A Person-Centered Approach to Clinical Supervision

1. A Person-Centered Approach to Clinical Supervision Jamie Marich, Ph.D., LPCC-S, LICDC-CS

2. About Your Presenter • LPCC-S, LICDC-CS (Ohio) • EMDRIA-Approved Consultant • Outcomes-Based Training with the International Center for Clinical Excellence • Author, Qualitative Researcher • Thirteen years of experience in a variety of human services venues • Began career as humanitarian aid worker in Bosnia-Hercegovina (2000-2003)

3. What Are Your Needs Today?

4. Objectives • To identify and discuss common problems in supervising counselors/clinicians • To address these commonly identified problems using a person-centered approach • To explain what the psychotherapeutic professions reveal about the importance of empathy and therapeutic alliance in treatment (regardless of specific method or model) • To apply these principles of empathy to the practice of clinical supervision • To utilize motivational interviewing approaches with resistant supervisees • To assist others in developing both work plans and self-care plans

5. Supervision vs. Consultation • In general, supervision carries more ethical responsibility in terms of licensure boards, legal issues, etc. • Both can involve a gatekeeper function, depending on the nature of the consultation sought • Both have similar approaches in terms of using the person-centered model

6. What does empathy mean to you?

7. Empathy • Coined by the German philosopher Rudolf Lotze in 1858 • The German word, Einfühlung, translates as “in” + “feeling” • Derives from the Greek empatheia, meaning “in” + “pathos” (feeling) • Pathos is also the root of “passion” and “pain”

8. Empathy Direct identification with, understanding of, and vicarious experience of another person's situation, feelings, and motives. Stedman’s Medical Dictionary (2002)

9. The Rogerian View of Empathy • “Being empathetic reflects an attitude of profound interest in the client’s world of meanings and feelings. The therapist receives these communications and conveys appreciation and understanding, assisting the client to go further or deeper. The notion that this involves nothing more than a repetition of the client’s last words is erroneous. Instead, an interaction occurs in which one person is a warm, sensitive, respectful companion in the typically difficult exploration of another’s emotional world. The therapist’s manner of responding should be individual, natural, and unaffected. When empathy is at its best, the two individuals are participating in a process comparable to that of a couple dancing, with the client leading and the therapist following.” • (Raskin & Rogers, in Corsini, 2000)

10. Can this be applied to supervision ?????

11. From Irvin Yalom • Therapy should not be theory driven, but relationship driven (The Gift of Therapy, 2001) • The Every Day Gets a Little Closer experiment (Yalom & Elkins, 1974)

12. Complex PTSD & Therapeutic Alliance • According to client experience, the quality of therapeutic alliance between client and clinician is an important mechanism in facilitating meaningful change for clients with complex PTSD (Fosha, 2000; Fosha & Slowiaczek, 1997; Pearlman & Courtois, 2005)

13. The Imperative of the Therapeutic Alliance • Using a collection of empirical research studies and chapters from the psychotherapeutic professions, Norcross (2002) demonstrated that a combination of the therapy relationship, together with discrete method, is critical to treatment outcomes. • Norcross further concluded that relational skills can be honed by therapists, and that it is the therapist’s responsibility to tailor these skills to the needs of individual clients.

14. The Imperative of the Therapeutic Alliance • Norcross’ contentions also supported by the massive literature reviews that appear in The Heart and Soul of Change: Delivering What Works in Therapy (Duncan, Miller, Wampold, & Hubbard, 2009)

15. The Common Factors • Client & extratherapeutic factors • Techniques that engage and inspire the participants • The therapeutic alliance • The clinician

16. The Common Factors • The common factors are a listing of four qualities that all successful psychotherapeutic approaches have in common • Developed by psychiatrist Saul Rosenzweig (1936), in response to the numerous philosophies of therapy asserting their superiority in his era • A review of over sixty years of literature on psychotherapy and therapeutic change supports the common factors hypothesis (Duncan, Miller, Wampold, & Hubbard, 2009)

17. Can the Common Factors Be Applied to Supervision?

18. The Common Factors • Client & extratherapeutic factors • Techniques that engage and inspire the participants • The therapeutic alliance • The clinician

