Post on 14-Aug-2020
MakingaCaseforClinicalSupervision
LearningObjectives
Participantswill:1. Understandscopeandcomponentsofclinicalsupervision
2. LearnhowtoincorporatetheCommonfactorsApproachtoclinicalsupervision
3. Articulatethevalueofclinicalsupervisionintreatmentsettings
SexualContact
• VulnerableAdult(VA)reportedsexualrelationshipwithastaffperson(SP),anintern,afterhe/shelefttreatment• SPreportedhavingacrushonVAwhiletheywereinthesamecollegeclasses• SPpursuedVAviaemailandphonemessages• VAmetSPandhadsex• SeniorstaffhadnoknowledgethatinternknewVApreviouslyalthoughSPsaidhe/sheinformedsupervisorofthis
• SPreportedVAcontactedSPaboutdifficulttimesandSPmetVAatacafétodiscusdifficultiesseveraltimes• SPreportedVAbecameaggressivewhenSPsuggestedtheyshouldnotcommunicatefurther• SPreportedVAcontinuedtobeharassingandaPetitionforHarassmentRestrainingOrderwasfiledbySPagainstVA• SPdeniedhavingasexualrelationshipwithVA• VAprovideddescriptionofidentifyingtattooonSP’sbodythatindicatesitwaslikelythattherewassexualcontactbetweenVAandSP• ItwasnotdeterminedwhethersexualabuseoccurredbecausetheVAwasnolongeraclientofthefacilityanditwasnotdeterminedthatSPactedasacaregiverinhis/herroleatfacility
AllegationsofNeglect
• VA’sillnesshistoryindicateditwaslikelytheVAwouldrequirecontinuedsupportstodevelopandmaintainsobriety• SP’sinteractionslikelyhinderedVA’sabilitytohaveconsistentunderstandingofthetherapeuticrelationshipwhichcouldimpacttheVA’sabilitytoaccessservicessuccessfullyinthefutureandnecessarytomaintaintheVA’sphysicalormentalhealthorsafety
Theseguysareinbigtrouble!
CasePresentation-MaltreatmentofaVulnerableAdult
• “Anysexualcontactorpenetrationbetweenafacilitystaffpersonorapersonprovidingservicesinthefacilityandaresident,patient,orclientofthatfacility.”
• “Thefailureoromissionbyacaregivertosupplyavulnerableadultwithcareorservices,includingbutnotlimitedtofood,clothing,shelter,healthcareorsupervisionwhichisreasonableandnecessarytoobtainormaintainthevulnerableadult’sphysicalormentalhealthorsafety,consideringthephysicalandmentalcapacityordysfunctionofthevulnerableadult…..”
NAADACCodeofEthics
• TheCounselingRelationship:….theaddictionprofessionalislikelytoencounterindividualswhoarevulnerableandexploitable….theaddictionprofessionalseekstosupport….ratherthantotakeunfairadvantage.• Clientself-determination:Theaddictionprofessionalrecognizesthatthereareclientswithwhomhe/shecannotworkeffectively.Insuchcasesarrangementsforconsultation,co-therapyorreferralaremade.Inrelationshipswithclients,students,employeesandsupervisors
he/shestrivestodevelopfullcreativepotentialandmature,independentfunctioning
NAADACCodeofEthics
• DualRelationships:Addictionprofessionalswillprovideservicesonlyincontextofaprofessionalsetting.Becausearelationshipbeginswithapowerdifferential,theaddictionprofessionalwillnotexploitrelationshipswithcurrentorformerclients,currentorformersuperviseesorcolleaguesforpersonalgain,includingsocialorbusinessrelationships.Theaddictionprofessionalwillnot,underanycircumstances,engageinsexualbehaviorwithcurrentorformerclients.
DeterminingResponsibility
• “..the..responsibilitybetweenthefacility,othercaregivers,andrequirementsplaceduponemployee,including….theadequacyofcaregiversupervision….”• “whetherthefacilityorindividualfollowedprofessionalstandardsinexercisingprofessionaljudgement.”• TheinvestigationdeterminedthattheSPwasresponsibleforthemaltreatmentandnottheagencyaswellbecausetheSPhadreceivedtrainingonReportingofMaltreatmentofVulnerableAdultsAct.
DeterminingRecurringand/orSeriousMaltreatment
• ItwasdeterminedthatthesubstantiatedmaltreatmentforwhichtheSPwasresponsibleforwasnotseriousandwasnotrecurring.
• TheSPwasnotdisqualifiedfromprovidingdirectcareservicesbutwasnotifiedthatanyfurtherreportswouldmeetthecriteriaof“recurring”andwouldresultindisqualification.
• Whowerethepotentialvictimsinthissituation?
• Whatmighthavemadeadifference?
• Keepthesethoughtswhileweforgeaheadmakingacaseforclinicalsupervision.
• Let’sseehowwecanthehelpSPnotmakethisorsimilarmistakesinthefuture.
WhatisClinicalSupervision?
