|
| A) | improper training in the art and science of clinical supervision. | ||
| B) | the supervisee's unwillingness to receive their own, personal therapy. | ||
| C) | unpreparedness on the part of the supervisor to work with professionals in a way that honors their humanity. | ||
| D) | an agency or administrative structure's unwillingness to offer proper time for clinical supervision or debriefing. |
A horrible supervisor has a huge impact on job satisfaction and performance. Most people can relate to the feeling of dread the seemingly authoritarian command of those in power can cause. In an ideal sense, a supervisor is supposed to be a mentor, a leader to learn from and hopefully to emulate as part of professional formation. Yet for a variety of reasons, these relationships, whether they be of a boss-employee, supervisor-supervisee, or mentor-protégé variety, can go horribly wrong. Although incompetence or unwillingness to accept feedback from those being led can be a factor in these troublesome dynamics, more often the problems seem to arise from unpreparedness on the part of the supervisor to work with people in a respectful way that manages dynamics of power, responsibility, and humanity.
| A) | True | ||
| B) | False |
The purpose of this course is to help supervisors or potential supervisors in the human services or helping professions to more effectively work with those they are entrusted to supervise. As will be explored, the supervisory relationship in the helping professions is unique because it implies more than just management, it entails genuine leadership in the formation of professionals who are typically new to the professions. Because respecting the personhood of the professional being supervised is paramount to a successful supervisory dynamic in the helping professions, it is important that the same person-centered principles used with clients (e.g., empathy, unconditional positive regard, congruence) be incorporated into work with supervisees. This course will address how to work these principles into supervision within traditional frameworks for clinical supervision. Although traditional models and approaches will be covered, in addition to ancillary issues such as legal/ethical management and monitoring self-care of your supervisees, learners are encouraged to think outside of the proverbial box when it comes to incorporating these person-centered elements. Just as there are a variety of models and theories in the helping professions to guide the execution of psychotherapy, there are a variety of models available to guide the supervision process; the developmental model, the psychodynamic model, the skills-based model, the systemic model, and the blended model are among the most popular. Whatever model is chosen to guide supervision, person-centered principles of empathy, congruence, and unconditional positive regard can be implemented to enhance delivery of supervisory services. Thus, the focus of this course is more practical, as opposed to academic. As such, learners are encouraged to view this course as an exercise in their professional development as a supervisor. Staying with the person-centered theme of the course, take time to reflect on your own experiences and be mindful of how you respond (or in the case of past reflections, responded) as a person. Reflection questions are included throughout the course to facilitate this process; the questions may also be used as journal prompts or guides for meditation. Above all, take from this course what you most need, personally and professionally. By approaching this course with an open mind to the personal and the professional, you will be best able to put person-centered supervision into action.
| A) | The skills model | ||
| B) | The systemic model | ||
| C) | The developmental model | ||
| D) | It can be used alongside any model with effectiveness. |
The purpose of this course is to help supervisors or potential supervisors in the human services or helping professions to more effectively work with those they are entrusted to supervise. As will be explored, the supervisory relationship in the helping professions is unique because it implies more than just management, it entails genuine leadership in the formation of professionals who are typically new to the professions. Because respecting the personhood of the professional being supervised is paramount to a successful supervisory dynamic in the helping professions, it is important that the same person-centered principles used with clients (e.g., empathy, unconditional positive regard, congruence) be incorporated into work with supervisees. This course will address how to work these principles into supervision within traditional frameworks for clinical supervision. Although traditional models and approaches will be covered, in addition to ancillary issues such as legal/ethical management and monitoring self-care of your supervisees, learners are encouraged to think outside of the proverbial box when it comes to incorporating these person-centered elements. Just as there are a variety of models and theories in the helping professions to guide the execution of psychotherapy, there are a variety of models available to guide the supervision process; the developmental model, the psychodynamic model, the skills-based model, the systemic model, and the blended model are among the most popular. Whatever model is chosen to guide supervision, person-centered principles of empathy, congruence, and unconditional positive regard can be implemented to enhance delivery of supervisory services. Thus, the focus of this course is more practical, as opposed to academic. As such, learners are encouraged to view this course as an exercise in their professional development as a supervisor. Staying with the person-centered theme of the course, take time to reflect on your own experiences and be mindful of how you respond (or in the case of past reflections, responded) as a person. Reflection questions are included throughout the course to facilitate this process; the questions may also be used as journal prompts or guides for meditation. Above all, take from this course what you most need, personally and professionally. By approaching this course with an open mind to the personal and the professional, you will be best able to put person-centered supervision into action.
