THE SUPERVISORY RELATIONSHIP:

PROBLEM-SOLVING IN SUPERVISION

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

Introduction• Supervision — the act of watching over the work of tasks

of another who may lack full knowledge of the concept at hand

• “Although supervision can be defined narrowly as the process of teaching a clinician how to conduct therapy, it frequently affects many aspects of a therapist’s professional and personal development.” (Liddle, 1988.)

Establishing Supervision• Share information about your background and gain

information about theirs.• Supervisor’s goals of supervision:

• Theory, and• Self of the Therapist.

• Supervisor’s philosophy and approach to supervision.

Barriers in Supervision

1. Supervisor’s personal issues / poor relationship,

2. Distraction,

3. Location and Timing, and

4. Poor structure

1. Supervisor’s Personal Issues • What are we bringing into supervision?

• Our politics:• When supervisors use the group to sort out their own personal politics, it

is not helpful and can be damaging.

• Our personal lives:• Supervisors must be careful not to engage in self-disclosure to the point

that time spent together become therapy sessions for the supervisor.

• What else?

• “Some of my struggles with supervision have included supervisors who, I sensed, lacked confidence and were highly anxious. I noticed that, when this occurs, I feel less confident—doubting myself, the case, and the direction of therapy.”

• “I experienced having a depressed supervisor, who was passive and what appeared to be disengaged. This was frustrating as I am relatively proactive, and appreciate being both challenged and encouraged to grow.”

Poor Relationship• What causes a poor relationship?

• Power struggles:• When do they occur?• How should we, as supervisors, handle such a situation?

• Personal differences:• Differences in theoretical orientation,• Cultural differences / differences in background, • Differences in expectations of the supervision experience, and• Closed-mindedness on either part.

• What else?

• “I had a group supervisor who did all of the talking and interrupted frequently during case presentations. Not productive! When the group brought this to her attention, she was receptive and agreed to let others contribute, which improved the experience.”

• “Some supervisors have gossiped about transfer cases which only leaves me to feel like they will also talk negatively or be judgmental about the cases I transferred.”

What is helpful?• Exploratory attitude:

• “I appreciate it when my supervisor understands that I have a better sense of my client by being in the room with them.”

• Good modeling:• “The best supervisor asked for my input first; she would give her

advice last. She was never afraid to say that she herself would consult if she didn’t have an answer. She would be supportive and excited for the case, not demeaning or labeling clients when she had only heard three lines about a case.”

2. Distraction • “I would prefer a supervisor reschedule supervision when they are very busy

or distracted instead of meeting with me. The time with a supervisor is very valuable and it should feel to the supervisee that they have the supervisor’s undivided attention.”

• “As a supervisee I felt that I needed every single second of focused supervision, because I felt lost with my clients.”

• “I had a supervisor who, whenever I arrived for my scheduled supervision hour, would be either out of her office, in her office with someone else, or just about to take lunch. I found this to be frustrating and discouraging.”

• “The scheduled time for supervision was situated between two other appointments for the supervisor and, thus, they often gave vague or general recommendations on how to conceptualize a particular case.”

What is helpful?• Consider the needs of the supervisee:

• Acknowledge the struggles they experience;• Affirm their efforts;• Ask for their opinions.

• “One of the most helpful aspects of supervision was when my supervisor asked more questions rather than rushing to help me diagnose or assume they knew my case. Curiosity about my case with helpful questions always opened up my experience more. Listening was key.”

3. Location and Timing• Location:

• It is unhelpful when “supervision takes place in a location that is inconvenient for the supervisee, e.g. far away from the clinic where they practice or where they have to pay money to park.”

• “Supervision done in a non-private space (i.e. other people are in the room) can make the supervisee feel unsafe to share certain information.”

• Timing:• “My supervisor gave me negative feedback about my response during a live

supervision. I went back into the therapy room with that on my mind instead of focusing on what was going on with the client.”

• “Inconsistency of having frequently changing supervision times and difficulty reaching my supervisor for assistance.”

• “It is not helpful when it feels like a parental approach where the focus is on what’s ‘right’ and ‘wrong’.”

• “Supervision that focuses more on validating the supervisee’s work than providing corrective and directive feedback plateaus fairly quickly in its utility.”

What is helpful?• Consider the needs of the therapist.• Protect the supervision time.• Be considerate when giving feedback:

• If it is negative, don’t give it in the middle of live supervision or right before an important event.

4. Poor Structure• “I probably would like more focus on what I was going through

personally, because I think my own anxieties and chaotic life were getting in the way of my own progress.”

• “I had one supervisor who has administrative question for me every time we met and I didn’t feel that they were relevant at the time because I needed more specific help with my cases.”

• “The supervisor seemed to have her own agenda. She was too direct in telling me what to do in most situations.”

• “When my supervisor made no comments at all on my work, I would this to be disconcerting. I had to ask directly for input.”

