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Supervision of Mental Health Counseling Interns






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Supervision of Mental Health Counseling Interns. On line training for field supervisors Clinical Mental Health Counseling Program Fall 08 . Reflections on supervisory experiences . Answer the following questions for yourself about your own supervision experiences .
Supervision of Mental Health Counseling Interns

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Slide 1

Supervision of Mental Health Counseling Interns

On line training for field supervisors

Clinical Mental Health Counseling Program

Fall 08

Slide 2

Reflections on supervisory experiences

Answer the following questions for yourself about your own supervision experiences

Slide 3

Your Supervision Experiences

What kind of supervision did you get:

  • As an intern

  • As a beginning counselor

    What was most helpful or least helpful

    What do you do that is the same as your supervisor

    What do you do that is different

Slide 4

Definitions of supervision at your work place

  • What is your understanding of the supervisory relationship

  • Is supervision expected to be clinical, administrative or both

  • How well prepared do you feel to fulfill this role (roles)

Slide 5

Why we need training

  • Supervision skills similar but not identical to counseling skills

  • Supervising without training gives message that “any good counselor will be good supervisor”

  • Supervisory training provides supervisor with framework to conduct and evaluate effectiveness of the supervision

Slide 6

Definition of Clinical Supervision

(Bernard and Goodyear, 2004)

An intervention provided by a more senior member of a profession to a more junior member or members of that same profession

Slide 7

Definition cont.

  • Relationship is:

    evaluative

    extends over time

  • Simultaneous purposes of:

    enhancing professional functioning

    monitoring quality

    gate keeping for the profession

Slide 8

How do you rate your skills

  • Evaluation of supervisees

  • Enhancement of supervisees skills

  • Monitoring of supervisees counseling relationships

  • Preventing incompetent, unethical or harmful counselors from practicing

  • Safeguarding well being of client

Slide 9

Basic elements of supervisor competence

  • Understand the roles and functions of a supervisor

  • Organize the supervisory experience

  • Be aware of the ethical and legal considerations in the relationship

  • Have a working model of supervisory process and work within that model to develop effective supervisory relationship

Slide 10

Roles and Functions of the Supervisor

Supervisor as teacher

  • evaluate observed counseling session interactions

  • Identify effective and ineffective interventions

  • Teach demonstrate or model intervention techniques

  • Explain rationale behind specific strategies

  • Interpret significant events in counseling sessions

Slide 11

Roles and Functions

  • Identify issues of class, culture and ethnicity in counseling session

  • Educate and provide resources for supervisee to learn about effects of class, culture, etc in counseling relationships

  • Model awareness and sensitivity to these issues in supervision

Slide 12

Roles and Functions

Supervisor as Counselor

  • Explore supervisee’s feelings during counseling or supervision session

  • Explore supervisee’s feelings about specific techniques and interventions

  • Facilitate supervisee’s self exploration of confidence or concerns in sessions

  • Help supervisee define personal growth areas

  • Provide opportunities for supervisees to process own affect or defenses

Slide 13

Roles and Functions

  • Help supervisee identify his/her values base, cultural background and social awareness

  • Explore the possible effect of these on supervisee’s counseling style and effectiveness

Slide 14

Roles and Functions

Supervisor as Consultant

  • Provide alternative interventions and/or conceptualizations for trainee use

  • Encourage brainstorming of strategies and interventions

  • Encourage discussion of client problems, motivations, etc

  • Solicit feedback from supervisee as to effectiveness of session

  • Ask supervisee to structure the session

    (Bernard and Goodyear, 2004)

Slide 15

Roles and Functions

Supervisor as evaluator

  • Provide regular and systematic feedback and evaluation

  • Provide information to graduate school programs, prospective employers, licensing boards and professional associations

  • Provide references when requested by licensing board or another agency

Slide 16

Roles and Functions

Supervisor as Administrator

  • Monitor supervisees’ adherence to policies and procedures of the agency

  • Monitor legal and ethical matters and documentation of client sessions

  • Help supervisee navigate bureaucracies

  • Monitor supervisees’ adherence to reporting laws

  • Monitor confidentiality of records

Slide 17

Roles and functions case study

A client arrived for her appointment wearing a distinctive coat. The therapist remarked on its bright and beautiful colors. At the end of the day, the therapist returned home to find a box with an identical coat on her doorstep. The note said the client had made a big effort to find the identical coat as a way to say thank you for all the help she had received.

