#76863: Clinical Supervision: A Person-Centered Approach

Supervision can have different meanings for different people. The word origin traces back to 17th century Latin, literally meaning "to look over." In this most basic definition of the word, it is clear it has multiple applications: parents can supervise their children at play, leaders can supervise volunteers, and employers can supervise those under their employ. In some professions, the supervisory relationship is simply one of a boss overseeing his or her employees. For instance, a movie theater manager may be responsible for making sure that his or her employees report to work on time and perform the tasks of their job description, like selling concessions, taking tickets, and sweeping theaters after shows. The manager may also be responsible for conducting quarterly evaluations and writing up or otherwise punishing an employee if he or she consistently fails to meet the tasks of the job. Ensuring that employees complete these tasks with efficiency is vital to ensuring satisfactory customer service, a priority for any person or entity running a business.

In consumer-driven businesses, supervisors can choose to be authoritarian, simply carrying out the function of management, or they can choose to see themselves more as mentors to those they supervise, helping supervisees grow in their job or their chosen profession. While taking on this mentorship component is an option in conventional business, it becomes a necessity in the helping professions. This combined mentorship and management component is the essence of clinical supervision. In examining educational trends in the history of the helping professions, discussion about clinical supervision is a relatively newer idea. In fact, there is little direct, empirical evidence within mental health professions to show that clinical supervision has an impact on clinician behavior and thus service quality with clients [1]. This is supported by reviews of the literature, with the majority of peer-reviewed literature on clinical supervision reading as theoretical in nature. Rather, the helping professions adopted the practice of clinical supervision as a measure of good common sense, carrying on the tradition of the master working with the apprentice that has existed in many professions for centuries.

Historically, Kadushin's definition of supervision is cited as one of the first guiding descriptions of what constitutes clinical supervision [2]. He described clinical supervision as, "an administrative and clinical process designed to facilitate the counselor's ability to deliver the best possible services to clients, both quantitative and qualitative, in accordance with agency policies and procedures, and the context of a positive relationship between counselor and supervisor" [2]. This foundational definition still resonates in the present day, especially because the duplicity of the administrative and clinical functions is acknowledged. Moreover, the imperative of quality supervision as a client care issue is directly stated in this seminal definition. In the Handbook of Clinical Social Worker Supervision, clinical supervision is defined as an interactional process in which a supervisor has been assigned or designated to assist in and direct the practice of supervisees in the areas of teaching, administration, and helping [3]. Kadushin's original thoughts, originating in social work, have been long regarded by the field of social work, with widespread acceptance in the field of clinical supervision as an effective practice [4]. However, the various helping professions have established their own definitions.

In the counseling field, clinical supervision is best defined as a process whereby consistent observation and evaluation of the counseling process is provided by a trained and experienced professional who recognizes and is competent in the unique body of knowledge and skill required for professional development [5]. In counselor education, supervision involves facilitating the counselor's personal and professional development as well as promoting counselor competencies for the welfare of the client [6].

The purpose of supervision in substance abuse counseling is to bring about change in the knowledge, skills, and behavior of another individual, typically one with less training and experience than the supervisor. Regardless of various models or definitions, there are five essential components that constitute supervision in the field of substance abuse counseling [6]:

Finally, in psychology, supervision is a distinct professional activity in which education and training aimed at developing science-informed practice are facilitated through a collaborative, interpersonal process. It involves observation, evaluation, feedback, the facilitation of supervisee self-assessment, and the acquisition of instruction and skills by instruction, modeling, and mutual problem solving [7]. Although there are solid merits in each definition, this last description serves as the best operational definition for this course. Not only does it cover many of the components of clinical supervision and the activities involved, but it emphasizes two key components that are essential to person-centered supervision. First, like in person-centered therapy, supervision is a collaborative process. Second, clinical supervision is educational in its nature. Although there may be managerial and legal/ethical implications in any given supervisory relationship, supervision is fundamentally an educational activity, a critical part of a helper's professional formation.

Formation is a term often used in seminaries and monastic life to describe the process by which a person responding to his or her vocation (or "calling") learns how to live the calling to the fullest. Formation entails receiving mentorship and formal instruction and growing through the initial trials or tests, often called a novitiate or probationary period. So much of what new helping professionals experience during their initial internships and first several years in the field parallels the concept of formation, and by choosing to view supervision as a function in assisting formation, supervisors can truly help new professionals to live their callings to help to the fullest. As British psychotherapists Peter Hawkins and Robin Shohet express, "supervision can be a place where a living profession breathes and learns" [8]. This is a beautiful concept, yet it is up to supervisors to create and foster an environment that is free of professional suffocation. This course will explore how adopting person-centered concepts into the function of supervision is optimal for establishing and maintaining such an environment.

