Clinical Supervision and Professional Development PDF

SECTION V CLIENT-CARE AND SELF-CARE PRACTICES Co...

SECTION V CLIENT-CARE AND SELF-CARE PRACTICES Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. López, L. L., & Hyatt-Burkhart, D. (2019). Clinical mental health counseling : Practicing in integrated systems of care. Springer Publishing Company, Incorporated. Created from tcsesl on 2024-06-20 19:17:30. Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. López, L. L., & Hyatt-Burkhart, D. (2019). Clinical mental health counseling : Practicing in integrated systems of care. Springer Publishing Company, Incorporated. Created from tcsesl on 2024-06-20 19:17:30.  CHAPTER 13 CLINICAL SUPERVISION AND PROFESSIONAL DEVELOPMENT DEBRA HYATT-BURKHART This chapter provides a brief overview of models of clinical supervision. It also offers a brief discussion of best practices, common struggles, and a salutogenic- or wellness-based approach to supervision, emphasizing how the latter complements parallel treatment interventions with consumers. The chapter urges counselor trainees to engage continuing education and continued professional development as a part of their career-pathway planning. The discussion emphasizes the importance of remaining current, concerning clinical counseling issues as an ethical issue that is inherent in being a professional. The following Council for the Accreditation of Counseling and Related Educational Programs (CACREP) standards are addressed in this chapter: CACREP 2016: 2F1.k, 2F1.l, 2F1.m CACREP 2009: 2G1.e Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. LEARNING OBJECTIVES After reviewing this chapter, the readers should be able to: 1. Demonstrate an understanding of the purpose, importance, and value of clinical supervision; 2. Demonstrate a basic knowledge of the commonly used models of clinical super- vision; 3. Articulate an understanding of a wellness-based and salutogenic-based approach to clinical supervision; and, 4. Demonstrate an understanding of the importance of continuing education and professional development as a part of ethical practice. López, L. L., & Hyatt-Burkhart, D. (2019). Clinical mental health counseling : Practicing in integrated systems of care. Springer Publishing Company, Incorporated. Created from tcsesl on 2024-06-20 19:17:30.  260 Section V Client-Care and Self-Care Practices INTRODUCTION: DEFINITION OF CLINICAL SUPERVISION Long before professional counselors embarked upon any kind of professional path, they received supervision. Merriam-Webster.com defines supervision as “a critical watch- ing and directing (as of activities or a course of action).” Parents, teachers, babysitters, coaches, and a whole host of other adults provided these counselors with critical watch- ing and directing beginning on the day that they were born. As children, they were super- vised in order to protect them from dangers of which they may have been unaware, to help them learn new ways of behaving, and to develop an understanding of social norms and expectations. As they matured, that watching and directing became more focused, nuanced, and targeted toward areas for growth and the enhancement of existing skills. As they moved into the world of work, a superior or boss at a job provided training, guidance, and an evaluation of their performance at that place of work. In internships and field experiences, on-the-job training and oversight by an experienced practitioner in the field was provided as an integral part of the learning environment. These activities were all types of supervision. Someone who had more knowledge, skills, and competen- cies helped those counselors to grow and develop in a way that informed them and kept them safe as they learned. Supervision is an essential component of the ethical practice of counseling. The 2014 American Counseling Association (ACA) Code of Ethics contains a number of standards that specifically address the need for ongoing supervision and consultation as a best prac- tice for the field. Counseling supervision is an extension of the types of supervision that commonly are received throughout our early lives, but this supervision is specifically focused on professional counseling-related behaviors. Although readers of this text are likely at the beginning of their educational process and have little practical experience with counseling, having a basic knowledge of the definition, purpose, approaches, and theories of clinical supervision will become highly applicable as they move forward in their careers. There are two main types of supervision in which professional counselors participate. The first is administrative supervision. Administrative supervision generally refers to the Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. monitoring, mentoring, and oversight counselors may receive regarding their general job functions. Here, the focus is usually upon documentation, paperwork, workplace behaviors, such as timeliness, and other managerial issues that can be found in most employment settings. The second type of supervision for professional counselors is clin- ical supervision. This supervision is focused upon a counselor’s work in the treatment of clients. It is quite common that one supervisor is responsible for providing both types of supervision, which, as I will discuss later, can be a significant tension that can create interesting issues for both the supervisor and supervisee. As clinical supervision is unique to the helping professions, we will focus more on its provision throughout this chapter. Bernard and Goodyear (2018) have provided one of the most commonly used defini- tions of clinical counseling. They define supervision as:... an intervention provided by a more senior member of a profession to a more junior colleague or colleagues who typically (but not always) are members of the same pro- fession. This ­relationship is evaluative and hierarchical, extends over time, and has the López, L. L., & Hyatt-Burkhart, D. (2019). Clinical mental health counseling : Practicing in integrated systems of care. Springer Publishing Company, Incorporated. Created from tcsesl on 2024-06-20 19:17:30.  