Conversations Regarding
Pam Santon MSW RSW
Registered Marriage and Family Therapist
Registered Sex Therapist
Approved Supervisor AAMFT
My Objectives for Our Conversation
• To underline the importance of supporting
supervisee’s in their support of clients through
competency-based supervisory practices
• To review basics of Supervisory processes
• To emphasize the need for Reflective Practice in
promoting the change process of clients
• To increase comfort with ‘Person of the Therapist’
methods of Supervision in promotion of the
professional development of supervisees
• To allow reflection of supervisory practices
Positioning You in the Conversation
Reflective Exercise #1
• How many people in the room are currently
Please take 5 minutes and talk to 3-4 of your
neighbours about the following:
• How does your program currently provide
supervision? Who gets supervision and
when? Who supervises who? What is it like
for supervisors? What is it like for
• As you consider your current supervision
system, what is working well? How do you
know? And what do you think needs change?
How do you know?
Positioning Myself in the Conversation
• My own experience of receiving supervision, or not
receiving it
• Clinical Director-ASYR 1992-2008: from 4 staff to 4
• Supervisor in private practice since 1996 including
the supervision of:
- Individual therapists or a group of therapists working
towards Clinical Membership or Approved Supervisor
Status with AAMFT
- Social Workers in the Ministry of Long-term Care and
a Family Health Team
- Peer Support Counsellors in the Ministries of Labour
and Natural Resources
- Students in a 4th Year Practicum Course in Family
Relations and Human Development
The Tricky Terrain of
Supervision in
the Field of Addictions
Specific Challenges in the Work of Addiction
• Clients presentation: Poly-addictions including
Process Addictions, Co-occurring Mental Health
issues, Trauma histories
• Visitor and Complainant Status of many clients and
frequent no shows
• Family Dynamics of client system and their feelings
of powerlessness
• Difficulties of clients with labelling and managing
feelings which often results in slow pacing of the
work and frequent relapse
• Polarized Models of Interventions
• Large caseloads and waiting lists
• Marginalization of the clients and their issues; and,
therefore the field and those who work in it: underserviced, underpaid
Supervising in the Addiction Field
• High caseload numbers and long waiting lists to
• Staff presenting complicated client issues and the
isomorphic pattern of powerlessness across the
levels of the system
• Sometimes less than satisfied, stressed-out staff
experiencing compassion fatigue, vicarious trauma
and/or burnout
• Responsibility for vacation and sick leave coverage
• Own caseload to serve to manage
• Managers, Executive Directors and Boards to
Why ‘Supervisee-Centred’
Frontline Staff as the Backbone of
the agency!
The Risk of Empathy
“After all, it's our gift for empathy
that draws us to our work. And yet,
empathy at full throttle--felt and
projected 100 percent with our
bodies, hearts, and minds--has its
Babette Rothschild
‘Boundaries Lost’
The Burnout Syndrome
• physical and emotional exhaustion as clinicians
develop negative self-concept, negative job attitudes,
and loss of concern for clients (Pines & Maslach,
• physical symptoms like fatigue, gastrointestinal
irritations, insomnia, and hypertension (Farber, 1990)
• emotional symptoms including despair (Kestnbaum,
1984), boredom and cynicism (Friedman, 1985),
withdrawal, and depression (Jayaratne & Chess,
• interpersonal problems, both in the workplace as
well as with family and friends (Kahill, 1988).