One of the core principles of the person-centered approach to psychotherapy is empathy. It may be valuable to pause and reflect on what empathy means to you. Perhaps it is more of a feeling or a body-level, visceral reaction to a specific memory in which someone showed empathy in a difficult situation. Empathy is a human quality that can manifest in a variety of arenas, not just in psychotherapy, and it is perhaps the inherent compassion of empathy, shown amongst people, that makes it so powerful.

A colloquial phrase often intoned to explain empathy is being able to "step into the shoes" of another person. German philosopher Rudolf Lotze coined the term empathy, as a humanistic concept, in 1858. The German word Einfühlung literally translates as "in" and "feeling." The derivation is from the Greek empatheia, em meaning "in" and pathos defined as feeling. Interestingly, pathos is also the root of the words "passion" and "pain," two elements of living that are significant to human experience and, of course, to psychotherapy. Although English language dictionaries interpret these origins in a variety of ways, useful definition of empathy to those in service professions appears in Stedman's Medical Dictionary, which defines the term as the "direct identification with, understanding of, and vicarious experience of another person's situation, feelings, and motives" [12]. When it comes to having empathy for supervisees, this final word of the definition (motives) is a significant part of the process. Consider that every helper is drawn into the field for a certain reason or a variety of reasons; these reasons constitute the motive of a developing helper for being in the field in the first place. Motive is a fascinating component of empathy that is not often considered, but it can help one to appreciate another person's perspective. Appreciating an individual's perspective is a key factor in being able to mentor, to coach, and ultimately to work with that individual.

Reflection

How could appreciating a supervisee's motive for becoming a helper and choosing to work in the helping professions help you to better supervise him or her?

For psychotherapeutic professionals, empathy is often associated with the person-centered or humanistic approach to psychotherapy and its father, Dr. Carl Rogers. Along with other elements, such as unconditional positive regard for the client and congruence, practicing empathy is vital to adopting a person-centered approach. Rogers created a metaphor of empathy as a dance between a client and the helper serving the client in order to explain the concept [13]:

If you re-read this passage, replacing the word client with supervisee, and the word therapist with supervisor, one has a good idea of the application of the metaphor. Consider whether or not this metaphor of "the dance" can make sense within the supervisory relationship.

On first reading, it may be concerning to think of giving supervisees this much autonomy, especially when one's license could be at risk if they end up going in an unforeseen direction. However, in any structured dance, one of the partners is the leader while the other is led. If one feels that he or she is being led erratically, they can halt the dance in order to make adjustments to correct the original problem. On the other hand, if both dancers try to lead, the overall training ultimately suffers. As scary as it may seem, the supervisees are the ones leading; they inform the supervisor of their needs and of where they need to go. One can best supervise by following their lead, knowing you have every right (and responsibility) to intervene if something is clearly wrong.

Reflection

What other ways can the concept of "the dance" as an empathetic concept be applied to clinical supervision? How might this metaphor work into your style of clinical supervision? Staying with the "dance" metaphor, how can embracing other person-centered principles, like unconditional positive regard and congruence, impact the supervisory relationship?

Psychiatrist Irvin Yalom is perhaps best known in the context of his text on group therapy [14]. However, one of his later works, The Gift of Therapy, may have a greater application to our professional formation as clinical supervisors [15]. In this text, published more than 30 years after his seminal piece on group therapy, Yalom declares that in spite of all his years writing about techniques, it really is the relationship that matters most [15].

Written in plain English as an "open letter" to young therapists, the book's thesis is that therapy should not be theory-driven, but relationship-driven. Yalom contends that our heightened sensibility to existential issues deeply influences the nature of the therapeutic relationship and the therapy itself [15]. According to this perspective, a therapist has no place forcing solutions, a piece of guidance that may be helpful in clinical work, especially with clients who seem to be labeled as "difficult" cases. This does not mean that supervisors should abandon theories, models, or technical training, but simply that letting humanity take precedence and focusing on building the relationship with supervisees should be a priority.

Reflection

Think about Yalom's assertion that therapy should be relationship-driven, not theory driven. Now consider applying this to supervision: Supervision should be relationship-driven, not model-driven. What benefits can be derived from taking this approach?

Although the relationship-based ideals expressed by Rogers and Yalom may sound humanistic but not exactly scientific, they are supported by the research literature. Several leaders in the field, in investigating what works in psychotherapy, assert through use of meta-analytic research and literature that the relationship is the vital ingredient in what makes therapy successful [16,17,18]. A term often used to refer to this concept is therapeutic alliance; however, in the context of clinical supervision, the term relational alliance is a better fit. A relational alliance is when two parties, such as a supervisor/supervisee, are engaging in a mutually respectful, trusting interaction, working toward a goal or benefit.

