Supervision of Mental Health Counseling Interns

Supervision of Mental Health Counseling Interns On line training for field supervisors Clinical Mental Health Counseling Program Fall 08

Reflections on supervisory experiences Answer the following questions for yourself about your own supervision experiences

Your Supervision Experiences What kind of supervision did you get: • As an intern • As a beginning counselor What was most helpful or least helpful What do you do that is the same as your supervisor What do you do that is different

Definitions of supervision at your work place • What is your understanding of the supervisory relationship • Is supervision expected to be clinical, administrative or both • How well prepared do you feel to fulfill this role (roles)

Why we need training • Supervision skills similar but not identical to counseling skills • Supervising without training gives message that “any good counselor will be good supervisor” • Supervisory training provides supervisor with framework to conduct and evaluate effectiveness of the supervision

Definition of Clinical Supervision (Bernard and Goodyear, 2004) An intervention provided by a more senior member of a profession to a more junior member or members of that same profession

Definition cont. • Relationship is: evaluative extends over time • Simultaneous purposes of: enhancing professional functioning monitoring quality gate keeping for the profession

How do you rate your skills • Evaluation of supervisees • Enhancement of supervisees skills • Monitoring of supervisees counseling relationships • Preventing incompetent, unethical or harmful counselors from practicing • Safeguarding well being of client

Basic elements of supervisor competence • Understand the roles and functions of a supervisor • Organize the supervisory experience • Be aware of the ethical and legal considerations in the relationship • Have a working model of supervisory process and work within that model to develop effective supervisory relationship

Roles and Functions of the Supervisor Supervisor as teacher • evaluate observed counseling session interactions • Identify effective and ineffective interventions • Teach demonstrate or model intervention techniques • Explain rationale behind specific strategies • Interpret significant events in counseling sessions

Roles and Functions • Identify issues of class, culture and ethnicity in counseling session • Educate and provide resources for supervisee to learn about effects of class, culture, etc in counseling relationships • Model awareness and sensitivity to these issues in supervision

Roles and Functions Supervisor as Counselor • Explore supervisee’s feelings during counseling or supervision session • Explore supervisee’s feelings about specific techniques and interventions • Facilitate supervisee’s self exploration of confidence or concerns in sessions • Help supervisee define personal growth areas • Provide opportunities for supervisees to process own affect or defenses

Roles and Functions • Help supervisee identify his/her values base, cultural background and social awareness • Explore the possible effect of these on supervisee’s counseling style and effectiveness

Roles and Functions Supervisor as Consultant • Provide alternative interventions and/or conceptualizations for trainee use • Encourage brainstorming of strategies and interventions • Encourage discussion of client problems, motivations, etc • Solicit feedback from supervisee as to effectiveness of session • Ask supervisee to structure the session (Bernard and Goodyear, 2004)

Roles and Functions Supervisor as evaluator • Provide regular and systematic feedback and evaluation • Provide information to graduate school programs, prospective employers, licensing boards and professional associations • Provide references when requested by licensing board or another agency

Roles and Functions Supervisor as Administrator • Monitor supervisees’ adherence to policies and procedures of the agency • Monitor legal and ethical matters and documentation of client sessions • Help supervisee navigate bureaucracies • Monitor supervisees’ adherence to reporting laws • Monitor confidentiality of records

Roles and functions case study A client arrived for her appointment wearing a distinctive coat. The therapist remarked on its bright and beautiful colors. At the end of the day, the therapist returned home to find a box with an identical coat on her doorstep. The note said the client had made a big effort to find the identical coat as a way to say thank you for all the help she had received.

Roles and functions case study The clinician is your supervisee. She states that when trying to return the gift to the client, the client became distraught and said it felt like a rejection of her. The client asked the therapist to keep the coat at least until the next session and if the therapist still wanted to give it back, she would take it. The client stated that she could not return the coat because it was on sale.

Roles and Functions Case Study What are the main issues in this situation What supervisory roles will be most useful to you in addressing these issues How do you see yourself structuring the feedback you will give What personal concerns may be raised for you by this situation (Fall and Sutton, 2004)

Models of Supervision Three main types of supervision models: Psychotherapy based models Developmental models Social Role models

Models • Psychotherapy based models Based on the use of specific theories of psychotherapy. Putney, Worthington, and McCullough (1992) concluded that style or role of the supervisor is influenced by the supervisor's theoretical orientation in these models

Models • Developmental models Two basic underlying assumptions: (a) Student counselor/supervisee moves toward competence in a series of stages (b) each student counselor/supervisee's developmental stage requires qualitatively different supervision environment if most favorable professional growth is to occur (Chagnon & Russell, 1995).

Models • Social role models Focus on roles that supervisors engage in during supervision. Primary range of roles includes: administrator counselor consultant evaluator teacher (Bernard, 1979; Carroll, 1996; Holloway, 1995; Williams, 1995).