Risk Factors
• Unrealistic therapeutic expectations
• Allowing personal issues to interfere in
professional practice (loss of boundaries)
• Working with clients with particularly severe
or traumatic issues
• Working in a community agency
• Being new to the field
• Being male
Supervisors as ‘Back Braces’
‘Strengthening the Core Muscles’
Myths of Individual Coping,
Realities of Organizational Policy
Kyle Killian 2007
“Stop blaming the victim for lack of life balance”
- Agencies to take responsibility for burnout by:
Better distribution of caseloads to ensure lower
numbers of trauma clients per counsellor
Reduced caseloads and more reflective supervision
Better policies to give frontline staff an increased
sense of control, efficacy & support
Clearly defined teams (Borrill 2000)
Participation in political advocacy
Role of Supervisor’s
in the Prevention of Burnout
Rosenberg, T. Pace M., PhD 2010
• In-service training on burnout
• Setting expectations about self-care
• Limit-setting around client numbers and
administrative duties
• Prioritizing supervision, peer meetings and
• support groups
• Modeling self-care, case consultation and self
• Including person of the Therapist issues in
supervision including: unresolved FOO issues,
therapist’s need to be liked, over-involvement &
feeling personally responsible for client-change
General Functions of Supervision
The Role of Supervision in Social Work
(An Irish Study 2010 Jeanne Marie Hughes MSW)
• Prevent stress and burnout in a profession
dedicated to paying attention to someone else’s needs
(Hawkins and Shohet 2006)
• Contains or manages anxiety and helps to cope with
the demands that the work entails (Brearer 1995)
• Supports reflective practice on the use of discretion
and judgment (Gould and Baldwin 2004)
• Educates, supports and manages (Kadushin 1992,
Morrison 2003)
• Teaches, guides, counsels and directs
(Page/Wosket 1994)
• Facilitates learning, provides an opportunity to plan
and evaluate work, supports workers and
promotes good standards of practice and
protection of the public (McGuiness 1993)
‘Great Supervisors’
• Non-judgmental and accepting of the supervisee’s
inexperience and mistakes
• Accessible and Available regularly for
conversations (weekly) (answer questions, offer
advice and provide feedback)
• Collaborative as well as directive
• Trusting of their abilities and potential
• Trustworthy and respectful of their information and
learning process
• Giving of their expertise and experience
• Modeling of professional practices, boundaries and
• Culturally sensitive and Informed
Great Supervisor’s Build
Resiliency in Supervisees
• By building trusting, safe relationships
• By being present and modeling positive
communication skills
• By being open and receptive to mistakes in
themselves and others
• By modeling self care
• By being reflective and mindful in their
interactions with supervisees
Components of
Quality Supervision
• Individual Supervision: 1.5 hours bi-weekly
(.5 administration, 1.0 clinical)
• Individual Training per learning Goals
• Group/Team Supervision
• Specific Training as a Team/Agency
• Peer Consultation- Formal and Informal
• Professional Consultation
• Supervision of Supervision
• Employee Assistance Program
According to the Literature
Addiction Counselling Competencies (98) The Knowledge, Skills, and
Attitudes of Professional Practice, TAP (Technical Assistance
Publication) 21 US Dept. of Health and Human Services, SA and MH
Services Administration, Centre for Substance Abuse Treatment 2008
Clinical Supervision Handbook A Guide for Clinical Supervisors for
Addiction and Mental Health, CAMH, 2008
Clinical Supervision and Professional Development of the Substance
Abuse Counsellor TIP ( Treatment Improvement Protocol) 52, US
Dept. of Health and Human Services, SA and MH Services
Administration, Centre for Substance Abuse Treatment 2009
Competencies for Substance Abuse Treatment Clinical Supervisor
TAP 21-A US Dept. of Health and Human Services, SA and MH Services
Administration, Centre for Substance Abuse Treatment 2008
The ‘Yin and Yang’
of Supervision
Supervision 101:
Roles, Stages, Power,
Relationship, Parallel Process,
Reflective Practice
Structuring Supervision
The Yin/Yang Continuum
(Jay Reeve-
Supervisory Practices
Technique- Based
Process- Based
- New to the field
- Focus on clinical
or position
- Crisis management
- Parallel Process
- Manualized treatment
- Development of
Anxiety producing
own therapeutic style
situations (ethical, SI/HI, policies etc)
Above all else,
In Taoist philosophy, truth does not lie in one pole or the other,
in yin or in yang.
Instead, the task of the sage is to provide what is lacking for
balance and integration..
When they think they know the answers
People are difficult to guide
When they know that they don't know
People can find their own way
Tao Te Ching (S. Mitchell, trans.), Harper Perennial; 1991.
The Many Hats
of the Supervisor
QuickTime™ and a
are needed to see this picture.
Isomorphism and Parallel Process
in Supervision
• Origins in the psychoanalytic concepts of
transference and counter transference
• Transference occurs when the counselor
recreates the presenting problem and
emotions of the therapeutic relationship within
the supervisory relationship
• Counter-transference occurs when the
supervisor responds to the counselor in the
same manner that the counselor responds to
the client.
• Thus, the supervisory interaction replays, or
is parallel with, the counseling interaction.
