Clinical Supervison.pptx

Clinical Supervision Intervention provided by a more senior member of a profession to a more junior colleague(s) who typically (but not always) are members of that same profession Evaluative and hierarchical Extends over time Enhances professional functioning of junior person; mo...

Clinical Supervision Intervention provided by a more senior member of a profession to a more junior colleague(s) who typically (but not always) are members of that same profession Evaluative and hierarchical Extends over time Enhances professional functioning of junior person; monitor quality of professional services, gatekeeper for profession A distinct professional activity Education and training aimed at developing science-informed practice through a collaborative interpersonal process Involves observation, evaluation, feedback, facilitation of supervisee self-assessment, and acquisition of knowledge and skills by instruction, modeling, and mutual problem-solving Builds on the recognition of the strengths and talents of the supervisee, supervision encourages self-efficacy Falender & Shafranske (2004) Primary Responsibilities/Roles Do you know how to teach? What are the skills you need to Training – skill development develop? What are the skills the supervisee needs? How do you do this? Counseling – How to increase supervisee’s self- conceptualization/intervention awareness Evaluation Ensuring that supervisee is Consultation - discuss internalizing concerns/reflecting Client care/safety  Administrative Supervisi Supportive on – 3 Types To be an effective supervisor, you need to be skilled at each of the three areas Educational/ clinical Administrative Supervision Relates to ensuring that work is performed and is performed in a manner that is consistent with agency policies Some specific areas would focus on caseworker contact and punctuality (in terms of meeting attendance and completing paperwork) Supportive Supervision Focuses on enhancing job performance by decreasing job related stress that interferes with work performance Increases the supervisee’s motivation and helps develop a work environment that enhances work performance Educational/Clinical Supervision Involves teaching a supervisee skills while also developing their self-awareness at the same time Can be the role of a site clinical supervisor and/or a university-based supervisor Site supervisor - emphasizes on the refinement of the counseling and intervention skills to better the client University-based supervisor - focuses on the teaching- learning goals This is done by analyzing the supervisee’s interactions with clients and then teaching them how to provide specific services to specific clients Cubic Model – A Conceptual Framework Parameters of supervision relationship processes individual differences supervision models ethical and legal consideration evaluation Supervisor tasks live supervision group supervision individual supervision organization supervision Supervisee developmental level (novice to expert) Clinical Skills Individual, group counseling Knowledge and application of Communication, interpersonal ethical guidelines and skills standards Micro skills in counseling Knowledge and understanding Conceptualization skills and interactions among Assessment or diagnosis systems, individual, family, Knowledge and experience in environment and presenting the use of methods and problems techniques of counseling or Awareness of role of multi- psychotherapy cultural and contextual issues Knowledge of variety of and ability to respond to intervention techniques for those issues change Understanding role of Written skills developmental factors in Crisis management client problems Supervision Skills Knowledge on role and functions of clinical supervisors Models, methods and techniques of clinical supervision; able to articulate a personal model of supervision; structure supervision and to implement a variety of supervisory interventions (e.g., individual, group) Understand the importance of the supervisory relationship and be able to facilitate it Role of systems, cultural issues and environmental factors Legal and ethical issues unique to clinical supervision Familiar with methods of evaluation of supervisee’s competency and ability to apply them throughout supervision Awareness of requirement and procedure required for licensure or certification Awareness and familiarity of the process of remediation for gatekeeping purposes Effective Behaviors for Clinical Supervisors Clarifies expectations and style of supervision Maintains consistent and appropriate boundaries Be knowledgeable about theories and current research Teaches practical skills Teaches case conceptualization Provides frequent scheduled supervision Be accessible and available Encourages the exploration of new ideas and techniques Fosters autonomy Models appropriate ethical behaviors and counseling skills Has a personalized therapeutic style Personally and professionally mature Perceives growth as an ongoing process Effective Behaviors for Clinical Supervisors Able to assess learning needs of the supervisee Provides constructive criticism and positive reinforcement Invests in the supervisee’s development Cares about well being of others Has the ability to be present and immediate Has an awareness of personal power Has the courage to expose vulnerabilities, make mistakes and take risks Non-authoritarian and non-threatening Accepts and celebrates diversity Has the ability to communicate effectively Aware of and accepts own limitations and strengths Willing to negotiate Works collaboratively  CLINICAL SUPERVISIONMODELS Categories of Clinical Supervision Models Psychotherapy Models Many techniques used in therapy are used in supervision Theories of therapy affects supervisors’ focus and behavior Theoretical orientation impacts supervisor functioning and therefore supervisee and client Different critical assumptions and beliefs, tenets, core conditions, etc. of different