| A) | True | ||
| B) | False |
Clinical supervision trainings are notoriously theoretical. But even clinical supervision trainings can be interesting if they meet the practical needs of those taking the course. Most states require some form of continuing education specific to supervision in order to acquire and/or to obtain supervisory endorsements on clinical licenses. Thus, it is imperative that operational foundations of various definitions and concepts connected to supervision be discussed.
| A) | govern. | ||
| B) | mentor. | ||
| C) | manage. | ||
| D) | look over. |
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.
| A) | leadership and education. | ||
| B) | education and mentorship. | ||
| C) | governance and education. | ||
| D) | mentorship and management. |
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.
| A) | True | ||
| B) | False |
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.
| A) | Yalom | ||
| B) | Corey | ||
| C) | Rogers | ||
| D) | Kadushin |
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.
| A) | True | ||
| B) | False |
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].
| A) | An experienced supervisor | ||
| B) | A solid theoretical orientation on the part of supervisor | ||
| C) | A "do no harm" focus for both client and supervisee | ||
| D) | Monitoring performance through direct or indirect observation |
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]:
An experienced supervisor
Actual clients in clinical settings
"Do no harm"/welfare focus for both the clients and the supervisee
Monitoring performance through direct or indirect observation
The goal of changing the counselor's behavior
| A) | True | ||
| B) | False |
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.
| A) | Spiritual | ||
| B) | Vocation | ||
| C) | Formation | ||
| D) | Hierarchical |
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.
| A) | there are no major differences. | ||
| B) | supervisors have more formal training than consultants. | ||
| C) | more of a legal/ethical responsibility exists with supervision. | ||
| D) | consultation is usually provided by an employer, while supervision is a paid service. |
Before delving into person-centered concepts and how to apply them to supervision, consider how taking on a consultant's role within the context of supervision may help a new professional to grow into the fullness of his or her calling. It is important to make an essential distinction, from the standpoint of responsibility, between a supervisor and a consultant. With technical, clinical supervision, in most states and within most organizations, the role of supervisor carries some form of responsibility. In essence, if the work of a counselor or helper is called into question, especially regarding an ethical breach, the supervisor will be questioned and may even be subjugated to legal or ethical responsibility if the counseling occurred under the umbrella of the supervisor's license or certification. A much higher degree of responsibility is implied with supervision compared to consultation, which can simply be defined as collaborating with a specialist who is called upon for his or her expert advice in the field, for instance, in matters of assessment, diagnosis, or treatment planning. Sears, Rudisill, and Mason-Sears describe a consultant as a "person with special knowledge, skills, or talent who makes needed expertise for clients available for a fee" [9]. When consultation services are provided, the consultant is being compensated for his or her opinion and guidance; there is no sense of responsibility or obligation implied in the relationship.
| A) | True | ||
| B) | False |
Formal, clinical supervision may never be this casual because there is such a responsibility implied with the relationship, but consider how adopting some of the spirit of peer-to-peer consultation may help those supervisees to better relate to their supervisor. Implementing some of the same skills practiced in consultation (e.g., fostering confidence, supporting self-efficacy) work in supervision as well. These skills can be especially effective with professionals who may be new to the field but entered the helping professions as a second or third career and are not necessarily new to life. For instance, when supervising those who are older chronologically, taking on more of a consultation-based, collaborative mindset may allow for more effective supervision.
| A) | The relationship between supervisee and supervisor | ||
| B) | The administrative structure of the agency in question | ||
| C) | The relationship between the supervised clinician and their clients | ||
| D) | All of the above |
A clinical supervisor is someone who can play four primary roles: a teacher, a coach, a mentor, and a consultant. However, a myriad of other roles can emerge at any given time: an administrator, a liaison (between upper management and those being supervised), a champion of the underdog, a client care coordinator, and even an emergency therapist or helper if the supervisee is encountering an especially rough day on the job due to personal circumstances. As with juggling many life roles, it is best for the supervisee to wear one hat at a time, but due to circumstances in the fast paced world of human services, this is often impossible. Regardless of what role or roles are being juggled at any given time, the most effective clinical supervision takes place in the context of a solid relationship between supervisee and supervisor. One could visualize these different roles orbiting the sun like planets, with the relationship as the sun. This is also a good metaphor for the person-centered approach to therapy. Just as adopting person-centered principles like empathy and unconditional positive regard can work alongside many models, so too can applying person-centered approaches to your specific philosophy or model of supervising others. An approach is not a model in and of itself; rather, it is a mindset or attitude that can be applied to a variety of existent models.