Conversations about Parallel Process
• Can increase self awareness and
professional growth
• Easier for the more experienced counsellor
because of their confidence in their
knowledge and methods of intervention
• Can cross the line into therapy so supervisee
permission is always required
• Supervisor should always pay attention to
how the therapeutic relationship and client
issues are presented by the counselor in the
supervisory session and use the awareness
as an intervention in facilitating growth in the
counselor, thereby helping the client
What Works in Therapy:
Project MATCH and the Alliance
Babor, T.F., & DelBoca, F.K. (eds.) (2003). United Kingdom:
Cambridge, 113.Treatment Matching in Alcoholism Treatment
• The largest study ever conducted on the
treatment of problem drinking:
• Three different treatment approaches studied
(CBT, 12 Three different treatment
approaches studied (CBT, 12- -step, step,
and Motivational Interviewing)
• Difference in outcome between approaches..
The client rating of the therapeutic alliance
was the best predictor of: Treatment
participation; Drinking behavior during
treatment; Drinking at 12- month follow up
The Clinical Responsibility
of the Supervisor
Anything the supervisor can do to reinforce
the therapeutic alliance will improve outcome.
Sound clinical supervision, including reflective
practice on ‘use of self’ and the person of
therapist, needs to be a priority for every
clinical setting.
Supervision Chain of Impact
Quality of
Impact on
Quality of
The Supervisory Relationship
• The relationship is the key to successful
supervision (Pritchard 1995).
• Trust is central to the supervisory
relationship. Supervision cannot proceed in a
climate of mistrust. Supervisor and
supervisee must work to establish a trusting
• Supervisor must be diligent to avoid using
information learned in the supervisory
process against the supervisee (Munson
Power in Supervision: Recommendations
for Supervisors and Supervisees
Murphy, M. 2005
• The results of this study highlight that positive
uses of power can enhance the supervisory
• “it is imperative for supervisors to model
appropriate uses of power for supervisees, so that
they will appropriately use power with their clients.
- empowerment in the supervisory relationship
isomorphically results with empowerment in the
therapeutic relationship”
• Open Discussions of power include
a) using the term Power in discussions
b) talking about power at the first supervision
session, and
c) revisiting power as a discussion topic throughout
the supervisory relationship.
Why Be Reflective?
• To Improve the quality of services
• To avoid clinical responses that can lead to
unintended and negative consequences in
• To replenishes counsellor reserves.
• To Avoid robotic practice, decisions,
• To builds confidence and creativity.
• To Strengthen:
• To foster empowerment, thoughtfulness,
Objectives of Reflective Supervision
Modelling Empowering Relationships
• Supervisor and clinician form a trusting relationship
• Establish consistent, predictable meetings and times
• Ask questions that encourage details about the
emerging relationship and the supervisee’s reactions
• Listen, emotionally present, teach/guide,
• To Integrate emotion and reason
• To foster the reflective process to be internalized by
the supervisee
• To explore the parallel process and to allow time for
personal reflection
• To attend to how reactions to the content affect the
Use of Self Model
‘Use of Self’ and ‘Person of the Therapists’
is a process through which therapists and
counsellors learn how to use their personal
emotional and cognitive reactions and
knowledge of self in order to:
1) inform conceptualizations of their clients
2) create a therapeutic relationship that is
collaborative and conducive to corrective
relating with the aim of overcoming
difficulties and facilitating personal growth.
Examples of
‘Use of Self’ in Supervision
1) Feeling stuck
around a separated
couple and wanting
them to reconcile.
2) Feeling powerless
with a supervisee
who wasn’t setting
clear boundaries
with a client
• Being triangulated in
FOO because of
cutoffs in own family
between siblings
• Inaction on the part
of the E.D. to
establish a policy
around domestic
3) Anger at a client for
frequent calls
between sessions.
• Fear of client taking
action on
professional ethics
4)Dislike of a client for
crying repeatedly in
• Feeling powerless
with emotional pain
• Withdrawal as a
protective move
How Personal Can
Supervision/Training Get?
Aponte 2004
1. Supervisees present their personal histories and
information about their life circumstances
2. Although supervisors may inquire about what they
believe is relevant, Supervisees are free to reveal
only what they wish to reveal
3. Supervisees and fellow team/group members are
bound by confidentiality for all personal information
revealed in the context of supervision.
4. Supervisors and supervisees are not to assume a
treatment contract (with all that implies) under the
guise of supervision
5. Supervisees may pursue personal treatment outside
the context of supervision, and Supervisors may
assist in this pursuit as appropriate.
‘To Thy Own Self Be True’-
Building or Revisiting
Your Philosophy of Supervision
Beginning with
‘The Self’ of the Supervisor:
Modelling Authenticity
Have a Supervisory Road Map:
A Philosophy of Supervision
A template for conducting supervision sessions.
