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Supervision

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NBCC, NAADAC, CAADAC, and California Board of Behavioral Sciences approved Mental Health continuing education and addictions counselor training series. Narrated versions and CEUs available at …

NBCC, NAADAC, CAADAC, and California Board of Behavioral Sciences approved Mental Health continuing education and addictions counselor training series. Narrated versions and CEUs available at http://www.allceus.com

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  • 1. CEUs available at All CEUs.com SUPERVISION Copyright CDS Ventures, LLC 2006
  • 2. CEUs available at All CEUs.com WHAT SHAPES CLINICAL SUPERVISION The theoretical model from which it is derived  (Therapy, Education) Copyright CDS Ventures, LLC 2006
  • 3. CEUs available at All CEUs.com THE PURPOSE OF SUPERVISION IS TO Bring about change in the knowledge, skills and  behavior of another Assist the counselor in self observing, self-  correcting, self reinforcing, and self soothing Ensure counselors remaining in the field are  competent with regard to personal characteristics, philosophical foundations, communication abilities, counseling skills, administrative skills, and ethical behaviors Copyright CDS Ventures, LLC 2006
  • 4. CEUs available at All CEUs.com DISCUSSION It is our duty to ensure counselors remaining in the field  are competent with regard to personal characteristics  philosophical foundations  communication abilities  counseling skills  administrative skills  ethical behaviors  For each of the above, identify 3 competencies in each area, how you would assess them and ways you can help supervisees enhance them. Copyright CDS Ventures, LLC 2006
  • 5. CEUs available at All CEUs.com FIVE MAIN COMPONENTS OF SUPERVISION An experienced supervisor  Clients in clinical settings  A primary concern to “do no harm” with regard to  both the client and supervisee Monitoring counselor performance through  observation The goal of changing the counselors behavior  Copyright CDS Ventures, LLC 2006
  • 6. CEUs available at All CEUs.com 3 MAIN COMPONENTS OF SUPERVISION Nurturance  Promote measurable development of skills and  competencies Raise the level of accountability in counseling  services and programs Copyright CDS Ventures, LLC 2006
  • 7. CEUs available at All CEUs.com SUPERVISION HELPS THE COUNSELOR… Understand himself/herself  Understand the process of counseling  Master the knowledge, skills and abilities of  counseling Copyright CDS Ventures, LLC 2006
  • 8. CEUs available at All CEUs.com SUPERVISION IS A lifelong process of professional development,  affirming, internalizing and demonstrating a professional self A disciplined, tutorial process where principles are  translated to practice with 4 overlapping foci Administrative  Evaluative  Clinical  Supportive  About people, their needs, concerns and growth  Copyright CDS Ventures, LLC 2006
  • 9. CEUs available at All CEUs.com SUPERVISION IS DISCIPLINED MEANS It is regularly scheduled, time limited with specific  agenda and expectations Copyright CDS Ventures, LLC 2006
  • 10. CEUs available at All CEUs.com SUPERVISION IS TUTORIAL MEANS It involves individualized assessment, goals and  training plans Copyright CDS Ventures, LLC 2006
  • 11. CEUs available at All CEUs.com SUPERVISION IS A PROCESS MEANS It is a relationship in which both parties work  together in an atmosphere of trust and respect Copyright CDS Ventures, LLC 2006
  • 12. CEUs available at All CEUs.com SUPERVISION TRANSLATES PRINCIPLES TO PRACTICE It teaches principles and how to use them  appropriately It helps counselors identify what they did, why they  did it, when they would do it again Discussion: How do you help counselors identify what they did, why they did it, when they would do it again? (i.e. case studies, round tables, scenario based training, group supervision etc.) Copyright CDS Ventures, LLC 2006
  • 13. CEUs available at All CEUs.com THE FOUR OVERLAPPING FOCI Administrative  Evaluative  Clinical  Supportive  Copyright CDS Ventures, LLC 2006
  • 14. CEUs available at All CEUs.com THE ADMINISTRATIVE FOCUS INVOLVES Organizational management including hiring,  training, evaluating, etc. Copyright CDS Ventures, LLC 2006
  • 15. CEUs available at All CEUs.com THE EVALUATIVE FOCUS Occurs in 2 main stages: goal setting and feedback  Should be proactive instead of always  reactive/corrective Provides the supervisor opportunities to provide  praise and encouragement while assisting the counselor in making necessary changes Is consultative with a focus on the client  Discussion: What does it mean to have a proactive approach to evaluation? Copyright CDS Ventures, LLC 2006
  • 16. CEUs available at All CEUs.com 3 ROADBLOCKS TO EFFECTIVE EVALUATION Lack of supervisor skills in evaluating supervisee  performance (i.e. lack of understanding regarding setting measurable goals/objectives) Confusion about the compatibility of evaluation and  supervision Anxiety evoking aspects of evaluation  Discussion: Discuss the major sources of anxiety for supervisees and methods you have found useful to assist them Copyright CDS Ventures, LLC 2006
  • 17. CEUs available at All CEUs.com THE SUPPORTIVE FOCUS OF SUPERVISION Providing hand-holding, cheerleading, morale  building, coaching and burnout prevention Exploring supervisees’ feeling during the  counseling and supervision sessions Facilitating supervisee self-exploration and growth  Assisting the supervisee in finding areas of success  in each hour of therapy Discussion: Identify one way you accomplish each of the above tasks in your supervision process. Copyright CDS Ventures, LLC 2006
  • 18. CEUs available at All CEUs.com SUPERVISION VS. COUNSELING MEANS Supervision addresses counselor personal growth  issues as they relate to the material the client is experiencing Supervisors identify personal growth issues, but refer  the supervisee to a counselor to explore these issues in depth Supervision helps counselors identify ways they may  be acting out personal issues in the counseling session Discussion: How do you differentiate the difference between supervision and counseling and how do you negotiate that boundary on a regular basis. Copyright CDS Ventures, LLC 2006
  • 19. CEUs available at All CEUs.com THE BEST SUPERVISOR TEACHES By example letting students watch you work  Copyright CDS Ventures, LLC 2006
  • 20. CEUs available at All CEUs.com LEADERSHIP INVOLVES Teaching, mentoring, coaching based in a set of  core values Copyright CDS Ventures, LLC 2006
