the supervision of psychotherapy: theory, research, and what i think i have learned from 30+ years...
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The supervision of psychotherapy:The supervision of psychotherapy: theory, research, and what I think theory, research, and what I think I have learned from 30+ years of doing I have learned from 30+ years of doing
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James E. MadduxDepartment of psychology
Center for the advancement of well-being
George Mason UniversitYFairfax, virginia, usa
Borrows GREATLY from...Borrows GREATLY from...
Joint presentation with Jonathan Mohr, University of Maryland.
Joint presentation with Stephen M. Saunders, Marquette University
USEFUL RESOURCESUSEFUL RESOURCESFUNDAMENTALS OF CLINICAL SUPERVISION BY JANINE BERNARD & RODNEY GOODYEAR (2009, PEARSON)
CRITICAL EVENTS IN PSYCHOTHERAPY SUPERVISION: AN INTERPERSONAL APPROACH BY NICHOLAS LADANY, MYRNA FRIEDLANDER, & MARY LEE NELSON (2008, AMERICAN PSYCHOLOGICAL ASSOCIATION)
.Nicholas Ladany (2005) in Koocher, Norcross, & Hill (Eds.) Psychologists’ Desk Reference.
USEFUL RESOURCESUSEFUL RESOURCESBradley, L.J. & Ladany, N. (Eds.). (2001).
Counselor supervision. Philadelphia: Brunner-Routledge.
Falender, C.A., & Shafranske, E.P. (2004). Clinical supervision: A competency-based approach. Washington, DC: American Psychological Association.
Watkins, C.E. (Ed.). (1997). Handbook of psychotherapy supervision. New York: Wiley.
OVERVIEWOVERVIEW
1. What is supervision and why is it important?
2. Models of supervision3. Best practices based on THEORY,
research, and experience.4. Suggestions and tips based on
my own experiences.5. Time for questions and
discussion
UNFORTUNATELY…UNFORTUNATELY…
NOT MUCH RESEARCH ON WHAT MAKES GOOD SUPERVISION.
WHAT I WILL PRESENT IS BASED ON A COMBINATION OF…◦THEORY◦RESEARCH◦BEST PRACTICES (APA SUPERVISION GUIDELINES)
◦MY OWN 30 YEARS OF EXPERIENCES
QUESTIONS FOR YOUQUESTIONS FOR YOU
Who has been supervised as a therapist in training?
Who has been a psychotherapy supervisor?
Who has received formal training in psychotherapy supervision?
QUESTIONS FOR YOUQUESTIONS FOR YOU
1. GOOD EXPERIENCE AS A SUPERVISEE?
2. BAD EXPERIENCE AS A SUPERVISEE?3. GOOD EXPERIENCE AS A
SUPERVISOR?4. BAD EXPERIENCE AS A SUPERVISOR?5. AS A SUPERVISOR, WHAT ARE YOU
GOOD AT?6. HOW WOULD YOU LIKE TO IMPROVE?
WHY IS SUPERVISION WHY IS SUPERVISION IMPORTANT?IMPORTANT?
•Third most common activity among practicing psychologists in the u.s.•Required for licensure in us.•Essential part of professional self-regulation (Gate-keeper role).•Can have a impact on more people than providing direct services.•It's fascinating and fun--and a great way to learn.
WHAT IS SUPERVISION?WHAT IS SUPERVISION?
"Supervision is an intervention provided by a more senior member of a profession to a more junior member or members of that same profession.”
SENIOR DOES NOT MEAN OLDER—BUT MORE EXPERIENCED
Bernard & Goodyear (2009)
SUPERVISION IS EXPERIENTIAL SUPERVISION IS EXPERIENTIAL LEARNINGLEARNING
DELIBERATE PRACTICE—AIMED AT IMPROVING SPECIFIC SKILLS.
• FEEDBACK FROM AN EXPERT• THAT IS IMMEDIATE, CLEAR, AND CONSISTENT
• PROVIDES CLEAR UNDERSTANDING OF WHAT AN INCORRECT RESPONSE IS
• AND WHAT A CORRECT RESPONSE IS.MORE LATER ON EVALUATION &
FEEDBACK
SUPERVISION VERSUS SUPERVISION VERSUS CONSULATIONCONSULATION
SUPERVISION IS…
1.IMPOSED OR REQUIRED (USUALLY).2.HIERARCHICAL (CLEAR POWER DIFFERENCES)3.EVALUATIVE & JUDGMENTAL4.EXTENDS OVER TIME5.WIDE-RANGING.
