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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 Clinical Staff

  • 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.


Na ve enthusiasm
Naïve Enthusiasm Clinical Staff


Trials and tribulations
Trials and Tribulations Clinical Staff


Calm after storm
Calm after Storm Clinical Staff


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

Credit Where Credit Due Clinical Staff

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

BTW-why are there so many awesome Davids?


Understanding change
Understanding Change Clinical Staff

  • 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 Clinical Staff

  • 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 Clinical Staff

  • Available

  • Accessible

  • Able

  • Affable

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


Care experiences
Care Experiences Clinical Staff

  • 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 Clinical Staff

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 Clinical Staff

  • 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 Clinical Staff

  • 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 Clinical Staff

  • 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 Clinical Staff 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 Clinical Staff

  • 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 Clinical Staff

  • Influential: Affective

  • Symbolic: Latent

  • Structural: Reactive

  • Replicative: Parallel

  • Counselor TX: Related

  • Information Gathering: Indirect+

  • Jurisdictional: Therapist+

  • Relationship: Facilitative

  • Strategy: Theory+


Skills model
Skills Model Clinical Staff

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 Clinical Staff

  • 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 Clinical Staff

  • Modeling and reinforcement are basic tools

    • Two way modeling: supervisor to supervisee and back again

  • Skills monitoring is ongoing


Methods continued1
Methods Continued Clinical Staff

  • 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 . . .


Task oriented model
Task Oriented Model Clinical Staff


Taking supervision to task
Taking Supervision to Task Clinical Staff

  • 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 Clinical Staff

  • 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 Clinical Staff

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 Clinical Staff

  • 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 Clinical Staff

  • 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 Clinical Staff

  • 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 Clinical Staff

  • 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? Clinical Staff

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 Clinical Staff

  • 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