervision Versus Counseling Clinical Supervision Administrative Supervision Counseling Purpose Improved client care, Improved job performance Ensure

compliance with agency and regulatory body policies and procedures Personal growth, Behavior changes, Better self understanding Outcom e Enhanced proficiency

in knowledge and skills Consistent use of appropriate formats Open ended, based on client needs Supervision Versus Counseling Clinical Supervision

Administrativ e Supervision Counseling Time Frame Short term and ongoing Short term and ongoing Based on client needs Agenda

Based on agency mission and clinician needs Based on agency needs Based on client needs Basic Process Teaching/learning specific skills, evaluating job performance,

negotiating learning objectives Clarifying agency expectations. policies and procedures, ensuring compliance Behavioral, cognitive, and affective process including listening, exploring and

teaching Multicultural Supervision Supervision with various groups Self awareness of variable related to supervisor and supervisee Challenging stereotypes and assumptions Broaching topics Successful Multicultural Supervision (Dressel, J.L, Consoli, A.J., Kim, B.S.K., & Atkinson, D.R., 2007) Tending to feelings of discomfort experienced by trainees concerning multicultural issues

Supporting supervisees own racial/ethnic identity development Presenting myself nondefensively by tolerating anger, rage, and fear around multicultural issues Providing supervisees a multiculturally diverse caseload to ensure breadth of clinical experience Attending to racial/ethnic ethnic cultural differences reflected in parallel process issues (supervisor/supervisee and supervisee/client) Successful Multicultural Supervision (Dressel, J.L, Consoli, A.J., Kim, B.S.K., & Atkinson, D.R., 2007) Addressing a broad range of differences (e.g. learning styles, interpersonal needs, social orientation, religious/spiritual beliefs, and race) Checking out the supervisory expectation with supervisees Initiating discussion about the importance of culture Acknowledging and discussing power issues in supervision that may be related to

racial/ethnic multicultural differences Encouraging supervisees to share, within supervision, their personal and professional cultural background and experiences Consulting colleagues willingly about my own reactions to racial/ethnic concerns from supervision Acknowledging my own lack of knowledge on racial/ethnic multicultural differences Successful Multicultural Supervision (Dressel, J.L, Consoli, A.J., Kim, B.S.K., & Atkinson, D.R., 2007) Testing hypotheses about my supervisees, not accepting just one view Self-disclosing aspects of my own cultural background Implementing knowledge and awareness of supervision theory by attending to supervisees' process and stage of development Engaging supervisees in peer review with each other's cases through case conferences Seeking understanding of supervisees' culture through both didactic and experiential means

on my own Providing written and verbal feedback regarding supervisees' multicultural interactions with staff and clients Providing multicultural readings and related training experiences for supervisees Being willing to confront supervisee's inadequate skills, listening if that is challenged on grounds of cultural insensitivity, but not backing away from my own standards and values Successful Multicultural Supervision (Dressel, J.L, Consoli, A.J., Kim, B.S.K., & Atkinson, D.R., 2007) Allowing supervisees to see clinical work in cross-cultural counseling and/or consultation through tapes or live observation Providing supervisees with information about various cultures Offering supervisees mentorship and other collaborative

professional opportunities with me (e.g., co-led presentations, coauthored papers) Departing from Western theoretical perspectives in supervision Having supervisees keep a journal that documents personal reactions to interactions with seminar facilitator and intern colleagues Triangulation 3 persons Mirror daily living Any time two people talk about a third in private

Supervis or Client Supervis ee Supervisory Self Care Stresses mirror those in counselingsupervisee behaviors and psychosocial intra and interpersonal dynamics, emotional demands, time management. Can ameliorate stresses of seeing clients as somewhat removed as a supervisor but can

also add to stress Supervisory Self Care Look at own unresolved issues with clients or supervisees clients Have a network of other supervising counselors to speak with Set aside time for healthy lifestyle behaviors: eating, sleeping, exercising Allow space from the clinical setting Permit self to not be a caretaker and caregiver for everyone (e.g. see Letting Go Poem) Take time off when necessary Reconceptualize being a supervisor not as one with all the answers (promotes burnout) but a more experienced facilitator Supervisory Self Care

Keep a clear contract (modify if necessary) in writing what supervision entails Charge an appropriate fee Keep your own professional development up to date Keep an idea about expectations ahead of time so there is some structure for supervision sessions Have an idea ahead of time about how you will let go of stress at the end of the work day Recommendations for Clinical Counseling Students Be proactive. Remain flexible.

