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Supervision Models Part I: How We Support and Care for Clinical Staff . B art A ndrews, PhD CAPA Training Institute June 23, 2014. Developmental Models. There are 3 stages of supervisor and supervisee development: Stage 1- Naïve Enthusiasm Stage 2- Trials and Tribulations

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supervision models part i how we support and care for clinical staff

Supervision Models Part I: How We Support and Care for Clinical Staff

Bart Andrews, PhD

CAPA Training Institute

June 23, 2014

developmental models
Developmental Models
  • There are 3 stages of supervisor and supervisee development:
    • Stage 1- Naïve Enthusiasm
    • Stage 2- Trials and Tribulations
    • Stage 3- Calm after the Storm
  • Lets take a look at how these stages apply to my preparation.
slide6

Credit Where Credit Due

“Powell is the man!”- David Patterson, June 17, 2014

BTW-why are there so many awesome Davids?

understanding change
Understanding Change
  • 30% of change is related to quality of relationship between client and counselor and/or counselor and supervisor
  • 40% from extratherapeutic factors
  • 15% is derived from hope/expectancy
  • 15% specific to therapeutic technique
relationship drives everything
Relationship Drives EVERYTHING
  • Better Clinical Supervision = Greater Job Satisfaction
  • Better Clinical Supervision = Better Retention
  • Better Clinical Supervision = Better Clinical Outcomes

“ . . .counselors view their supervisors as a primary resource for education, training, coaching, morale building and consultation,” (Powell and Brodsky, 2004).

the 4 a s of supervision
The 4 ‘A’s’ of Supervision
  • Available
  • Accessible
  • Able
  • Affable

Good supervision is largely a matter of caring for staff and mutually beneficial interdependency

care experiences
Care Experiences
  • What care have you received from a supervisor?
  • What has a supervisor said (or not said) that has had the biggest impact on you?
  • What has a supervisor done (or not done) that has had the biggest impact on you?
philosophy continuum
Philosophy Continuum

Insight: Process, Goals, Traits

Skill: Processes, Goals, Traits

Acquiring new behaviors

Action is the catalyst

Problem resolution

Symptom relief

Skill development

Problem oriented

Directive

Therapist Driven

  • Experimentation
  • Exploration
  • Discovery
  • Interpretation
  • Self Development
  • Life Enrichment
  • Self Awareness
  • Facilitative
  • Client Driven
9 descriptive dimensions
9 Descriptive Dimensions
  • Influential: Affective Vs Cognitive
  • Symbolic: Latent Vs Manifest
  • Structural: Reactive Vs Proactive
  • Replicative: Parallel Vs Discrete
  • Counselor TX: Related Vs Unrelated
  • Information Gathering: Indirect Vs Direct
  • Jurisdictional: Therapist Vs Supervisor
  • Relationship: Facilitative Vs Hierarchical
  • Strategy: Theory Vs Technique

STAGES OF DEVELOPMENT ALWAYS RELEVANT

psychodynamic model
Psychodynamic Model
  • Focus on the intrapersonal and

interpersonal dynamics of the

counselor in relation to ALL others

  • Dynamic Awareness Goal: understanding

dynamic contingencies:

    • Impact of past learning on current situations
    • Observing changes in the dynamic
    • Making therapeutic use of dynamic in counseling
  • Goal is to refine supervisee’s mode of listening
    • Increase sensitivity to transference and countertransference
    • Awareness of drives and defense mechanisms
assumptions
Assumptions
  • Similarities in structure and dynamics of therapy and supervision- ISOMORPHIC RELATIONSHIPS
  • Parallel processes between relationships
  • Supervisor interprets this dynamic
  • What is said and done is just the surface
supervisor kkills sorry freudian slip i meant skills
Supervisor Kkills(sorry, Freudian slip) I meant Skills
  • Listening
  • Musing
  • Suspension of judgment
  • Tolerance for ambiguity
  • Rejection of illusion
  • Think confession for therapists!
developmental stages
Developmental Stages
  • Childhood
    • Space to play, home base
    • Bonding
    • Demarcating space
  • Adolescence
    • Structure building
    • Work and play-experimentation
    • Conflict
  • Adult
    • Internalized values
    • Identity settles
    • Transition to colleague
descriptive dimensions psychodynamic
Descriptive Dimensions-Psychodynamic
  • Influential: Affective
  • Symbolic: Latent
  • Structural: Reactive
  • Replicative: Parallel
  • Counselor TX: Related
  • Information Gathering: Indirect+
  • Jurisdictional: Therapist+
  • Relationship: Facilitative
  • Strategy: Theory+
skills model
Skills Model

