Supervision of Mental Health Counseling Interns
On line training for field supervisors
Clinical Mental Health Counseling Program
Reflections on supervisory experiences
Answer the following questions for yourself about your own supervision experiences
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
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)
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
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
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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
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
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
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
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
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
Roles and Functions
Supervisor as Consultant
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
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
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.
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.
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)
Models of Supervision
Three main types of supervision models:
Psychotherapy based models
Social Role 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
- 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).
- Social role models
Focus on roles that supervisors engage in during supervision.
Primary range of roles includes:
(Bernard, 1979; Carroll, 1996; Holloway, 1995; Williams, 1995).
Stoltenberg’s Developmental Model
Views training process as sequence of identifiable stages through which trainee progresses
Provides a conceptual framework for supervisor and supervisee
Four Stages of Development :
- Conditional dependency
- Lacks confidence
- Needs support and direction
- Needs opportunity to explore
- Feelings and become more self aware
- May be anxious about performance and evaluation
- 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
- 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
Capable of independent practice
Aware of personal limitations
Interested in process of counseling
Comfortable with interdependent/collaborative approach
Seeks peer supervision
Bernard’s Discrimination Model
Three basic roles for supervisors:
Four main foci for supervision:
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.
- Help student counselors/supervisees focus on interpersonal and intrapersonal interactions.
- Especially important when helping student counselors/supervisees conduct a self-evaluation
- Student counselor/supervisee and supervisor relate as colleagues
- Exchange ideas about interventions, goals, and treatment plans.
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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
- 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
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
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
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.
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.
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
Major Legal and Ethical Issues in Supervision
- 1. Due Process.
- 2. Informed Consents.
- 3. Dual Relationships.
- 4. Competencies
- 5. Confidentiality
A legal term for a procedure that ensures that “notice and hearing must be given before an important right is taken away”.
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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
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.
- 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?
- 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
- 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
Informed consent with supervisees
- Types of information that trainees need are:
- Choices of supervisor
- The form of supervision
- The time that will be allotted for supervision.
- The expectations of the supervisor.
- The type of documentation that the supervisor requires
- 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.
- 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.
- 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?
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.
- 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.
- Defined as any relationships in addition to the professional one.
- Dual relationships between supervisors and supervisees can be difficult to define and correct
- Problematic dual relationships between supervisors and supervisees include:
- Intimate relationships
- Therapeutic relationships
- Work relationships
- Social relationships
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.
- 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.
- 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.
- 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.
- 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
of assessment process
awareness and knowledge of diversity and its affects
sensitivity to multiple roles with supervisee
- 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
- 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
- Scientific thinking and the translation of scientific findings to practice throughout professional development
- Responsibility for client and supervisee rests with the supervisor
- Responsible for sensitivity to diversity in all its forms
- Balance between support and challenging
- Social Context
- 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
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.
Supervisees must understand what will happen to information that they divulge in supervision.
- The supervisee has a right to privacy—
The Supervisory Relationship