  • 21. CEUs available at All CEUs.com 10 PRINCIPLES FOR LEADERSHIP Take full responsibility for the decisions you make 1. Put subordinates wellbeing above your own 2. Give subordinates full credit for successes 3. Take risks when they are in the best interest of the 4. organization or the client Protect, support, defend subordinates to senior 5. management Copyright CDS Ventures, LLC 2006
  • 22. CEUs available at All CEUs.com LEADERSHIP CONT… Take a personal interest in the welfare of your staff 6. Make decisions promptly 7. Be a teacher 8. Do not play favorites 9. Do not give orders just to show who is boss 10. Copyright CDS Ventures, LLC 2006
  • 23. CEUs available at All CEUs.com BOTTOM UP MANAGEMENT MEANS Participation in the decision making process is  spread throughout the corporation A leader is a servant first  Supports, instead of directing, the teams that  design and implement the tasks Copyright CDS Ventures, LLC 2006
  • 24. CEUs available at All CEUs.com SIX MAJOR STAKEHOLDERS Employees  Customers  Vendors  Competitors  Community  Owners  Copyright CDS Ventures, LLC 2006
  • 25. CEUs available at All CEUs.com 4 PRINCIPLES OF THE NEW ORGANIZATION Networked systems  Servant leadership  Participatory management  Stakeholder involvement  Copyright CDS Ventures, LLC 2006
  • 26. CEUs available at All CEUs.com TRAITS OF AN EFFECTIVE SUPERVISOR The 4 “A’s”  Available  Accessible  Able  Affable Discussion: In what ways are you available, accessible, able and affable? How could you improve in any of these areas? Copyright CDS Ventures, LLC 2006
  • 27. CEUs available at All CEUs.com ANSWER THE FOLLOWING QUESTIONS How do I believe change occurs  What are the crucial variables in training and  supervision How do I measure success in supervision  How do I contribute to that success  What learning objectives do I have for supervision  What techniques will I apply to ensure learning  objectives are met Discussion: Answer each of the above questions Copyright CDS Ventures, LLC 2006
  • 28. CEUs available at All CEUs.com MODELS OF SUPERVISION LAYERS Philosophical foundation  Descriptive dimensions  The supervisor’s and supervisee’s stage of  development Contextual factors including personal  characteristics and setting/environment Copyright CDS Ventures, LLC 2006
  • 29. CEUs available at All CEUs.com THE PHILOSOPHICAL LAYER Basic beliefs about how we know what we  know, what motivates people and how people change Copyright CDS Ventures, LLC 2006
  • 30. CEUs available at All CEUs.com TEN DESCRIPTIVE DIMENSIONS Influential  Symbolic  Structural  Replicative  Counselor in treatment  Information gathering  Jurisdictional  Relationship  Strategy  Copyright CDS Ventures, LLC 2006
  • 31. CEUs available at All CEUs.com INFLUENTIAL Determines whether the client and supervisee are  influenced at an affective or cognitive level Copyright CDS Ventures, LLC 2006
  • 32. CEUs available at All CEUs.com SYMBOLIC Deals with whether latent or manifest content is  addressed in counseling and supervision Copyright CDS Ventures, LLC 2006
  • 33. CEUs available at All CEUs.com STRUCTURAL Describes whether therapy and supervision are  spontaneous or planned Copyright CDS Ventures, LLC 2006
  • 34. CEUs available at All CEUs.com REPLICATIVE Refers to the extent to which the supervisor sees  observed interactions as representations of isomorphic processes Copyright CDS Ventures, LLC 2006
  • 35. CEUs available at All CEUs.com COUNSELOR IN TREATMENT Has to do with whether training and personal  therapy are viewed as related or unrelated activities Copyright CDS Ventures, LLC 2006
  • 36. CEUs available at All CEUs.com INFORMATION GATHERING Contrasts indirect methods of obtaining information  with direct observation of therapy sessions Copyright CDS Ventures, LLC 2006
  • 37. CEUs available at All CEUs.com JURISDICIONAL Concerns who is responsible for client care  Copyright CDS Ventures, LLC 2006
  • 38. CEUs available at All CEUs.com RELATIONSHIP Determines whether the counselor or supervisor  functions at the facilitative or hierarchical role with respect to the client or supervisee Copyright CDS Ventures, LLC 2006
  • 39. CEUs available at All CEUs.com STRATEGY Highlights the teaching of theory versus technique  in supervision Copyright CDS Ventures, LLC 2006
  • 40. CEUs available at All CEUs.com THE STAGE OF DEVELOPMENT LAYER Includes not only the development of the  supervisee but the supervisor not only as a clinician, but also as a supervisor Copyright CDS Ventures, LLC 2006
  • 41. CEUs available at All CEUs.com THE CONTEXTUAL FACTORS LAYER 5 Categories  Training  Philosophy  demographic characteristics of supervisor supervisee  and clients Setting  Clinical issues  Copyright CDS Ventures, LLC 2006
  • 42. CEUs available at All CEUs.com DEVELOPMENTAL APPROACH The supervisor provides:  Nonjudgmental support  Uses a counseling, therapeutic approach addressing feelings thoughts and actions that may impede the supervisees professional performance  Is consultative with self-evaluation an exploration  Employs self supervision Copyright CDS Ventures, LLC 2006
  • 43. CEUs available at All CEUs.com STRUCTURES UNDERLYING DEVELOPMENT Autonomy  Self and other awareness  Motivation  Copyright CDS Ventures, LLC 2006
  • 44. CEUs available at All CEUs.com DEVELOPMENTAL APPROACH Counselor Level 1 “Forming”  Characterized by: high dependence on others, lack of self and  other awareness, categorical thinking, high motivation and commitment to work Plagued by feelings of anxiety and driven by the desire to do it  right And formulate clinical concepts on the basis of a single aspect  of the client history Practice by formulas such as “All clients in early recovery are  __________quot; Copyright CDS Ventures, LLC 2006
  • 45. CEUs available at All CEUs.com CONT… Do not know how to formulate treatment plans  Cannot visualize and articulate therapeutic process from  intake through intervention to termination The supervisor environment is one that encourages  autonomy of providing instruction support and modeling within a structured setting The primary responsibility of supervisors for level 1  counselors is to protect client needs at all times while encouraging risk-taking by the counselor To facilitate growth a supervisor should introduce the counselor  to ambiguity and conflict It is imperative that supervisors working with level 1 counselors  take into account the supervisees learning style Copyright CDS Ventures, LLC 2006