In the text The Heart and Soul of Change: What Works in Psychotherapy, Duncan, Miller, Wampold, and Hubbard assert that the collaborative, therapeutic alliance between client and clinician (and perhaps by extension the supervisee and supervisor) is a primary factor in determining successful therapy outcomes and is more important than the specific execution of therapeutic protocols [19]. They also stressed that obtaining continuous client feedback throughout the therapeutic process is critical to enhancing client care. When this literature is examined as a whole, it is clear that little difference exists among the specific factors (e.g., technical elements) of researched therapeutic therapies. Rather, there are a series of four common factors among these therapies that seem to be contributing to change. These common factors are: the clients and their extra-therapeutic factors (e.g., what they bring to the table in therapy and situations out of the control of the clinician); models and techniques that work to engage and inspire an individual client; the therapeutic relationship/alliance; and therapist factors. Interestingly, these four common factors were first proposed and published by psychiatrist Saul Rosenzweig in 1936, predating the work of Rogers and Yalom [20]. Rosenzweig, who grew discouraged with the "therapy wars" waging around him at the time, asserted the fields need to focus on the factors that all good therapies have in common instead of fighting over what is superior about a specific approach or technique. By respecting the common factors and focusing on these simple, humanistic elements, therapists can best meet people where they are coming in to therapy.

Respecting the common factors, as a therapist or a supervisor, does not give one permission to throw competence to the wind and abandon theory, technique, or model altogether. Rather, it is important to reconceptualize their meanings to the overall helping process. According to Duncan, Miller, Wampold, and Hubbard [19]:

Reflection

If you replace the word client with supervisee and the word therapist with supervisor in this quote, what do you notice? How might this apply to your approach to supervision?

Norcross arrived at similar conclusions in Psychotherapy Relationships that Work: Therapist Contributions and Responsiveness to Patients [21]. Using a collection of empirical research as part of an American Psychological Association Task Force, Norcross concluded that the therapy relationship, together with discrete method, influences treatment outcomes. Norcross further concluded that therapists can hone these relational elements and that it is their responsibility to tailor these skills to the needs of individual patients. Thus, the relationship should drive the theory, not the other way around, which is concomitant to Yalom's contentions.

"Imbuing fear" is the notion of being too afraid to do something, and this often happens with people trained in a new approach to therapy, especially with something that can seem complicated, like eye movement desensitization and reprocessing (EMDR) [23]. If trainers and instructors overload people with information, trainees can become afraid, fearing that if they miss one step, they will somehow mess up the whole therapy or do grave harm to a client. Although the desire to "do no harm" is noble, by focusing too much on little details, people can miss the big picture of therapy, such as how fostering a safe, therapeutic context is most likely to promote a healthy environment for therapy.

The same is true in supervision. Supervisees may become overwhelmed if they are bombarded with negative feedback and too many things to work on at once. Letting the supervisee know what is being done right (fostering confidence) and giving him or her no more than two or three things to work on at a time will result in the best outcomes. This can be accomplished in many ways, but one useful tool is what is referred to as the "compliment sandwich." In the "compliment sandwich," share with supervisees something that they are doing right, then insert an area of improvement, and then end with a compliment. While this approach may seem too soft to some, especially those of a more militaristic or direct temperament, it can be successful.

Often, people are so used to getting criticized that being praised and empowered in a genuine way becomes an effective supervisory technique. Shaming and criticism can make people defensive, especially if it causes them to doubt their own abilities or competencies. Recognizing this dynamic is part of what fostering confidence is all about. Working with new counselors who are very raw and seem to need a great deal of work can make the art of fostering confidence difficult, but it can be done. Even starting with a singular strength and building upon it will get farther than focusing only on all of the areas that need improvement. When working with supervisees, make it a point to tell them what they are doing that is positive and beneficial to those that they serve. A simple "You can do it!" can go a long way.

Trouble can arise if a supervisor focuses on the specifics of a technique and imbues fear by focusing on everything that can go wrong and being militant about following the letter of the law. By not focusing so much on the technique and what can go wrong, people are in a better place to learn, and this is a person-centered idea. As clinicians, we stress the importance of helping clients find their senses of self-efficacy and empowerment, so why would we not impart this same attitude of discovery and exploration with supervisees? Of course, correction may also be necessary. Remember the parallel of the dance: they are leading, you are following, but you have the right at any time to say "halt" if something seems amiss. Staying with the dance analogy, should a good partner criticize you and constantly make suggestions, or cheer you on for the good job that you are doing?