19. Do You Struggle with Being Empathetic in Supervision?

20. What Were Some of Your Best Experiences with Supervision?What Were Some of Your Worst?

21. Now It’s Your Turn… • Write up a brief case (5-7 traits) : • An actual supervisee • A composite supervisee • A fictional character

22. Reactions/Discussion From Guided Imagery Empathy Exercise

23. Lessons From My EMDR Supervision Experiences…

24. Lessons From My EMDR Supervision Experiences… • By the book vs. Go with the flow…depends on who you ask. • This is what the book says to do…this is what I actually do. • “Imbuing” fear vs. Fostering confidence • Within the context of the relationship, don’t be afraid to ask, “What’s this really about?” • The importance of outcomes & seeking feedback • Repair the ruptures (Dworkin & Errebo, 2010)

25. The “Resistant” Supervisee or Consultee

26. Motivational Interviewing (Miller & Rollnick, 2002) • Collaboration- Counseling involves a partnership that honors the client’s expertise and perspectives. The counselor provides an atmosphere that is conductive rather than coercive to change. • Evocation- The resources and motivation for change are presumed to reside within the client. Intrinsic motivation for change is enhanced by drawing on the client’s own perceptions, goals, and values. • Autonomy- The counselor affirms the client’s right and capacity for self-direction and facilitates informed choice.

27. Motivational Interviewing: 4 Principles (Miller & Rollnick, 2002) • Express Empathy • Develop Discrepancy • Roll with Resistance • Support Self-Efficacy

28. What is the Application to Clinical Supervision?

29. General Proverbs That Go Along Way… • Meet them where they’re at • Do unto others as you would have them do unto you • Remember what it was like

30. Please Return by 1:00pm

31. “The problem with winning the rat race is that even if you win, you’re still a rat.” -Lilly Tomlin

32. Stress vs. Burnout • How would you define stress? • How would you define burnout?

33. Stress vs. Burnout SOURCE: Stress and Burnout in Ministry (Croucher, n.d.)

34. Stress vs. Burnout Burnout is most common in the workplace. You may be flirting with burnout if: • Every day on the job is a bad one. • Caring about work seems like a total waste of energy. • The majority of your day is spent on tasks you find either mind-numbingly dull or unpleasant. • Nothing you do appears to make a difference in a workplace full of bullying, clueless, or ungrateful supervisors, colleagues, and clients. SOURCE: Helpguide.org

35. Common Signs and Symptoms of Burnout • Powerlessness • Hopelessness • Emotional exhaustion • Detachment • Isolation • Irritability • Frustration • Being trapped • Failure • Despair • Cynicism • Apathy SOURCE: Helpguide.org

36. An Important Point to Remember • Workplace burnout isn’t the same as workplace stress. When you’re stressed, you care too much, but when you’re burned out, you don’t see any hope of improvement. • Dealing with stressors may be a preventative measure against burnout.

37. Causes of Burnout • While some careers have higher rates of burnout, it’s present in every occupation. • Those most at risk are employees who feel underpaid, underappreciated, or criticized for matters beyond their control. • Service professionals who spend their work lives attending to the needs of others, especially if their work puts them in frequent contact with the dark or tragic side of human experience, are also at high risk. SOURCE: Helpguide.org

38. Causes of Burnout • Setting unrealistic goals for yourself or having them imposed upon you. • Being expected to be too many things to too many people. • Working under rules that seem unreasonably coercive or punitive. • Doing work that frequently causes you to violate your personal values. • Boredom from doing work that never changes or doesn’t challenge you. • Feeling trapped for economic reasons by a job that fits any of the scenarios above. SOURCE: Helpguide.org

39. Causes of Stress and Burnout • The information on the following slides is presented by the National Institute for Occupational Safety and Health (NIOSH). • A booklet by this organization, Stress at Work, is an excellent resource that you may consider adding to your personal library. • Follow along as these scenarios are presented; make mental notes or check off which scenarios may apply to you and your workplace.