  • 46. CEUs available at All CEUs.com DEVELOPMENTAL APPROACH Counselor Level 2 quot;Stormingquot;  Realizing that cannot save the world, level two counselors  become frustrated by their inability to solve difficult problems Characterized by: vacillating between autonomy and  dependence, more self-aware of self and others, and consistently motivated Although level 2 counselors have more skills and tools, they  often do not know which tools to use with which client or why Often vacillates between rejecting advice and assistance to  desperately wanting to be comforted and protected Level 2 counselors can empathize excessively with the client  Copyright CDS Ventures, LLC 2006
  • 47. CEUs available at All CEUs.com CONT… Level 2 counselors progress in a cyclical rather than linear  fashion regressing at times to earlier developmental issues Copyright CDS Ventures, LLC 2006
  • 48. CEUs available at All CEUs.com DEVELOPMENTAL APPROACH Counselor Level 3 quot;Normingquot;  Involves establishing one's own therapy model and  normalizing that approach in a range of clinical situations Characterized by: secure autonomy, awareness and  acceptance of self and others, stable motivation Copyright CDS Ventures, LLC 2006
  • 49. CEUs available at All CEUs.com DEVELOPMENTAL APPROACH Supervisors: Level 1 quot;Formingquot;  Displays a mechanistic approach  Place a strong expert role  Depends on own supervisor  Is moderately to highly structured  Is invested in trainees adopting their own model  Has trouble with level 2 counselors  Copyright CDS Ventures, LLC 2006
  • 50. CEUs available at All CEUs.com DEVELOPMENTAL APPROACH Supervisors: Level 2 quot;Stormingquot;  Displays confusion, conflict issues  Sees supervision and counseling as more complex,  multidimensional Has fluctuating motivation  Focuses on supervisee  Loses objectivity  Blames supervisee for supervisor’s problems  Copyright CDS Ventures, LLC 2006
  • 51. CEUs available at All CEUs.com DEVELOPMENTAL APPROACH Supervisors: Level 3 quot;Normingquot;  Functions autonomously  Displays self and supervisee awareness  Differentiates boundaries and roles  Able to supervise at all times  Prefers to work with a certain level of counselor  Copyright CDS Ventures, LLC 2006
  • 52. CEUs available at All CEUs.com THE PSYCHODYNAMIC APPROACH Regard supervision is a therapeutic process focusing  on the intrapersonal and interpersonal dynamics of the counselor in relation to clients, colleagues, supervisors and significant others The goal is dynamic awareness which includes  understanding dynamic contingencies including past learning experiences that reassert themselves and present situations, observing changes in the dynamic, and making therapeutic use of the dynamic in counseling Copyright CDS Ventures, LLC 2006
  • 53. CEUs available at All CEUs.com CONT… The primary methods of observation and the  psychodynamic model of supervision are not directed such as process notes, verbatim reports, and oral presentations. The psychodynamic approach focuses on the  affective dimension, latent content, is reactive, observes parallel processes, uses indirect methods of information gathering, believe the therapist has jurisdiction, form facilitative relationships and focus heavily on theory instead of technique Copyright CDS Ventures, LLC 2006
  • 54. CEUs available at All CEUs.com PSYCHODYNAMIC APPROACH PHASES Phase 1: Childhood: supervisor creates a safe  place for supervisee to explore new techniques Phase 2: Adolescence: alternating between  exploration into new areas and retreating to the safety of home Phase 3: Adulthood: mutual interdependence  between supervisor and supervisee built on the foundation of basic universal values such as faith, hope, love, peace and respect Copyright CDS Ventures, LLC 2006
  • 55. CEUs available at All CEUs.com THE SKILLS MODEL OF SUPERVISION Three Basic Tenets  Counselors must learn the appropriate skills and  extinguish inappropriate behaviors Supervision assists counselors in developing and  assimilating specific skills Counselor knowledge and skill should be formulated in  behavioral terms Copyright CDS Ventures, LLC 2006
  • 56. CEUs available at All CEUs.com THE SKILLS MODEL OF SUPERVISION Establishing a relationship between supervisee and  supervisor is a dynamic component of the learning process Supervision begins by asking what one needs to  learn to be an affective counselor The next step is to set realistic, measurable, and  timely supervision goals that enhance the supervisees motivation Copyright CDS Ventures, LLC 2006
  • 57. CEUs available at All CEUs.com SKILLS METHODS Skills monitoring is an ongoing process that helps the  counselor identify appropriate professional performance Role-playing and simulation techniques are used to  practice new skills Micro training breaks down a specific skill into well-  defined measurable categories, and enabling the counselor to acquire skills in small steps Other behaviorally based techniques contribute to skills-  training as well What the counselor learns in one context is generalized  to other contexts Copyright CDS Ventures, LLC 2006
  • 58. CEUs available at All CEUs.com CONT… Identifies categories of necessary tasks that are not theory  specific which apply across the board, regardless of whether one is psychodynamic, behavioral, or skill based in orientation Is characterized by an emphasis on the cognitive aspects,  manifests contents, is proactive, believes relationships are to streets, uses direct methods of information gathering, the jurisdiction to the supervisor, is hierarchical and technique oriented Copyright CDS Ventures, LLC 2006
  • 59. CEUs available at All CEUs.com THE SYSTEM'S MODEL OF SUPERVISION The primary focus is on a larger whole, or systems  which is defined as an integrated and related set of components or subsystems organized for the purpose of obtaining of specific objectives Copyright CDS Ventures, LLC 2006
  • 60. CEUs available at All CEUs.com THE STRUCTURAL MODEL OF SUPERVISION Examines the organizational structure of the family  is the primary source of the family's problems, impeding a clear flow of information and decision making Copyright CDS Ventures, LLC 2006
  • 61. CEUs available at All CEUs.com THE STRATEGIC MODEL OF SUPERVISION Looks for strategies functions and meanings and  family interactions The therapist generates new strategies and skills  for the family to resolve the problem behaviors, focusing on the function of the symptom Technical skills are taught with a view toward the  development of the conceptual framework, giving the supervisee a method of thinking and not a model of therapy Copyright CDS Ventures, LLC 2006