Chapter 13 Clinical Supervision and Professional Development 261 simultaneous purposes of enhancing the professional functioning of the more junior person; monitoring the quality of professional services offered to the clients that she, he, or they see; and serving as a gatekeeper for the particular profession the supervisee seeks to enter. (Bernard & Goodyear, 2018, p. 9) There are parts of this definition with which I agree, and others to which I prefer a different approach. Supervision is not always provided by a senior member to a junior member. Sometimes, peers of equal tenure provide supervision to one another and, in fact, sometimes the supervisor is actually newer to the profession than the supervisee. Other definitions of clinical supervision provide a clearer delineation of the purpose and desired outcomes without limiting the scope of the relationship. One such definition is that provided by Inskipp and Proctor (2019) who define supervision as: A working alliance between the supervisor and counsellor in which the counsellor can offer an account or recording of her work; reflect on it; receive feedback and where appro- priate, guidance. The object of this alliance is to enable the counsellor to gain in ethical competence, confidence, compassion and creativity in order to give her best possible ser- vice to the client. (p. 1) This definition encompasses many of the components of the Bernard and Goodyear definition but seems more clearly to articulate the tasks involved in supervision and its overall purpose. In particular, the notions that the work is conducted through an alliance between the counselor and supervisor (without specification of the tenure or status of the participants) and that the ultimate goal of supervision is to improve the functioning of the counselor in order to attend best to the client’s needs seem to be highlighted. Purpose of Clinical Supervision Within Ethical Practice These definitions delineate three important facets of the work of clinical supervision. The primary objective is to protect the client and ensure that the counselor is providing Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. services that, at a minimum, do no harm and, at an aspirational level, are providing the best services possible to the clients. In short, there is a gatekeeping, evaluative function to supervision wherein the supervisor is responsible for ensuring that the supervisee is competent, healthy, and unimpaired relative to the practice of counseling. The second objective of clinical supervision is to enhance the ethical and practical functioning of the counselor. Supervisors work to assist supervisees to improve their general skills, develop their competencies, and enhance their understanding and imple- mentation of the code of ethics. Finally, supervisors provide support, encouragement, and guidance to their super- visees. Supervision is a multipurpose endeavor that, when done well, balances the ten- sion between the supervisor being appropriately challenging and thought-provoking and offering the necessary support and reassurance. When provided effectively, super- vision can be an important part of counselor self-care. Self-care is an important part of a counselor’s efforts to maintain general and mental health. Taking care of one’s self and maintaining a healthy emotional approach to the work is also essential for a clinician’s López, L. L., & Hyatt-Burkhart, D. (2019). Clinical mental health counseling : Practicing in integrated systems of care. Springer Publishing Company, Incorporated. Created from tcsesl on 2024-06-20 19:17:30.  262 Section V Client-Care and Self-Care Practices ability to provide clients with the best possible services. Supervisors have the ability to help counselors stay well, find benefit from the work, and maintain longevity in the profession. As mentioned, supervision is a vital component of the ethical practice of counseling. The 2014 ACA Code of Ethics contains a number of standards that specifically address the need for ongoing supervision and consultation as a best practice for the field. Standard F.1.a. of the ACA 2014 Code of Ethics states that “A primary obligation of counseling supervisors is to monitor the services provided by supervisees. Counseling supervisors monitor client welfare and supervisee performance and professional development” (p. 12). The work of counseling is serious. Counselors are involving themselves in people’s lives, relationships, fundamental psychological functioning, and systemic contexts. Hav- ing oversight of one’s work is crucial to maintaining objectivity. We cannot always know where our blind spots or missteps are, but a supervisor can help us to see them, reflect upon them, and keep our clients safe. When discussing supervision with my students, I like to use the analogy of golf. I love to play the game, but I am by no means ready for the professional tour. I have bad habits with my form that have developed over time. I know I have these bad habits, because when I hit the ball, it does not always go where I want it to go. Sometimes, it ends up in the woods or in the lake, despite that fact that I was aiming at the hole in the center of the green. When I hit an errant shot, I rarely know what I did wrong, but my playing partners, who can see my swing, do know. They watched me swing the club! They can see that I picked my head up, or lifted my foot, or failed to rotate my hips. From my vantage point, inside my own body, I can’t see those things. Their van- tage point, or their “super vision,” can provide me with critical information that may improve my next shot. Clinical supervision of counseling is much the same. Practi- tioners are often too close to the treatment of the client to see clearly what is occurring with the process. There may be areas for improvement and areas of strength that, when pointed out, can be changed or enhanced