A roadmap of your principles, knowledge and
behaviours as they relate to supervision.
Build a dynamic ‘Philosophy of Supervision’ that
clarifies your values, insights and beliefs in
this moment and review and update
Components of
a Philosophy of Supervision
Change and Components of Supervision
Developmental Stages of Supervision
Gender issues
Ethical Issues
Self of the Supervisor
Using a ‘Collage’ to define
Your Philosophy of Supervision
“I suggest that (Supervisees) avoid reifying human
predicaments into symptoms…. All of this is mostly a
matter of cleaning out enough psychological "debris"
so that supervisees can sit comfortably, listen
carefully, and think creatively. When I supervise, I
give example after example of interventions that
challenge clients' suppositions and help them explore
new terrain. Then I hope for the best. Perhaps
Marsha Linehan, the inventor of Dialectical Behavior
Therapy, put it best when she advised new students
to stop trying to act like therapists: "If they would act
like themselves, they would be better off. . . . All you
are trying to be is simply one human being trying to
help another human being. That's all this is."
Unfortunately, the(diagnostic) category obscures that
fact.”Jay Efran, Ph.D., Temple University.
Supervisee-Centred Supervision
Robert Taibbi: Clinical Director and Supervisor for 30 years
“The administrative stuff plays second fiddle to your real
job though: helping the supervisee--from scared
beginners to confident (sometimes overconfident)
pros to burned-out timeservers--figure out what they
need and how to weave together their strengths,
skills, and personalities into a unique and personal
clinical style.
Obviously, you need good supervisory skills, but you
must apply those skills in creative ways at different
times with different staff because one size definitely
doesn't fit all in this work.
It's the relationship between supervisor and
supervisee (rather than a set of skills, per se) that's
the key to helping him or her learn what it really
means to be a therapist and practice therapy.”
Using a ‘Collage’ to define
Your Philosophy of Supervision
“I suggest that (Supervisees) avoid reifying human predicaments
into symptoms…. All of this is mostly a matter of cleaning out
enough psychological "debris" so that supervisees can sit
comfortably, listen carefully, and think creatively. When I
supervise, I give example after example of interventions that
challenge clients' suppositions and help them explore new
terrain. Then I hope for the best. Perhaps Marsha Linehan, the
inventor of Dialectical Behavior Therapy, put it best when she
advised new students to stop trying to act like therapists: "If they
would act like themselves, they would be better off. . . . All you
are trying to be is simply one human being trying to help another
human being. That's all this is." Unfortunately, the(diagnostic)
category obscures that fact.”Jay Efran, Ph.D., Temple
My Personal
Supervision Philosophy
• Collaborative- power to as opposed to power-over
• Accountable to the client system and the agency
• Reflective in that the supervisee needs to be centred
and grounded in their ‘use of self’
• Necessary- frontline staff as the backbone of the
• Developing of the Unique Talents of the
‘professional part’ of the clinician
• Informed by client feedback and the literature
• Empowering of ‘the Person’ of the Clinician
• Strength-based- building on talents and abilities
• Mistake Friendly- aware that we learn through trial
and error
Exercise #2
‘The Person’ of the Supervisor
In groups of 3 or 4, identify the following:
a) The major models of therapy, counselling or
change process that you value.
b) A life experience that you have had that
informs your experience of supervision.
b) 2-3 Personal Strengths you bring to your
Supervisory Role
c) 5- 8 adjectives that best describe your values
in regard to your supervisory practices.
The Methods and Tools
of the ‘Yang’
of Supervision
Methods and Tools of Reflective,
‘Use of Self’,
‘The Person of’ Supervision
• Mindfulness
• Self Supervision
• Reflective
• Supervision of
• Outside Supervision,
Consultation and
Learning Contract*
Feedback Forms*
Evaluation Tools*
Cultural Genogram*
Mindfulness and Supervision
Mindfulness is intentionally being aware of
what really is in the current moment
Jon Kabat-Zinn
The aim of supervision of clinical work ought to
be supervision of the therapist’s own selfsupervision.
As Confucius said, Give a man a fish and you
feed him for a day; teach him to fish and you
feed him for a hundred years
(O’Hanlon & Wilk, 1987).