Let's apply this idea to the case of Ms. V, the young counselor who feels overwhelmed as an intern with agency work. How would she feel if, after criticizing herself already due to frustrating interactions with clients, her supervisor simply harped on her for everything that she was doing wrong? Part of a supervisor's job may entail evaluating areas of further training Ms. V should pursue, or perhaps it may require suggesting that Ms. V seek out some of her own therapy in order to work through her blocking issues. However, think of how much more smoothly broaching these issues will be if Ms. V knows her supervisor cares about her as a person. Here is an example of how a person-centered supervisory interaction could play out:

Supervisor: V, I got your email about the session you had with L (client in question) and that it took a toll on you. How can I best help you with this?

Ms. V: I don't know. I just feel in over my head.

Supervisor: Okay…Can you help me understand a little bit more about what you mean by "over your head"?

Ms. V: I mean, I have thought about it…I've really been thinking about it for the last several days, and I think he's right. I mean, what do I really know about real life? I'm just a privileged little white girl who has a degree.

Supervisor: Wow, that's heavy…Is that what L said?

Ms. V: More or less.

Supervisor: And you've been thinking about this for the last several days since it happened?

Ms. V: That's all I've been able to think about.

Supervisor: Wow, that's heavy stuff, V. I'm sorry that you've been beating yourself up about this issue. I just want to assure you that you are not alone here. We have all been told off or talked down to by clients at one point or another during our careers.

Ms. V: Really?

Supervisor: Absolutely.

Ms. V: It just seems to come so easy for so many people.

Supervisor: I hear that it can seem that way. You may have heard that cliché before that everyone who's an expert at something was once a beginner. That applies here, too, V.

Ms. V: I just feel like I'm not cut out for this.

Supervisor: Can you tell me more about that?

Ms. V: Well, yeah. I mean, the people that we're dealing with here in the city. I've just never had to deal with this kind of pain before. I can't even imagine what it's like to be on welfare, or to have parents that ran off on you, or to be addicted to drugs. I want to help people, but I just don't know what to say.

Supervisor: I hear that. What seemed to bother you the most about what L said to you?

Ms. V: I don't think it was what he said as much as how he said it. Just that he towered over me and I felt paralyzed to say or do anything. I get that I can never really understand what's going on in his life, but he was so harsh about it.

Supervisor: Interesting. There are a couple of ways we can approach this. We can look at what about this interaction with L triggered things for you. Or we might re-examine what you remember saying in the conversation that seemed to set L off. You tell me, V, where do you need to go with this?

Reflection

What are the person-centered approaches that you see at work with Ms. V in this interaction? If you were in Ms. V's shoes, how would you react to this approach/the beginning of this supervisory interaction?

In many cases supervisors face a choice of going by the book, or following their intuition. Some people are "by the book" and more interested in following the letter of the law, and others have more of a free-spirited, intuitive, experiential orientation. Some want to see an empirical research study to inform every intervention, while others are content with the feedback that they receive from clients or others. Others approach decision making in the human services with a combination of these approaches: the letter and the spirit, the logic and the intuition, the research and the experience. All vantage points can be helpful in the human services professions, and this applies to supervision as well.

Of course, all supervisees are different, so the approaches used with them must differ in order to be truly person-centered and meet people where they are. Although some may request technical instruction and specific feedback, many supervisees are looking for an experience richer than the technical elements that they can read in a text. Textbooks are full of information about what to do in theory, but guidance from an experienced supervisor gives a better understanding of the art of counseling and how to handle tricky scenarios that clinical life entails.

As a supervisor, it is important to give your supervisees options. An experienced clinician can respond to supervisees' questions regarding complex scenarios by presenting what the textbook says to do and what he or she would actually do (if they differ), providing information on both perspectives on the matter. Offering choice is the very essence of empowerment.

Some experts argue that the field, as a whole, would be enriched if practitioners candidly shared what they actually do, as opposed to what the standards state [23]. Offering supervisees choices on how to handle a situation, just like the supervisor gave Ms. V a choice on where she wanted to go with her supervisory session following the difficult encounter with a client, is paramount, especially if a person-centered approach to supervision is desired. Here's an example of how this choice dynamic may play out with a different supervisee, Mr. B:

Supervisor: So, what would you like to work on today?

Mr. B: Well, I'm struggling. When I was in treatment all of those times that didn't work, I used to get pretty nasty with counselors when they brought up the idea of going to AA or NA meetings. Then, I got clean in a 12-step program and it all clicked, as you know from my story. So now when I talk with clients about meetings or using 12-step language, they're getting smart with me the same way that I used to get with counselors. And it's frustrating me like crazy. I just want to shake them sometimes and tell them that they're going to keep failing until they get into a program.