  • 62. CEUs available at All CEUs.com ADDICTIONS UNIQUE CHARACTERISTICS Costs  Denial  Lack of a Consistent Pattern  Deleterious Consequences  Pervasive Effects  Copyright CDS Ventures, LLC 2006
  • 63. CEUs available at All CEUs.com GOALS FOR ADDICTION TREATMENT Detoxification  Dealing with patient denial  In overcoming guilt, shame, self blame, and other  destructive emotions Establishing a healthy lifestyle and behaviors that  make it possible to maintain sobriety Aftercare in a program of self-help and/or ongoing  therapy Copyright CDS Ventures, LLC 2006
  • 64. CEUs available at All CEUs.com OBJECTIVES FOR 12-STEP RECOVERY Six Dimensions  Cognitive objectives mean that abusers must understand  how substance abuse has affected their life, how denial and rationalizations contribute to continue drinking or drug use despite negative consequences, and how the negative consequences are connected with the alcoholic drug abuse Copyright CDS Ventures, LLC 2006
  • 65. CEUs available at All CEUs.com CONT… Emotional objectives include the need to  acknowledge feelings such as anger, resentment, loneliness and deal with these emotions in a way that minimizes relapse Relationship objectives include understanding how  the substance abuse affects relationships with people Behavioral objectives include understanding how  substance abuse affects everything one does Copyright CDS Ventures, LLC 2006
  • 66. CEUs available at All CEUs.com Social objectives include the need to participate in  self-help programs and to reevaluate relationships Spiritual objectives include the need to experience  hope that the addiction can be arrested, to believe and trust in a power greater than oneself, and to acknowledge one's own character defects and the harm ones actions have caused Copyright CDS Ventures, LLC 2006
  • 67. CEUs available at All CEUs.com MINNESOTA MODEL PHILOSOPHY Elements  Addicts can change their beliefs, attitudes, and behaviors  Alcoholism or addiction is a primary chronic, multifaceted  disease characterized by loss of control Both long and short-term treatment goals are specified  including abstinence and a better lifestyle Copyright CDS Ventures, LLC 2006
  • 68. CEUs available at All CEUs.com ALCOHOL AND DRUG ABUSE MODEL (ADAM) OF SUPERVISION People have the ability to bring about change in  their lives with the assistance of a guide People do not always know what is best for them,  and may be blinded by their resistance to, and denial of the issues The key to growth is mental insight and behavioral  change in the right amounts at a appropriate time Change is constant and inevitable  Copyright CDS Ventures, LLC 2006
  • 69. CEUs available at All CEUs.com Supervision the guidance to concentrate on what is  changeable It is not necessary to no great deal about the cause  or function of a manifest problem to resolve it There are many correct ways to view the world  Copyright CDS Ventures, LLC 2006
  • 70. CEUs available at All CEUs.com DESCRIPTIVE DIMENSIONS OF THE ADAM Influential: given the tendency of the field to attract  people with their own history of recovery, the supervisor must attend to both cognitive and affective issues at all stages of the counselor’s development Symbolic: emphasizes primarily manifest content,  being less concerned with historical information, viewing the unconscious material as interesting but nonessential to bringing about the desired behavioral changes in client and supervisees Copyright CDS Ventures, LLC 2006
  • 71. CEUs available at All CEUs.com Structural: involves teaching the 12 core functions  with highly specific learning goals and explicit supervisory activities Replicative: Counselors behave in Supervision in a  manner parallel to clients in therapy Counselor in treatment: therapy is not an essential  ingredient in the counselor supervision and it is inappropriate for the supervisor to provide therapy Copyright CDS Ventures, LLC 2006
  • 72. CEUs available at All CEUs.com information gathering: varies from direct and indirect based  on counselor competency jurisdictional: the responsibility for the welfare of the client  rests ultimately with the supervisor relationships: nonhierarchical, consultative, facilitative  strategy: moves from technique to heavily theory based as  counselors increase competency Copyright CDS Ventures, LLC 2006
  • 73. CEUs available at All CEUs.com DISCUSSION Which supervision model fits you best and why:  developmental, psychodynamic, skills, systems or the alcohol and drug abuse model of supervision? Copyright CDS Ventures, LLC 2006
  • 74. CEUs available at All CEUs.com 4 FACTORS THAT AFFECT CHANGE Extra therapeutic factors which are all factors related  to client and not the actions of the therapist Relationship factors, the single most significant issue  in the therapy outcome, including caring, empathy, warmth, acceptance, mutual affirmation, and encouragement of risk taking Placebo factors, such as hope and expectancy  Technique factors, account for only 15% of  therapeutic change Copyright CDS Ventures, LLC 2006
  • 75. CEUs available at All CEUs.com WHAT COUNSELORS NEED TO LEARN How to attend themselves to the client's feelings,  establish rapport, to demonstrate caring, compassion, and empathy How to find a collaborative instead of combative  metaphor for treatment How to develop and monitor the therapeutic alliance  How to marshal and enhance the potential for  success through the use of social support networks, community services and family and community resources Copyright CDS Ventures, LLC 2006
  • 76. CEUs available at All CEUs.com How to avoid falling into conventional wisdom that when  treatment does not meet the desired outcome it is the client's faults How to promote the client sends a personal control and  empowerment How to focus on the future and the client's ability to  overcome the past How to engage in brief therapy  Copyright CDS Ventures, LLC 2006
  • 77. CEUs available at All CEUs.com How to establish the affective qualities essential to  counseling before they are taught diagnostics How to adapt a relationship to different clients and their  needs The earlier change happens in treatment the more likely  will be a positive outcome How to identify not what the person needs, but what the  person already has to work with Help is when the mind is present in the heart, when  mind, body and spirit are integrated and when an individual is at peace with his mind body and spirit even if one of those elements is experiencing pain or suffering Copyright CDS Ventures, LLC 2006