SUPERVISION VERSUS SUPERVISION VERSUS CONSULATIONCONSULATION
CONSULTATION TYPICALLY IS…
1.FREELY SOUGHT--NOT IMPOSED.2.NON-HIERARCHICAL (BETWEEN EQUALS).3.NON-EVALUATIVE.4.MORE OFTEN A ONE-TIME EVENT.5.MORE PROBLEM-SPECIFIC.6.FREEDOM TO "TAKE IT OR LEAVE IT."
SUPERVISION VERSUS SUPERVISION VERSUS PSYCHOTHERAPYPSYCHOTHERAPY
SIMILARITIES…
IT INVOLVES EXAMINATION OF THOUGHTS, FEELINGS, AND BEHAVIOR THAT ARE PROBLEMATIC.REQUIRES A STRONG WORKING ALLIANCE.A MAJOR GOAL IS PERSONAL GROWTH
SUPERVISION VERSUS SUPERVISION VERSUS PSYCHOTHERAPYPSYCHOTHERAPY
• BUT…IN SUPERVISION…• THE OVER-RIDING GOAL IS HELPING
THE SUPERVISEE BECOME MORE EFFECTIVE WITH CLIENTS.
• TO PROVIDE "THERAPY" THAT HAS BROADER GOALS IS UNETHICAL
• CREATES A DUAL RELATIONSHIP—CONFUSING & POTENTIALLY HARMFUL
• SUPERVISION IS EVALUATIVE BY DEFINITION AND BY NECESSITY.
• DIFFERENCE IS, OF COURSE, A FINE LINE.
SUPERVISION IS A COMPLEX SUPERVISION IS A COMPLEX ACTIVITY THAT HAS MULTIPLE ACTIVITY THAT HAS MULTIPLE GOALSGOALS1. SUPERVISEE PROFESSIONAL
DEVELOPMENT
2. CLIENT WELFARE
3. PROTECTION OF PUBLIC
4. PROTECTION OF PROGRAM AND
PROFESSION—GATEKEEPER ROLE
Especially important when there are no laws
regulating practice—or weak laws.
MOST DIFFICULT BALANCE TO MOST DIFFICULT BALANCE TO STRIKESTRIKE
CLIENT WELFARE VERSUS SUPERVISEE DEVELOPMENT.HOW MUCH DO YOU TELL THEM WHAT TO DO? VERSUSLETTING THEM USE THEIR OWN JUDGMENT?LETTING THEM MAKE MISTAKES?
MODELS OF SUPERVISIONMODELS OF SUPERVISION
• MOST Models based on theories of psychotherapy
• you supervise the way you do therapy.
• WILL DISCUSS FOUR—NOT MUTUALLY EXCLUSIVE—CAN BE INTEGRATED
Person-centered modelsPerson-centered models (e.g., Carl Rogers) (e.g., Carl Rogers)
• Belief in growth potential.• Emphasis on conditions THAT FACILITATE THE SUPERVISORY RELATIONSHIP.◦Empathy, genuineness, warmth
• Providing these facilitates trust required for supervision.
• Supervisor is also modeling these skills for supervisee.
• Most CONCERNED WITH BEING supportIVE of supervisee
• Less didactic & directive than other models• ENCOURAGES AUTONOMY• Emphasizes but also normalizes fears/anxiety “This is difficult for you. Is this harder than you
expected?” “It is difficult to confront patients.” “I remember how nervous I was when …”
• Can be EASILY integrated other models
ADVANTAGES OF Person-centered models
Cognitive-behavioral modelsCognitive-behavioral models
•Psychotherapy is a set of teachable, learnable skills.•Skills can be CLEARLY defined and measured.•Supervision should have specific goals• aND should address specific THOUGHTS BEHAVIORS.•What do to more of? What to do less of?•includeS examinATION OF supervisee’S thoughts and beliefs that interfere with THEIR WORK WITH CLIENTS
COGNITIVE-BEHAVIORAL MODELSCOGNITIVE-BEHAVIORAL MODELS
Challenge maladaptive beliefs of trainees
• Technique: Stop tape and ask trainee:
•What were you thinking and feeling when you made that response?
•HOW DID THAT AFFECT YOUR BEHAVIOR?
•HOW WELL DID THAT WORK?
•What could you think differently next time that might help you respond more effectively?