What is helpful?• “It is helpful to have a balance between educating and exploring. It is

important to explore personal issues in addition to discussing educational material such a theories, medications, and other contextual topics.”

• “I have found that, when I set the agenda for my supervision hour, I obtain more assistance. For example, I have been proactive in letting my supervisor know that I would like to become more astute in diagnosis. As a result, we spend more time focusing on diagnosing and the problem areas I wanted to address.”

Environment

1. Rapport,

2. Safety,

3. Structure, and

4. Knowledge.

Rapport• “Supervisors who are dedicated to, and willing to work at, their

craft are powerful role models to their trainees.”(Liddle, 1988.)

• “The honesty and authenticity aspect refers to supervisors who are open, consistent yet flexible, while also processional. Patience, I think, is more difficult given time restraints, number of cases being supervised, alternative responsibilities, and so forth. However, having a supervisor who is patient enables me to be most present and patient with clients.”

• “Each supervisor has shaped and impacted my life professionally and personally. Supervisors who have given me feedback in ways to grow and improve have been great, as well as then they have voiced what they considered as my strengths. I feel very lucky to have experienced such a diverse body of supervisors and consider this a crucial role.”

Building Rapport• Questions to ask:

• Am I more relational or more instructional?• What personal qualities am I demonstrating in supervision?• What do I think about / How do I feel about the therapist I am

supervising?• Do I like supervision, or do I see it as a chore?• What do I know about the therapist’s interpersonal style?• Do I communicate respect and acceptance in my interactions with

the therapist?

Safety• “…establishing rapport and creating a safe and calm environment to

discuss issues.”

• “Another component to supervision I found extremely influential was my supervisor’s support with helping me to attempt problem solving independently. Having that thought process and experience occur throughout days when I was feeling overwhelmed was invaluable and empowering.”

• “Like a therapist would create a safe, predictable environment for the client, a supervisor should do the same. The supervisee is in a vulnerable position as each has a set of ideas, thoughts, and feelings that are shared with a supervisor. Without a safe environment, the supervisee may hold their struggles with clients or difficulty in other areas from the supervisor. Holding information can hurt the client, the supervisor/supervisee relationship, and most significantly, the growth and development of the therapist.”

Promoting Safety• Demonstrate respect for the therapist.• Demonstrate respect for others, e.g. their clients, peers,

etc.• Communicate concern for the therapist’s well-being.• Maintain confidentiality.

Structure• “This was a learning process, of course, but the framework was set from

the beginning—supervision was a place to openly discuss clients and the problems that surfaced.”

• “Selecting one or two cases and observing trainee’s work from the beginning to the end…to allow the supervisor to better examine and improve trainee’s weaknesses and challenges over time.”

• “It would be helpful for me to have a discussion regarding conceptualizing cases and third of fourth sessions, so that the supervisor and supervisee could conceptualize, set treatment plan, and discuss challenges of the cases.”

• “Encourage supervisors to discuss these topics early on when the relationship is established. Supervisees really don’t known what to expect and especially don’t know how to best bring up complaints or suggestions.”

Establishing Structure• Questions to ask:

• What are my expectations of the therapist?• What are the therapist’s expectations of me and of supervision?• What is the scope and nature of training being provided at my

location?• How will I assess progress and evaluate performance?• Have I reviewed pertinent information and so referenced in the

contract?

Knowledge• “From the start of training, it was clear that trainees were encouraged to

think about cases critically and from various theoretical orientations; supervision was a time when we would conceptualize cases.”

• “it was challenging for me when I had a supervisor who was focused on one theoretical orientation and has experience with only one population.”

• “It is definitely discouraging and frustrating when I ask a supervisor how I could assist a client in processing a particular situation and their response is ‘I don’t know.’ I understand that supervisors are human, too, but let’s collaborate and devise a plan or solution.”

• “My supervisor no longer provided services directly to clients and, at times, is seemed like maybe she forgot what it was like to do therapy.”

What is helpful?• Discussing therapeutic techniques appropriate for specific

cases;• Discussing transference and counter-transference;• Reviewing how non-verbal behaviors influence therapy; and• Conceptualizing a case from more than one perspective.

Supervisor Roles

• Three situations:1. High-risk situations,

2. Giving feedback, and

3. Teaching.

High-risk Situations• Role:

• Provide instruction, including review of pertinent laws, regulations, and policies;

• Assist via practical support.

• Response:• Manage anxiety;• Provide emotional support;• Give immediate feedback at conclusion.

• “…providing necessary information, informing about the legal and ethical issues, providing strategies to handle situations. The supervisor’s non-anxious presence, providing a safe environment for the trainee to discuss concerns and worries, and using self-disclosure.”

Giving Feedback• Role:

• Trainer – instruct, question, reinforce, correct;• Mentor – encourage;• Guide – show the way, demonstrate;• Evaluator – assess and report;

• Response:• When is feedback given?

