Clinical Supervision Models PRESENTED BY: SHANNON M. ELLER, LPC, LMFT, RPT, CPCS, NCC BRIGHTER...

Clinical Supervision Models

PRESENTED BY:

SHANNON M. ELLER, LPC, LMFT, RPT, CPCS, NCC

BRIGHTER TOMORROWS CONSULTING, LLC1815 NORTH EXPRESSWAY—SUITE B; GRIFFIN, GA 30223

PHONE: (770) 486-7424, FAX: (770) 412-1087WWW.BRIGHTER-TOMORROWS.COM

Ethical Standards Around Supervisory Process

• Usual, Customary, Reasonable (UCR);• Supervisor responsibility ;• Vicarious liability:

1. form of strict, secondary liability that arises under the common law doctrine of agency,

2. respondeat superior – the responsibility of the superior for the acts of their supervisee (the responsibility of any third party that had the "right, ability or duty to control" the activities of a violator).


Ethical Dilemmas

• Competency• Expertise• Referral • Termination• Abandonment


Ethical Dilemmas

• Counselor Welfare• Impairment• Ethical Complaints• Use of Technology (social media, internet/web

services)• Supervision vs Consultation


Ethical Standards

Multicultural Issues• Knowledge• Awareness• Skills Sets• Sensitivity• Respect


• Knowledgeable

• Experienced

• Effective Communicators

• Synthesizers

• Relational

• Confident

• Flexible

• Systemically Oriented

Clinical Supervision ModelsAttributes of Good Supervision

The greatest good you can do for another is

not just to share your riches, but to reveal

to him his own.

-Benjamin Disraeli


You cannot teach a man anything.

You can only help him discover

it within himself.

-Galileo Galilei


Current Research/ Literature

• Multicultural Considerations

• Individual, Triadic, Group


• Foundations: • Educator

• Supervisor

• Consultant

• Group Discussion

• Role Plays

• Performance Domains:

• Interventions

• Conceptualization

• Personal and Professional Development


Supervision• A means of transmitting the skills, knowledge, and attitudes of a

particular profession to the next generation of that profession.

• This relationship is evaluative, extends over time, and

• Has the simultaneous purpose of enhancing the professional functioning of the junior member(s),

• Monitoring the quality of services offered, and

• Serving as a gatekeeper for those who are to enter the particular profession.• Bernard & Goodyear(2004)


• Theory-Based Models

• Influenced by supervisor’s theoretical orientation

• Focus on specific counseling skills from different theoretical orientations

• Murphy & Kaffenberger, 2007

• Developmental Models

• Beginning, intermediate, advanced

• From rigid and shallow to competence and self-assured

• Stoltenberg & Delworth, 1987

• Interpersonal Process Recall

• Integrative Models; Social Role Models

• Three supervisory roles, three areas for skill-building

• Discrimination Model

• Bernard, 1979

• Parallel Process


Clinical Responses

What makes good supervision?

What is “bad” supervision?


Good Supervision is:• Flexibility about theory, technical principles, and

trainee’s learning style

• Respectful attitude, supportive and non-judgmental

• Openness, Curious, Relaxed and Patient


Poor Supervision Styles

• Administrative vs Clinical

• Job Seniority vs Knowledge/Skills

• Confrontational vs Challenging

• Negative vs Positive

• Critical vs Supportive


Negative trainee (T) experiences with supervisors (S)

• (T) came to supervision prepared to discuss cases and review tapes, but the (S) used the entire session to self-disclose and process a recent event that the (S) had experienced.

• (S) shut off the (T)’s therapy session tape and asked, “Why are you showing this to me?”

• (T) asked for more supportive feedback rather than just feedback about mistakes, and the supervisor declined to provide that kind of supervision.


“Good Supervisory Experiences”

• She really gave me permission to think about things without pressuring

me to do anything.”

• “What was so great was that my S. was really affirming of…my ability

to speak clearly… . I felt like she appreciated those abilities that I had

taken pride in the past and which I had felt, I just hadn’t felt were being

recognized at all, at any level.”

• “Maybe his [the S’s] being willing to hear what I had to say, maybe it

modeled, maybe I should consider what he has to say.”


Discrimination Model (B&G)

• Basic assumptions• Supervisors must assume different roles with

supervisees

• Roles are chosen on the basis of a number of factors (Educator, Counselor, Supervisor)

• Developmental stage

• Theoretical orientation

• Presenting issue


Discrimination Model Basics

• Developmental vs Evaluative Focus

• Supervisor first attends to focus areas:• Intervention skills

• Conceptualization skills

• Personalization skills


Supervisory Working Alliance

• Supervisory alliance predicts:• Supervisees’ willingness to disclose

• Client perception of therapeutic alliance

• Supervisory alliance related to:• Supervisor ethical behavior

• Use of effective evaluation practices

• Supervisor self-disclosure (professional)


Supervision Best Practices

• Ability to convey principles and concepts with clarity

• Ability to think out loud in order to model clinical inference process

• Willingness to allow supervisees to view supervisor’s own clinical work


Supervision Best Practices

• Relies on the supervisory working alliance

• Effective clinical relationship with supervisees based on common factors.

• Integration of own personal and professional development and growth processes.

• Sharing stakeholder position in supervision process.


Barriers to Good Supervision

• Power Struggles/ Poor Boundaries

• Lack of Safety/Trust

• Differences in Theoretical Orientation

• Personality Differences/ Personal Issues

• Lack of Rapport/ Positive Regard

• One-Up/One-Down Mentality

• Poor Structure/Distraction


Promoting Safety and Trust

(Confidentiality and Privacy)

• Respect for clients

• Respect for rising clinician as colleague

• Respect for process

• Respect for profession


Types of Clinical Evaluation

• Formative feedback (informal/ongoing)• Summative feedback (formal/terminal)

• Two core problems• Defining competence• Conflicts with self-concept as a “helper”

• Can result in avoidance of evaluator role


• Verbally, Non-Verbally, Written, Modeling

• During Supervision (in session, throughout training, at end)

• Strengths

• Areas of Improvement

• Practical Suggestions


Roles of Supervision

• Educator: • Instruction, Questioning, Reinforcement

• Mentor: Encouragement

• Guide: Demonstration and Modeling

• Evaluator: Assessment


Evaluation Methods

Live vs Self-Report

• Advantages

• Disadvantages


Live (In-Vivo) Observations

• Bug-in-ear

• Bug-in-eye

• Telephone contact

• Two-way mirror

• Greek chorus

• Live observation

• Co-facilitation


Clinical Staffing

• Audiotape

• Videotape (IPR)

• Case Conceptualization

• Progress Note/ Tx Plan Review

• Advantages/ Disadvantages


Types of Supervision

• Individual

• Dyadic

• Triadic

• Group

• Advantages/Disadvantages


Case Scenarios

Finding Your Own Style


Clinical Supervision Models PRESENTED BY: SHANNON M. ELLER, LPC, LMFT, RPT, CPCS, NCC BRIGHTER...

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