Structure of therapy sessions1. Mood check2. Set agenda3. Bridge from last session4. Prioritize agenda5. Discuss problems6. Homework7. Summary/Feedback
Structure of supervision sessions1. Check in2. Set agenda3. Bridge from last session4. Prioritize agenda5. Discuss cases, problems6. Homework7. Summary/Feedback
COGNITIVE-BEHAVIORAL MODELSCOGNITIVE-BEHAVIORAL MODELS(FROM BECK ET AL, 2008)(FROM BECK ET AL, 2008)
ADVANTAGES OF COGNITIVE-ADVANTAGES OF COGNITIVE-BEHAVIORAL MODELSBEHAVIORAL MODELS
• Emphasis on specific skills.• TEACHES SELF-MONITORING AND SELF-REFLECTION
• Takes an incremental rather than entity view of psychotherapY TRAINING.
Psychodynamic modelsPsychodynamic models
AttenTION to the relationship Between therapist & client Between supervisor & supervisee• “What is it like for you to be in
supervision?”• “What is it like for you during our
interactions?”• “When I criticize you, what are
your feelings?”
Advantages of PSYCHODYNAMIC Advantages of PSYCHODYNAMIC MODELMODEL
Focuses on supervisee’s concerns and anxieties.
Focuses on supervisee’s feelings toward client & supervisor.
Deals with transference and counter-transference issues.
Developmental modelsDevelopmental models
• NOT LINKED TO A SPECIFIC THEORY OF THERAPY
• Supervisees go through different stages of development.
• A different supervisory approach is needed for each stage.
• Stages based on:• Self-other awareness.• Motivation.• Autonomy
Simplified integrative Simplified integrative “model”“model” Good therapy consists to a large
degree of specific behaviors or skills.
• These behaviors can be defined, taught, learned, and measured.
• You have to have goals. You have to know what needs to be learned.
• Self-efficacy beliefs must be developed along with skills.
• A STRONG WORKING ALLIANCE & TRUST ARE ESSENTIAL
Simplified integrative Simplified integrative “model”“model” Everyone learns at a different pace.• People move back and forth between
“stages” depending on the challenge.• So you have to adjust your approach
person to person and moment to moment.• You are constantly modeling, so
practice what you preach.• Feelings can help or hurt. You must
attend to them—THE CLIENTS’, THE SUPERVISEE’S & YOURS
• you must attend to the relationshipS—YOU & SUPERVISEE AND SUPERVISEE & CLIENT.
Necessity of a good supervisory alliance
Without trust and openness, then none of the tasks of supervision are possible
Can put clients/patients at risk
SUPERVISORY RELATIONSHIPSUPERVISORY RELATIONSHIP
SUPERVISORY RELATIONSHIPSUPERVISORY RELATIONSHIP
• WHAT THE RESEARCH SAYS:
• SUPERVISORY ALLIANCE PREDICTS◦SUPERVISEE WILLINGNESS TO SELF-DISCLOSE
◦CLIENT PERCEPTION OF THERAPEUTIC ALLIANCE
• SUPERVISORY ALLIANCE RELATED TO◦SUPERVISOR ETHICAL BEHAVIOR◦USE OF EFFECTIVE EVALUATION PRACTICES◦SUPERVISOR SELF-DISCLOSURE (PROFESSIONAL)
SUPERVISORY RELATIONSHIPSUPERVISORY RELATIONSHIP
The alliance between the supervisor and the supervisee is the responsibility of the supervisor
Explicit attention to relationship issues facilitates the development of an alliance
◦ Need transparency regarding roles and role conflicts, evaluation processes, expectations and requirements, etc.
◦ WILL RETURN TO THIS LATER
BUILDING A GOOD SUPERVISORY RELATIONSHIP
WHAT CAN THE SUPERVISOR DO?
Creating an STRONG supervisory Creating an STRONG supervisory alliancE: WHAT CAN HELP?alliancE: WHAT CAN HELP?
◦ ATTENTIVE◦ DEPENDABLE◦ Non-authoritarian◦ COLLABORATIVE (IN SETTING GOALS,
EVALUATION)◦ Empathic & Supportive◦ ENTHUSIASTIC & MOTIVATING◦ RESPECTFUL OF BOUNDARIES◦ TRUSTHWORTHY◦ OPEN TO NEW IDEAS.◦ FLEXIBLE.