• Yourdefinition• Benefits• Whathaveyourexperiencesbeenasasupervisororsupervisee• Whatwashelpful?• Whatwasn’thelpful?• Whatwouldyouchange?
SomeDefinitionsofClinicalSupervision
“…Adisciplinedtutorialprocesswhereinprinciplesaretransformedintopracticalskillswithfouroverlappingfoci:administrative,evaluative,clinicalandsupportive.”Powell&Brodsky,2004,p.11
ClinicalSupervision
….isaninterventionprovidedbyaseniormemberoftheprofessiontoamorejuniormember..Thisrelationshipisevaluative,extendsovertime,andhassimultaneouspurposesofenhancingtheprofessionalfunctioningofferedtoclients..andservesasagatekeeper
Bernard&Goodyear,p.82004
ClinicalSupervision
…isasocialinfluenceprocessthatoccursovertime,inwhichthesupervisorparticipateswiththesuperviseetoensurequalitycare.Effectivesupervisorsobserve,mentor,coach,evaluate,inspire,andcreateanatmospherethatpromotesself-motivation,learningandprofessionaldevelopment.Theybuildteams,createcohesion,resolveconflictandshapeagencyculture,whileattendingtoethicalanddiversityissuesinallaspectsoftheprocess.Suchsupervisioniskeytobothqualityimprovementandthesuccessfulimplementationofconsensus- andevidence-basedpractices.
TAP-21A,2007,p.3
ModelsofSupervision
• Competency-based Skillsandlearningneeds,SMARTgoalsetting• Treatment–based Traintoaparticulartheoreticalapproach• Developmentalapproaches Understandthatcounselorsneeddifferentinterventionsastheyprogress• Integratedmodels Blendabovemodels
Tip52
TheRelationship
Teacher Coach
ConsultantMentor
TheRelationship
• Teacher-learningexperiences,provideinformation,challenges,neworrenewedmethods• Mentor-learningexperiences,rolemodel,guide,challenge-non-clinicalcounseling
• Consultant-ethics,problemsolving,protectingclientsandagency
• Coach-identifystrengthsandopportunitiesforimprovement
GeneralSupervisionGoals
Toensurequalitypatientcare,protecttheclients,institution,professionandcounselor
GeneralSupervisionGoals
Topromotecounselorprofessionalgrowthanddevelopment
GeneralSupervisionGoals
Tomonitorthecounselor’sperformanceasa“gatekeeper”throughobservationandevaluation
GeneralSupervisionGoals
Toempowercounselorstoengageincontinuousprofessionalandethicaldevelopment
CommonFactorsApproachtoClinicalSupervision
• Originatedinclinicalandcounselingpsychologyfirst,byNealE.Miller,HansEysenck,JeromeFrank,CarlRogersandothers• Proposesthatdifferentevidencebasedpracticessharecommonfactorsthataccountforeffectiveness• Somemostoftenstatedcommonfactorsinpsychotherapyare:a. Anexpectationtobehelped-hopeb. Thetherapeuticrelationshipc. Arationalorconceptualschemethatprescribesagivenritualorprocedureforresolvingthemd. Theactiveparticipationofbothpatientandtherapistincarryingoutthatprocedure
CommonFactorsinSupervision• AsdefinedbyGeorgiosK.Lampropoulos,MA,BAinTheClinicalSupervisorVol.21(1)2002
• TheSupervisoryRelationship
a.Thehumanrelationship- empathy,authenticity,warmth,unconditionalpositiveregard,
b.TheWorkingAlliance-contract,goals,tasks
c.TransferenceandCountertransferenceandattachmentstyles
CommonFactorsinSupervision
SupportandRelieffromTensionandAnxiety
a. Regardingskills,performanceandevaluationb. Mutualunderstandingthatsupervisionisa“safeplace”to
discussmistakesandthatsuperviseesareindevelopmentc. Importanttomatchsupporttostageofdevelopment
StagesofSuperviseeDevelopment
• DependentonSupervisor
• Dependency-autonomyconflict
• ConditionalDependency
• MasterCounselor
• Encourageautonomywithnormativestructure-instruction,self-awareness• Highlyautonomouswithlownormativestructure-support,clarification,lessinstruction• Autonomouswithstructureprovidedbythecounselor• Canfunctionadequatelyinmostsituations,supervisioncollegial
Kagan’sInterpersonalProcessRecall(IPR)
Counselorreviewstapedinterview• Counselorandsupervisorexplorepossibleperceptions/biasesthatcounselormightnotbeawareof• Counselorpracticesexpressingthoughtsorfeelingsaboutclientinasafeenvironment• Counselormaydiscoverareaofneededpersonaldevelopment• Counselormaychangebehaviorandattitudetowardclient
Self-exploration,AwarenessandInsight
• SelfMonitoring
• Cognitivequestioning
• UseofKagan’sInterpersonalProcessRecallmethod
CommonFactors:InstillationofHopeandRaisingExpectations
HowwillIeverbecomeacounselorwithsomuchtolearn?