Slide 18

Roles and functions case study

The clinician is your supervisee. She states that when trying to return the gift to the client, the client became distraught and said it felt like a rejection of her. The client asked the therapist to keep the coat at least until the next session and if the therapist still wanted to give it back, she would take it. The client stated that she could not return the coat because it was on sale.

Slide 19

Roles and Functions Case Study

What are the main issues in this situation

What supervisory roles will be most useful to you in addressing these issues

How do you see yourself structuring the feedback you will give

What personal concerns may be raised for you by this situation

(Fall and Sutton, 2004)

Slide 20

Models of Supervision

Three main types of supervision models:

Psychotherapy based models

Developmental models

Social Role models

Slide 21

Models

  • Psychotherapy based models

    Based on the use of specific theories of psychotherapy.

    Putney, Worthington, and McCullough (1992) concluded that style or role of the supervisor is influenced by the supervisor's theoretical orientation in these models

Slide 22

Models

  • Developmental models

    Two basic underlying assumptions:

    (a) Student counselor/supervisee moves toward competence in a series of stages

    (b) each student counselor/supervisee's developmental stage requires qualitatively different supervision environment if most favorable professional growth is to occur

    (Chagnon & Russell, 1995).

Slide 23

Models

  • Social role models

    Focus on roles that supervisors engage in during supervision.

    Primary range of roles includes:

    administrator

    counselor

    consultant

    evaluator

    teacher

    (Bernard, 1979; Carroll, 1996; Holloway, 1995; Williams, 1995).

Slide 24

Stoltenberg’s Developmental Model

Views training process as sequence of identifiable stages through which trainee progresses

Provides a conceptual framework for supervisor and supervisee

Slide 25

Stoltenberg’s model

Four Stages of Development :

  • Dependent

  • Dependent-autonomous

  • Conditional dependency

  • Integrated

Slide 26

Dependent Stage

Supervisee:

  • Lacks confidence

  • Needs support and direction

  • Needs opportunity to explore

  • Feelings and become more self aware

  • May be anxious about performance and evaluation

Slide 27

Dependent-autonomous stage

Supervisee:

  • Moves away from imitating supervisor and initiates new behaviors

  • May become overconfident or overwhelmed

  • Level of motivation may fluctuate

  • May express stress due to lack of confidence and wanting to appear competent

Slide 28

Conditional Dependency

Supervisee:

  • Checks in with supervisor if she/he runs into difficulty

  • Strong clinical skills

  • Establishes personal style and uses multiple approaches

  • May depend on supervisor as peer or colleague

Slide 29

Integrated stage

Supervisee:

Capable of independent practice

Aware of personal limitations

Interested in process of counseling

Comfortable with interdependent/collaborative approach

Seeks peer supervision

Slide 30

Bernard’s Discrimination Model

Three basic roles for supervisors:

Teacher

Counselor

Evaluator

Four main foci for supervision:

Intervention

Conceptualization

Personalization

Professional Behaviors

Slide 31

Teacher role

Determine what is critical for the student counselors/supervisees to learn

Give information, instruction, and guidance

Evaluate student counselors/supervisees

Give regular verbal and written feedback of strengths and areas for growth.

Slide 32

Counselor role

  • Help student counselors/supervisees focus on interpersonal and intrapersonal interactions.

  • Especially important when helping student counselors/supervisees conduct a self-evaluation

Slide 33

Consultant role

  • Student counselor/supervisee and supervisor relate as colleagues

  • Exchange ideas about interventions, goals, and treatment plans.

Slide 34

The four foci

  • Intervention focuses on:

    What the supervisee is doing in the session

    that is observable by the supervisor

    • Conceptualization focuses on:

      How the supervisee understands what is happening in the session

    • Personalization focuses on:

      Supervisee’s style and ability to mange transference and countertransference

Slide 35

Interaction of role and focus

When determining what role will be prominent at any one time during supervision, it is helpful to consider the purpose, or goal, of the role and how it fits with the focus of the supervisionat that point

Slide 36

Supervisor behavior

  • In any given situation, the supervisor is:

    Assessing supervisee’s developmental stage

    Assessing need for a particular focus

    choosing an appropriate role to address that focus

    Making an intervention around a particular focus using skills appropriate to the chosen role

Slide 37

Case studies - the Developmental and Discrimination Models

  • Identify the role the counselor plays

  • The main focus discussed in the vignette

  • Your assessment of the development stage or stages that would fit well with the supervisor’s approach

  • How effective you think this supervisor’s approach is

  • How would you change what they’re doing

Slide 38

Case 1

Dr. Snyder believes her role as a supervisor is to provide monitoring and direction for her supervisees. She keeps a close watch on them as she wants to make sure they are not being given too much responsibility. She puts a lot of time and energy into her supervisees. Her supervisees benefit from seeing her work but not from doing the work themselves and many do not feel confident about their clinical work

Slide 39

Case 2

Mr. Lee meets weekly with his supervisees and has clearly defined goals for supervision. He gives feedback on a regular basis and has a reputation for being direct. Mr. Lee is a highly skilled clinician and often gives advice about how to work with clients.