Creating an STRONG supervisory Creating an STRONG supervisory alliancE: WHAT CAN HELP?alliancE: WHAT CAN HELP?
Provide clear and simple conceptual framework
Work to reduce anxiety, including your own. Normalize mistake making (e.g., self-disclosure)
ASK FOR FEEDBACK (“How are we doing?”) “Practice what you preach” (Be a good model)
MODEL GOOD PROFESSIONAL ETHICS
TO DO ALL OF THIS, YOU MUST VIEW SUPERVISION AS A IMPORTANT PROFESSIONAL ACTIVITY.
INITIAL QUESTIONS TO ASK TO DEVELOP INITIAL QUESTIONS TO ASK TO DEVELOP TRUST & RAPPORT & SET GOALSTRUST & RAPPORT & SET GOALS
What are your previous experiences with supervision?
What was helpful?What was not helpful?What are your goals?What are your expectations?What are your fears? Concerns?
INITIAL QUESTIONS TO ASK TO INITIAL QUESTIONS TO ASK TO DEVELOP TRUST & RAPPORT & SET DEVELOP TRUST & RAPPORT & SET
GOALSGOALS(ADAPTED FROM CAMPELL, 2006)(ADAPTED FROM CAMPELL, 2006)
WHAT WOULD YOU LIKE TO GET OUT OF SUPERVISION WITH ME?
DO YOU HAVE SPECIFIC AREAS OF IMPROVEMENT IN MIND?
WHAT WOULD HAVE TO HAPPEN IN HERE TO MAKE THIS WORTH YOUR TIME & EFFORT?
WHAT IS THE MOST IMPORTANT THING YOU WOULD LIKE TO GET FROM THIS EXPERIENCE.
HOW CAN I BE OF MOST HELP TO YOU?WHAT PARTICULAR NEEDS OF PARTICULAR CLIENTS CAN I BE HELPFUL WITH?
THE “GOLDEN RULE” OF SUPERVISIONTHE “GOLDEN RULE” OF SUPERVISION(CAMPBELL, 2006)(CAMPBELL, 2006)
“Treat supervisees in the same way you wish to be treated and the same way you wish them to treat clients.”
STRUCTURING A SUPERVISION STRUCTURING A SUPERVISION SESSIONSESSION◦ SUPERVISEE MUST COME PREPARED!◦ WHICH CLIENTS DO YOU WANT TO DISCUSS TODAY?◦ WHY THOSE CLIENTS?◦ HOW MUCH TIME DO YOU WANT TO SPEND ON EACH ONE?
◦ WHICH ONE DO YOU WANT TO START WITH?◦ WHAT SPECIFIC CONCERNS DO YOU HAVE ABOUT YOUR LAST SESSION WITH THIS CLIENT?
◦ PLAY A SECTION OF THE TAPE THAT WAS A PROBLEM FOR YOU.
◦ TELL ME AT WHAT POINTS YOU WERE STUCK OR UNCERTAIN OR WHERE YOU THINK YOU WENT WRONG.
◦ WHAT COULD YOU HAVE DONE DIFFERENTLY?◦ WHAT DIFFERENCE WOULD THAT HAVE MADE?
SUPERVISEE SHOULD BE REQUIRED TO…SUPERVISEE SHOULD BE REQUIRED TO…
BRIEFLY STATE THE CLIENT’S OVERALL GOALS.
BRIEFLY STATE THE GOALS FOR THAT SESSION.
STATE THE REASON FOR SELECTING THAT PART OF THE SESSION FOR REVIEW.
BRIEFLY SUMMARIZE WHAT HAPPENED BEFORE THAT SECTION (SET THE STAGE).
EXPLAIN WHAT HE/SHE WAS TRYING TO ACCOMPLISH IN THAT SECTION OF SESSION.
CLEARLY STATE THE SPECIFIC HELP DESIRED FROM THE SUPERVISOR.
USING AUDIO & VIDEO USING AUDIO & VIDEO RECORDINGSRECORDINGS
OF SESSIONS OF SESSIONS
• Essential • VIDEO IF POSSIBLE.• You need to see as well as hear what
goes on in the session. • Cannot rely on supervisee’s report• NOT HAVING SAMPLES OF THERAPY
SESSIONS TO SEE AND HEAR EASILY LEADS TO ABSTRACT THEORETICAL DISCUSSIONS
• AND VAGUE SUGGESTIONS
HOW TO USE RECORDINGS OF SESSIONS.HOW TO USE RECORDINGS OF SESSIONS.