| A) | True | ||
| B) | False |
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) | True | ||
| B) | False |
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.
| A) | Empathy, passion, congruence | ||
| B) | Empathy, congruence, alliance | ||
| C) | Empathy, unconditional positive regard, congruence | ||
| D) | Empathy, unconditional positive regard, communication |
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]:
Being empathetic reflects an attitude of profound interest in the client's world of meanings and feelings. The therapist receives these communications and conveys appreciation and understanding, assisting the client to go further or deeper. The notion that this involves nothing more than a repetition of the client's last words is erroneous. Instead, an interaction occurs in which one person is a warm, sensitive, respectful companion in the typically difficult exploration of another's emotional world. The therapist's manner of responding should be individual, natural, and unaffected. When empathy is at its best, the two individuals are participating in a process comparable to that of a couple dancing, with the client leading and the therapist following.
| A) | True | ||
| B) | False |
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.
| A) | the provision of continuous feedback. | ||
| B) | a group of counselors agreeing to a set code of ethics or professional conduct. | ||
| C) | the initiation of an inappropriate dual relationship during the supervisory process. | ||
| D) | two parties engaging in a mutually respectful, trusting interaction, working toward a goal or benefit. |
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.
| A) | The client | ||
| B) | Therapist factors | ||
| C) | The therapeutic alliance | ||
| D) | Evidence-based intervention |
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.
| A) | all supervisees are alike. | ||
| B) | the great common thread is to appeal to the most basic components of personhood. | ||
| C) | you must be conducting psychotherapy within the person-centered tradition for it to work. | ||
| D) | Both B and C |
The next step is applying these principles to the practice of clinical supervision. By accepting that the same person-centered concepts used with clients can be applied to supervisees, a better connection (or relational alliance) may be established. There are many ways to conduct supervision, just as there are a myriad of ways to conduct psychotherapy; the great common thread is to appeal to the most basic components of personhood. Supervisees are, above anything else, humans, and embracing this humanity as opposed to their status as a supervisee helps them to grow to their fullest potential. Supervision is a process that supervisees can view as a punitive chore, and many who have had negative experiences with supervisors have viewed it as such. So, consider how the field can be changed by taking an institution that is often dreaded and approaching it as a safe container in which growth can occur and potential can be explored.
| A) | True | ||
| B) | False |
In addition, there is a potential to achieve tremendous progress by focusing on commonalities as opposed to divisive differences. This humanistic principle is evident in Rosenzweig's common factors. Supervisors can teach those they supervise and work with them to implement understanding into their work. However, it can be beneficial to address this idea of focusing on what the various approaches to supervision have in common in order to best meet supervisees where they are in the supervisory process. Powell captured the spirit of Rosenzweig's common factors in psychotherapy with his five common components of supervision [6]. Powell noted that there are many definitions of what constitutes supervision in the various helping professions, so it is important to look at the commonalities in these various definitions. To review, these five common elements are:
An experienced supervisor
Actual clients in clinical settings
"Do no harm"/welfare of both clients and the supervisee
Monitoring performance through direct or indirect observation
The goal of changing the counselor's behavior
| A) | True | ||
| B) | False |
These common elements show that various models can work, as long as they meet these criteria. Just as it is important for therapists to have a variety of different models or techniques on hand in order to engage and inspire clients, it is important for supervisors to have a variety of ways to work with a supervisee. This logic is the ultimate representation of clinical common sense; just as no two clients are alike, no two supervisees are alike. Embracing this logic is a hallmark of putting person-centered supervision into action.
| A) | Dignity | ||
| B) | Autonomy | ||
| C) | Confidentiality | ||
| D) | Non-malfeasance |
Powell writes about the importance of non-malfeasance, or doing no harm, to both clients and supervisees [6]. Considering the emotional welfare of the supervisee in addition to that of the client represents a person-centered value that clinical supervisors often neglect, especially those who are overly administrative in their mindsets or those who see it as their duty to shape a new generation of therapists in their image. Respecting the individual dignity of a supervisee is not only a person-centered concept, it is a way to put non-malfeasance into action.