40. Job Conditions That May Lead to Stress • The Design of Tasks. Heavy workload, infrequent rest breaks, long work hours and shiftwork; hectic and routine tasks that have little inherent meaning, do not utilize workers' skills, and provide little sense of control. • Example: David works to the point of exhaustion. Theresa is tied to the computer, allowing little room for flexibility, self-initiative, or rest. SOURCE: National Institute for Occupational Safety and Health

41. Job Conditions That May Lead to Stress • Management Style. Lack of participation by workers in decision- making, poor communication in the organization, lack of family-friendly policies. • Example: Theresa needs to get the boss's approval for everything, and the company is insensitive to her family needs. SOURCE: National Institute for Occupational Safety and Health

42. Job Conditions That May Lead to Stress • Interpersonal Relationships. Poor social environment and lack of support or help from coworkers and supervisors. • Example: Theresa's physical isolation reduces her opportunities to interact with other workers or receive help from them. SOURCE: National Institute for Occupational Safety and Health

43. Job Conditions That May Lead to Stress • Work Roles. Conflicting or uncertain job expectations, too much responsibility, too many "hats to wear." • Example: Theresa is often caught in a difficult situation trying to satisfy both the customer's needs and the company's expectations. SOURCE: National Institute for Occupational Safety and Health

44. Job Conditions That May Lead to Stress • Career Concerns. Job insecurity and lack of opportunity for growth, advancement, or promotion; rapid changes for which workers are unprepared. • Example: Since the reorganization at David's plant, everyone is worried about their future with the company and what will happen next. SOURCE: National Institute for Occupational Safety and Health

45. Job Conditions That May Lead to Stress • Environmental Conditions. Unpleasant or dangerous physical conditions such as crowding, noise, air pollution, or ergonomic problems. • Example: David is exposed to constant noise at work. SOURCE: National Institute for Occupational Safety and Health

46. Personal Susceptibility to Stress or Burnout: 7 Domains Assess the Extent of Your Risk Factors 1.) The nature of the stressor Stressors that involve central aspects of your life (your marriage, your job) or are chronic issues (a physical handicap, living from paycheck to paycheck) are more likely to cause severe distress. 2.) A crisis experience Sudden, intense crisis situations (being raped, robbed at gunpoint, or attacked by a dog) are understandably overwhelming. Without immediate intervention and treatment, debilitating stress symptoms are common. 3.) Multiple stressors or life changes Stressors are cumulative, so the more life changes or daily hassles you're dealing with at any one time, the more intense the symptoms of stress.

47. 4.) Your perception of the stressor The same stressor can have very different effects on different people. For example, public speaking stresses many out, but others thrive on it. Additionally, if you’re able to see some benefit to the situation—the silver lining or a hard lesson learned—the stressor is easier to swallow. 5.) Your knowledge and preparation The more you know about a stressful situation, including how long it will last and what to expect, the better able you’ll be to face it. For example, if you go into surgery with a realistic picture of what to expect post-op, a painful recovery will be less traumatic than if you were expecting to bounce back immediately. 6.) Your stress tolerance Some people roll with the punches, while others crumble at the slightest obstacle or frustration. The more confidence you have in yourself and your ability to persevere, the better able you’ll be to take a stressful situation in stride. 7.) Your support network A strong network of supportive friends and family members is an enormous buffer against life’s stressors. But the more lonely or isolated you are, the higher your risk of stress.

48. Costs of Stress and Burnout There is a clear connection between workplace stress and physical and emotional problems. According to the National Institute for Occupational Safety and health, early warning signs of job stress include: • Headache • Sleep disturbance • Upset stomach • Difficulty concentrating • Irritability • Low morale • Poor relations with family and friends SOURCE: Helpguide.org

49. Costs of Stress and Burnout Evidence suggests that workplace stress plays an important role in several types of ongoing health problems, especially: • Cardiovascular disease • Musculoskeletal conditions • Psychological disorders • Workplace injury SOURCE: Helpguide.org

50. Costs of Stress and Burnout • According to the Journal of Occupational and Environmental Medicine, health care expenditures are nearly 50% greater for workers who report high levels of stress. SOURCE: National Institute for Occupational Safety and Health