Supervisor: I see. Well, I can relate to some extent. It can be a struggle when you feel that, as a person, you worked hard and something really clicked for you, and you just don't see why others won't get it too.

Mr. B: Yeah, that's a big part of what's going on. I didn't think it would bother me so much.

Supervisor: What do you think you need to do to address it?

Mr. B: I mean, meetings are the only way for a person to get clean. How can I make them see that?

Supervisor: Well, let me share this with you. Technically, if we look at what the studies in the field say about getting sober, we know that meetings aren't the only way to get and stay clean, although they are certainly one of the most popular and effective ways. Again, that's what the field as a whole teaches, so we need to respect that. But what this treatment center has learned through experience and feedback is that meetings seem to work the best for the most people who come through our doors…if they want to stay sober long-term.

Mr. B: I don't know if I buy that. About what "the field" says.

Supervisor: I'm not saying you have to buy it, B. I'm just sharing the information with you. What you do with it is up to you. I'm just asking you to keep an open mind to it and think about how sharing both sides with a client, like I just shared with you, might be helpful.

Reflection

Think about the dichotomy of rules versus intuition. Which best represents your approach to clinical supervision, or do you embody both? Have you received feedback from your supervisees about which they most value?

Outcomes, or clear data/evidence to show whether or not (or to what extent) a certain intervention is effective, are an important component of evaluation in the psychotherapeutic professions. Certain agencies and accrediting bodies place more value on outcomes data than others. Regardless of what one's opinion about tracking formal outcomes, consider that reviewing a treatment plan to see if something is working to help a client reach his or her goals is a way of measuring and evaluating outcomes. Clinicians must be able to demonstrate which interventions work, not only to the entities (like third-party payers) who are supporting treatment, but to clients so that they stay engaged. Some clinicians are advocates of tracking outcomes on an agency-by-agency and case-by-case level to most effectively determine whether or not an approach is working [19]. However, the thought of asking a client "How am I doing?" scares many clinicians, because they fear they might not be able to handle what the client shares. Although it can be frightening, consider how setting an honest culture of feedback within the therapeutic context can foster a more interactive therapeutic alliance. Setting the culture of feedback consists of assuring the supervisee that he or she will not be punished for sharing honest reactions and following through with this commitment.

The same commitment to setting a culture of feedback can be practiced within the supervisory relationship as well. Because of the precarious power dynamic that may exist between supervisee and supervisor, following through on this commitment to non-retaliation becomes imperative to achieving and maintaining this healthy feedback culture. A supervisor can simply obtain feedback by asking at the end of each session or every few sessions. Some examples include, "How useful was the session for you today?" or "Is there anything I could have done differently today that might help better next time?" The fact that a supervisor asks these questions can help to forge the professional relationship.

Supervisors can also elicit this feedback within a session, on a micro level. When sharing a suggestion or offering guidance to a supervisee, ask if the suggestion feels right or is helpful. If a culture of feedback has been promoted within a solid relational alliance, this feedback will be reliable. Consider how a dialogue in this approach might play out between Ms. T, another case outlined previously, and her supervisor:

Ms. T: I find that J (a client on Ms. T's case load) is frustrating me more and more. I don't know if she's just rubbing me the wrong way or if I'm doing something wrong.

Supervisor: What seems to be the source of the frustration?

Ms. T: Well, she comes into session, always with a catastrophe, just chattering and chattering away and I can't get a word in edgewise.

Supervisor: Hmm…Did you ever deal with these chatty types when you were working at the hospital?

Ms. T: Sure, but it never seemed to be this bad. And I never have this sense, like I had with J, that she's expecting me to fix things for her. And I mean, how can I fix things for her? She won't let me suggest anything.

Supervisor: Well, that is a very good point. Just to look at it though, did you ever do anything with your clients at the hospital that seemed to get them on track?

Ms. T: Well, it's little, but I usually found that the "take a deep breath" line would work, even if I was interrupting them to suggest they take a breath.

Supervisor: I think that you're on to something, T. In my work, I really praise the benefit that breath and using the body can have with clients. So let me share with you something I've tried before with clients like J.

Ms. T: Okay.

Supervisor: Clearly, there is some type of relationship established because J keeps coming back for sessions and seems to trust you. So, the next time that she comes in, after you get the initial hellos out of the way, be assertive. Ask if she is willing to try something different to start this session. Ask her if she would be willing to just do some breathing for the first 5 minutes of the session, before you do any talking.

Ms. T: Interesting. You think that would work?

Supervisor: I've tried it before with some success with those chatty types of clients or those who want to analyze everything.

Ms. T: What if she resists?