| A) | True | ||
| B) | False |
Putting the person-centered value of empathy into action as a supervisor is based on remembering what it was like to be supervised. It also entails being willing to step into the shoes of a supervisee and consider what he or she may be going through at any point in professional formation. As will be discussed in the next session, there are ways to build empathy and cultivate putting it into action. Although some supervisors and counselors may naturally be more empathetic than others, empathy is an action word, and as a person-centered value, it can be practiced and built.
| A) | Charitable giving | ||
| B) | Stepping into the shoes of another | ||
| C) | Honoring physical reactions to a person or situation | ||
| D) | Providing feedback without concern about the supervisee |
The idea of "stepping into the shoes" of another to better appreciate his or her perspective is the hallmark of putting empathy in to practice. We are encouraged, as professionals, to do it with clients, and many do it quite well, but it is important to consider this with supervisees as well. Engaging in such a practice is an effective way to build competence as a person-centered supervisor. There are simple ways to practice this art. For instance, take one of the four cases introduced at the beginning of this section. As a supervisor, which case would you be most likely to struggle supervising? Reread that case and then take a moment to reflect and ask yourself, "What is he or she really going through? If I had to put myself in his or her shoes for a day, how would I respond?" Often, supervisors most struggle with supervisees whose shoes they "resist" stepping in to. This simple exercise, inspired by guided imagery, is one of the best ways to practice exploring one's potential for empathy and what blocks exist that keep you from being as effective a person-centered supervisor as possible. In some cases, resistance is more than about dissimilarity to one's own life or fear-based (e.g., fear being in a position in life in which more schooling and more supervision is necessary). However, if one is able to honor and access this sense of trepidation, he or she may be able to connect to what Rothschild and Rand called somatic empathy [22]. Somatic empathy is about noting and honoring physical reactions to a person or a situation, recognizing that this response is likely mirroring what that person is experiencing. A sense of trepidation and visceral uneasiness at the thought of having to be in a supervisee's position gives a supervisor a better understanding of the trepidation and uneasiness he or she is likely experiencing in the work context. So much of empathy is being attuned to visceral, body-level clues. Instead of ignoring them, these responses can be used to better work with others.
| A) | True | ||
| B) | False |
The idea of "stepping into the shoes" of another to better appreciate his or her perspective is the hallmark of putting empathy in to practice. We are encouraged, as professionals, to do it with clients, and many do it quite well, but it is important to consider this with supervisees as well. Engaging in such a practice is an effective way to build competence as a person-centered supervisor. There are simple ways to practice this art. For instance, take one of the four cases introduced at the beginning of this section. As a supervisor, which case would you be most likely to struggle supervising? Reread that case and then take a moment to reflect and ask yourself, "What is he or she really going through? If I had to put myself in his or her shoes for a day, how would I respond?" Often, supervisors most struggle with supervisees whose shoes they "resist" stepping in to. This simple exercise, inspired by guided imagery, is one of the best ways to practice exploring one's potential for empathy and what blocks exist that keep you from being as effective a person-centered supervisor as possible. In some cases, resistance is more than about dissimilarity to one's own life or fear-based (e.g., fear being in a position in life in which more schooling and more supervision is necessary). However, if one is able to honor and access this sense of trepidation, he or she may be able to connect to what Rothschild and Rand called somatic empathy [22]. Somatic empathy is about noting and honoring physical reactions to a person or a situation, recognizing that this response is likely mirroring what that person is experiencing. A sense of trepidation and visceral uneasiness at the thought of having to be in a supervisee's position gives a supervisor a better understanding of the trepidation and uneasiness he or she is likely experiencing in the work context. So much of empathy is being attuned to visceral, body-level clues. Instead of ignoring them, these responses can be used to better work with others.