major theories Psychodynamic Model Working alliance Parallel process - supervisor and supervisee; supervisee and client Informed the practice and theories of supervisors of all orientations Role: supervisor as therapist/teacher; supervisee as client/ student Components: Understand role of personal issues in supervisory relationship Encourage insight, self-exploration and continual reality testing Understand the presence of intrapsychic issues, including transference, counter-transference, and resistance  Behavioral Model Purpose: to teach the supervisee appropriate counseling skills (behaviors) while assisting her/him to extinguish inappropriate counseling behaviors Focus: supervisees behavior which is broadly defined as the supervisee’s thinking, feeling, and acting behaviors Goals: based on the specific skills needs of the individuals supervisee Components: Ability to analyze skills and assess learning Need to set goals in supervision Construct and implement strategies to accomplish set goals Use of observable behaviors for monitor Use of a final evaluation to gauge success Techniques: Use behavioral description to objectify goals and define success Self-management methods (checklists, relaxation techniques, etc.) Apply social learning principles such as modeling, role reversal, role playing, and practice Most useful in training micro-counseling skills Developmental Models  Focus on supervisee’s change over time as a developmental process  At each level, supervisees are viewed as expanding their knowledge, competence, and repertoire of skills as they grow  Supervisees at different levels of competency based on age, gender, previous training, previous experiences in supervision, previous work experience (supervisee factors)  Difficult to assess developmental level but should use a combination of direct and indirect methods (e.g. observation, collection of background information)  Most research on the description of beginning supervisees, less on advanced ones  Developmental process – not necessarily smooth, dependent upon supervisee’s ability to learn and grow, other changes such as settings, supervisors, development of new skills, facing difficult clients (Loganbill et al. 1982)  Interpersonal Development Model (IDM) Supervisee Beginning Intermediate- Advanced- Supervise level level e Supervisee Supervisee Advanced Supervisor Confirmation of Supervisor identity and role Intermediate- level Supervisor Exploration Beginning Supervisor Expert Structure Supervisor role Teacher/Monitor Evaluator/Challenger Colleague/Consultant Dependent Conflictual Autonomous Goals set Mutual goal setting Goals set by by supervisor supervisee IDM Post-degree supervisees in developmental stages (structural) Level 1 Supervisee (beginning their master’s level training) are viewed as dependent and in need of structure Supervisor: teacher Level 2 Supervisee (master level interns) are recognized as experiencing conflict between dependency and their desire for autonomy Supervisor: coach Level 3 Supervisee (post master degree and doctoral level supervisee) are described as much more stable in their professional development At this level, supervisees are much more desirous of mutual sharing, challenge, and confrontation on the part of the supervisor Supervisor serves as a consultant IDM Supervisee development (personality attributes) Level 1 – Highly anxious or naïve Supervisee is eager to do the right thing Assume an “expert” stance Level 2 – Confusion and conflict (short-lived) Supervisee experiences fluctuating motivation Level 3 – Motivation stabilizes, increased sense of autonomy Supervisee’s motivation and commitment more consistent, improved, more accurate self appraisal Supervision as one of the many roles Level 3i – Mastery of supervision knowledge and skills Master supervision level Supervisee Levels Questionnaire-Revised ID M  Development over three over-riding structures:  Self-other awareness: cognitive and affective  Motivation  Autonomy  Eight domains of professional functioning:  Intervention skills competence  Assessment techniques  Interpersonal assessment  Client conceptualization  Individual differences  Theoretical orientation  Treatment plans and goals  Professional ethics ID M Intervention: facilitative or authoritative Facilitative (likely for advanced supervisee): Cathartic – affective Catalytic - open-ended, encouragement, self exploration Supportive Authoritative (likely for beginning supervisee): Prescriptive – giving advice or making suggestion Informative – providing information Confrontative – identifying discrepancies Process Models – Discrimination Model (DM)  Discrimination Model (Bernard, 1979, 1997)  3 foci: Intervention/process of counseling Conceptualization Personalization 4th professional issue (Lanning, 1986)  Roles/styles [Hart & Nance, 2003] (Supervisory Style Inventory): Teacher – task oriented Counselor – interpersonally sensitive Consultant -attractive D M High/low support and high/low direction High support/high direction – supportive teacher High support/low direction – counselor Low support/high direction – directive or expert teacher Low support/low direction - consultant Group Supervision The regular meeting of a group of supervisees: (a) with a designated supervisor; (b)to monitor the quality of their work; and (c) to further their understanding of themselves as clinicians, of the clients with whom they work, and of service delivery in general.” (Bernard & Goodyear, 2018) It offers opportunities that offset the lack of individual attention that is the cornerstone of individual supervision  PROCESS AND INGRIDENTS OF CLINCIAL SUPERVISION Foundational Tasks for Site Clinical Supervision Initial communication Program/university supervisor initiates and communicates expectations (writing, internet information, face-to-face) The interview Formal and provide feedback Orientation Training manual or have other staff at sites to come and provide information On-going tasks Communication