Jamie Marich PhD LPCCS LICDCCS About Your Presenter LPCCS LICDCCS Ohio EMDRIAApproved Consultant OutcomesBased Training with the International Center for Clinical Excellence ID: 493270
Download Presentation The PPT/PDF document "A Person-Centered Approach to Clinical S..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
A Person-Centered Approach to Clinical Supervision
Jamie Marich, Ph.D., LPCC-S,
LICDC-CSSlide2
About Your Presenter
LPCC-S,
LICDC-CS
(Ohio)
EMDRIA-Approved Consultant
Outcomes-Based Training with the International Center for Clinical Excellence
Author, Qualitative Researcher
Thirteen
years of experience in a variety of human services venues
Began career as humanitarian aid worker in Bosnia-Hercegovina (2000-2003) Slide3
What Are Your Needs Today?Slide4
Objectives
To identify and discuss common problems in supervising counselors/clinicians
To address these commonly identified problems using a person-centered approach
To explain what
the
psychotherapeutic professions
reveal
about the importance of empathy and therapeutic alliance in treatment (regardless of specific
method or model)
To apply these principles of empathy to the practice of clinical supervision
To utilize motivational interviewing approaches with resistant supervisees
To assist others in developing both work plans and self-care plans Slide5
Supervision vs. Consultation
In general, supervision carries more ethical responsibility in terms of licensure boards, legal issues, etc.
Both can involve a gatekeeper function, depending on the nature of the consultation sought
Both have similar approaches in terms of using the person-centered modelSlide6
What does
empathy
mean to you?Slide7
Empathy
Coined by the German philosopher Rudolf
Lotze
in 1858
The German word,
Einfühlung
, translates as
“
in
”
+
“
feeling” Derives from the Greek empatheia, meaning “in” + “pathos” (feeling) Pathos is also the root of “passion” and “pain” Slide8
Empathy
Direct identification with, understanding of, and vicarious experience of another person's situation, feelings, and motives
.
Stedman
’
s Medical Dictionary (2002) Slide9
The Rogerian
View of Empathy
“
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.”(Raskin & Rogers, in Corsini, 2000)Slide10
Can this be
applied to
supervision ?
????Slide11
From Irvin Yalom
Therapy should not be theory driven, but relationship driven
(The Gift of Therapy, 2001)
The
Every Day Gets a Little Closer
experiment (
Yalom
& Elkins, 1974) Slide12
Complex PTSD &
Therapeutic Alliance
According to client experience, the quality of therapeutic alliance between client and clinician is an important mechanism in facilitating meaningful change for clients with complex PTSD (
Fosha
, 2000;
Fosha
&
Slowiaczek
, 1997; Pearlman &
Courtois
, 2005)Slide13
The Imperative of the
Therapeutic Alliance
Using a collection of empirical research studies and chapters from the psychotherapeutic professions, Norcross (2002) demonstrated that a combination of the therapy relationship, together with discrete method, is critical to treatment outcomes.
Norcross further concluded that relational skills can be honed by therapists, and that it is the therapist
’
s responsibility to tailor these skills to the needs of individual clients. Slide14
The Imperative of the
Therapeutic Alliance
Norcross’ contentions also supported by the massive literature reviews that appear in
The Heart and Soul of Change: Delivering What Works in Therapy
(Duncan, Miller,
Wampold
, & Hubbard, 2009)Slide15
The Common Factors
Client
&
extratherapeutic
factors
Techniques that engage and inspire the participants
The therapeutic alliance
The clinician Slide16
The Common Factors
The common factors are a listing of four qualities that all successful psychotherapeutic approaches have in common
Developed by psychiatrist Saul
Rosenzweig
(1936), in response to the numerous philosophies of therapy asserting their superiority in his era
A review of over sixty years of literature on psychotherapy and therapeutic change supports the common factors hypothesis (Duncan, Miller,
Wampold
, & Hubbard, 2009)Slide17
Can the Common Factors
Be Applied to Supervision?Slide18
The Common Factors
Client
&
extratherapeutic
factors
Techniques that engage and inspire the participants
The therapeutic alliance
The clinician Slide19
Do You Struggle with Being
Empathetic in Supervision?Slide20
What Were Some of Your Best Experiences with Supervision?
