Supervision Models
Part I: How We
Support and Care for
Clinical Staff
Bart Andrews, PhD
CAPA Training Institute
June 23, 2014
Developmental Models
• There are 3 stages of supervisor and supervisee
development:
– Stage 1- Naïve Enthusiasm
– Stage 2- Trials and Tribulations
– Stage 3- Calm after the Storm
• Lets take a look at how these stages apply to my
preparation.
Naïve Enthusiasm
Trials and Tribulations
Calm after Storm
Credit Where Credit Due
“Powell is the
man!”- David
Patterson, June
17, 2014
BTW-why are
there so many
awesome
Davids?
Understanding Change
• 30% of change is related to quality of relationship between
client and counselor and/or counselor and supervisor
• 40% from extratherapeutic factors
• 15% is derived from hope/expectancy
• 15% specific to therapeutic technique
Relationship Drives EVERYTHING
• Better Clinical Supervision = Greater Job
Satisfaction
• Better Clinical Supervision = Better Retention
• Better Clinical Supervision = Better Clinical
Outcomes
“ . . .counselors view their supervisors as a primary resource
for education, training, coaching, morale building and
consultation,” (Powell and Brodsky, 2004).
The 4 ‘A’s’ of Supervision
•
•
•
•
Available
Accessible
Able
Affable
Good supervision is largely a matter of caring for staff and
mutually beneficial interdependency
Care Experiences
• What care have you received from a supervisor?
• What has a supervisor said (or not said) that has had
the biggest impact on you?
• What has a supervisor done (or not done) that has had
the biggest impact on you?
So What is a Model of Supervision?
Philosophy Continuum
Insight: Process, Goals,
Traits
• Experimentation
• Exploration
• Discovery
• Interpretation
• Self Development
• Life Enrichment
• Self Awareness
• Facilitative
• Client Driven
Skill: Processes, Goals,
Traits
• Acquiring new behaviors
• Action is the catalyst
• Problem resolution
• Symptom relief
• Skill development
• Problem oriented
• Directive
• Therapist Driven
9 Descriptive Dimensions
•
•
•
•
•
•
•
•
•
Influential:
Symbolic:
Structural:
Replicative:
Counselor TX:
Information Gathering:
Jurisdictional:
Relationship:
Strategy:
Affective Vs Cognitive
Latent Vs Manifest
Reactive Vs Proactive
Parallel Vs Discrete
Related Vs Unrelated
Indirect Vs Direct
Therapist Vs Supervisor
Facilitative Vs Hierarchical
Theory Vs Technique
STAGES OF DEVELOPMENT ALWAYS RELEVANT
Psychodynamic Model
• Focus on the intrapersonal and
interpersonal dynamics of the
counselor in relation to ALL others
• Dynamic Awareness Goal: understanding
dynamic contingencies:
– Impact of past learning on current situations
– Observing changes in the dynamic
– Making therapeutic use of dynamic in counseling
• Goal is to refine supervisee’s mode of listening
– Increase sensitivity to transference and countertransference
– Awareness of drives and defense mechanisms
Assumptions
• Similarities in structure and dynamics of therapy and
supervision- ISOMORPHIC RELATIONSHIPS
• Parallel processes between relationships
• Supervisor interprets this dynamic
• What is said and done is just the surface
Supervisor Kkills(sorry, Freudian
slip) I meant Skills
•
•
•
•
•
•
Listening
Musing
Suspension of judgment
Tolerance for ambiguity
Rejection of illusion
Think confession for therapists!
Developmental Stages
• Childhood
– Space to play, home base
– Bonding
– Demarcating space
• Adolescence
– Structure building
– Work and play-experimentation
– Conflict
• Adult
– Internalized values
– Identity settles
– Transition to colleague
Descriptive DimensionsPsychodynamic
•
•
•
•
•
•
•
•
•
Influential:
Symbolic:
Structural:
Replicative:
Counselor TX:
Information Gathering:
Jurisdictional:
Relationship:
Strategy:
Affective
Latent
Reactive
Parallel
Related
Indirect+
Therapist+
Facilitative
Theory+
Skills Model
3 Basic Tenets
1) Counselors must learn the appropriate skills and extinguish
inappropriate behaviors
2) Supervision assists counselors in developing and
assimilating specific skills
3) Counselor knowledge and skills should be formulated in
behavioral terms
9 Methods of Skill Supervision
1. Establishing a Relationship between supervisee and
supervisor is a dynamic component of the learning process
– Focus is on skill acquisition via instruction and modelling
2. Supervision begins by asking what one needs to lean to be
an effective counselor
– Current skill level? What skills are needed? Task list?