Evaluation Supervisor as agency presentative Time management Clinical Supervision Process and Tasks The supervision contract Training elements – frequency, length, duration Learning structure – audiovisual, co-therapy, assigned readings, seminar attendance, etc. Supervision structure – individual, group, combination, rotation of units, lines of authorities Agency conformity Others: Purpose, goals and objectives Context of services Methods of evaluation – formative and summative Duties and responsibilities Procedural considerations – emergency procedure, format of recordkeeping Supervisor's scope of practice Actions to Best Practices of Supervision  Supervisor uses role play, practice, and skill development  Supervisor uses praise and constructive feedback regularly  Supervision contract  Evaluation articulated and used  Supervisor facilitates reflective practice  Supervisor attends to supervisee feelings, concerns, reactions, and supervision conflicts, strains  Supervisor integrates diversity (multiple identities)  Supervisor models and upholds legal and ethical standards/ practices  Counselor Teacher Consultant Beginni Intermedi Advanc ng ate ed stage stage stage 1) Build rapport – 1) Promote 1)Provide independence and self- WORKING ALLIANCE correcti supervision 2) Work collaboratively 2) Preparation of first ve 3) Endorse teamwork session (contracts 3) Communicate feedbac 4) Encourage the use of consultation and peer duties, k support responsibilities, 2)Coachi 5) Model and teach self- expectations care (contracts) ng 6) Continue self- 4) Create a safe 3)Proble exploration and environment for understanding of supervisee m- limitations 5) Develop self- solving 7) Champion lifelong learning and awareness professional 6) Mindful of development differences, 8) Advocate for mental COMMON TECHNIQUES OF CLINICAL SUPERVISION Reasons for Choosing Specific Methods 1. Supervisor preference 2. Supervisee developmental level 3. Supervisee learning goals 4. Supervisor goals for supervisee 5. Supervisor’s own learning goals 6. Contextual factors Methods of Supervision 1) Self-report 2) Process notes and case notes 3) Live observation 4) Audio and video recordings 5) Transcript 6) Written feedback 7) Routine outcome measurement 8) TADS 9) Group supervision (triadic and group) 1) Self-Report Relatively dominant Most frequently used method Why is self-report a difficult method to perform well? At worst, requires little effort/planning, “distorts rather than reports,” At best, “an intense tutorial relationship” As good as observational and conceptual abilities of supervisee and the seasoned insightfulness of the supervisor 2) Process Notes and Case Notes Process notes can be tedious but case notes are more common in counseling and psychology practices Can and should be used to support all other methods Supervisor can use “leads” to prompt supervisee to process information from notes for use in case conference Ethical concerns? Personal reflections? Objectives/plans for this session and next? 3) Live Observation Live observation most frequently used in in- house training clinics (e.g., Family Clinic, Counseling Center) Direct observation (low percentage) – no direct interaction Different than Live Supervision – observation AND active supervision during session Three advantages: High safeguard for client welfare Complete picture of client and supervisee More engaged in determining what cases are discussion in supervision 4) Audio and Video Recordings A revolution in supervision Supervisees may be resistant (more than clients) How do clients feel about being recorded? Effective audio/video recordings: Preselect segments with intention: Highlight most productive part Highlight most important part Highlight supervisee’s struggle Underscore content issues (metaphors, recurring themes) Clarify (paralanguage, nonverbal behavior) Focus on +/- interpersonal and cross-cultural dynamics Select based on what you are trying to teach the supervisee Remember to have supervisee cue up appropriate segments ahead of time. 5) Transcripts Especially helpful for novices (Arthur and Gfoerer, 2002) Positives: Concrete Able to review whole session Negatives: Time consuming Nonverbal cues and paralanguage lost Mistakes can be glaring Overly focused on content rather than development Intermittent or abbreviated use seems most practical 6) Written Feedback Allows for more careful consideration of feedback Can review recordings and provide written feedback outside of supervisory session Leaves a “paper trail” or record of supervision Tailor to fit learning needs - Discrimination Model Teacher Counselor Consultant 7) Routine Outcome Measurement Records of session-by-session of client clinical measures Client-completed short outcome indicators Software graphs client progress (next week) Use of client progress to highlight progress and setback for targeted supervision Evidence-based methods to bring out supervisee’s blind spot Many web-based software to use 8) Technology Assisted Distance Supervision (TADS)/Live Supervision e-supervision(Duding and Justice, 2004), cyber-supervision (Chapman et al., 2011) Similar outcomes as face-to-face supervision, yet less “intrusive” for supervisees No difference between synchronous and asynchronous experiences Phone in/walk in Consultation break Videoconferencing Ear Bug – had been shown to be intrusive 9) Group Supervision Styles Authoritative : supervision in the group rather than with the group Participative: encourages active participation of group Cooperative : the group provides supervision; supervisor facilitates Structuring group supervision Regardless of the circumstance or level of expertise of supervisees, supervisors, importance of group leaders, need to spend time at the very beginning on the structure and goals of the supervision group Goals & purpose for the group Expectation & roles for supervisor and supervisees Safety and set rules Potential areas of conflict How to resolve problems Evaluation