  • 78. CEUs available at All CEUs.com SUPERVISORS NEED TO Offer mystery, compassion, openness, and a  simple presence instead of answers or being the expert Learn contemplative listening which means being  receptive to visual, auditory, kinesthetic and intuitive cues, without an agenda, and without a compulsion to help The most important phrases a supervisor can learn  are quot;I don't knowquot; and quot;I could be wrongquot; Copyright CDS Ventures, LLC 2006
  • 79. CEUs available at All CEUs.com The goal of Supervision should not be the separate  autonomy of the individual but the realization of one's essential connection and relatedness to something broader than the self Copyright CDS Ventures, LLC 2006
  • 80. CEUs available at All CEUs.com ESTABLISHING SUPERVISORY RELATIONSHIPS Creating a contract involving mutually defined goals  for both parties that allow for realistic accountability Establishing a working relationship which includes  laying groundwork of trust and respect Assessing the counselor's clinical knowledge and  skills and training needs using standardized instruments, transcripts and other methods of observation Setting learning goals for the supervision and a form  of supervision training plan Copyright CDS Ventures, LLC 2006
  • 81. CEUs available at All CEUs.com GOALS OF SUPERVISION SHOULD BE Clearly stated, attainable, specific, measurable and  observable In writing (individual development plan, IDP) and  agreed upon by the supervisor and supervisee Contain specific action steps to bring about the  outcome Contain specific procedures to evaluate the  outcome Copyright CDS Ventures, LLC 2006
  • 82. CEUs available at All CEUs.com INDIVIDUAL DEVELOPMENT PLANS Include the following  Expectations for supervision including the model of  therapy, the number and types of patient to be seen, the number and duration of supervision sessions, and the techniques and interventions to be used The counselor's experience and readiness for the  position including the counselor's base of knowledge and his or her strengths and areas for growth Copyright CDS Ventures, LLC 2006
  • 83. CEUs available at All CEUs.com Procedures to be used to observe the counselor  and practice Procedures to be used to determine the counselor's  reasoning, conceptualization, and decision-making skills Procedures to be used to evaluate the counselor  Procedures to be used to intervene to help the  counselor achieve supervision goals Copyright CDS Ventures, LLC 2006
  • 84. CEUs available at All CEUs.com ASSESS THE LEARNING ENVIRONMENT Questions  Is there sufficient challenge in the learning environment  to keep the supervisee motivated Is the theoretical or philosophical dissonance between  supervisor and supervisee manageable Does the supervisee have the necessary knowledge and  skills to begin this process Does the supervisee have sufficient personal  development self-esteem and sense of self-worth to progress What is the supervisee's investment in the learning  process Copyright CDS Ventures, LLC 2006
  • 85. CEUs available at All CEUs.com CONT… Does the supervisee possess the basic and affective  qualities needed for counseling such as empathy warmth and genuineness Is the amount of support available to the supervisee  sufficient and proportional to the challenge Are the goals and means of supervision clear and  understood by all parties Copyright CDS Ventures, LLC 2006
  • 86. CEUs available at All CEUs.com Are the evaluation criteria realistic, measurable, attainable,  accurate, relevant and clearly understood To what extent can the supervisee process feedback  Is the supervisory environment conducive to risk taking  To what extent is the supervisor able to help the supervisee  integrate new techniques and skills Is there a basis for terminating the supervision at the  appropriate time Copyright CDS Ventures, LLC 2006
  • 87. CEUs available at All CEUs.com MANAGING THE SUPERVISORY WORKLOAD Everyone providing direct counseling services  should receive at least one hour of supervision per week Individual sessions should run approximately 1  hour and small group sessions should run approximately 1 1/2 hours Copyright CDS Ventures, LLC 2006
  • 88. CEUs available at All CEUs.com CONT… Supervisors should discuss with their supervisees  whether they are going to observe entire sessions, parts of sessions, live sessions, or tapes Peer group supervision can be used to manage  larger groups where level 3 counselors supervise level 1 and 2 counselors and level 3 counselors meet in a small group for supervision with the supervisor Copyright CDS Ventures, LLC 2006
  • 89. CEUs available at All CEUs.com It is rarely possible to supervise more than 15  counselors without suffering an unacceptable level of personal stress or deviation from professional standards Copyright CDS Ventures, LLC 2006
  • 90. CEUs available at All CEUs.com METHODS OF OBSERVATION INCLUDE Videotapes  Cofacilitation  One-way mirror supervision  Role playing  Copyright CDS Ventures, LLC 2006
  • 91. CEUs available at All CEUs.com WORKING WITH VIDEOS Clear goals must be set to determine why, when,  and how videotaped sessions will be conducted Interactive processes recorded on tape should be  related to the actual counseling session, its goals, and the memories of the session and the rationale for the intervention should be explored Copyright CDS Ventures, LLC 2006
  • 92. CEUs available at All CEUs.com Tape segment should be selected for review  because they provide teaching moments not pretexts for scoring critical points The supervisor should provide gradual feedback,  not a litany of judgments, and allow time between segments discuss and assimilate feedback It is vital to have signed releases from patients prior  to taping Copyright CDS Ventures, LLC 2006
  • 93. CEUs available at All CEUs.com The day prior to taping the counselor should inform the  patient that the videotaping is planned for the next session and provide the patient the opportunity to state that they do not want to have the session taped quot;Patient resistancequot; to videotaping is usually a projection of  the counselor's resistance Tapes must be erased after the training sessions as they are  admissible as evidence in court. Further it is not enough to just tape over the session material, a magnetic tape erasure should be used Copyright CDS Ventures, LLC 2006