3. Set realistic, measurable and timely goals to enhance
motivation
–
Is this reminding anyone of SMART goals and MI?
Methods Continued
4. Modeling and reinforcement are basic tools
–
Two way modeling: supervisor to supervisee and back again
5. Skills monitoring is ongoing
Methods Continued
6. Role Playing and Simulation
7. Microtraining-breaking down skills into small steps
–
–
Simulated session that is video taped
Supervisor provides feedback and re-demonstrates on tape
8. Other Techniques are added
–
–
–
Self management
Overt and covert stimulus control
Relaxation Training
9. Generalization of Skills
–
In what other situations might you use . . .
Task Oriented Model
Taking Supervision to Task
• Drawn from behavioral and computer science models
• Behavioral variables are manipulated to influence outcome
of supervision
• By reinforcing the variables of counselor behavior,
supervisor can train more effective counselors
• Not specific to any theoretical models
• Tasks and reinforcement/shaping can be applied to specific
skills for whatever model or technique an agency is using
Direct Observation
• Direct viewing of work is key
• Modeling, feedback and programmed interventions
• Using live material for supervision
Hierarchical System/3
Levels/Parallel Activity
Client level
1. Client database-what is going on with me
2. Client comes with set of hopes/goals
3. Make goals overt
4. Establish treatment plan
5. Put treatment in place
6. Goals met
7. Termination
Counselor Level
1. Preparation
2. Establish client data base/evaluation-what is going on with
client
3. Determine goals
4. Develop treatment plans
5. Carry out treatment plans
6. Evaluate progress
7. Goals met
8. Termination procedures
Supervisor Level
1.
2.
3.
4.
5.
6.
7.
Supervisor and Client Database-what is going on with them?
A. Supervisor preparation task
B. Determine supervisee’s preparation task
Determine Supervision goals
Supervision Plan
A. Determine Assessment Procedures
B. Determine Observation Procedures
C. Present Supervision Plan
Observe Therapist
A. Observe Delivery
B. Observe Impact
Evaluate and Intervene
A. Case file and assessment results
B. Interview with Counselor
Determining Counselor Progress
A. Update counselor database
B. Determine need for additional training/supervision
End Supervision
Developmental Stages-Skills
• Apprentice
– Motivated
– Inwardly insecure/anxious
– Eager to please
• Journeyman
– Demonstrates some skill
– Some challenging behavior
– Starting to generalize
• Expert
– Able to generalize across contexts
– Mastered technical skills
– Integrated personal model of therapy
Descriptive Dimensions-Skills
•
•
•
•
•
•
•
•
•
Influential:
Symbolic:
Structural:
Replicative:
Counselor TX:
Information Gathering:
Jurisdictional:
Relationship:
Strategy:
Cognitive
Manifest
Proactive
Discrete
Unrelated
Direct
Supervisor
Hierarchical
Technique
Descriptive Dimensions, Really?
•
•
•
•
•
•
•
•
•
Influential:
Symbolic:
Structural:
Replicative:
Counselor TX:
Information Gathering:
Jurisdictional:
Relationship:
Strategy:
Dynamic
Skill
Affective
Latent
Reactive
Parallel
Related
Indirect+
Therapist+
Facilitative
Theory+
Cognitive
Manifest
Proactive
Discrete
Unrelated
Direct
Supervisor
Hierarchical
Technique
What’s Next: Blended Model
• Blended Model acknowledges that substance use providers
need their own model
• Also called contemplative because it includes spiritual and
faith based elements
• Recognizes that successful supervision BLENDS both
insight and skill based models
• Philosophical model is evidence based AND consistent with
substance use professionals training and agency goals
COMING SOON TO A CAPA NEAR YOU
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