What Were Some of Your Worst?Slide21
BREAK TIMESlide22
Now It’s Your Turn…
Write up a brief
case (5-7 traits) :
An actual supervisee
A composite supervisee
A fictional character Slide23
Reactions/Discussion From
Guided Imagery
Empathy ExerciseSlide24
Lessons From My EMDR Supervision Experiences…Slide25
Lessons From My EMDR Supervision Experiences…
By the book vs. Go with the flow…depends on who you ask
.
This is what the book says to do…this is what I actually do.
“Imbuing” fear vs. Fostering confidence
Within the context of the relationship, don’t be afraid to ask, “What’s this really about?”
The importance of outcomes & seeking feedback
Repair the ruptures (
Dworkin
&
Errebo
, 2010) Slide26
The “Resistant” Supervisee or
ConsulteeSlide27
Motivational Interviewing (Miller &
Rollnick
, 2002)
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.Slide28
Motivational Interviewing: 4 Principles (Miller &
Rollnick
, 2002)
Express Empathy
Develop
Discrepancy
Roll
with
Resistance
Support
S
elf-EfficacySlide29
What is the Application
to Clinical Supervision?Slide30
General Proverbs That Go Along Way…
Meet them where they’re
at
Do unto others as you would have them do unto you
Remember what it was like Slide31
Please Return by
1:00pmSlide32
“
The problem with winning the rat race is that even if you win, you
’
re still a rat.
”
-Lilly TomlinSlide33
Stress vs. Burnout
How would you define stress?
How would you define burnout?Slide34
Stress vs. Burnout
STRESS
BURNOUT
Characterized
by over-engagement
Characterized
by disengagement
Emotions are over-reactive
Emotions are blunted
Produces urgency and hyperactivity
Produces helplessness and hopelessness
Loss of energy
Loss of motivation, ideals, and hopeLeads to anxiety disordersLeads to detachment and depressionPrimary damage is physicalPrimary damage is emotionalMay kill you prematurelyMay make life seem not worth living
SOURCE:
Stress and Burnout in Ministry
(Croucher, n.d.) Slide35
Stress vs. Burnout
Burnout is most common in the workplace. You may be flirting with burnout if:
Every
day on the job is a bad one.
Caring about work seems like a total waste of energy.
The majority of your day is spent on tasks you find either mind-numbingly dull or unpleasant.
Nothing you do appears to make a difference in a workplace full of bullying, clueless, or ungrateful supervisors, colleagues, and clients.
SOURCE: Helpguide.org Slide36
Common Signs and Symptoms of Burnout
Powerlessness
Hopelessness
Emotional exhaustion
Detachment
Isolation
Irritability
Frustration
Being trapped
Failure
Despair
Cynicism
Apathy SOURCE:
Helpguide.org
Slide37
An Important Point to Remember
Workplace burnout
isn’t
the same as workplace stress. When
you’re
stressed, you care too much, but when
you’re
burned out, you
don’t
see any hope of improvement.
Dealing with
stressors may
be a preventative measure against burnout.Slide38
Causes of Burnout
While some careers have higher rates of burnout,
it’s
present in every occupation.
Those most at risk are employees who feel underpaid, underappreciated, or criticized for matters beyond their control.
Service professionals who spend their work lives attending to the needs of others, especially if their work puts them in frequent contact with the dark or tragic side of human experience, are also at high risk.
SOURCE: Helpguide.orgSlide39
Causes of Burnout
Setting unrealistic goals for yourself or having them imposed upon you.
Being expected to be too many things to too many people.
Working under rules that seem unreasonably coercive or punitive.
Doing work that frequently causes you to violate your personal values.
Boredom from doing work that never changes or
doesn’t
challenge you.
Feeling trapped for economic reasons by a job that fits any of the scenarios above.