to increase the efficacy of the supervisees’ Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. work. A knowledgeable, outside supervisor, who has the benefit of greater objectivity, often can help to expose such issues. With respect to skill development, standard C.2.d. of the ACA (2014) Code of Ethics states “Counselors continually monitor their effectiveness as professionals and take steps to improve when necessary. Counselors take reasonable steps to seek peer supervision to evaluate their efficacy as counselors” (p. 9). It is not just supervisors who are respon- sible for monitoring our effectiveness; it is our responsibility to seek out supervision. Early in counseling practitioners’ careers, some level of clinical supervision is mandated. The CACREP (2015) standards dictate that practicum and internship students receive a minimum of 1.5 hours of group supervision at the university level and 1 hour of individ- ual supervision at their sites. Further, all state licensure boards require that prelicensed counselors work under clinical supervision for 2 or more years, although the number of hours and types of supervision vary widely (ACA, 2016). A review of state requirements reveals that most stipulate a minimum of 100 hours of face-to-face clinical supervision prior to being eligible to obtain a license. Many states permit a blend of distance and López, L. L., & Hyatt-Burkhart, D. (2019). Clinical mental health counseling : Practicing in integrated systems of care. Springer Publishing Company, Incorporated. Created from tcsesl on 2024-06-20 19:17:30.  Chapter 13 Clinical Supervision and Professional Development 263 in-person oversight, as well as group and individual formats. Just as there is no uni- form requirement for counseling licensure in the United States, there is no standardized approach as to the number of hours, type, and approach to prelicensure supervision (Gray & Erickson, 2013). What is clear in the ACA 2016 report is that prelicensed coun- selors are required to engage in supervised work in order to qualify to earn their license. The implication is that supervision is an essential part of counselor development. Unfortunately, the requirement for clinical supervision does not generally extend beyond the achievement of licensure. A review of the continuing education require- ments for licensed professional counselors across the country contained in the ACA 2016 report cited earlier found no mandate for any ongoing supervised practice. There are requirements for continuing education hours related to training as a supervisor, but there is no reference to any need to continue to receive some level of clinical supervision once a practitioner has obtained a license. This lack of mandate for ongoing supervision may be one reason that not all counseling positions offer clinical supervision as a routine or compulsory part of the job. Often, supervision is conducted at the personal cost of the counselor or through a network of peers who agree to support one another. Regardless of how it occurs, ongoing, post-licensure clinical supervision is an important part of an ethical approach to the work of counseling. As research into the benefits of supervision continues, such practice may be incorporated into continuing education requirements in the future. Models of Clinical Supervision Just as there are many theoretical models of counseling, there are many theoretical models that are applied to clinical supervision. Counseling theory provides an organiz- ational framework that helps clinicians to understand their client’s development, behav- ior, and thinking (Kottler & Montgomery, 2010). Further, theory can provide clinicians with insight into the overall direction of treatment and appropriate interventions to use Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. with their clients (Rønnestad & Skovholt, 2013). The same notions apply to grounding the work of clinical supervision into a theoretical orientation or specific model. Super- vision theory provides the supervisor with a conceptual framework or mechanism for understanding counselors and their work (Bernard & Goodyear, 2018). As in coun- seling theory, the models of supervision can be segregated into categories based upon the focus of the models themselves. What follows is a brief discussion of the categories of models of clinical supervision and an overview of common approaches within each category. These models and approaches are provided as an introduction to theories of clinical supervision. As students progress through their program of studies and begin to practice counseling and receive supervision, it will be important for them to develop a deeper understanding of supervisory practices. Students quickly will become con- sumers of supervision in the fieldwork experiences. Further, it is not uncommon for relatively novice counselors to find themselves in supervisory roles in the field. This basic overview can serve as a springboard toward a more nuanced understanding of supervision. López, L. L., & Hyatt-Burkhart, D. (2019). Clinical mental health counseling : Practicing in integrated systems of care. Springer Publishing Company, Incorporated. Created from tcsesl on 2024-06-20 19:17:30.  