Slide 40

Case 3

Ms. Adams sees supervisees as junior colleagues who should be functioning independently. She learned through the “sink” or “swim” method and that worked well for her, so she sees no reason that it won’t work well for her supervisees.

Slide 41

Common questions in supervision

  • What to do:

  • When there is conflict

  • When your supervisee is not prepared for supervision

  • When your supervisee fails to follow policies or supervisor recommendations

  • When your supervisee is attracted to a client

  • When you are attracted to a supervisee

Slide 42

Major Legal and Ethical Issues in Supervision

  • 1. Due Process.

  • 2. Informed Consents.

  • 3. Dual Relationships.

  • 4. Competencies

  • 5. Confidentiality

Slide 43

Due Process

A legal term for a procedure that ensures that “notice and hearing must be given before an important right is taken away”.

Slide 44

Due Process

  • Substantive due process

    States that criteria and procedures that govern training programs MUST be applied consistently and fairly.

Slide 45

Due Process

Procedural due process:

  • Student or supervisee must be appraised of academic and performance requirements and program regulations

  • Receive notice of any deficiencies

  • Be evaluated regularly

  • Have the opportunity to be heard if their deficiencies have led to a change in status

Slide 46

Case Study

Hannah is in a master’s program in mental health counseling. She has completed 10 courses in the program and is currently in practicum. Hannah has received a great deal of formative feedback throughout the practicum indicating that she had many areas that needed improvement. At the conclusion of the practicum, Hannah’s instructor a assigns Hannah a grade of F for the course. At this time, Hannah is informed that a failing grade in the practicum is grounds for dismissal from the program. Hannah is told that she may retake the practicum one time, but that the faculty is not optimistic that she will improve enough to receive a B or better, a condition for her continuing in the program. Although Hannah knew that she was not doing as well in the practicum as some others, she had no awareness that she was in danger of being terminated from the program until the final evaluation. It is likely that Hannah will take the advice of the faculty and will discontinue the training program at this time.

Slide 47

Case Study

  • Have Hannah’s due process rights been protected?

  • How vulnerable is her practicum instructor and the program if she should decide to challenge their decision?

  • Even if Hannah does not appeal, what are the potential systemic implications of such a process?

  • Even though there is no ill will evident in the action of the faculty and no indication that their decision was capricious or arbitrary, did the process that they followed adequately protect the student and was it legally defensible?

Slide 48

Informed Consent

  • A concept handed down from the medical profession that states that all patients must be informed of any risks that a recommended treatment carries and also be advised of the alternative treatments available

Slide 49

Informed Consent

  • Supervisors have three levels of responsibility:

    • To determine that clients have been informed by the supervisee of the parameters of treatment

    • Ascertain that clients are aware of parameters of supervision that will effect them

    • To provide informed consent for supervisee concerning his/her rights , expectations and responsibilities

Slide 50

Informed consent with supervisees

  • It is essential that supervisees understand and agree to the procedures of supervision

    BEFORE it begins and at any time when it requires a change.

Slide 51

Informed Consent

  • Types of information that trainees need are:

    • Choices of supervisor

    • The form of supervision

    • The time that will be allotted for supervision.

Slide 52

Informed Consent

  • The expectations of the supervisor.

  • The type of documentation that the supervisor requires

Slide 53

Case Study

  • Latoya is in her pre-doctoral internship, working with substance abusing clients. In supervision she shares that one client in particular has been “getting to her” most likely because some of the client’s situation is so similar to Latoya’s past. Latoya’s supervisor immediately suggests that Latoya receive counseling regarding this issue. When Latoya says that she believes her past therapy was sufficient and that she would prefer to view the situation as a supervision one, her supervisor states that she will only continue to work with Latoya if she commits to counseling.