3 Basic Tenets

  • Counselors must learn the appropriate skills and extinguish inappropriate behaviors
  • Supervision assists counselors in developing and assimilating specific skills
  • Counselor knowledge and skills should be formulated in behavioral terms
9 methods of skill supervision
9 Methods of Skill Supervision
  • Establishing a Relationship between supervisee and supervisor is a dynamic component of the learning process
    • Focus is on skill acquisition via instruction and modelling
  • Supervision begins by asking what one needs to lean to be an effective counselor
    • Current skill level? What skills are needed? Task list?
  • Set realistic, measurable and timely goals to enhance motivation
    • Is this reminding anyone of SMART goals and MI?
methods continued
Methods Continued
  • Modeling and reinforcement are basic tools
    • Two way modeling: supervisor to supervisee and back again
  • Skills monitoring is ongoing
methods continued1
Methods Continued
  • Role Playing and Simulation
  • Microtraining-breaking down skills into small steps
    • Simulated session that is video taped
    • Supervisor provides feedback and re-demonstrates on tape
  • Other Techniques are added
    • Self management
    • Overt and covert stimulus control
    • Relaxation Training
  • Generalization of Skills
    • In what other situations might you use . . .
taking supervision to task
Taking Supervision to Task
  • Drawn from behavioral and computer science models
  • Behavioral variables are manipulated to influence outcome of supervision
  • By reinforcing the variables of counselor behavior, supervisor can train more effective counselors
  • Not specific to any theoretical models
  • Tasks and reinforcement/shaping can be applied to specific skills for whatever model or technique an agency is using
direct observation
Direct Observation
  • Direct viewing of work is key
  • Modeling, feedback and programmed interventions
  • Using live material for supervision
hierarchical system 3 levels parallel activity
Hierarchical System/3 Levels/Parallel Activity

Client level

  • Client database-what is going on with me
  • Client comes with set of hopes/goals
  • Make goals overt
  • Establish treatment plan
  • Put treatment in place
  • Goals met
  • Termination
counselor level
Counselor Level
  • Preparation
  • Establish client data base/evaluation-what is going on with client
  • Determine goals
  • Develop treatment plans
  • Carry out treatment plans
  • Evaluate progress
  • Goals met
  • Termination procedures
supervisor level
Supervisor Level
  • Supervisor and Client Database-what is going on with them?
    • Supervisor preparation task
    • Determine supervisee’s preparation task
  • Determine Supervision goals
  • Supervision Plan
    • Determine Assessment Procedures
    • Determine Observation Procedures
    • Present Supervision Plan
  • Observe Therapist
    • Observe Delivery
    • Observe Impact
  • Evaluate and Intervene
    • Case file and assessment results
    • Interview with Counselor
  • Determining Counselor Progress
    • Update counselor database
    • Determine need for additional training/supervision
  • End Supervision
developmental stages skills
Developmental Stages-Skills
  • Apprentice
    • Motivated
    • Inwardly insecure/anxious
    • Eager to please
  • Journeyman
    • Demonstrates some skill
    • Some challenging behavior
    • Starting to generalize
  • Expert
    • Able to generalize across contexts
    • Mastered technical skills
    • Integrated personal model of therapy
descriptive dimensions skills
Descriptive Dimensions-Skills
  • Influential: Cognitive
  • Symbolic: Manifest
  • Structural: Proactive
  • Replicative: Discrete
  • Counselor TX: Unrelated
  • Information Gathering: Direct
  • Jurisdictional: Supervisor
  • Relationship: Hierarchical
  • Strategy: Technique
descriptive dimensions really
Descriptive Dimensions, Really?

DynamicSkill

  • Influential: Affective Cognitive
  • Symbolic: Latent Manifest
  • Structural: Reactive Proactive
  • Replicative: Parallel Discrete
  • Counselor TX: Related Unrelated
  • Information Gathering: Indirect+ Direct
  • Jurisdictional: Therapist+ Supervisor
  • Relationship: Facilitative Hierarchical
  • Strategy: Theory+ Technique
what s next blended model
What’s Next: Blended Model
  • Blended Model acknowledges that substance use providers need their own model
  • Also called contemplative because it includes spiritual and faith based elements
  • Recognizes that successful supervision BLENDS both insight and skill based models
  • Philosophical model is evidence based AND consistent with substance use professionals training and agency goals

COMING SOON TO A CAPA NEAR YOU

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