264 Section V Client-Care and Self-Care Practices Developmental Models of Clinical Supervision As the name implies, developmental models of clinical supervision focus on the stage or level of evolving skills, competencies, confidence, and awareness of the counselor supervisee and the ways in which supervisors accommodate the changing needs of their supervisees. These models subscribe to the notion that as supervisees grow and acquire more advanced competencies, their needs and preferences within the supervisory rela- tionship also shift (Russell-Chapin & Chapin, 2012). As the needs of the supervisee shift, it is the responsibility of supervisors to alter their approach and interventions to meet the new needs of their supervisee. Throughout the process of developmental supervision, it is the job of the supervisor to provide interventions, feedback, and support that are appropriate for the current functioning of the supervisee, while being mindful to chal- lenge the supervisee in order to scaffold higher order thinking (Smith, 2009). There are many developmental models of supervision that differ slightly in the lens through which development is viewed. Some developmental models take an approach grounded in psychosocial developmental theory (Loganbill, Hardy, & Delworth, 1982; Stoltenberg, 1981), while others adopt a life-span approach (Rønnestad & Skolvholt, 2003). What is consistent among these models is that they identify specific characteristics common to counselors at various stages of growth and that they pinpoint corresponding sets of supervisory tasks and interventions necessary to support supervisees during each state of development. For the purposes of this overview, I present Stoltenberg, McNeil, and Delworth’s (1998) Integrated Developmental Model (IDM) of supervision, which is the most widely used of these types of models (Bernard & Goodyear, 2018) and the Rønnestad and Skolvholt (2003) model, which emphasizes the continued development of counselors across the life span. Integrated Developmental Model The IDM provides four distinct levels or stages of supervisee development (although Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. the forth level is labeled 3i, which can be confusing). Each level is assessed through the domains of motivation, autonomy, and awareness. Level 1 supervisees are characterized as having limited training and/or experience (perhaps at the beginning of field work). Motivation is generally high, as is the level of anxiety. Level 1 supervisees want to know the “right” way to work with clients. Their autonomy is limited, they depend on the supervisor for positive support, and they prefer little confrontation. Level 1 supervisees have limited awareness. They tend to focus on themselves with minimal insight. They are resistant to evaluation, which may be perceived as critical and discouraging. Supervision at this level tends to be characterized by a great deal of support with directive or prescrip- tive interventions provided by the supervisor. Level 2 supervisees have some experience (perhaps being toward the end of their practicum or internship). Their motivation and confidence fluctuate from confused and unsure to very confident. Autonomy also vacillates between dependency and a strong desire for independence. Awareness is more centered on the client instead of the self, but issues with fusion and enmeshment may arise with the growing ability to empathize López, L. L., & Hyatt-Burkhart, D. (2019). Clinical mental health counseling : Practicing in integrated systems of care. Springer Publishing Company, Incorporated. Created from tcsesl on 2024-06-20 19:17:30.  Chapter 13 Clinical Supervision and Professional Development 265 with the client. Level 2 counselors function much like adolescents commonly behave with their parents. There is a push and pull between needs and wants. A tension exists between the counselors wanting to be independent and autonomous versus wanting to be given direction and told how to do the work correctly. Here, supervisors must balance support and challenge with direction and self-determination as supervisees’ needs dic- tate. Level 3 supervisees are much more stable in their functioning. These counselors are more experienced and secure in their competencies (new professionals). They tend to have stable motivation that involves realistic assessments of their own functioning. They have developed a sense of their own competencies and skills sets and can thereby function autonomously with confidence. Level 3 supervisee awareness is comprised of a balance between empathetic engagement with the client and attention to self-care and individuation (Falender & Shafrenske, 2004). Level 3 supervisees are approaching a more collaborative and collegial relationship with the supervisors as skill levels between the two tend to be less and less disparate. The supervisory relationship here is less hier- archical and more egalitarian. There is little direct intervention and a more consultative atmosphere to the work. Finally, Level 3i (integrated) supervisees have begun to integrate skills and compe- tencies across all of the domains involved with client care (Bernard & Goodyear, 2018). Stoltenberg et al. (1998) identified the following eight areas of professional growth in which the supervisee will develop: 1. Interventions skills competence—the confidence to engage in therapeutic interventions; 2. Assessment techniques—understanding and administering assessments; 3. Interpersonal assessment—using the self in conceptualizing client issues; 4. Client conceptualization—being able to understand how the clients’ biopsy- chosocial environment influences their functioning; Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. 5. Individual differences—understanding multicultural influence upon the client; 6. Theoretical orientation—understanding and applying theory; 7. Treatment plans and goals—ability to plan and organize appropriate interven- tions; and, 8. Professional ethics—integration of professional and personal ethics. Level 3i supervisees have a motivation toward professional practice that is charac- terized by autonomy and an accurate assessment of their own strengths and areas for growth. Supervision with Level 3i supervisees is much more consultative and colle- gial than at lower levels of development. The supervisor is a partner in the ongoing, collaborative development of the supervisee. As part of the ongoing refinement of the IDM model, McNeill, Stoltenberg and Romans (1992) developed the Supervisee ­Levels ­Questionnaire—Revised, which can be used by supervisors to assess objectively the developmental level of their supervisees. López, L. L., & Hyatt-Burkhart, D. (2019). Clinical mental health counseling : Practicing in integrated systems of care. Springer Publishing Company, Incorporated. Created from tcsesl on 2024-06-20 19:17:30.  