• You don't need to listen to an entire session.
• You can teach more through a micro-examination of just five minutes HERE AND THERE.
• REQUIRE SUPERVISEE TO REVIEW RECORDING BEFORE SUPERVISION.
• ASK SUPERVISEE TO PLAY A SECTION WHERE HE/SHE HAD DIFFICULTY.
• AND A SECTION WHERE IT WENT WELL.• The opening minute or two of a therapy
session are crucial. • USE “INSTANT REPLAY”• FOCUS ON GENERAL PRINCIPLES AND SKILLS.
REVIEWING BRIEF SECTIONS OF AUDIO- REVIEWING BRIEF SECTIONS OF AUDIO- OR VIDEO TAPESOR VIDEO TAPES
(ADAPTED FROM CAMPBELL, 2006)(ADAPTED FROM CAMPBELL, 2006)
AS YOU WATCHED THAT SEGMENT, WHAT WERE YOU MOST AWARE OF?
HOW ARE YOU FEELING AT THIS POINT?WHAT WERE YOU THINKING & FEELING RIGHT THEN WHEN THE CLIENT SAID THAT?
WHERE DID YOU WANT TO GO WITH THAT COMMENT? WHAT WAS YOUR GOAL?
WHAT DO YOU WISH YOU HAD SAID INSTEAD?WHEN THE CLIENT BEGAN TO TALK ABOUT ____, YOU CHANGED THE TOPIC. WHAT WAS GOING ON?
WHAT TO DO IF CONFLICTS ARISEWHAT TO DO IF CONFLICTS ARISE—AND THEY WILL!—AND THEY WILL!
• conflict IS INEVITIBLE BECAUSE
• Supervisor is supportive, but…
• also must evaluate
• Supervisee wants to learn, BUT…
• also wants to demonstrate he/she is competent
• AND AVOID APPEARNING INCOMPETENT
POSSIBLE CONFLICTS in POSSIBLE CONFLICTS in SupervisIONSupervisION
Supervisor perceived as unempathic, uncaring, unfair, unavailable, unmotivated
Supervisee seems unmotivatedRole confusion: Friends or boss/employee?Diversity/Multicultural issues impacting relationshipInappropriate self-disclosure by supervisee with clients or with supervisor
Inappropriate self-disclosure by supervisor.
POSSIBLE CONFLICTS IN POSSIBLE CONFLICTS IN SUPERVISIONSUPERVISION
Excessive agreement and compliance with supervisor
Excessive anxiety during supervision. Non-disclosure by supervisee; hiding
potentially negative information Resistance or defensiveness in response
to feedback. Disagreement over TREATMENT strategies.
THINGS SUPERVISEES SOMETIMES THINGS SUPERVISEES SOMETIMES HIDE OR FAIL TO DISCLOSEHIDE OR FAIL TO DISCLOSENegative or overly positive feelings about clients (fear, anger, attraction)
Negative feelings about supervisor
Mistakes during sessionsAnxiety about working with clients
Anxiety about being supervised/evaluated
““RED FLAGS” (1)RED FLAGS” (1)
Sudden change in supervisee behavior with clients or supervisor
Excessive anxietyReluctance to interact with clients or supervisor
Withdrawn, aloof, apatheticPreoccupied with A PARTICULAR clientLate or misses supervisionForgets tapes, progress notesLACK OF PREPARATION
““RED FLAGS” (2)RED FLAGS” (2)
• Defensive in response to critical feedback
• Angry towards clients•“They are not cooperating”•“They are not making progress”
• Over-compliance with suggestions from supervisor
Ethical and legal issuesEthical and legal issues
• Responsible for client welfare and supervisee development.
• Informed consent IS ESSENTIAL
• INFORMED CONSENT OF CLIENT• INFORMED CONSENT OF SUPERVISEE.
Informed Consent of patientInformed Consent of patient
• CLIENTS/Patients must be told that therapist is a trainee being supervised
• Basic ethical practice• It’s the right thing to do• It’s the smart thing to do!
Informed Consent of Informed Consent of clientclient
• Protection against malpractice charges Direct Liability – e.g., you have not kept informed
adequately by the supervisee and you suggest an intervention that leads to harm of the patient
Vicarious Liability – Supervisors may be liable for any negligent acts of the supervisee
Failure to monitor supervisee performance is a significant ethical violation
INFORMED CONSENT OF CLIENTINFORMED CONSENT OF CLIENT(DETAILS MAY DEPEND ON SETTING)(DETAILS MAY DEPEND ON SETTING)
SUPERVISEE’S TRAINING STATUS.RATIONALE FOR AND BENEFITS OF SUPERVISION.