Benefits of Mindful Practice
Mindfulness and Supervision
AAMFT Supervision Bulletin 2010
• Reduces anxiety and increases calm
• Increases ability to be present and in the
• Reduces internal ‘chatter’ and negative self
• Increases self reflection and boundary setting
• Allows easier transitioning between clients or
• Increases clients/supervisee’s experience of
being heard, validated and responded to
Goal: to increase therapeutic presence
Regular practice of mindfulness meditation
with MFT supervisees resulted in significant
improvement of in-session skills
- Increased patience
- Increased ability to attend to the client’s
- Increased ability to attend to one’s own
- Reduced reactivity and judgment
- Better handling of challenges
Methods of Mindfulness Meditation:
Practices that bring the clinician’s awareness
fully into the present without judging or evaluating
that experience
• Meditation
• Body Awareness: Body Scan- what is
your body telling you
• Body Movement: dance, walk
• Journaling
• Art
The Reflective Supervisory Conversation
(Leonardo daVinci Institute, The Netherlands 2008)
Discuss the alternatives
Process is lead by supervisor
Co-construct new ideas
Explain your point of view
Discover supervisee‘s
point of view
Clarify Reception
Active Listening
Prompting Phrases for
Reflecting Practice
• “I’m wondering…”
• “Can we explore for a
• “What are your thoughts
• “How would you
• “What are the
possibilities you see
• “How will your
• “Can you tell me (a little
more) about…”
• “How would you
• “What would happen if
you tried…”
• “How do you
understand/Can you
help me understand…”
• “If you viewed this from
perspective, what would
you see…”
• “What do you need from
me today to feel
• Chronicle families and major elements of their
histories over a minimum of three
• Provide graphic annals of families
membership, characteristics, and
interpersonal relationships
• Reflect the transmission of family patterns
from generation to generation (Kuehl, 1995)
and provide a provisional blueprint for change
(Lieberman, 1979, p. 57).
Reflective Exercise #3
The Cultural Genogram
Constantine 2003
• In your small groups, discuss the
demographic variables you use to identify
yourself culturally including SES, race,
ethnicity, religion, gender/sexual identity,
education etc.
• What worldviews (e.g., values, assumptions,
and biases) do you bring to supervision
based on your cultural identities?
• What struggles and challenges have you
faced working with supervisees who were
from different cultures than your own?
Cultural Awareness Continuum
in Supervision Cross,1989
• Cultural Destructiveness- superiority of dominant
culture and inferiority of other cultures; active
• Cultural Incapacity- Separate but equal treatmentpassive discrimination
• Cultural Blindness- Sees all cultures and people as
alike and equal; discrimination by ignoring culture
• Cultural Openness (Sensitivity)- Basic
understanding & appreciation of importance
sociocultural factors in work with minority populations
• Cultural Competence- Capacity to work with more
complex issues and cultural nuances
• Cultural Proficiency- Highest capacity for work with
minority populations; a commitment to excellence
and proactive effort
Culturally Responsive Supervision
• Inclusive of the multiple awareness of self
and other
• Multi-cultural competence as a stated mutual
goal of supervision
• Strong working alliance in supervisory dyad
supports trust and respect vital for risk-taking,
development of self-awareness and
multicultural sensitivity
• Self awareness is a prerequisite for multi
cultural competency (Richardson&Molinaro
Teaching Multicultural Competence
- acceptance and respect for cultural differences in
supervisor/ therapist/client relationships
- adaptation of supervisory/therapeutic approaches to fit
socio-cultural contexts
- self-awareness regarding the impact of values,
attitudes, biases and cultural differences
- acquisition of cultural knowledge and sensitivity
- a multicultural experience in the world
- provision of services to accommodate diversity in
culture and socioeconomic status
- reflection on beliefs and behaviors related to age,
gender, ethnicity, power, religion/spirit uality, context,
Seek factual knowledge when faced with
new cultural situations
Develop an open and sensitive working
alliance with your supervisee
Practice Mindful awareness and teach it
Be aware that matching of supervisor and
supervisee personal characteristics does not
seem to be crucial in the creation of
meaningful relationships
Recognize that the ability of the supervisor
to discuss similarities and differences seems
to be the critical dimension
The Professional Genogram
Magnuson (2000)
to examine influences of professional mentors,
authors, and theorists.
parallel the family genogram structure
feature a chronology of direct professional mentors,
influential theorists and philosophies above
participant symbols
lines can be added to illustrate relationships between
the persons, philosophies, and entities that are
provides a forum for examining assumptions that
inform the person-of the-professional
Reflective Exercise #4
With 3-4 other participants discuss what
methods of Reflective Clinical
Supervisory practice you are currently
using and find helpful.
What other method or tool will you try next

MA1 - Supervisee-Centred Clinical Supervision