SOURCE: Helpguide.orgSlide40
Causes of Stress and Burnout
The information on the following slides is presented by the National Institute for Occupational Safety and Health (NIOSH).
A booklet by this organization,
Stress at Work
, is an excellent resource that you may consider adding to your personal library.
Follow along as these scenarios are presented; make mental notes or check off which scenarios may apply to you and your workplace. Slide41
Job Conditions That May Lead to Stress
The Design of Tasks
. Heavy workload, infrequent rest breaks, long work hours and shiftwork; hectic and routine tasks that have little inherent meaning, do not utilize workers' skills, and provide little sense of control.
Example:
David works to the point of exhaustion. Theresa is tied to the computer, allowing little room for flexibility, self-initiative, or rest.
SOURCE: National Institute for Occupational Safety and Health Slide42
Job Conditions That May Lead to Stress
Management Style.
Lack of participation by workers in decision- making, poor communication in the organization, lack of family-friendly policies.
Example:
Theresa needs to get the boss's approval for everything, and the company is insensitive to her family needs.
SOURCE: National Institute for Occupational Safety and Health Slide43
Job Conditions That May Lead to Stress
Interpersonal Relationships.
Poor social environment and lack of support or help from coworkers and supervisors.
Example:
Theresa's physical isolation reduces her opportunities to interact with other workers or receive help from them.
SOURCE: National Institute for Occupational Safety and Health Slide44
Job Conditions That May Lead to Stress
Work Roles.
Conflicting or uncertain job expectations, too much responsibility, too many "hats to wear."
Example:
Theresa is often caught in a difficult situation trying to satisfy both the customer's needs and the company's expectations.
SOURCE: National Institute for Occupational Safety and Health Slide45
Job Conditions That May Lead to Stress
Career Concerns.
Job insecurity and lack of opportunity for growth, advancement, or promotion; rapid changes for which workers are unprepared.
Example:
Since the reorganization at David's plant, everyone is worried about their future with the company and what will happen next.
SOURCE: National Institute for Occupational Safety and Health Slide46
Job Conditions That May Lead to Stress
Environmental Conditions.
Unpleasant or dangerous physical conditions such as crowding, noise, air pollution, or ergonomic problems.
Example:
David is exposed to constant noise at work.
SOURCE: National Institute for Occupational Safety and Health Slide47
Personal Susceptibility to
Stress or Burnout: 7 Domains
Assess the Extent of
Your
Risk
Factors
1.) The nature of the stressor
Stressors that involve central aspects of your life (your marriage, your job) or are chronic issues (a physical handicap, living from paycheck to paycheck) are more likely to cause severe distress.
2.) A crisis experience
Sudden, intense crisis situations (being raped, robbed at gunpoint, or attacked by a dog) are understandably overwhelming. Without immediate intervention and treatment, debilitating stress symptoms are common.
3.) Multiple stressors or life changes
Stressors are cumulative, so the more life changes or daily hassles you're dealing with at any one time, the more intense the symptoms of stress.Slide48
4.) Your perception of the stressor
The same stressor can have very different effects on different people. For example, public speaking stresses many out, but others thrive on it. Additionally, if you
’
re able to see some benefit to the situation—the silver lining or a hard lesson learned—the stressor is easier to swallow.
5.) Your knowledge and preparation
The more you know about a stressful situation, including how long it will last and what to expect, the better able you
’
ll be to face it. For example, if you go into surgery with a realistic picture of what to expect post-op, a painful recovery will be less traumatic than if you were expecting to bounce back immediately.
6.) Your stress tolerance
Some people roll with the punches, while others crumble at the slightest obstacle or frustration. The more confidence you have in yourself and your ability to persevere, the better able you
’
ll be to take a stressful situation in stride.