NAME AND CREDENTIALS OF SUPERVISOR.SUPERVISOR CONTACT INFORMATION.OBSERVATION METHODS (AUDIO? VIDEO?)OTHERS WHO MAY BE OBSERVING (STUDENTS?)
NATURE OF CONFIDENTIALITYLIMITS OF CONFIDENTIALITY.
INFORMED CONSENT OF SUPERVISEEINFORMED CONSENT OF SUPERVISEEThe supervision contractThe supervision contract
(borrowed from stephen saunders)(borrowed from stephen saunders)
SupervisION ContractSupervisION Contract
Explicit signed agreement regarding all aspects of supervision
◦ Time, Place, DURATION◦ Goals◦ Theoretical orientations◦ Responsibilities of both parties◦ Possible outcomes◦ Evaluation procedures◦ Confidentiality ISSUES◦ ETHICAL AND LEGAL ISSUES◦ Payment?
SupervisION ContractSupervisION Contract
Useful for developing a good supervisory relationship
Useful in preventing (and resolving) problems
An important legal and ethical document
SUPERVISION CONTRACTSUPERVISION CONTRACT
• Multiple examples and templates available
• Sutter et al. (2002) Professional Psychology: Research and Practice, vol. 33, 495-498.
• C. J. Osborn & T.E. Davis (1996). Clinical Supervisor, vol. 14, 121-134.
• Falendar and Shafranske, 2004
ETHICAL AND LEGAL ISSUES:◦ “Supervisee must follow ethical and legal codes,
guidelines and principles … mandates pertaining to confidentiality will be respected and followed …”
◦ “Supervisor is responsible for the professional services provided by individuals under his/her supervision … will assign to the supervisee only such tasks as supervisee is competent to deliver …”
SUPERVISION CONTRACT; SUPERVISION CONTRACT; SAMPLE LANGUAGESAMPLE LANGUAGE
◦ Why supervision? “Supervision is being conducted for the purpose of
….” Skill development TO MEET Licensure REQUIREMENTS ENHANCING Patient care
What activities are being supervised?
(e.g., “Will supervise treatment using CBT for persons diagnosed with various disorders being seen at this clinic …”)
SUPERVISION Contract:SUPERVISION Contract:SAMPLE LANGUAGESAMPLE LANGUAGE
SUPERVISION Contract:
SAMPLE LANGUAGE
GOALS OF SUPERVISION “This supervisory arrangement is established for
the purpose of establishing new competencies, increasing the supervisee’s sense of efficacy …”
“… for purposes of post-doctoral experience towards licensure as a clinical psychologist …”
SUPERVISION Contract
PROFESSIONAL STATUS & LIMITATIONS:
◦Supervisee: Present level of training (perhaps detailing experience to date)◦Supervisor: Statement about supervisor’s “Scope of Competence”
Clinical training & experience Licensure Special expertise Training and experience in supervision
EVALUATION OF SUPERVISIONEVALUATION OF SUPERVISION
APA Ethics code: • In academic and supervisory relationships, psychologists establish a timely and specific process for providing feedback to students and supervisees.
• Information regarding the process is provided to the student at the beginning of supervision.
• Psychologists evaluate students and supervisees based on their actual performance on relevant and established program requirements.
EVALUATIONEVALUATION
Two types of evaluation◦ Formative feedback (ongoing)◦ Summative feedback (formal--at the
end)Two core problems
◦ Defining competence—need clear standards.
◦ Conflicts with self-concept as a “helper,”
◦ can lead to avoidance of evaluator role.
◦ NEED TO Keep in mind gate-keeper role.
THE FUNDAMENTAL PRINCIPLE OF THE FUNDAMENTAL PRINCIPLE OF EVALUATIONEVALUATION
A rating of poor performance at the end of supervision should never come as a surprise to the supervisee.
In other words, summative feedback should be consistent with ongoing formative feedback.
EVALUATION TIPSEVALUATION TIPS Discuss evaluation methods and
criteria AT the beginning. REVIEW THEM AS NECESSARY Address the discomfort (of both
of you). Encourage and model self-
evaluation. Provide continual feedback. SEEK CONTINUAL FEEDBACK (“HOW ARE
WE DOING? HOW IS THIS GOING FOR YOU?”