266 Section V Client-Care and Self-Care Practices The IDM is not without criticism. Ladany, Marotta, and Muse-Burke (2001) con- ducted a study of 100 supervisees and found that there was no predicted preference for supervisor style or approach based on the trainees’ experience, skill with conceptualiza- tion, or familiarity with client’s presenting symptoms. Their study suggests that devel- opmental models may take too simplistic of an approach to counselor development and should, perhaps, incorporate a more nuanced assessment that focuses less on supervisee experience levels. Further, although IDM has been explored empirically and refined as a result of the research conducted, the model does not contain significant detail regarding specific supervisor interventions and techniques for working with supervisees at each level. There are few explicit details as to how a supervisor can and should intervene in order best to meet the needs of practitioners at each specific stage. Finally, the model also is weighted heavily toward the examination of counselor trainees and students and does not give consideration to the ongoing developmental behaviors of counselors across their life span (Haynes, Corey, & Moulton, 2003). This final criticism leads us to the dis- cussion of the Rønnestad and Skovholt model. Rønnestad and Skovholt Model Rønnestad and Skovholt (1993) formulated their model as a result of a longitudinal, qualitative study of 100 counselors who had a range of experience from beginning grad- uate school through 40 years of practice, with an average of 25 years of experience. Ini- tially, their data led them to identify eight stages of counselor development, 20 themes of development that occur over time, and a general model of development and stagnation. In 2003, Rønnestad and Skovholt presented a more refined approach to their model that contains six “phases” of development and 14 themes. They dropped the use of the term "stage" in favor of the use of the word "phase" because they felt that the word stage indi- cated a “hierarchical, sequential and invariant ordering of qualitatively different func- tioning/structures” (Rønnestad & Skovholt, 2003, p. 40). The names of each phase are fairly self-explanatory, but I describe them briefly in the following for clarity. Note that Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. the first three phases correspond quite closely with the first three level of the IDM. Phase 1: Lay Helper. This phase is characterized by new counselors who are not par- ticularly well trained and rely upon their own experiences to provide support and to give advice. They tend to have issues with becoming enmeshed with their clients. Phase 2: Beginning Student. This phase is characterized by students early in their professional training. These supervisees are generally anxious, rely upon their supervi- sors for guidance and direction, and have low self-confidence that they know the “right” approach to their clients. They need significant support and may respond to criticism negatively. Phase 3: Advanced Student. This phase is characterized by students who are gener- ally finishing their program of studies and fieldwork experiences. These practitioners have more confidence than those in previous phases of development but still require support and encouragement that they are on the right path with their clients. Phase 3 supervisees are generally cautious and do not engage in significant risk taking (Bernard & Goodyear, 2018). López, L. L., & Hyatt-Burkhart, D. (2019). Clinical mental health counseling : Practicing in integrated systems of care. Springer Publishing Company, Incorporated. Created from tcsesl on 2024-06-20 19:17:30.  Chapter 13 Clinical Supervision and Professional Development 267 Phase 4: Novice Professional. Spanning across the first few years after graduate school training, novice professionals are engaged in solidifying their own style and approach to counseling independent of the guidance of formal schooling. These supervisees are estab- lishing their own preferences and approach to the work of counseling. They are growing in confidence while developing a more realistic assessment of their own skill sets and strength. Phase 5: Experienced Professional. In this phase, relatively experienced counselors are engaged in integrating their own core understanding of the work and themselves within the counseling relationships that they form. They are better able to establish working relationships that are characterized by appropriate boundaries that promote quality empathetic engagement without enmeshment. Counselors in this phase have developed an understanding that there really is no “right” answer or approach with any given client, and they are flexible with their style. Phase 6: Senior Professionals. Characterized by practitioners with more than 20 years of experience, this phase looks in some ways like Erikson’s stage of integrity versus despair. Here, counselors have a realistic view of the work. They have developed an indi- vidualized, genuine style and are consciously aware of their own importance within the work. This phase may contain themes of loss as mentors may have retired or died. As mentioned, Rønnestad and Skovholt’s (2003) study also produced 14 themes related to counselor development. These themes are: 1. Professional development involves an increasing higher order integration of the professional self and the personal self. 2. The focus of functioning shifts dramatically over time from internal to external to internal. 3. Continuous reflection is a prerequisite for optimal learning and professional development at all levels of experience. 4. An intense commitment to learn propels the developmental process. 5. The cognitive map changes: Beginning practitioners rely on external expertise, Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. while seasoned practitioners rely on internal expertise. 6. Professional development is a long, slow, continuous process that can also be erratic. 