Supervisor: That's definitely a possibility. Whenever a client puts up a protest, a common line that I use is, "Would you be willing to try it? It's something different than what we've been doing and I have a feeling it may work better for you." Make her realize that you are interested in trying every possible option to help her.

Ms. T: That's a good point. I never thought of it that way.

Supervisor: How is this suggestion we just discussed resting for you?

Ms. T: I like it. It feels good, and it's certainly worth a try.

Reflection

What does feedback mean to you? What frightens you or concerns you about directly asking for feedback from a supervisee?

At one time or another, you have likely asked a client, "What is this really about?" For instance, a client may be having an intense reaction to what seems to be a petty stressor, but it becomes clear after observing some deep, visceral level distress that something else is going on. Perhaps that "petty" work stressor is a reminder of a stressful dynamic with an abusive parent. Within the context of a working, therapeutic alliance, asking a client to examine the underlying cause of distress can be a powerful intervention, and it can be in clinical supervision as well. However, one should not use this strategy with a supervisee who is new or with whom you have not formed a working relational alliance yet. This question can backfire if the supervisee ends up resenting it. But, if the alliance is established, this simply placed question can open up a world of new discovery. Let's revisit the supervisee case of Ms. V and the dialogue explored in an earlier session about her struggles with her client, L, and see how the approach of asking what the distress is really about may work with her. Remember that the conversation left off with the supervisor giving Ms. V an option about what she most needed to address:

Ms. V: I don't think it was what he said as much as how he said it. Just that he towered over me and I felt paralyzed to say or do anything. I get that I can never really understand what's going on in his life, but he was so harsh about it.

Supervisor: Interesting. There are a couple of ways we can approach this. We can look at what about this interaction with L triggered things for you. Or we might re-examine what you remember saying in the conversation that seemed to set L off. You tell me, V, where do you need to go with this?

Ms. V: I'm not sure.

Supervisor: Well, just take a minute then. You can close your eyes and get silent if you need. Ask yourself where you most need to go today.

Ms. V: Okay. (She briefly pauses) It's the way he just got up and stood over me. I felt very unsafe.

Supervisor: Okay, V. That's very honest. If I can ask, being towered over like that and not feeling safe, what is that really about?

Ms. V: Wow, I didn't think of that parallel. Whenever my parents doubted my opinion on something, especially about my career choice and field of study in college…whenever I fought them on anything, they would stand up, even if we were at the dinner table. It's like it was their way of making me feel small. Even if we were all standing during an argument, it would seem like they became 10-foot-tall giants when they started to argue.

Supervisor: How interesting. Is there a chance that your interaction with L triggered this dynamic with you?

Ms. V: Oh, absolutely. And I think it hit me even harder because my parents never really wanted me to go into this field in the first place, even though they financially supported my education. It's like L telling me I don't know what I'm doing is hitting me even harder because that sounds like something they would say.

Supervisor: That's really fascinating, V. Is this something you're comfortable continuing to talk about with me or do you feel you may want to address it with someone else?

As a point of clarification, a supervisor, even a person-centered one, should never become the supervisee's therapist; obvious complications can arise with a dual relationship. However, it is inevitable that a supervisor will explore some issues of emotional significance with a supervisee, especially if these issues are triggered by on-the-job issues or if these issues impact one's ability to do the job. If it is clear that using the "what's this about" or other exploratory approaches opens up more than the supervisory relationship is designed to contain, it then becomes the supervisor's responsibility to explore the supervisee's potential need for clinical services of his or her own. That exploration is what the last line of this dialogue leads to. This idea will be explored further later in this course.

Reflection

Have you ever used the question "What is this really about?" with a supervisee? What type of results did it yield? Is there another way to ask this question in a manner that works better with your style?

A rupture is a break or a disturbance that causes impairment in flow or function. Ruptures can occur in every kind of relational alliance, whether it is a personal relationship, a romantic relationship, a therapeutic relationship, or a supervisory relationship [24]. A rupture occurs when something goes wrong, for whatever reason, in a relationship. Unless it's addressed in some manner, it can permanently alter the relationship and have an impact on its success or failure. Even if the original rupture is significant, if it is addressed effectively, it can positively impact the relationship overall.

Ruptures can happen in supervisory relationships for a variety of reasons. What is most important for supervisors to accept is that if they played a role in causing the rupture by offending or otherwise causing friction with a supervisee, they take responsibility and address it immediately. Just like the "golden rule" logic can go a long way, so too does the simple act of admitting when one is wrong. Many supervisors or managers are reticent to do this, feeling that it will make them look weak or that admitting fault can undermine authority. However, nothing creates more respect for those in power than when they can admit that they are wrong and correct a mistake.