7.) Your support networkA strong network of supportive friends and family members is an enormous buffer against life’s stressors. But the more lonely or isolated you are, the higher your risk of stress. Slide49
Costs of Stress and Burnout
There is a clear connection between workplace stress and physical and emotional problems. According to the National Institute for Occupational Safety and health, early warning signs of job stress include:
Headache
Sleep disturbance
Upset stomach
Difficulty concentrating
Irritability
Low morale
Poor relations with family and friends
SOURCE: Helpguide.orgSlide50
Costs of Stress and Burnout
Evidence suggests that workplace stress plays an important role in several types of ongoing health problems, especially:
Cardiovascular disease
Musculoskeletal conditions
Psychological disorders
Workplace injury
SOURCE: Helpguide.orgSlide51
Costs of Stress and Burnout
According to the
Journal of Occupational and Environmental Medicine
, health care expenditures are nearly
50%
greater for workers who report high levels of stress.
SOURCE: National Institute for Occupational Safety and Health Slide52
Costs of Stress and Burnout
According to the St. Paul Fire and Marine Insurance Company, problems at work are more strongly associated with health complaints than are any other life stressor-more so than even financial problems or family problems.
SOURCE: National Institute for Occupational Safety and Health Slide53
Costs of Stress and Burnout
Studies show that stressful working conditions are associated with increased absenteeism, tardiness, and intentions by workers to quit their jobs-all of which have a negative effect on productivity and a
company’s
bottom line.
SOURCE: National Institute for Occupational Safety and Health Slide54
If You are a Supervisor or
“
Boss
”
Much of the
Stress at Work
booklet is geared towards you and what your organization can do to promote a healthier work environment.
Pay special attention to the material from Page 12 onward in the
Stress at Work
booklet.
If procedural or organizational change is something that you have a desire to bring about, you will find the suggestions in this booklet helpful.
Slide55
SOURCE: National Institute for Occupational Safety and Health Slide56
Compassion Satisfaction and Fatigue Test (1996) Slide57
Small Group Activity
What are some ways that a working individual can go about taking care of himself/herself to reduce stress and to minimize the development of burnout?
Are there any issues or strategies specific to your profession that need to be considered?
You have 15 minutes to consider these questions in your group; share your experiences if you are willingSlide58
Strategies for Developing a
Self-Care Plan
What did you come up with in your small group discussions? Slide59
Recovering Professionals
What makes people in recovery enter the helping professions?
What are some special pitfalls for risk that recovering professionals may face?
Can anything be shared based on your experience or small group discussions? Slide60
Break Time (15 Minutes)Slide61
Strategies for Developing a
Self-Care Plan
Go
for a walk.
Spend time in nature.
Talk to a supportive friend.
Sweat out tension with a good workout.
Write in your journal.
Take a long bath.
Play with a pet.
Work in your garden.
Get a massage.
Curl up with a good book. Take a yoga class. Listen to music. Watch a comedy. Slide62Slide63Slide64
Strategies for Developing a
Self-Care Plan
Logistical issues:
Clarify job description
Develop a work plan
Ask for new dutiesSlide65
Strategies for Developing a
Self-Care Plan
The common sense things we often overlook:
Take time off
Resist perfectionism
Flip negative thinking
Prioritize/ “To Do”
Lists
Talk it out
Find humor in a situation
Learn how to say “no” Slide66
Strategies for Developing a
Self-Care Plan
On nurturing yourself; remember, it is a
necessity
, not a
luxury
:
Set aside relaxation time.
Include rest and relaxation in your daily schedule. Don
’
t allow other obligations to encroach. This is your time to take a break from all responsibilities and recharge your batteries.
Connect with others.
Spend time with positive people who enhance your life. A strong support system will buffer you from the negative effects of stress. Do something you enjoy every day. Make time for leisure activities that bring you joy, whether it be stargazing, playing the piano, or working on your bike. Keep your sense of humor. This includes the ability to laugh at yourself. The act of laughing helps your body fight stress in a number of ways. SOURCE: Helpguide.org Slide67
Strategies for Developing a
Self-Care Plan
On adopting a healthy lifestyle:
Exercise regularly.
Eat a healthy diet.
Reduce caffeine and sugar.
Avoid alcohol, cigarettes, and drugs.
