clinical supervision models presented by: shannon m. eller, lpc, lmft, rpt, cpcs, ncc brighter...
TRANSCRIPT
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).
Clinical Supervision Models
Ethical Dilemmas
• Competency• Expertise• Referral • Termination• Abandonment
Clinical Supervision Models
Ethical Dilemmas
• Counselor Welfare• Impairment• Ethical Complaints• Use of Technology (social media, internet/web
services)• Supervision vs Consultation
Clinical Supervision Models
Ethical Standards
Multicultural Issues• Knowledge• Awareness• Skills Sets• Sensitivity• Respect
Clinical Supervision Models
• 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
Clinical Supervision Models
You cannot teach a man anything.
You can only help him discover
it within himself.
-Galileo Galilei
Clinical Supervision Models
Current Research/ Literature
• Multicultural Considerations
• Individual, Triadic, Group
Clinical Supervision Models
• Foundations: • Educator
• Supervisor
• Consultant
• Group Discussion
• Role Plays
• Performance Domains:
• Interventions
• Conceptualization
• Personal and Professional Development
Clinical Supervision Models
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)
Clinical Supervision Models
• 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 Supervision Models
Clinical Responses
What makes good supervision?
What is “bad” supervision?
Clinical Supervision Models
Good Supervision is:• Flexibility about theory, technical principles, and
trainee’s learning style
• Respectful attitude, supportive and non-judgmental
• Openness, Curious, Relaxed and Patient
Clinical Supervision Models
Poor Supervision Styles
• Administrative vs Clinical
• Job Seniority vs Knowledge/Skills
• Confrontational vs Challenging
• Negative vs Positive
• Critical vs Supportive
Clinical Supervision Models
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.
Clinical Supervision Models
“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.”
Clinical Supervision Models
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
Clinical Supervision Models
Discrimination Model Basics
• Developmental vs Evaluative Focus
• Supervisor first attends to focus areas:• Intervention skills
• Conceptualization skills
• Personalization skills
Clinical Supervision Models
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)
Clinical Supervision Models
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
Clinical Supervision Models
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.
Clinical Supervision Models
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
Clinical Supervision Models
Promoting Safety and Trust
(Confidentiality and Privacy)
• Respect for clients
• Respect for rising clinician as colleague
• Respect for process
• Respect for profession
Clinical Supervision Models
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
Clinical Supervision Models
• Verbally, Non-Verbally, Written, Modeling
• During Supervision (in session, throughout training, at end)
• Strengths
• Areas of Improvement
• Practical Suggestions
Clinical Supervision Models
Roles of Supervision
• Educator: • Instruction, Questioning, Reinforcement
• Mentor: Encouragement
• Guide: Demonstration and Modeling
• Evaluator: Assessment
Clinical Supervision Models
Evaluation Methods
Live vs Self-Report
• Advantages
• Disadvantages
Clinical Supervision Models
Live (In-Vivo) Observations
• Bug-in-ear
• Bug-in-eye
• Telephone contact
• Two-way mirror
• Greek chorus
• Live observation
• Co-facilitation
Clinical Supervision Models
Clinical Staffing
• Audiotape
• Videotape (IPR)
• Case Conceptualization
• Progress Note/ Tx Plan Review
• Advantages/ Disadvantages
Clinical Supervision Models
Types of Supervision
• Individual
• Dyadic
• Triadic
• Group
• Advantages/Disadvantages
Clinical Supervision Models
Case Scenarios
Finding Your Own Style
Clinical Supervision Models