StructureGuidance
Createwonder&curiosityGoalsetting
Selfdisclosureofsupervisor’sdevelopment
ChallengecognitivedistortionsGroupwork
EncourageboundarysettingAcceptanceofclient’sstageof
changeandconditionEncouragecreativityFocusonstrengthsSelfAwarenessEncouragementIntegrateselfcare
Structure
SuperviseeSessionPlan• Name___________________________Date_______________• Goalsforsession• SpecificCaseConceptualization/Assessments• TherapeuticAlliance/Skills/Interventions/Effectiveness:• Ethical/ProfessionalIssues• Self-Knowledge/Awareness• Planforfollowingweekincludingself-careplan
S.M.A.R.TGoals
• IdentifywhatI wanttoachieve
• Ask,whatdoIneedtodotoSpecificallyachievewhatIwant?
• Ask,iswhatIplantodoMeasurable? HowwillIknowifIaccomplishedit?
• DecidehowIwillbeAccountable formyplan?
• Relevant?Realistic?Willthisactivityreallyhelpmeachievemygoal? Canitbedone?
• Timespecific? WhenwillIdothisactivity?
S.M.A.R.TGoals
NowwriteyourS.M.A.R.T. goal• Inorderto__________________I will__________________by oron_______ andbeaccountableto___________________.
ExposureandConfrontationofProblems
• Identifyproblemsandexploreeffectivealternativebehaviorsandskillsby• Roleplay• Instructionabouttheoriesandinterventions• Reframingproblem
AcquisitionandMasteryofNewKnowledge
MatchLearningstyles
Exposureandpracticeovertime
Supervisees’self-attributionofprofessionaldevelopment
ExerciseUsingCommonFactors
• Formgroupsofthree-onesupervisor,onesupervisee,oneobserver• Roleplayasupervisionsessionusingthecommonfactors• Whatsupervisionmodelsandcounselingtheoriesframeworkwereused?• Whatcommonfactorswereused?__Therapeuticrelationship__Support,relieffromtension__Workingalliance__Instillationofhope__selfexploration__ExposureofProblemsandcorrectiveaction__Acquisition/Masteryofnewknowledge__Others__________________
Howtoavoidfallingintotheiceinthefirstplaceoratleastnottwice!
Whatwouldyoudoasasupervisortodecreasethelikelihoodthatthemaltreatmentandpossiblesexualabuseofavulnerablefromhappening?
Whatarethebenefitsofeffectiveclinicalsupervision?
ReferencesandResourcesforfurtherLearning
AddictionTechnologyTransferNetwork(ATTC)NationalOffice,2022,ClinicalSupervisionFoundationspartOne,UniversityofMissouri
AddictionTechnologyTransferCenterNetwork.(ATTC)NationalOffice,2011 ClinicalSupervisionFoundationsPartOne,UniversityofMissouri,KansasCity, availableonline-www.ATTC.Telephone-816-235-6888
AddictionTechnologyTransferCenterNetwork.(ATTC)NationalOffice,2011 ClinicalSupervisionFoundationsPartTwo:Participant Workbook.UniversityofMissouri,KansasCity, availableonline-www.ATTC.Telephone-816-235-6888
AddictionTechnologyTransferCenterNetwork.(ATTC)NationalOffice,2011 ClinicalSupervisionFoundationsPartTwo:Trainer Guide,University ofMissouri,KansasCity, availableonline-www.ATTC.Telephone-816-235-6888
ReferencesandResourcesforfurtherLearning
Bernard,J.M.,andGoodyear,R.K.Foundations ofClinicalSupervision(3rd ed).Boston:Allyn&Bacon,2004
Campbell,J.M.EssentialsofClinicalSupervision.NewYork:JohnWileyandSons,2006
Lampropoulos,GeorgiosK.,MA,BAinTheClinicalSupervisorVol.21(1)2002
Morgan,MichaelandSprenkle,Douglas, CommonFactorsinSupervision,JournalofMaritalandFamilyTherapy, Vo.33.No.1,1-17/,Jan.2007.NorthwestFrontierAddictionTechnologyTransferCenterNetwork.(ATTC)2011,PerformanceAssessmentRubricsforAddictionCounselorCompetencies Portland,OR:Oregon HealthandScienceUniversity
Powell,D.J.and Brodsky,A.Clinical Supervisionin AlcoholandDrugAbuseCounseling:Principles,Models,Methods(Reviseded.)SanFranscisco:Jossey-Bass,2004
ReferencesandResourcesforfurtherLearning
U.S.DepartmentofHealthandHumanServices,(2009), ClinicalSupervisionandtheDevelopmentoftheSubstanceAbuseCounselorTIP52,(HHSPublicationNo.(SMA)09-4435)Rockville,MD:SubstanceAbuseandMentalHealthServicesAdministration
U.S.DepartmentofHealthandHumanServices,(2007),CompetenciesforSubstanceAbuseTreatmentClinicalSupervisors,(HHSPublicationNo.(SMA)07-4242)Rockville,MD:SubstanceAbuseandMentalHealthServicesAdministration