Ask for what you need; do not demand it. (e.g. I would like to exploreCould you help me with that?) Take responsibility for your growing and learning in supervision Recommendations for Clinical Counseling Students Make time for self assessment and reflection Avoid blaming and excuses. Focus instead on problem solving. Instead of looking at what the supervisor is not doing ask what you can learn from that supervisor. Case Discussions & Videos

What would you do? Bibliography Adler,A. (1908). Social interest. Boston, MA: Allyn & Bacon Press. Allen, G.J., Szollos, S.J., & Williams, B.E. (1986). Doctoral students comparative evaluations of best and worst psychotherapy supervision. Professional Psychology: Research and Practice, 17, 91-99. Allen, J. (1976). Peer group supervision in family therapy. Child Welfare, 55, 183-189. Altucher, N. (1967). Constructive use of the supervisory relationship. Journal of Counseling Psychology, 14, 165-170. Bauman, W.F. (1972). Games counselor trainees play: dealing with trainees resistance. Counselor Education and Supervision, 11, 251-256. Berger,N,& Graff,L. (1995). Making good use of supervision. In D.G. Martin & A.D. Moore (Eds.) Basics of clinical practice: A guidebook for trainees in the helping profession (pp.408-432). Prospect Heights,IL: Waveland Press.

Bernard, J. & Goodyear, R. (1992). Fundamentals of clinical supervision. Allyn & Bacon: Boston, MA. Bernard,J.M. (1994). Receiving and using supervision. In H.Hackney & S. Cormier (eds.). Counseling strategies and preventions (pp.169-189). Needham Heights,MA: Allyn & Bacon Bibliography Bernard, J.M. (1979). Supervisor training: A discrimination model. Counselor Education and Supervision, 19, 60-68. Bernard, J.M. (1997). The discrimination model. In C.E. Watkins, Jr. (ed.) Handbook of psychotherapy supervision (pp.310-327). NewYork: Wiley. Bernard, J.M. & Goodyear,R.K. (2004). Fundamentals of clinical supervision (3rd ed.. Needham Heights, MA: Allyn & Bacon. Bierig, J. R. (1983). Whatever happened to professional self regulation? American Bar Association Journal, 69, 616-619.

Borders, L. D. (1989c, August). Learning to think like a supervisor. Paper presented at the annual meeting of the American Psychological Association, New Orleans. Borders, L. D. (1989e). [ review of Supervising counselors and therapists: A developmental approach]. The Clinical Supervisor, 7, 161-166. Borders, L. D., Fong, M. L. & Neimeyer, G. J. (1986). Counseling students level of ego development and perceptions of clients. Counselor Education and Supervision, 26, 36-49. Borders, L. D. & Leddick, G. R. (1987). Handbook of counseling supervision. Alexandria, VA: Association for Counselor Education and Supervision Bibliography Bubenzer, D.L., Mahrle, C. & West, J.D. (1987). Live counselor supervision: Trainee acculturatuon and supervisor interventions. Paper presented at the annual convention of the American Association for Counseling and Development, New Orleans. Carns, M.R. & Carns, A.W. (1994). The use of the Adlerian life-style and the four goals of misbehavior in supervision. Individual psychology: Journal of Adlerian Theory, Research, and

Practice, 50, 341-348. Cohen, R. J. (1979). Malpractice: A guide for mental health professionals. New York: Free Press. Cohen, M., Gross, S, & Turner, M. (1976). A note on a developmental model for training family therapists through group supervision. Journal of Marital and Family Counseling, 2, 48-56. Conn, S.R., Roberts, R.L., & Powell, B.M. (2009). Attitudes and satisfaction with a hybrid model of counseling supervision. Educational Technology & Society, 12(2), 298-306. Corey, G. (1986). Theory and practice of counseling and psychotherapy (3rd ed.). Monterey, CA: Brooks/Cole. Corey, G. , Corey, M.S., & Callanan, P. (1988). Issues and ethics in the helping professions (3rd ed.). Monterey, CA: Brooks/Cole. Cormier, L.S., & Bernard J. M. (1982). Ethical and legal responsibilities of clinical supervisors. Personnel and Guidance Journal, 60, 486-491 Bibliography Council for Accreditation of Counseling and Related Educational Programs. (1994).