Part of a supervisor's responsibility is being able to recognize what his or her part is in a situation and what part the supervisee may play. Of course, supervisors are not always in the wrong in the case of the breach and it is not totally their job to fix the rupture. However, it is their responsibility, if they know that a rupture exists, to bring it to light and attempt to elicit a repair with the supervisee, even if he or she is are clearly in the wrong. Consider how this dynamic might play out for the supervisor working with Mr. N, the PhD psychology student/social worker introduced earlier:

Supervisor: N, I need to ask how you feel things are going with our supervision sessions.

Mr. N: Oh, fine.

Supervisor: Fine?

Mr. N: Yup, no complaints. You're doing a good job, if that's what you want to know.

Supervisor: Thanks, N. Bringing this up with you is a bit tricky, because we've had a collegial relationship, and I'd like to think friendship, for many years now.

Mr. N: Uh, oh. I feel a lecture. What's the problem?

Supervisor: Now, don't jump to conclusions. There's just something I feel I need to address. According to the terms of our supervisory agreement for your psychology license, I need to meet with you in person at least once a week for our session. I've noticed that you've been showing up at least 15 minutes late to almost all of our sessions, and you're skipping a few of our meetings, which doesn't seem to be like you at all.

Mr. N: It's no big deal. I'm just really busy juggling my work at family services, my course work, coming here, and doing some of the new evaluation tasks I'm being asked to complete. I thought you understood this.

Supervisor: I'm sensitive to the position you're in. I'm just starting to feel like the time I'm setting aside doesn't matter to you or that these sessions are more of a chore for you than anything.

Mr. N: Well, to be perfectly honest with you, they kind of are. It's one more thing I have to do.

Supervisor: I can appreciate that. Is there any part of you that is resenting being supervised?

Mr. N: Well, it's kind of tricky, yes. I know there are some different tasks as a psychologist that I have to learn, but in essence, I'm just doing the same thing I've always done as an independent social worker.

Supervisor: I understand. But I would be dishonest with you if I kept pretending that everything was okay here. Above all, I want to make sure that you're alright and to see if there's anything I can reasonably do here to make this situation more beneficial for you.

Mr. N: Is it okay if I think about that and get back to you?

Supervisor: Absolutely. If I were in your situation and needed to go through supervision all over again to get a new license, I would probably be a little salty, too, so know that I can relate. I just hope we can figure out a way to move forward that works for both of us.

Reflection

Think about the concept of repairing a rupture. When is the last time one of your life relationships had a rupture that was able to be repaired? What was helpful in repairing the rupture?

These models are a sampling of available proposed models to explain counselor development. A common theme in all of these models is perhaps captured in a statement from Hogan's work: "The overall aim of supervision is to foster growth toward independence, moving the clinical trainee from student, to colleague, to expert" [25]. Supervisors are essentially guiding a new professional's growth through a process. Person-centered supervision acknowledges that each clinical professional's process, although one of growth, is unique to that person.

Reflection

Do any of the models described in this section jump out at you as effectively describing the clinical growth of a professional you are entrusted to supervise? Which of these models seem to best describe how you developed as a counselor?

The concept of self-care can be explored in each of the supervisory cases discussed previously. Assuming that a solid, relational alliance is in place, these cases will explore ways that a supervisor can make suggestions to a supervisee on improving self-care measures.

There are many ways to introduce self-care strategies to a supervisee in a manner that does not cross into the realm of therapy. Appreciating the context of their situation and their life is absolutely vital. If supervisees are resistant, it may help to bring up that self-care for the helper is ultimately a quality-of-service issue and an ethical imperative [36].

Prior to offering supervision services, counselors are trained in supervision methods and techniques. Counselors who offer supervision services regularly pursue continuing education activities, including both counseling and supervision topics and skills.

Counseling supervisors are aware of and address the role of multiculturalism/diversity in the supervisory relationship.

When using technology in supervision, counselor supervisors are competent in the use of those technologies. Supervisors take the necessary precautions to protect the confidentiality of all information transmitted through any electronic means.

Counseling supervisors clearly define and maintain ethical professional, personal, and social relationships with their supervisees. Supervisors consider the risks and benefits of extending current supervisory relationships in any form beyond conventional parameters. In extending these boundaries, supervisors take appropriate professional precautions to ensure that judgment is not impaired and that no harm occurs.

Sexual or romantic interactions or relationships with current supervisees are prohibited. This prohibition applies to both in-person and electronic interactions or relationships.

Counseling supervisors do not condone or subject supervisees to sexual harassment.

Supervisors are prohibited from engaging in supervisory relationships with individuals with whom they have an inability to remain objective.