  • 94. CEUs available at All CEUs.com CREATIVE WAYS TO USE VIDEOTAPES Running the tape and fast-forward to convey a  heightened image of the counselors and clients body movements Turn down the audio to try to fill in what is being  said on the basis of nonverbals While reviewing the tape prior to supervision, the  supervisor might do voiceover dubbing questions for the supervisee onto the tape Copyright CDS Ventures, LLC 2006
  • 95. CEUs available at All CEUs.com COFACILITATION CONSIDERATIONS It is time-consuming  It is obtrusive and alters the dynamics of counseling  It can be anxiety provoking for both counselor and  client If the session is not also videotaped, there is no  record of the session to review later Copyright CDS Ventures, LLC 2006
  • 96. CEUs available at All CEUs.com GUIDELINES FOR COFACILITATION The supervisor should sit in the group or beside the  counselor in an individual counseling session The supervisor should begin the session with a  pledge of confidentiality Prior to the session the supervisor and supervisee  should briefly discuss the background of the session, salient issues and plans for the session Copyright CDS Ventures, LLC 2006
  • 97. CEUs available at All CEUs.com CONT… The supervisor should take notes during the  session as a means of recalling key issues to be discussed later The supervisors interventions during the session  should be limited to no more than three or four comments Feedback should be given to the counselors as  soon as possible after the session Copyright CDS Ventures, LLC 2006
  • 98. CEUs available at All CEUs.com CONT… If a group session is led by two counselors to  supervisor should meet with the to supervisees jointly Cofacilitation should be used in conjunction with  videotaping whenever possible Copyright CDS Ventures, LLC 2006
  • 99. CEUs available at All CEUs.com GROUP SUPERVISION BENEFITS It provides a cost-effective way of supervising more  people in the same time It offers each counselor a reality testing of her  perceptions through peer validation Learning is enhanced by diversity of people in the  group Groups create a working alliance among  counselors that engenders a sense of psychological safety Copyright CDS Ventures, LLC 2006
  • 100. CEUs available at All CEUs.com The group process facilitates learning by setting up a  microcosm of the larger social environment Group disclosure enhances the potential for self-disclosure,  confrontation, and opportunities for growth Empathy and sharing of interests are available to a greater  extent than in individual supervision When the group works together over time personal growth  on the part of the individual members can be reinforced possibly by the group's Alternative clinical approaches and methods are available to  a far greater extent than a single supervisor can offer The potential for critical feedback is greatly expanded  Copyright CDS Ventures, LLC 2006
  • 101. CEUs available at All CEUs.com PROCESSES IN GROUP SUPERVISION cohesiveness  a sense of we-ness  a shared frame of reference  tolerance of diverse opinions  movement toward common goals  like any group leader, the task of the supervisor is  to help the group identify its norms, and to model appropriate qualities, behaviors, and skills Copyright CDS Ventures, LLC 2006
  • 102. CEUs available at All CEUs.com CASE PRESENTATIONS Are useful in groups and individual supervision  Should be built around problems and solution-  oriented questions to be answered Should move from client information to dynamics,  prognosis, and treatment plan Allow the supervisor to observe the counselor's  actions, determine their impact on the client, assess the counselor's clinical reasoning process, and help the counselor improve treatment delivery Copyright CDS Ventures, LLC 2006
  • 103. CEUs available at All CEUs.com CASE PRESENTATION PROBLEMS Too many presentations into short of a time  Focusing on a specific problem instead of giving a  case overview Material is not contextualized  Supervisee dynamics interfere with free and open  discussion of the case There are expectations for interventions beyond  the capabilities of the counselor Copyright CDS Ventures, LLC 2006
  • 104. CEUs available at All CEUs.com ROLE PLAYING IS… An alternative to observing the clinician and an  actual counseling session Ideal for practicing skills  An opportunity to learn-by-doing in a safe  environment and receive helpful feedback Copyright CDS Ventures, LLC 2006
  • 105. CEUs available at All CEUs.com FEEDBACK AND INTERVENTION Can be triaged into three levels: immediate  intervention, non-immediate intervention, suggestions Copyright CDS Ventures, LLC 2006
  • 106. CEUs available at All CEUs.com 5 TYPES OF SUPERVISORY INTERVENTION facilitative: bringing about discussion through  nondirective questions confrontive: addresses specific action or behavior  and require the counselor to answer a question about it conceptual: contributes new information and a  different way of visualizing the case Copyright CDS Ventures, LLC 2006
  • 107. CEUs available at All CEUs.com CONT… prescriptive: direct the counselor to respond in a  particular manner the next time a certain set of circumstances occurs catalytic: moves the process along by asking  provocative, or what if questions Copyright CDS Ventures, LLC 2006
  • 108. CEUs available at All CEUs.com FEEDBACK IS Supervisor's response to the data presented  Supportive, challenging and pragmatic  Designed to bring about a positive change in the  professional life of the counselor Copyright CDS Ventures, LLC 2006
  • 109. CEUs available at All CEUs.com EFFECTIVE FEEDBACK Is elicited rather than imposed  Is timely  Is communicated clearly, directly and with regard  to specific issues Is constructive and descriptive rather than critical  or judgmental Is directed toward changeable behavior  Is not used as a disciplinary weapon  Copyright CDS Ventures, LLC 2006
  • 110. CEUs available at All CEUs.com CONT… Constructive feedback is sandwiched between  positive feedback and/or recognition of work well done Copyright CDS Ventures, LLC 2006
  • 111. CEUs available at All CEUs.com METHODS OF PROVIDING FEEDBACK Trunking or breaking down information into  manageable bites Providing nonthreatening but thought-provoking  were challenging questions Sharing one's own experiences in concrete terms  Providing support and encouragement  Suggesting alternatives  Copyright CDS Ventures, LLC 2006
  • 112. CEUs available at All CEUs.com EFFECTIVE CHALLENGES ARE Tentative  Phrased with the tone of care and respect  Tied to reinforcement  Built upon steps which have already been  successfully accomplished Focused on specific and concrete behaviors  Copyright CDS Ventures, LLC 2006