| A) | Lack of training | ||
| B) | A pressure to "do it right" | ||
| C) | The legal and administrative responsibilities | ||
| D) | Both B and C |
Doing brief guided imagery meditations in order to "step into the shoes" of supervisees, as described previously, is one option for developing one's ability to be empathetic and build on existing capacity for empathy and unconditional positive regard that may already exist as a therapist. Even if one is a very empathetic therapist who is capable of putting person-centered principles into action with clients, it is still important to do these exercises to evaluate capacity for practicing these principles with supervisees. Even though the principles are similar, the context differs, which is why it is important to practice building empathetic capacity with supervisees. For instance, all of the administrative and legal/ethical responsibilities associated with supervision may result in a sense of nervousness or pressure to "do it right." In this new context, empathetic capacities can be significantly altered. Thus, doing these "step into their shoes" types of exercises can help to better appreciate the perspective of your supervisee, and it may be worthwhile for you to notice how the context or pressures of "being a supervisor" affect one's supervisory practice.
| A) | True | ||
| B) | False |
Constant correction and criticism from a supervisor are generally ineffective. However, if you value the supervisee and welcome his or her newness as something "fresh," as something to be welcomed as opposed to something to be feared, a supportive relationship in which corrective feedback is much more likely to be received will be created. Many have experienced success with this logic in working with clients.
| A) | True | ||
| B) | False |
Supervisees often feel that their supervisor holds their future in their hands, whether it be for internships to get a license or while licensed in order to become independently licensed. They may be scared that sharing personal experiences will be used against them later, or they may be reticent to seek additional help, fearing it will damage the relational alliance. Simply appreciating that supervisees may see you this way and making a conscious choice not to exploit that dynamic is putting humanistic empathy into action within the supervisory relationship. Although in cases of unethical or downright inappropriate behavior it may be necessary to use leverage as a supervisor to bring about change in the supervisee's behavior, these uses of leverage should be implemented only in exceptional cases. A supervisee, in regular circumstances, should not be made to fear that you, as the supervisor, can destroy them over a personality conflict or power struggle.
| A) | True | ||
| B) | False |
Another potent way to building empathetic capacities, whether for working with clients or supervisees, is to quite literally remember what it was like. Ineffective supervisors may be either so jaded or so caught up in being an "expert" that they forget what it was like to be a developing professional in need of supervision. It is important to call upon our past memories of what it was like to be "supervised," whether it was in a human services capacity or in another job. Even negative experiences will inform your choices as a supervisor, giving insight into what not to do.
| A) | deflating fear. | ||
| B) | addressing fear. | ||
| C) | fostering confidence. | ||
| D) | exploring confidence. |
"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.
| A) | Offering a compliment reinforced with a gift | ||
| B) | Offering an area of improvement, inserting a compliment, and then offering another area of improvement | ||
| C) | Offering a compliment, inserting an area of improvement, and then offering another compliment | ||
| D) | None of the above |
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.
| A) | True | ||
| B) | False |
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.
| A) | True | ||
| B) | False |
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.
| A) | making obtaining feedback optional. | ||
| B) | allowing supervisee feedback to affect the relational alliance negatively. | ||
| C) | scheduling a mandatory outcomes analysis at the end of each supervisory meeting. | ||
| D) | assuring the supervisee that he/she will not be punished for honest reactions and following through with this commitment. |
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.
| A) | True | ||
| B) | False |
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:
| A) | shows weakness to your supervisees. | ||
| B) | undermines your authority as a supervisor. | ||
| C) | is an excellent way to repair ruptures in the alliance. | ||
| D) | None of the above |
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.
| A) | True | ||
| B) | False |
In supervising clinicians, navigating developmental appropriateness becomes an even more complex task. Consider the four cases introduced earlier in this course. According to traditional, Ericksonian development, Ms. V is at a different stage of development than the other three, and one could argue that Ms. T and Mr. N are perhaps transitioning between two developmental stages at these points in their careers. Consider how approaching Ms. V about issues might be different than how you would approach Mr. N, for instance. To revisit the common sense logic that resonates throughout this course, person-centered supervision is all about appreciating where a person is coming from and meeting that person where he or she is.