7. Professional development is a lifelong process. 8. Many beginning practitioners experience much anxiety in their professional work. Over time, anxiety is mastered by most. 9. Clients serve as a major source of influence and serve as primary teachers. 10. Personal life influences professional functioning and development throughout the professional life span. 11. Interpersonal sources of influence propel professional development more than “impersonal” sources of influence. 12. New members of the field view professional elders and graduate training with strong affective reactions. López, L. L., & Hyatt-Burkhart, D. (2019). Clinical mental health counseling : Practicing in integrated systems of care. Springer Publishing Company, Incorporated. Created from tcsesl on 2024-06-20 19:17:30.  268 Section V Client-Care and Self-Care Practices 13. Extensive experience with suffering contributes to heightened recognition, acceptance, and appreciation of human variability. 14. For the practitioner there is a realignment from self as hero to client as hero. Supervisors can use this list of themes to help supervisees explore specific areas for growth and development within any of the six phases. These themes help to provide the supervisor with directions upon which to focus supervisee self-reflection, which ­Rønnestad and Skovholt (2003) assert is an essential part of counselor development. Theoretic Specific Models of Counselor Supervision If there is a theoretic orientation to counseling, there is likely a corresponding theory of supervision that goes along with it. Theoretic specific approaches to supervision tend to wax and wane in popularity along with the theories to which they are attached. There are, however, a number of theories that have endured, which I briefly review in the following subsections. Psychodynamic Supervision I begin our discussion of the theoretic specific models of supervision with the psychody- namic model because it has its beginnings rooted in classic, Freudian psychodynamics. As expected, this approach examines the transference and countertransference, affec- tive reactions, and defense mechanisms familiar to the practice of psychodynamic-based counseling. In its earliest forms, psychodynamic supervision fell into one of two distinct views. Those in the Budapest School believed that supervision should be a part of the therapist’s personal work in analysis. Those in the Viennese School believed that super- vision should be a process by which the supervisee was taught about and learned about psychodynamic work and how his or her experience within the work was explained by the theory. In either case, the supervisor, just as the psychoanalyst, is seen as an unin- volved expert who possesses the skills and knowledge to educate and promote the super- Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. visee’s development (Frawley-O’Dea & Sarnat, 2001). Psychodynamic supervision has continued to be developed, refined, and researched. Frawley-O’Dea and Sarnat (2001) sought to modernize psychodynamic theory as it is applied to supervision. They conceptualize the work as occurring in three separate categories: patient-centered, supervisee-centered, and supervisory matrix-centered. Patient-centered revolves around the patient’s (or client’s) behaviors, symptoms, and pre- sentation, where the supervisor maintains the detached, expert role. Here, the supervisor is very much a teacher engaged in a low conflict, didactic relationship with the super- visee. Supervisee-centered focuses on the counselor’s experience of and reactions to the work of counseling while addressing their own anxieties and resistance (Falender & Sha- franske, 2004). Finally, the supervisory matrix-centered approach focuses on both the client’s and supervisee’s issues as needed. There is also an additional layer of examination of the relationship between the supervisee and the supervisor, because this relationship often can mimic that which happens between counselor and client. This phenomenon is called parallel process. López, L. L., & Hyatt-Burkhart, D. (2019). Clinical mental health counseling : Practicing in integrated systems of care. Springer Publishing Company, Incorporated. Created from tcsesl on 2024-06-20 19:17:30.  Chapter 13 Clinical Supervision and Professional Development 269 CASE ILLUSTRATION 13.1 AN EXAMPLE OF PARALLEL PROCESS Take the case of a Sam, a supervisee who is defensive regarding the feedback that the su- pervisor is providing regarding the treatment of a client. Sam’s supervisor has been working with him regarding his tendency to not confront his clients in session. Sam has difficulty accepting this criticism and finds ways to refute or discount the information as being false. He tries to provide his supervisor with examples of when he has been confrontational and prove to his supervisor that her assessment of his abilities is incorrect. Sam’s client, Michael, also is demonstrating resistance to the feedback that is being provided during counseling sessions. Sam has been trying to point out that Michael says that he wants to have a closer relationship with his wife, but his actions push her away. In session, Michael attempts to provide Sam with examples of times that he acted in a manner that would bring him closer to his wife. He tried to prove that Sam is incorrect in his observations. Michael is engaged in denying or rejecting Sam’s critical information. Although the topic at hand is not the same, Sam and Michael are both trying to discount the feedback they are receiving and disprove the observations of another. Parallel process can be a powerful dynamic in the client–counselor–supervisor relation- ship that can negatively impact progress if it left unaddressed. I will talk more about this process later in this chapter. Frawley-O’Dea and Sarnat (2001) discussed three dimensions of psychodynamic supervision that can provide a conceptual framework within which to understand the process of supervision. Dimension one