  • 113. CEUs available at All CEUs.com TRANSFERENCE & COUNTERTRANSFERENCE That transference reactions that may arise even from  the way they decorate their office That not all emotional reactions to clients are  countertransference That not all countertransference reaction to harmful  Of the difference between healthy personal or  therapeutic responses to clients and unhealthy responses arising from the counselor's own unresolved conflicts Copyright CDS Ventures, LLC 2006
  • 114. CEUs available at All CEUs.com PHYSICAL CONTACT GUIDELINES Physical contact for the client is justified only if it  is therapeutically supportive Nothing that cannot be done in public should be  done in private If you do something with one client, you should  be willing to do it with all clients Copyright CDS Ventures, LLC 2006
  • 115. CEUs available at All CEUs.com DETERMINING SKILL LEVELS Supervisors should not assume a developmental  level based on the counselor's experience and training Supervisors should not assess counselor simply on  the basis of initial impressions Supervisors should not determine developmental  level simply on the basis of performance in one or two domains Copyright CDS Ventures, LLC 2006
  • 116. CEUs available at All CEUs.com Supervisors should use several sources of  information to assess counselor's development including assessments by former supervisors, measurements administered by the current supervisor, counselor self-assessments, client ratings, and work samples Copyright CDS Ventures, LLC 2006
  • 117. CEUs available at All CEUs.com COUNSELOR COMPETENCIES 6 Areas  Personal characteristics  Philosophical foundations  Communications  Counseling skills  Adjunctive or administrative activity  Ethical behaviors  Copyright CDS Ventures, LLC 2006
  • 118. CEUs available at All CEUs.com SOURCES OF ANXIETY FOR SUPERVISEES Beginner's quandary or the fear of the unknown  The spun glass theory that their clients are  delicate objects Performance and approval anxiety  Dominance anxiety  Copyright CDS Ventures, LLC 2006
  • 119. CEUs available at All CEUs.com DEALING WITH ANXIETY Identify the supervisees anxious behaviors/defense  mechanisms Assist the supervisee and recognizing and  exploring the cognitive pattern, and the needs of expresses Challenge the irrational beliefs with questions  Copyright CDS Ventures, LLC 2006
  • 120. CEUs available at All CEUs.com CONT… Assist the supervisee in constructing rational and  logical thoughts related to the anxiety or anger Challenge the supervisee to take a behavioral risk  and try out the logical arguments Ask the supervisee to write down the name of each  client and state what aspect of each case worries him or her Copyright CDS Ventures, LLC 2006
  • 121. CEUs available at All CEUs.com BIASES AFFECTING SUPERVISION INCLUDE Recency: remembering what happened last  week, not six months ago Overemphasis on one factor as opposed to the  bigger picture Unforgivingness leading to an inability to  acknowledge improvement Prejudice based upon negative attributions  Favoritism  Copyright CDS Ventures, LLC 2006
  • 122. CEUs available at All CEUs.com CONT… Grouping or stereotyping  Indiscrimination, being either too approving or too  critical Copyright CDS Ventures, LLC 2006
  • 123. CEUs available at All CEUs.com PROTECTING AGAINST BIASES By using standardized rating scales for all  employees Creating behaviorally anchored rating scales for all  employees Copyright CDS Ventures, LLC 2006
  • 124. CEUs available at All CEUs.com EQS ARE Effective questions  Open ended questions that ask what, and how  instead of why Copyright CDS Ventures, LLC 2006
  • 125. CEUs available at All CEUs.com OVERCOMING ROADBLOCKS INCLUDE Solution-focused methods  Identifying previous times when a similar issue was  resolved or provided less of a problem Using a miracle question to identify goals  Breaking goals down into smaller objectives  How have you been able not to have the problem bother  you in the past Identifying exceptions to problems (i.e. When does this  problem not exist) Copyright CDS Ventures, LLC 2006
  • 126. CEUs available at All CEUs.com CONT… Assisting the counselor in adopting a future  orientation Cheerleading  Encouraging change to continue by highlighting  successes not errors Copyright CDS Ventures, LLC 2006
  • 127. CEUs available at All CEUs.com PREVENTING BURNOUT Maintain adequate self and other awareness  Have a mentor and supervision of their supervision  Maintain some client load to stay in touch with the  very reason they went into counseling in the first place Seek extra counseling on personal issues interfere  Constantly strive towards personal growth  Copyright CDS Ventures, LLC 2006
  • 128. CEUs available at All CEUs.com Ethical and Legal Concerns Copyright CDS Ventures, LLC 2006
  • 129. CEUs available at All CEUs.com MALPRACTICE PREVENTION Providing high-quality clinical care grounded in  genuine empathy and alliance building Avoiding dual relationships  Continuously maintaining some form of  supervision/consultation Meticulous, high-quality documentation  Copyright CDS Ventures, LLC 2006
  • 130. CEUs available at All CEUs.com DOCUMENTATION SHOULD Date and times of supervision was provided  The names of those supervised  The general areas and clinical issues discussed  The names of the client discussed  The name or names of any person sought for  consultation on an issue Copyright CDS Ventures, LLC 2006
  • 131. CEUs available at All CEUs.com KEY BOUNDARIES Sexual involvement with clients or supervisees is  prohibited One does not supervise one's spouse  A supervisor should not act as a supervisees  therapist or counselor A supervisor should not sponsor a supervisee in a  12 step or other self-help program Supervisors and supervisees who are friends  should maintain boundaries carefully Copyright CDS Ventures, LLC 2006
  • 132. CEUs available at All CEUs.com DETERMINING ETHICAL VIOLATIONS Is it legal  Is it balanced and fair to all concerned in the short  and long-term How I feel about myself if my family, my colleagues  or the community knew Copyright CDS Ventures, LLC 2006
  • 133. CEUs available at All CEUs.com 4 ETHICAL RESPONSIBILITIES OF SUPERVISEES Uphold professional standards of practice  Recognize and deal with personal problems when  they interfere with clinical effectiveness Treat the supervisor with respect and dignity  Treat information shared in supervision with the  highest degree of confidentiality Copyright CDS Ventures, LLC 2006
  • 134. CEUs available at All CEUs.com THE PRINCIPLE OF VICARIOUS LIABILITY The supervisor assumes clinical responsibility for  the client just as much as if the client were under his or her own personal care Copyright CDS Ventures, LLC 2006