INVOLVE SUPERVISEE IN HIS/HER OWN EVALUATION
EFFECTIVE FORMATIVE FEEDBACK EFFECTIVE FORMATIVE FEEDBACK BEGINS WITH EFFECTIVE GOALSBEGINS WITH EFFECTIVE GOALS
Effective goals are: MUTUALLY AGREED ONClearSpecificMEASURABLECHALLENGING—OUTSIDE OF “COMFORT ZONE”BUT SEEM Achievable
QUALITIES OF EFFECTIVE QUALITIES OF EFFECTIVE FORMATIVE FEEDBACKFORMATIVE FEEDBACK
Immediate : Address it as soon as you see or hear it.Specific: Refer to specific behaviors that person can change.Clear and concise—”short and sweet”Encourage self-evaluation: Ask supervisee what he/she could do differently.offer concrete suggestions, not vague generalities..Refer to research if possible.Frequent and continual—every session and throughout the session CONSISTENTSHOULD INCLUDE GENEROUS & SPECIFIC PRAISE.INCLUDING SUPERVISEE SELF-PRAISE
FORMATIVE FEEDBACK;FORMATIVE FEEDBACK;SUPERVISION PROGRESS NOTES SUPERVISION PROGRESS NOTES
Date and session number of supervision
Identification of client(s) discussed
Follow-up on previous supervision/feedback
Progress made on goals (of patient)
Interventions suggested Concerns raised Goals for next client sessions
FORMATIVE FEEDBACK:FORMATIVE FEEDBACK:USING AUDIO & VIDEO RECORDINGSUSING AUDIO & VIDEO RECORDINGS
OF SESSIONS OF SESSIONS
• Essential • VIDEO IF POSSIBLE.• You need to see as well as hear what
goes on in the session. • Cannot rely on supervisee’s report• NOT HAVING SAMPLES OF THERAPY
SESSIONS TO SEE AND HEAR EASILY LEADS TO ABSTRACT THEORETICAL DISCUSSIONS
• AND VAGUE SUGGESTIONS
HOW TO USE RECORDINGSHOW TO USE RECORDINGS OF SESSIONS. OF SESSIONS.
• You don't need to listen to an entire session.
• You can teach more through a micro-examination of just five minutes HERE AND THERE.
• REQUIRE SUPERVISEE TO REVIEW RECORDING BEFORE SUPERVISION.
• ASK SUPERVISEE TO PLAY A SECTION WHERE HE/SHE HAD DIFFICULTY.
• AND A SECTION WHERE IT WENT WELL.• The opening minute or two of a therapy
session are crucial. • USE “INSTANT REPLAY”• FOCUS ON GENERAL PRINCIPLES AND SKILLS.
REVIEWING BRIEF SECTIONS OF AUDIO- REVIEWING BRIEF SECTIONS OF AUDIO- OR VIDEO TAPESOR VIDEO TAPES
(ADAPTED FROM CAMPBELL, 2006)(ADAPTED FROM CAMPBELL, 2006)
AS YOU WATCHED THAT SEGMENT, WHAT WERE YOU MOST AWARE OF?
HOW ARE YOU FEELING AT THIS POINT?WHAT WERE YOU THINKING & FEELING RIGHT THEN WHEN THE CLIENT SAID THAT?
WHERE DID YOU WANT TO GO WITH THAT COMMENT? WHAT WAS YOUR GOAL?
WHAT DO YOU WISH YOU HAD SAID INSTEAD?WHEN THE CLIENT BEGAN TO TALK ABOUT ____, YOU CHANGED THE TOPIC. WHAT WAS GOING ON?