• After each supervision;• Throughout training; and• During evaluations

• How is feedback given?• Verbally, non-verbally, and written.

• “I valued a chance to receive feedback regarding strengths, weaknesses, and areas for growth. After evaluations, I was more aware of my goals as a therapist.”

• My supervisor approved of everything I did and did not offer any constructive feedback, which was not helpful.”

What is included in feedback?• Areas where the therapist did well:

• Connected with the client,• Was consistent with the theory, or• Effectively utilized a technique or intervention.

• Areas for improvement; and• Practical suggestions.

Teaching• Role:

• Self of the therapist as a teaching model:“Aside from cases, talking about Self of the Therapist issues impacted me and my work in a positive way. I found that I could feel stuck with my clients because the issues they presented were parallel to mine. Discussing current stressors and problems in the trainee’s life allows for movement in the trainee’s clinical work.”

• Response:• Theory:

“Individual supervision has given me the opportunity to discuss ways to improve my theoretical approach in working with clients.”

• Case Conceptualization:“It was helpful when my supervisor aided me in conceptualizing the clients in a holistic way, and utilized clinical terms. I feel this modeling was highly effective.”

• Application of outside resources:• “I liked supervisors who used visuals and genograms…and who shared some of their

resources.”

• Technique:• “Supervision is most helpful for me when supervisors provide direct feedback and

model technique and the application of theory.”

Supervision Modlaities

1. Live supervision,

2. Videotape review, and

3. Case consultation.

Live Supervision• This is the live supervision of a therapist while she is

conducting a therapy session. The supervisor may be in the room or observing via one-way mirror or closed-circuit monitoring.

• Keep suggestions/interventions with the supervisee focused on behavioral or conceptual issues.

• Use the relationship as the instrument of change when wanting to guide the supervisee’s own thoughts and behaviors related to their work.

Live Supervision, continued• Advantages:

• Observation of the therapist’s verbal and non-verbal skills;• Ability to see patterns and ways the therapist may be challenging

or reinforcing them;• Provides context for the supervisor.

• Disadvantages:• More equipment and room requirements than other forms of

supervision;• May foster the role of “expert” on the part of the supervisor;• Inherent possibility of undermining the therapist’s confidence,

especially if they are new learners;• Ability to influence current session has passed.

Videotape Review• Advantages:

• Able to stop the video, making it possible to study the interaction;• Therapist is able to see him/herself as a part of the system;• Therapist is more likely to incorporate feedback when visually reinforced by

video; herder to argue when the ‘evidence’ is present;• Therapist is able to see the change that comes about as a result of the

intervention;• Supervisor has more opportunity for evaluation though direct observation

and evaluation;• More convenient than live supervision, easier to schedule.

• Disadvantages:• Video tends to mute the intensity;• Not able to view entire session due to time, thus may not be

representative;• Ability to influence current session has passes.

Case Consultation• Advantages:

• Convenient, inexpensive, and requires no equipment;• Requires that the therapist synthesize the information and present

it in a cogent, articulated manner;• If there are communication or organizational issues present in

session, they will likely be demonstrated during case review with the supervisor;

• There is time to think about the session, potential for greater reflections and less emotional reactivity;

• Disadvantages:• No was to know what actually occurred in session, therefore:

• Assessment of therapist’s skills is inhibited;• Therapist’s possible contribution to patterns is less apparent.

Value of Supervision• “Supervision has helped me grow both professionally and

personally. I have learned how to balance theoretical approaches with my own unique personality. It has helped me become more confident in working with clients and with other professionals. It has helped me learn to integrate information and form case conceptualizations. It has also lead to my personal growth in that I have become more confident and empowered. Overall, supervision has influenced who I am.”

References• Liddle, H. (1988). Systemic Supervision: Conceptual overlays and pragmatic guidelines. In H. A.

Liddle, D. C. Breunlin, & R. C, Schwartz (Eds.), Handbook of family therapy training and

supervision. New York: Guilford Press.• McCollum, E. E., & Wetchler, J. L. (1995). In defense of case consultation: Maybe ‘dead’

supervision isn’t dead after all. JMFT, 21(2), 155-166.• Moskowitz, S. A., & Rupert, P. A. (1983). Conflict resolution within the supervisory relationship.

Professional Psychology: Research and Practice, 14, 634-641.• Quarto, C. J. (2002). Supervisor’s and supervisee’s perceptions of control and conflict in

counseling supervision. The Clinical Supervisor, 12(2), 27-27.

• Schwartz, R. C. (1988). The trainer-trainee relationship in family therapy training. In H. A Liddle, D. C. Breunlin, and R. C. Schwartz (eds.), Handbook of family therapy training and supervision. New York: Guildford Press.

• Smith, M. “Structure and Problem-Solving in Supervision” [PowerPoint slides: Print.]