Supervisors are responsible for incorporating into their supervision the principles of informed consent and participation. Supervisors inform supervisees of the policies and procedures to which supervisors are to adhere and the mechanisms for due process appeal of individual supervisor actions. The issues unique to the use of distance supervision are to be included in the documentation as necessary.

Supervisors establish and communicate to supervisees procedures for contacting supervisors or, in their absence, alternative on-call supervisors to assist in handling crises.

Supervisors make their supervisees aware of professional and ethical standards and legal responsibilities.

Supervisors or supervisees have the right to terminate the supervisory relationship with adequate notice. Reasons for considering termination are discussed, and both parties work to resolve differences. When termination is warranted, supervisors make appropriate referrals to possible alternative supervisors.

Students and supervisees have a responsibility to understand and follow the ACA Code of Ethics. Students and supervisees have the same obligation to clients as those required of professional counselors.

Students and supervisees monitor themselves for signs of impairment from their own physical, mental, or emotional problems and refrain from offering or providing professional services when such impairment is likely to harm a client or others. They notify their faculty and/or supervisors and seek assistance for problems that reach the level of professional impairment, and, if necessary, they limit, suspend, or terminate their professional responsibilities until it is determined that they may safely resume their work.

Before providing counseling services, students and supervisees disclose their status as supervisees and explain how this status affects the limits of confidentiality. Supervisors ensure that clients are aware of the services rendered and the qualifications of the students and supervisees rendering those services. Students and supervisees obtain client permission before they use any information concerning the counseling relationship in the training process.

Supervisors help supervisees learn ethical decision-making, a process that is both cognitive and emotional. Supervisors should discuss and model the process of identifying and exploring problems, looking at issues, values, principles, and regulations. Supervisors and their supervisees should discuss possible consequences, as well as costs and benefits, of certain actions. They should explore what actions best achieve fairness, justice, and respect for others, make a decision about actions to be taken, and evaluate them after implementation. When a supervisee makes an ethical mistake, he or she, with the assistance of the supervisor, should try to ameliorate any damage and learn how to avoid that mistake in the future. If appropriate or required by the jurisdiction, the violation may have to be reported to the licensing board.

The supervisory relationship is an excellent forum for supervisees to learn about boundaries with clients. Ethical issues related directly to supervision include the nature of the professional responsibility to the supervisee, appropriate boundaries, and responsibilities when dealing with incompetent or unethical behavior. Becoming involved in a romantic or familial relationship with a supervisee is an ethical violation and should be strictly avoided because it creates marked role conflict that can fatally undermine the supervisory relationship. If the supervisor recognizes a potential boundary issue with a supervisee, he or she should acknowledge it, assess how the boundary issue has affected supervision, and resolve the conflict. Although the supervisory relationship is between professionals, supervisors usually have more power in the relationship than supervisees. To avoid boundary problems and conflicts of interest with a supervisee, the ethical supervisor must accept his or her power and be comfortable in using that authority to ensure accountability and protect clients. Other ethical considerations include the following:

Supervisors should be discreet in sharing personal information and not allow it to become the focus of supervision. When personal information is disclosed, it should be brief and support the goals of supervision. Supervisors should explain their comments and rationale to help supervisees gain understanding of appropriate techniques to use in the interview process with clients.

Supervisors make supervisees aware of safety issues and train them how to respond to workplace conflict, respond to threats and harassment, protect property, and deal with assaults and their emotional aftermath. Supervisors help supervisees plan for safety in the office and in the community by learning non-violent response strategies and appropriate ways to respond to crises.

The social work supervisor should decide whether an alternative practice, a non-traditional social work intervention, is the best modality of treatment for a supervisee to use with a client. When a supervisee uses an alternative practice, the supervisor should have expertise of that practice and ensure that the supervisee has the prerequisite training and knowledge to perform the alternative practice. In situations in which the supervisor does not have the skills to provide the alternative practice, it may be necessary to involve a second supervisor. In such cases, the two supervisors should work closely together to avoid conflicts and ensure effective use of the alternative practice for the client.

Social work supervisors share responsibilities for the services provided to clients. Liability of supervisors has been determined by the courts and includes direct liability related to negligent or inadequate supervision and vicarious liability related to negligent conduct by supervisees.

Supervisors and supervisees should both have professional liability insurance. In an agency setting, a supervisor's potential liability is affected by his or her level of responsibility and authority. Supervisors should familiarize themselves with the scope of their responsibility and authority, which may be specified in an agency written policy manual, the supervisor's job description, or a written contractual agreement.

The requirements and expectations of a supervisor's position also may affect liability, especially in situations in which the supervisor may have competing demands and is unable to adequately perform his or her supervisory functions. Such situations may present legal challenges.