Stoltenberg’s Developmental Model Views training process as sequence of identifiable stages through which trainee progresses Provides a conceptual framework for supervisor and supervisee

Stoltenberg’s model Four Stages of Development : • Dependent • Dependent-autonomous • Conditional dependency • Integrated

Dependent Stage Supervisee: • Lacks confidence • Needs support and direction • Needs opportunity to explore • Feelings and become more self aware • May be anxious about performance and evaluation

Dependent-autonomous stage Supervisee: • Moves away from imitating supervisor and initiates new behaviors • May become overconfident or overwhelmed • Level of motivation may fluctuate • May express stress due to lack of confidence and wanting to appear competent

Conditional Dependency Supervisee: • Checks in with supervisor if she/he runs into difficulty • Strong clinical skills • Establishes personal style and uses multiple approaches • May depend on supervisor as peer or colleague

Integrated stage Supervisee: Capable of independent practice Aware of personal limitations Interested in process of counseling Comfortable with interdependent/collaborative approach Seeks peer supervision

Bernard’s Discrimination Model Three basic roles for supervisors: Teacher Counselor Evaluator Four main foci for supervision: Intervention Conceptualization Personalization Professional Behaviors

Teacher role Determine what is critical for the student counselors/supervisees to learn Give information, instruction, and guidance Evaluate student counselors/supervisees Give regular verbal and written feedback of strengths and areas for growth.

Counselor role • Help student counselors/supervisees focus on interpersonal and intrapersonal interactions. • Especially important when helping student counselors/supervisees conduct a self-evaluation

Consultant role • Student counselor/supervisee and supervisor relate as colleagues • Exchange ideas about interventions, goals, and treatment plans.

The four foci • Intervention focuses on: What the supervisee is doing in the session that is observable by the supervisor • Conceptualization focuses on: How the supervisee understands what is happening in the session • Personalization focuses on: Supervisee’s style and ability to mange transference and countertransference

Interaction of role and focus When determining what role will be prominent at any one time during supervision, it is helpful to consider the purpose, or goal, of the role and how it fits with the focus of the supervisionat that point

Supervisor behavior • In any given situation, the supervisor is: Assessing supervisee’s developmental stage Assessing need for a particular focus choosing an appropriate role to address that focus Making an intervention around a particular focus using skills appropriate to the chosen role

Case studies - the Developmental and Discrimination Models • Identify the role the counselor plays • The main focus discussed in the vignette • Your assessment of the development stage or stages that would fit well with the supervisor’s approach • How effective you think this supervisor’s approach is • How would you change what they’re doing

Case 1 Dr. Snyder believes her role as a supervisor is to provide monitoring and direction for her supervisees. She keeps a close watch on them as she wants to make sure they are not being given too much responsibility. She puts a lot of time and energy into her supervisees. Her supervisees benefit from seeing her work but not from doing the work themselves and many do not feel confident about their clinical work

Case 2 Mr. Lee meets weekly with his supervisees and has clearly defined goals for supervision. He gives feedback on a regular basis and has a reputation for being direct. Mr. Lee is a highly skilled clinician and often gives advice about how to work with clients.

Case 3 Ms. Adams sees supervisees as junior colleagues who should be functioning independently. She learned through the “sink” or “swim” method and that worked well for her, so she sees no reason that it won’t work well for her supervisees.

Common questions in supervision • What to do: • When there is conflict • When your supervisee is not prepared for supervision • When your supervisee fails to follow policies or supervisor recommendations • When your supervisee is attracted to a client • When you are attracted to a supervisee

Major Legal and Ethical Issues in Supervision • 1. Due Process. • 2. Informed Consents. • 3. Dual Relationships. • 4. Competencies • 5. Confidentiality

Due Process A legal term for a procedure that ensures that “notice and hearing must be given before an important right is taken away”.

Due Process • Substantive due process States that criteria and procedures that govern training programs MUST be applied consistently and fairly.

Due Process Procedural due process: • Student or supervisee must be appraised of academic and performance requirements and program regulations • Receive notice of any deficiencies • Be evaluated regularly • Have the opportunity to be heard if their deficiencies have led to a change in status

Case Study Hannah is in a master’s program in mental health counseling. She has completed 10 courses in the program and is currently in practicum. Hannah has received a great deal of formative feedback throughout the practicum indicating that she had many areas that needed improvement. At the conclusion of the practicum, Hannah’s instructor a assigns Hannah a grade of F for the course. At this time, Hannah is informed that a failing grade in the practicum is grounds for dismissal from the program. Hannah is told that she may retake the practicum one time, but that the faculty is not optimistic that she will improve enough to receive a B or better, a condition for her continuing in the program. Although Hannah knew that she was not doing as well in the practicum as some others, she had no awareness that she was in danger of being terminated from the program until the final evaluation. It is likely that Hannah will take the advice of the faculty and will discontinue the training program at this time.

Case Study • Have Hannah’s due process rights been protected? • How vulnerable is her practicum instructor and the program if she should decide to challenge their decision? • Even if Hannah does not appeal, what are the potential systemic implications of such a process? • Even though there is no ill will evident in the action of the faculty and no indication that their decision was capricious or arbitrary, did the process that they followed adequately protect the student and was it legally defensible?

Informed Consent • A concept handed down from the medical profession that states that all patients must be informed of any risks that a recommended treatment carries and also be advised of the alternative treatments available

Informed Consent • Supervisors have three levels of responsibility: • To determine that clients have been informed by the supervisee of the parameters of treatment • Ascertain that clients are aware of parameters of supervision that will effect them • To provide informed consent for supervisee concerning his/her rights , expectations and responsibilities

Informed consent with supervisees • It is essential that supervisees understand and agree to the procedures of supervision BEFORE it begins and at any time when it requires a change.

Supervision of Mental Health Counseling Interns