is the nature of the supervisor’s authority in relationship to the supervisee. Bernard and Goodyear (2018) describe this authority Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. as occurring on a continuum between uninvolved/involved and knowing/unknowing. Dimension two is the focus of the supervisor related to the three categorical approaches described previously. Finally, dimension three refers to the roles and approach that the supervisor may adopt within the supervisory session. Frawley-O’Dea and Sarnat (2001) identify didactic teacher, Socratic questioner, container of supervisees’ affective reac- tions, and counselor, among others (Bernard & Goodyear, 2018). Person-Centered Supervision Person-centered supervision is based upon the counseling theory of the same name developed by Carl Rogers. His theory centers upon the belief that people are capable of understanding themselves and their problems and that they can use this understand- ing to resolve effectively their own issues without direction, guidance, or interpretation of these issues from a counselor (Haynes et al., 2003). Of importance in Roger’s theory was the emphasis that he placed upon the characteristics of the counselor and the rela- tionship between counselors and clients in assisting clients to achieve self-actualization López, L. L., & Hyatt-Burkhart, D. (2019). Clinical mental health counseling : Practicing in integrated systems of care. Springer Publishing Company, Incorporated. Created from tcsesl on 2024-06-20 19:17:30.  270 Section V Client-Care and Self-Care Practices and the attainment of their goals. In person-centered counseling, the counselor is not an expert or an authority, but someone who creates a relationship that is characterized by genuineness, caring, respect, acceptance, and understanding that helps clients to feel free to work toward the resolution of their own problems (Corey, 2017). Person-centered counseling supervision is conducted in much the same manner as counseling. The supervisor is not viewed as an expert or an authority figure but rather acts as a collaborator or partner (Smith, 2009). The relationship between the supervisor and supervisee is the primary facilitator for growth and change on the part of the super- visee. The supervisor’s role is to create the environment that helps to free supervisees from being locked into their own preconceived notions of themselves and the work so that they can develop more effective ways of functioning. Cognitive Behavioral Supervision Cognitive behavioral supervision (CBS) is based upon the tenets of cognitive behavioral therapy (CBT) first developed by Aaron Beck in the 1960s. He found that people’s auto- matic thoughts, beliefs, and assumptions created distress and disturbance and led them to behave in certain ways. Beck and his colleagues described CBT as follows: The approach consists of highly specific learning experiences designed to teach the patient the following operations: (1) to monitor his negative, automatic thoughts (cognitions); (2) to rec- ognize the connections between cognitions, affect, and behavior; (3) to examine the evidence for and against his distorted automatic thoughts; (4) to substitute more reality-oriented inter- pretations for these biased cognitions; and (5) to learn to identify and alter the dysfunctional beliefs which predispose him to distort experiences. (Beck, Rush, Shaw, & Emery, 1979, p. 4) In CBS, the central purpose is to teach clinicians CBT and enhance their understand- ing of the use of the theory and to eliminate any misconceptions related to the provision of CBT (Liese & Beck, 1997). The focus is on the supervisor teaching and evaluating the skills and competencies of the supervisee as they relate to the provision of CBT. As the Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. theory has developed, some supervisors have begun to incorporate a focus on the super- visees’ own cognitions and beliefs as they influence the supervisees’ behavior with clients and perhaps the supervisees’ professional identity (Haynes, Corey, & Moulton, 2003). As in CBT, the relationship between the supervisee and supervisor has only minimal impor- tance to the process, which is focused on mastery of CBT skills. Systemic Supervision Systemic models of supervision most often are used by those who are engaged in the practice of family therapy. Models such as structural, Bowenian, and strategic family therapy all share a focus upon the interactions, relationships, and systemic dynam- ics that influence a system’s members. As with other theoretically specific models, the supervisory applications of systems theories all vary slightly in accordance with the specific approach, but they have a common understanding of the importance of client, supervisee, and supervisor as in relationship with one another. Further, the biopsychosocial context of all of the members of the system is viewed as an essential López, L. L., & Hyatt-Burkhart, D. (2019). Clinical mental health counseling : Practicing in integrated systems of care. Springer Publishing Company, Incorporated. Created from tcsesl on 2024-06-20 19:17:30.  