SUMMATIVE FEEDBACKSample summative evaluation
SUMMATIVE FEEDBACKSample summative evaluation
)
◦Group should be in addition to, not instead of, individual supervision
◦Don’t use because you are overworkedAdvantages◦Students get more exposure to more clients◦Students get exposure to other therapeutic styles◦Students get opportunity to give and get feedback
and support◦Encourages team building◦Encourages multicultural discussions
Group supervisionGroup supervision
Possible challenges◦Time management: one or two assertive or problem
students may take up all of the time◦Conflict between students◦Making sure some students don’t “hide” or get left
behind◦Overly critical peers◦Client confidentiality (e.g., students talking in hallway
about clients)◦Supervisee confidentiality (i.e., no discussing with
students not in the group)
Group supervisionGroup supervision
Strategies for Group Supervision◦Giving each student each week equal time is probably not feasible Students’ needs will change from week to week
◦Suggest starting with “check-in,” i.e., ask each student what he or she needs from group, especially urgent needs Beware students that decline every week
◦Highlight any shared concerns or issues◦As a student presents, ask for reactions and suggestions from others
Group supervisionGroup supervision
INADEQUATE AND HARMFUL INADEQUATE AND HARMFUL SUPERVISIONSUPERVISION
Just like psychotherapy, supervision can be inadequate and even harmful to supervisees and to clients
Ellis et al, 2014, THE COUNSELING PSYCHOLOGIST
Attempted to define inadequate and harmful supervision
Surveyed 363 supervisees
INADEQUATE AND HARMFUL INADEQUATE AND HARMFUL SUPERVISIONSUPERVISION
RESULTS93% reported receiving inadequate supervision◦Mainly failure to observe and monitor sessions (40%) and lack of a supervision contract (54%)
35.3% reported receiving HARMFUL supervisionOf these, 25% reported not feeling safe from exploitation
EXAMPLES OF POTENTIALLY EXAMPLES OF POTENTIALLY HARMFUL BEHAVIORSHARMFUL BEHAVIORS
Sexually inappropriate comments or behaviors
Physical, emotional, or psychological aggression
Boundary violations, including inappropriate self-disclosure
Exploitative dual relationshipsPublic humiliation (e.g., in group supervision)
HOW TO CREATE A SAFE HOW TO CREATE A SAFE EVIRONMENTEVIRONMENT
(ADAPTED FROM CAMPBELL, 2006)(ADAPTED FROM CAMPBELL, 2006)
1. Address at beginning possible sources of anxiety
2. Be genuine, tolerant and respectful3. Be available, reliable and
consistent4. Focus on strengths and successes,
not just problems5. Model empathic responding6. Normalize mistake-making7. Encourage risk-taking8. Use humor
SUMMARYSUMMARY
WHAT I THINK (OR HOPE) I HAVE LEARNED IN 30+
YEARS
FOUR BASIC ASSUMPTIONSFOUR BASIC ASSUMPTIONS
• Good therapy is not "magic.”
• Good therapy is not "rocket science.”
• Good supervision is not "magic.”
• Good supervision is not "rocket science."
21 SPECIFIC SUGGESTIONS21 SPECIFIC SUGGESTIONS
1. Keep it simple—ESPECIALLY AT THE BEGINNING.
2. Review the basics over and over and over again
3. Warn them about trying too hard to help (“Never work harder than your client.”)
4. Focus on understanding rather than "helping"
5. Kindness and patience are essential …6. but so are courage and firmness7. Admit when you do not know something
(don't fake it)
8. Empathize◦Don't be afraid of trainee's fears or yours
◦Address the supervisee’s emotions◦But don't don’t try to do therapy instead of supervision (may suggest they obtain therapy)
9. Discourage excessive and non-relevant self-disclosure
10.Self-disclose about your own experiences in supervision
11.Check in often for understanding12.Encourage both self-criticism & self-
praise13.Praise often
• Tell them what they are doing well• Be specific
14.Be specific with criticism & suggestions
15.But first . . . ASK trainee to suggest what he/ she could have done differently:
"What could you do the next time something like this happens?"
16.Send them to the research literature17.Push them out of their comfort zone18.Collaborate19.Avoid abstract theoretical
discussions that are not tied to specific examples of what to do in therapy
20.Expect differences and conflicts; Deal with them directly
21.Always keep in mind that you are always modeling how to do therapy & how to be a professional.
BEST PRACTICES:BEST PRACTICES:APA SUPERVISION GUIDELINESAPA SUPERVISION GUIDELINESAMERICAN PSYCHOLOGIST, JANUARY, 2015AMERICAN PSYCHOLOGIST, JANUARY, 2015
Be competent in the areas of practice that you supervise. Know your limitations.
Seek training in supervision. Be mindful of diversity issues. Build and maintain a collaborative relationship.
Specify responsibilitIES of each party (contract)
Specify competencies and learning goalsProvide feedback that is ongoing, clear, and behaviorally-anchored
Seek and use feedback from superviseesBe mindful of gatekeeper roleBe aware that client welfare is your highest duty
QUESTIONS?COMMENTS?
SUGGESTIONS?