Get enough sleep. Slide68
Strategies for Developing a
Self-Care Plan
On unhealthy ways of coping with stress:
Smoking
Self-medicating with alcohol or drugs
Using sleeping pills or tranquilizers to relax
Overeating or eating too little
Sleeping too much
Procrastinating
Withdrawing from friends, family, and activities
Filling up every minute of the day to avoid facing problems
SOURCE: Helpguide.org Slide69
Strategies for Developing a
Self-Care Plan
Suggestion from the National Institute for Occupational Safety and Health:
Balance between work and family or personal life
A support network of friends and coworkers
A relaxed and positive outlook
SOURCE: National Institute for Occupational Safety and Health Slide70
Strategies for Developing a
Self-Care Plan
Suggestions from the Presenter:
If you have a spiritual belief system, use it to help you deal with stress.
Always make time for your hobby or activities that you enjoy; even when your time is minimal, you may experiences greater consequences later if you don
’
t keep doing at least one thing for yourself that you enjoy
Seek outside help if necessary: EAPs, support groups, helping professionals
Use healthy boundaries in the workplace when it comes to your personal lifeSlide71
Small Group Exercise
Get into your original groups.
Take about 5-10 minutes and write down a plan for self-care based on information that you learned today or based on strategies that you have already implemented in your life for self care.
Write out at least five points of your plan using
“
I will
”
statements (e.g.,
“
I will go ballroom dancing at least twice a week
,”
“
I will refrain from talking with my boss about politics”).Share what items you are willing to share with other group members.Slide72
How Can You Work With Supervisees to Develop Their Work & Self-Care Plans?Slide73
References
Courtois
, C.A., & Pearlman, L.A. (2005). Clinical applications of the attachment framework: Relational
treatment
of complex trauma.
Journal of Traumatic Stress,
18
(5), 449-459.
Croucher
, R. (
n.d.
). Stress and burnout in ministry. Retrieved March 20, 2008, from
www.helpguide.org/ mental/burnout_signs_symptoms.htmDworkin, M., & Errebo, N. (2010). Rupture and repair in the EMDR client/clinician relationship: Now moments and moments of meeting. Journal of EMDR Practice and Research, 4(3), 113-123.empathy. (2002). Stedman’s Medical Dictionary. Retrieved February 18, 2012, from Dictionary.com website http://dictionary.reference.com/browse/empathyFigley, C.R. & Stamm, B.H. (1996). Psychometric Review of Compassion Fatigue Self Test. In B.H. Stamm (Ed.), Measurement of Stress, Trauma and Adaptation. Lutherville, MD: Sidran Press. Fosha, D. (2000). The transforming power of affect: A model for accelerated change. New York: Basic Books. Fosha, D., & Slowiaczek, M.I. (1997). Techniques to accelerate dynamic psychotherapy.
American
Journal
of
Psychotherapy
, 51
(2), 229-251.
Helpguide.org
. (2008). Preventing burnout: Signs, symptoms, and strategies to avoid it. Retrieved March 20,
2008
, from http://www.helpguide.org/mental
/
burnout_signs_symptoms.htm
Slide74
References
Marich, J. (2011).
EMDR made simple: Four approaches for using EMDR with every client.
Eau Claire, WI:
Premiere
Education & Media.
Miller, W.R., &
Rollnick
, S. (2002).
Motivational interviewing: Preparing people for change.
New York: W.W.
Norton
& Co. National Institute for Occupational Safety and Health. (n.d.). Stress at work. Cincinnati, OH: U.S. Department of Health and Human Services. Norcross, J. (2002). Psychotherapy relationships that work: Therapist contributions and responsiveness to patients. New York: Oxford University Press.Yalom, I. (1973). Every day gets a little closer: A twice-told therapy. New York: Basic Books. Yalom, I. (2001). The gift of therapy: Reflections on being a therapist. London: Piatkus Books. Slide75
To contact today’s presenter:
Jamie
Marich, Ph.D
., LPCC-S,
LICDC-CS
Mindful Ohio
jamie@jamiemarich.com
www.mindfulohio.com
www.jamiemarich.com
www.drjamiemarich.com
www.dancingmindfulness.com
www.TraumaTwelve.com Phone: 330-881-2944