Slide 54

Case Study

  • Pauline is in her first month of employment at a residential center for alcoholic mothers. Most of her assignments have been what she considers “babysitting,” rather than any serious work with her charges. When she talks to her supervisor about this, she is informed that she will not be assigned a case load for the first 6 months and only then if she is perceived as “ready.” This is news to Pauline. She is frustrated because she turned down another job where she could have begun to work with kids immediately. Pauline is upset further because her husband has been notified by his firm that he will be transferred in 9 months to another location. Had Pauline known the conditions of her present position, she would not have accepted the job.

Slide 55

Case Study

  • In each situation:

    • How egregious is the violation of the supervisees right to informed consent?

    • To what extent do institutional materials cover issues of informed consent for staff?

    • How might each situation have been handled to better address the rights of the supervisee?

Slide 56

Informed consents for Supervisors

  • Supervisors must also be afforded informed consent.

  • Need to be fully aware of the heavy responsibility, accountability and possible culpability involved in supervision.

Slide 57

Dual Relationships

  • Ethical standards for all MH disciplines strongly advise that dual relationships between therapist and clients be avoided.

  • It is the responsibility of the supervisor to be sure that supervisees understand the definition of dual relationships and avoid all such relations.

Slide 58

Dual Relationships

  • Defined as any relationships in addition to the professional one.

  • Dual relationships between supervisors and supervisees can be difficult to define and correct

Slide 59

Dual Relationships

  • Problematic dual relationships between supervisors and supervisees include:

    • Intimate relationships

    • Therapeutic relationships

    • Work relationships

    • Social relationships

Slide 60

Boundaries in Supervision

  • Boundary transgressions by trainees and beginning counselors are the second most common type of transgression

  • Second only to violations of confidentiality

  • These two categories account for 47% of all complaints made to monitoring bodies.

Slide 61

Boundary Issues

  • The best way to address ethical transgressions is preventive education and honest discussions between supervisors and supervisees on not only the possibility but also the probability of occasional sexual attraction to clients, supervisees and supervisors.

Slide 62

Boundary Issues

  • It is supervisors responsibility to raise questions on topic on a regular basis or be sure it is on the agenda for all supervision sessions.

  • Supervisors’ openness is vital in assisting supervisees manage intense feelings.

Slide 63

Supervisor competence

  • Attending to the best interest of the client and the supervisee simultaneously is the greatest clinical and ethical challenge of supervision.

  • Monitoring supervisee competence begins with the assumption that the supervisoris a knowledgeable clinician.

Slide 64

Supervision Competencies

  • Knowledge:

    • Of area being supervised

    • Of models, theories, modalities and research on supervision

    • Of professional development (how therapists develop)

    • Of ethics and legal issues specific to supervision

Slide 65

Supervision Competencies

Knowledge:

of assessment process

awareness and knowledge of diversity and its affects

Skills:

supervision modalities

relationship skills

sensitivity to multiple roles with supervisee

Slide 66

Supervision Competencies

  • Ability to provide effective formative and summative feedback

  • Ability to promote growth and self-assessment in trainees

  • Ability to conduct own self-assessment process

  • Ability to assess the learning needs and developmental level of the supervisee

Slide 67

Supervision Competencies

  • Ability to encourage and use evaluative feedback from the trainee

  • Teaching and didactic skills

  • Ability to set appropriate boundaries

  • Ability to seek consultation when supervisory issues are outside the domain of supervisory competence

  • Flexibility

  • Scientific thinking and the translation of scientific findings to practice throughout professional development

Slide 68

Supervision Competencies

  • Values

    • Responsibility for client and supervisee rests with the supervisor

    • Respectful

    • Responsible for sensitivity to diversity in all its forms

    • Balance between support and challenging

    • Empowering

Slide 69

Supervision Competencies

  • Social Context

    • Diversity

    • Ethical and legal issues

    • Developmental process

    • Knowledge of the immediate system in which supervision takes place

    • Awareness of the social/political context in which supervision takes place

Slide 70

Confidentiality in Supervision

Dimensions of confidentiality that the supervisor must safeguard:

  • The supervisee must keep confidential all client information except for the purposes of supervision.

  • The supervisee must also be informed that any discussions that take place INsupervision are also confidential.

Slide 71

Confidentiality

  • The supervisee has a right to privacy—

  • Supervisees must understand what will happen to information that they divulge in supervision.

  • Slide 72

    The Supervisory Relationship

    • Goals

    • Tasks

    • Bonds

    Slide 73

    Working Alliance


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