| A) | Mutuality | ||
| B) | Inception | ||
| C) | Conformism | ||
| D) | Skill development |
Inception (e.g., insecurity, dependency, inadequacy)
Skill development (i.e., move from dependency to autonomy/adequacy)
Consolidation (e.g., self-confidence, individuation)
Mutuality (e.g., creativity, independent practice)
| A) | Formation | ||
| B) | Stabilization | ||
| C) | Refreshment | ||
| D) | Self-awareness |
| A) | 12-step paradigm | ||
| B) | Hot-seat technique | ||
| C) | Motivational interviewing | ||
| D) | Therapeutic confrontation |
The approach of motivational interviewing can be incorporated into supervisory practice much as it is used in psychotherapy. As the name of this approach suggests, motivational interviewing is about asking a series of questions to enhance an individual's overall drive toward change, a shift from confrontational or directive approaches to counseling [31]. Motivational interviewing assumes that all people have within them the abilities and the skills they need to change. Mental health professionals can help people realize this potential so they can manifest change for themselves. Motivational interviewing, as a strategic approach, works well alongside many theories and techniques in counseling. It is ultimately very effective because the conclusions that one draws from oneself that lead to change are more likely to persist in the long-term than changes that feel forced by outside entities. Because motivational interviewing steers away from specific direction or confrontation, it is person-centered in its aims. The substance abuse field increasingly regards motivational interviewing as the best approach to working with resistant clients. Consider how using an approach that works with clients may also apply to work with supervisees, especially supervisees who may be resistant to supervision.
| A) | The time commitment involved | ||
| B) | The supervisee is academically advanced | ||
| C) | The supervisor is younger/less experienced at life | ||
| D) | All of the above |
Many professionals resent being supervised, and these resentments can take on a variety of shapes. The time commitment is often a first barrier for busy professionals. Older professionals like Ms. T and Mr. N who have been working in human services in some capacity for many years but are moving into a new area of service within the professions are likely to feel some level of resentment. This resentment can be more significant if they are being supervised by younger professionals, contingent, of course, upon personal variables. Professionals like Mr. B may be more likely to experience this resentment or be resistant if they feel they know more about "real recovery," obtained through life experiences, compared to a supervisor who has learned only through formal training. Super students like Ms. V may be prone to entering an internship or work site feeling that she knows it all and could be sensitive to correction. Inferiority fears, which may be present in all four cases for a variety of reasons, can also be a major reason for resisting supervision and the corrective feedback that comes with it.
| A) | Evocation | ||
| B) | Autonomy | ||
| C) | Collaboration | ||
| D) | Confrontation |
Consider the three major principles of motivational interviewing described by Miller and Rollnick [31]:
Collaboration: Counseling involves a partnership that honors the client's expertise and perspectives. The counselor provides an atmosphere that is conductive rather than coercive to change.
Evocation: The resources and motivation for change are presumed to reside within the client. Intrinsic motivation for change is enhanced by drawing on the client's own perceptions, goals, and values.
Autonomy: The counselor affirms the client's right and capacity for self-direction and facilitates informed choice.
| A) | Express empathy. | ||
| B) | Confront resistance. | ||
| C) | Support codependency. | ||
| D) | Develop correspondence. |
Perhaps these principles make sense in terms of working with a supervisee, but the next step is putting them into action in the supervisory relationship in working with resistant supervisees. Miller and Rollnick suggest for resistant clients [31]:
Express empathy.
Develop discrepancy.
Roll with resistance.
Support self-efficacy.
| A) | True | ||
| B) | False |
The ethical duties of supervisors are somewhat more complex than those of other practitioners. In this role, there must be a coexisting consideration for the welfare of both supervisees and clients [32]. Among the many relevant issues, five are central to supervisor ethics: competency, confidentiality, informed consent, dual relationships, and duty to warn.
| A) | limiting practice to professional competencies. | ||
| B) | assessing supervisees' competency in relation to one's own. | ||
| C) | improving personal knowledge when a deficit is recognized. | ||
| D) | Both A and C |
Competency is the ethical duty to practice in one's areas of knowledge and abilities. This consists of limiting practice to professional competencies (including multicultural competency) and improving personal knowledge when a deficit is recognized in order to better assist clients and supervisees. The competencies of supervisees must also be known and managed effectively. The National Board of Certified Counselors (NBCC) Code of Ethics states that those "who provide clinical supervision services shall intervene in situations where supervisees are impaired or incompetent and thus place client(s) at risk" [10].
| A) | True | ||
| B) | False |
Competency and confidentiality are arguably the two most important ethical principles pertaining to the helping professions. They are also the cornerstone of the Hippocratic Oath, from which all modern ethical codes trace their lineage. The following is translated from the Oath: "Whatever I see or hear in the lives of my patients, whether in connection with my professional practice or not, which ought not to be spoken of outside, I will keep secret, as considering all such things to be private" [33].