Accreditation standards and procedure manual. Alexandria, VA: Author. Dollarhide,C.T., & Nelson,M.D. (2000). Adlerian supervision: A proposed model. The Canadian Journal of Aderian Psychology, 30, 35-46. Drapela, V.J. & Drapela, G.B. (1986). The role of the counselor in intern supervision. School Counselor, 34, 92-99. Getzel, G. S. & Salmon, R. (1985). Group supervision: An organizational approach. The Clinical Supervisor, 3, 27-43. Goldberg, D.A. (1985). Process notes, audio, and video tape: Modes of presentation in psychotherapy training. The Clinical Supervisor, 3, 3-13 Goodyear, R.K. & Sinnett, E. R. (1984). Current and emerging ethical issues for counseling psychologists. The Counseling Psychologist, 12 (3), 87-98. Green, S.L. & Hansen, J.C. (1986). Ethical dilemmas in family therapy. Journal of Marital and Family Therapy, 12, 225-230. Green, S.L. & Hansen, J.C. (1989). Ethical dilemmas in family therapy. Journal of Marital and Family Therapy, 15, 149-158. Haas, L.J., Malouf, J.L., & Mayerson, N.H. (1986). Ethical dilemmas in psychological practice:

Results of a national survey. Professional Psychology: Research and Practice, 17, 316-321. Bibliography Hall, J. E., (1988a). Protection in supervision. Register Report, 14, 3-4. Hall, J. E. (1988 b). Dual relationships in supervision. Register Report, 15, 5-6. Hart,G.M. &Nance,D. (December 2003). Styles of counselor supervision as perceived by supervisors and supervisees. Counselor Education and Supervision, 43, 146-156. Holloway, E.L. (1988a). Instruction beyond the facilitative conditions: A response to Biggs. Counselor Education and Supervision, 27, 252-258. Holloway, E.L. & Hosford, R.E. (1983). Towards developing a prescriptive technology of counselor supervision. The Counseling Psychologist, 11(1), 73-77. Holloway, E.L. & Roehlke, H.J. (1987). Internship: the applied training of a counseling psychologist. The Counseling Psychologist, 15, 205-260. Holloway, E.L. & Wolleat, P.L. (1981). Style differences of beginning supervisors: An interactional analysis. Journal of Counseling Psychology, 28, 373-376.Kadushin, A.

(1968). Games people play in supervision. Social Work, 13, 23-32. Ladany, N., Walker, J.A., ?& Melincoff, D.S. (June 2001). Supervisory style: Its relation to the supervisory working alliance and supervisor self-disclosure. Counselor Education & Supervision, 40, 263-275. Bibliography Lambert,M.J., Hansen,N.B., & Finch, A.E. (2001). Patient-focused research. Using patient outcome data to enhance treatment effects. Journal of Consulting and Clinical Psychology, 69, 159-172. Lemberger,M.E. & Dollarhide, C.T. (Summer 2006). Encouraging the supervisees style of counseling: An Adlerian model for counseling supervision. The Journal of Individual Psychology, 62(2), 106-125. Littrell, J. M., Lee-Borden, N., & Lorenz, J.A. (1979). A developmental framework for counseling supervision. Counselor education and supervision, 19, 19-136. Lizzio, A., Stokes, L., & Wilson, K. (November 2005). Approaches to learning in professional supervision: Supervisee perceptions of processes and outcome. Studies in Continuing Education, 27(3), 239-256. Loganbill, C., Hardy, E., & Dilworth, U. (1982). Supervision: A conceptual model. The Counseling Psychologist, 10 (1), 4-42.

Margolin, G. (1982). Ethical and legal considerations in marital and family therapy. American Psychologist, 37, 788-801. McMahon, M, & Simons,R. (June 2004). Supervision training for professional counselors: an exploratory study. Counselor Education & Supervision, 43, 301-309. Melnick, J., & Fall, M. (Sept. 2008). A Gestalt approach to group supervision. Counselor Education & Supervision, 48, 48-60. Nelson, M.D., Johnson,P, & Thorngren,J.M. (Jan. 2000). An integrated approach for supervising mental health counseling. Journal of Mental Health Counseling, 22(1), 45-59. Nyman, S.J., Nafzinger, M.A., & Smith, T.B. (Spring 2010). Client outcomes across counselor training level within a multitiered supervision model. Journal of Counseling & Development, 88, 204-209. Ohio Counselor and Social Worker Board. (2011). Ohio laws and rules governing the practice of counseling and social work: Columbus, OH: Author Bibliography Ober, A. M., Granello, D.H., & Henfield, M.S. (March 2009). A synergistic model to enhance multicultural