  • 135. CEUs available at All CEUs.com COMMON LEGAL AND ETHICAL ERRORS Confusing supervision with case management  Focusing on the client's needs rather than a  supervisee’s development Relying on the supervisor's clinical skills in  supervision thereby turning supervision into therapy Adopting lax attitude with supervision occurring on  a sporadic basis Copyright CDS Ventures, LLC 2006
  • 136. CEUs available at All CEUs.com CONT. . . Conducting casual case conferences and crisis  management supervision Using supervisory power inappropriately  Copyright CDS Ventures, LLC 2006
  • 137. CEUs available at All CEUs.com SUPERVISOR ACCOUNTABILITY Did the supervisor make a reasonable effort to  supervise including direct observation of counselors in action Was the supervisor competent to perform the  tasks of the supervisor Copyright CDS Ventures, LLC 2006
  • 138. CEUs available at All CEUs.com THE LEGAL CRITERION FOR MALPRACTICE IS a breach of duty  Copyright CDS Ventures, LLC 2006
  • 139. CEUs available at All CEUs.com CONFIDENTIALITY Is one of the top five charges (and successful  suits) against therapists Is regulated by HIPAA  Must be spelled out in a notice of privacy  practices given to all new patients May be waived under certain circumstances  including Examination by the federal government as it  relates to terrorist activity Imminent threat of harm to self or others  Copyright CDS Ventures, LLC 2006
  • 140. CEUs available at All CEUs.com NONDISCLOSURE BY SUPERVISEES Is reported by 97% of supervisees  Should be addressed in the supervision contract  Copyright CDS Ventures, LLC 2006
  • 141. CEUs available at All CEUs.com SUPERVISION CONTRACT Components  An individualized training plan for the supervisee  The schedule  format, duration, roles, responsibilities, goals and objectives of supervision Information on the supervisor's training and model of  supervision Emergency and crisis management procedures including  the availability of 24-hour coverage in the event of a clinical emergency Clarification of the roles of an academic supervisor  Copyright CDS Ventures, LLC 2006
  • 142. CEUs available at All CEUs.com CONT… The ratio of the number of clients to the number of  supervision hours Formative and summative evaluation procedures  Disciplinary procedures, due process, rights of the  supervisee, and sanctions Copyright CDS Ventures, LLC 2006
  • 143. CEUs available at All CEUs.com HOW SUPERVISORS PROTECT THE CLIENT Knowing the clinical competencies and limitations  of the supervisees Assessing the complexity of client issues prior to  assigning a case to a supervisee Determining whether the supervisee is adequately  trained to assume the case Ensuring the supervisees do not have too many  cases Copyright CDS Ventures, LLC 2006
  • 144. CEUs available at All CEUs.com CONT… Protecting the supervisee from having too many  difficult to treat cases Identifying and resolving learning and personal  problems that may compromise the supervisees effectiveness Ensuring that there is sufficient supervision time for  the cases assigned Copyright CDS Ventures, LLC 2006
  • 145. CEUs available at All CEUs.com CONTEXTUAL FACTORS IN SUPERVISION Involve identifying stereotypes that inhibit learning  and prevent people from seeing the uniqueness of each individual Requires the supervisor to actively engage the  supervisee in exploration of how their beliefs and stereotypes are affecting treatment and developing strategies for working through them Copyright CDS Ventures, LLC 2006
  • 146. CEUs available at All CEUs.com 5 WAYS OF MAXIMIZING CONTEXTUAL FACTORS Context can be used to create and deepen the attachment  between client and counselor, supervisee and supervisor They can be used to promote and enhance competency, or  support and challenge They can be used to enhance manageability, and identify  which information collected is irrelevant They can be used to differentiate among the universal,  transcultural, culture specific, and idiosyncratic behaviors of all parties They can be used to provide a relativistic framework for  assessment and intervention Copyright CDS Ventures, LLC 2006
  • 147. CEUs available at All CEUs.com GENDER AND ETHNICITY IN SUPERVISION Shape belief systems about what constitutes  mental illness, the manifestation of symptoms, defensive styles, and patterns of coping Impact verbal and nonverbal communication  Introduce different values with regard to  relationships, connectedness and structure/concreteness Impact help-seeking patterns in the way people use  and respond to treatment Copyright CDS Ventures, LLC 2006
  • 148. CEUs available at All CEUs.com STARTING A SUPERVISION PROGRAM Requires a realistic view of what can be achieved  within a particular working environment Must be broken down into specific steps that can  be implemented sequentially or in a nonlinear manner May need to begin by implementing a supervision  program with a small group of supervisees Should encourage resistant staff to become  educated about the value of supervision Copyright CDS Ventures, LLC 2006
  • 149. CEUs available at All CEUs.com COUNSELOR IMPAIRMENT 5 Stages  Compulsive overwork  A change in behavior and attitudes  Onset of crises and a progressive deterioration of job  performance General immobilization and quot;if onlyquot;  thinking, daydreaming, and tardiness Confusion and overreaction to supervisor's  recommendations as well if any real or imagined criticism Copyright CDS Ventures, LLC 2006
  • 150. CEUs available at All CEUs.com CONT… Depression, apathy, cynicism, laziness, and lack of  cooperation Discipline and termination  Copyright CDS Ventures, LLC 2006
  • 151. CEUs available at All CEUs.com SUPERVISOR RESPONSIBILITIES & COUNSELOR IMPAIRMENT Early identification and referral for counseling  Consultation and decision about how sick the counselor  can be before he's taken off-line Awareness that a person must have two years without  abuse of substances before returning to alcohol and drug abuse counseling Requirements to notify the counselor's professional  credentialing organization when there is a violation of ethical codes including substance impairment Copyright CDS Ventures, LLC 2006
  • 152. CEUs available at All CEUs.com SUMMARY There are a host of ways to supervise and issues to  be considered in counseling and supervision. By engaging in and providing regular supervision  we maintain the welfare of our clients and our profession. Copyright CDS Ventures, LLC 2006