| A) | refuse to discuss any cases. | ||
| B) | only discuss clients whose issues are "not serious." | ||
| C) | obtain permission from the agency before discussing cases with a supervisor. | ||
| D) | limit discussions to only case information necessary for the purposes of supervision. |
Although they are somewhat different concepts, confidentiality and the right to privacy are closely related. The supervisor/supervisee relationship is unique in that confidential information is shared between practitioners. To respect a client's right to privacy and to maintain confidentiality, it is recommended that only the most pertinent case information (as deemed necessary for the purposes of supervision and/or consultation) be exchanged between professionals [10,32]. For example, only a client's first name should be shared and other identifying information should remain undisclosed (e.g., demographics). The NBCC Code of Ethics states that practitioners "shall respect client's privacy and shall solicit only information that contributes to the identified counseling goals" [10]. Remember that this also applies to supervisors.
| A) | limitations of confidentiality. | ||
| B) | the potential for dual relationships. | ||
| C) | how to express concerns regarding the supervision process. | ||
| D) | All of the above |
Supervisors have the responsibility of ensuring that clients are informed about all aspects of therapy/interventions, including the appropriateness of services, what to expect during and from the services, the limitations of confidentiality, and supervision procedures. Supervisors also have the responsibility of informing supervisees about: the supervision process, including the potential for dual relationships, limitations of confidentiality, and performance standards and reviews; procedures for responding to emergencies and absences; legal and ethical standards related to the profession; how to express concerns regarding the supervision process; and due process appeals of supervisory actions or decisions [10,11,32].
| A) | True | ||
| B) | False |
Professional ethical codes explicitly forbid romantic or sexual relationships between a supervisor/supervisee. For example, the NBCC Code of Ethics states that certified counselors "who act as counselor educators, field placement or clinical supervisors shall not engage in sexual or romantic intimacy with current students or supervisees. They shall not engage in any form of sexual or romantic intimacy with former students or supervisees for two years from the date of last supervision contact" [10]. Similarly, the National Association of Social Workers (NASW) Code of Ethics states that "social workers who function as supervisors or educators should not engage in sexual activities or contact (including verbal, written, electronic, or physical contact) with supervisees, students, trainees, or other colleagues over whom they exercise professional authority" [34]. The American Counseling Association (ACA) Code of Ethics also prohibits sexual or romantic interactions and relationships [11].
| A) | choice. | ||
| B) | guideline. | ||
| C) | suggestion. | ||
| D) | imperative. |
As the wording suggests, self-care simply involves taking care of oneself. However, in the helping professionals, self-care carries a more potent meaning. Because those in these professions spend so much time and energy taking care of other people, it is imperative that they make time and energy to take care of themselves. The psychotherapeutic professions are placing increasing importance on the role of therapist self-care to shield against burnout and vicarious traumatization, which improves one's ability to better serve clients. Honoring self-care is an ethical imperative for therapists to embrace [35,36]. This idea makes a great deal of sense; healthier people make healthier, more effective therapists, which will have a positive effect on the people they are entrusted to serve. Thus, it becomes important to discuss self-care as a supervision issue, especially if a supervisor identifies that a supervisee's lack of self-care seems to be impacting his or her job performance.
| A) | It sets a solid example for clients. | ||
| B) | Self-care promotes mental clarity. | ||
| C) | No real reason exists; it's just a paradox. | ||
| D) | None of the above |
Simply having the opportunity to sit down with someone more experienced who is in a solid position to share experience, strength, hope, and perspective can be very helpful to supervisees, resulting in clinicians who are better prepared for their jobs. Supervisors and mentors, within the context of a solid, relational alliance, can make small yet powerful suggestions on how a supervisee can better take care of his or her self. One such suggestion is to prioritize self-care time, and some have recommended that self-care be allotted at least three hours per week. Although seemingly a paradox, the more time we allot to take care of ourselves, the more time we will inevitably have to complete necessary tasks. In addition, taking time for self-care will allow one to be more mentally present and thus more efficient.
| A) | Having a psychotherapist | ||
| B) | A relaxed and positive outlook | ||
| C) | Balance between work and family life | ||
| D) | A support network of friends and coworkers |
The National Institute for Occupational Safety and Health summarizes the essentials of a self-care plan as [38]:
Balance between work and family or personal life
A support network of friends and coworkers
A relaxed and positive outlook