competence in supervision. Counselor Education & Supervision, 48, 204-221. Openshaw, L. (October 2012). Challenges in Clinical Supervision Presented at NASW Convention. Patrick, K.D. (1989). Unique ethical dilemmas in counselor training. Counselor Education and Supervision, 28, 337-341. Pearson,Q.M. (October 2004). Getting the most out of clinical supervision: Strategies for mental health. Journal of Mental Health Counseling, 26(4), 361-373. Pearson, Q.M. (October 2000). Opportunities and challenges in the supervisory relationship: Implications for counselor supervision. Journal of Mental Health Counseling, 22(4), 283-305. Ponterotto, J.G. & Zander, T.A. (1984). A multimodal approach to counselor supervision. Counselor Education and Supervision, 24, 40-50. Pope, K.S., Tabachnick,B.G. & Keith-Spiegel,P. (1988). Good and poor practices in psychotherapy: National survey of beliefs of psychologists. Professional Psychology: Research and Practice, 19, 547-552. Sansbury, D.L. (1982). Developmental supervision from a skill perspective. The Counseling Psychologist, 10 (1), 53-57. Schoenwald,I.S.& Kopp,R.R. (1986). Lifestyle and the roles of the supervisor in an organization: an integration. Individual Psychology: Journal of Adlerian Theory, Research, and Practice, 42, 350-359.

Schutz, B.M. (1982). Legal liability in psychotherapy. San Francisco, CA: Josey-Bass. Snider, P.D. (1985). The duty to warn: A potential issue of litigation for the counseling supervisor. Counselor Education and Supervision, 25, 66-73. Stein, D.M.& Lambert, M.J. (1995). Graduate training in psychotherapy: Are therapy outcomes enhanced? Journal of Consulting and Clinical Psychology, 63, 182, 196. Bibliography Stolzenberg, C.D.& Delworth, U. (1987). Supervising counselors and therapists: a developmental approach. San Francisco: Josey-Bass. Stolzenberg, C.D.& Delworth, U. (1988). Developmental models of supervision: It is developmentResearch response to Holloway. Professional Psychology: Research and Practice, 19, 134-137. Supervision Interest Network, Association for Counselor Education and Supervision. (1993). ACES ethical guidelines for counseling supervisors. ACES Spectrum, 53(4), 5-8. Supervision Interest Network, Association for Counselor Education and Supervision. (1990). Standards for counseling supervisors. Journal of Counseling and Development, 69, 30-32. Tennyson, W.W. & Strom,S.M. (1986). Beyond professional standards: Developing responsibleness. Journal of Counseling and Development, 64, 298-302.

Tholstrop, M. (April 2005). Supervisory self care. Counselling and Psychotherapy Journal, 16(3), 41-42. Tromski-Kingshirn,D.M. & Davis, T.E. (2007). Supervisee perceptions of their clinical supervision: a study of the dual role of clinical and administrative supervisor. Counselor Education and Supervision, 46, 294-304. Vaccaro, N., & Lambie, G.W. (2007). Computer-based counselor-in-training supervision: Ethical and practical implications for counselor educators and supervisors. Counselor Education & Supervision, 47, 46-57. Whipple,J.L., Lambert,M.J., Vermeersch,D., Smart,D.W., Nielson,S.L., & Hawkins, E.J. (2003). Improving the effects of psychotherapy: The use of early identification of treatment failure and problem solving strategies in routine practice. Journal of Counseling Psychology, 50, 59-68. Bibliography Wise, P.S., Lowery, S. & Silverglade, L. (1989). Personal counseling for counselors in training: Guidelines for supervisors. Counselor Education and Supervision, 28, 326-336.

Woody, R.H. and associates. (1984). The law and practice of human services. San Francisco: Jossey-Bass. Worthen, V.E. & Lambert,M.J. (2007). Outcome oriented supervision: advantages of adding systematic client tracking to supportive consultations. British Association for Counseling and Psychotherapy, 48-53. Worthington,R.L., Tan,J.A., & Poulin,K. (2002). Ethically questionable behaviors among supervisees: An exploratory investigation. Ethics and Behavior, 12(4), 323-351. Yager, G. G., Armsworth, M. W.., Williams, G. T., & Levinthal, C.E. (1981, October). Ten suggestions for maximizing learning in supervision. Paper presented at the North Central Association for Counselor Education and Supervision, Milwaukee, WI. (ERIC Document Reproductions

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