Chapter 13 Clinical Supervision and Professional Development 271 component of the functioning of the relationship. Simply put, the client/family has a context and a worldview that are created as a result of their experience within their own context. The counselor/supervisee and the supervisor each has his or her own unique context and worldview. When the counselor/supervisee is in relationship with the client, the counselor must consider the context and worldview of the client in order to be effective. So too must the supervisor take into consideration the context of the supervisee and the client. The participants are in relationship with one another (even if the supervisor is in relationship with the client through the supervisee), and each must consider the context of the other in order to promote understanding and communication. The supervisory process is characterized by oversight of the work from the perspec- tive of the specific model’s tenets (e.g., rules, roles, hierarchy in structural family therapy; triangles, differentiation and cut-offs in Bowenian family therapy) and an exploration of the supervisee’s experiences as a part of the family’s system. One of the unique fea- tures of systemic supervision is the focus on the isomorphic process systemic therapists believe is inherent to the work. Isomorphism is similar to parallel process, but it is more than simply a replication of patterns of behavior, it is a similarity in structure and form of the relationships. The word itself is from the Greek isos meaning equal and morphe meaning form or shape. In supervision, isomorphism is the mirroring of the supervisor/ supervisee relationship to supervisee/client relationship and perhaps even further to the dynamic relationships of the family (Liddle, 1988). Often, isomorphic relationships cre- ate “stuckness” or lack of progress in counseling (Lee, 1997). CASE ILLUSTRATION 13.2 Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. ISOMORPHISM IN SUPERVISION Once when I was supervising a team of counselors who were conducting in-home family therapy, the team expressed feeling as if they were making no headway in counseling. They had been working with this particular family for about 7 months and were feeling as if the family had just decided to stop trying. The team talked about the parents’ relationship struggle and how, when they first began counseling, they were excited about doing their homework and actively engaged in activities designed to improve their relationship. Now, they often failed to complete tasks, had returned to old patterns of behavior, and seemed as distant from one another as they had at the start of their counseling work. Further, the kids in the family had increased their acting out behaviors leaving mom feeling overwhelmed and unsupported by dad. When we processed this information and the team’s feelings about their progress in supervision, it dawned on me that the team had become less productive in supervision. They had been late with paperwork, failed to follow through with suggestions, and seemed to be somewhat overwhelmed by their cases. López, L. L., & Hyatt-Burkhart, D. (2019). Clinical mental health counseling : Practicing in integrated systems of care. Springer Publishing Company, Incorporated. Created from tcsesl on 2024-06-20 19:17:30.  272 Section V Client-Care and Self-Care Practices Upon further reflection, I came to see that I had been less attentive in supervision and less available to them due to a number of administrative concerns that were pressing and that were negatively impacting my ability to function. When I exposed this isomorphic pro- cess in supervision, the team and I were able to re-contract how we wanted our relationship to function. I agreed to return to making the time for supervision a priority and increase my responsiveness to their needs. They in turn agreed that they would be more mindful about how they divided the work between them so that neither of them felt overwhelmed or over- burdened. As a team, they presented their thoughts to the parents, who endorsed that they had been feeling stuck, but did desire positive change. In the end, the changes made at mul- tiple levels of the system nudged all of the members to make alterations in their functioning that led to individual and system changes. Awareness of the influence of isomorphism and its power as a disrupter of and tool for change is one of the greatest contributions of systemic supervision to the field (Bernard & Goodyear, 2018). Integrative Supervision Not surprisingly, integrative models of supervision are those that incorporate the tech- niques, theories, and tenets of multiple approaches (Haynes et al., 2003). Sometimes, supervisors practice what often is referred to as technical eclecticism, where the supervi- sor is merely pulling techniques and activities from various theoretical approaches with- out grounding them in the theory from which they are borrowed. This notion is akin to technical eclecticism in counseling where, for example, an individual who practices from an existential model may borrow the empty chair exercise from Gestalt therapy. A psy- chodynamic supervisor might ask the supervisee to look at the contextual experience of the client, or a supervisor who uses the IDM may ask the supervisee to explore the dynamic present in the supervisory relationship. The use of the technique from another theory is a tool that does not alter the theoretic orientation to the work itself. Copyright © 2019. Springer Publishing Company, Incorporated. All rights reserved. Theoretically, integrative supervision is the synthesis or fusion of the basic tenets and concepts of multiple theories of supervision (Smith, 2009). Here, the theories themselves are overlaid onto one another. Most supervisors are likely to have a foundational ground- ing in person-centered supervision but most also lay another theory on top of that. Many supervisors practice a strength-based approach that is grounded in a specific theoretic model, such as psychodynamic or IDM. Social Role Supervision According to Holloway (1995), social role models of supervision focus more on what supervisors do during the process and how they organize the supervision than from what theory they practice. The most widely known of these types of models is likely Ber- nard and Goodyear’s (2018) discrimination model. The discrimination model provides supervisors with an organizational structure within which they can perform the work, understand their role and function, and react López, L. L., & Hyatt-Burkhart, D. (2019). Clinical mental health counseling : Practicing in integrated systems of care. Springer Publishing Company, Incorporated. Created from tcsesl on 2024-06-20 19:17:30.  Chapter 13 Clinical Supervision and Professional Development 273 flexibly to the needs of their supervisees. The model provides supervisors with a way to conceptualize their roles and their f