Conversations Regarding Supervisee-Centred Supervision

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Pam Santon MSW RSW. Registered Marriage and Family Therapist. Registered Sex Therapist. Approved Supervisor AAMFT. My Objectives for Our Conversation. To underline the importance of supporting supervisee’s in their support of clients through competency-based supervisory practices. ID: 585465 Download Presentation

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Conversations Regarding Supervisee-Centred Supervision

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Conversations Regarding Supervisee-Centred Supervision

Pam Santon MSW RSW

Registered Marriage and Family Therapist

Registered Sex Therapist

Approved Supervisor AAMFT


My Objectives for Our Conversation

To underline the importance of supporting supervisee’s in their support of clients through competency-based supervisory practices

To review basics of Supervisory processes

To emphasize the need for Reflective Practice in promoting the change process of clients

To increase comfort with ‘Person of the Therapist’ methods of Supervision in promotion of the professional development of supervisees

To allow reflection of supervisory practices


Positioning You in the ConversationReflective Exercise #1

How many people in the room are currently supervisors? Please take 5 minutes and talk to 3-4 of your neighbours about the following: How does your program currently provide supervision? Who gets supervision and when? Who supervises who? What is it like for supervisors? What is it like for supervisees? As you consider your current supervision system, what is working well? How do you know? And what do you think needs change? How do you know?


Positioning Myself in the Conversation

My own experience of receiving supervision, or not receiving it

Clinical Director-ASYR 1992-2008: from 4 staff to 4 teams

Supervisor in private practice since 1996 including the supervision of:

- Individual therapists or a group of therapists working towards Clinical Membership or Approved Supervisor Status with AAMFT

Social Workers in the Ministry of Long-term Care and a Family Health Team

Peer Support Counsellors in the Ministries of Labour and Natural Resources

Students in a 4th Year Practicum Course in Family Relations and Human Development


The Tricky Terrain of Supervision in the Field of Addictions


Specific Challenges in the Work of Addiction

Clients presentation: Poly-addictions including Process Addictions, Co-occurring

Mental Health

issues, T



Visitor and Complainant Status

of many clients and frequent no shows

Family Dynamics

of client system and their feelings of powerlessness

Difficulties of clients with labelling and managing feelings which often results in

slow pacing

of the work and

frequent relapse

Polarized Models of Interventions


caseloads and



Marginalization of the clients and their issues; and, therefore the field and those who work in it:

under-serviced, underpaid


Supervising in the Addiction Field

High caseload numbers and long waiting lists to manage

Staff presenting complicated client issues and the isomorphic pattern of powerlessness across the levels of the system

Sometimes less than satisfied, stressed-out staff experiencing compassion fatigue, vicarious trauma and/or burnout

Responsibility for vacation and sick leave coverage

Own caseload to serve to manage

Managers, Executive Directors and Boards to appease



Why ‘Supervisee-Centred’ Supervision

Frontline Staff as the Backbone of the agency!


The Risk of Empathy

“After all, it's our gift for empathy that draws us to our work. And yet, empathy at full throttle--felt and projected 100 percent with our bodies, hearts, and minds--has its risks.”

Babette Rothschild



‘Boundaries Lost’The Burnout Syndrome

physical and emotional exhaustion

as clinicians develop negative self-concept, negative job attitudes, and loss of concern for clients (Pines & Maslach, 1978).

physical symptoms

like fatigue, gastrointestinal irritations, insomnia, and hypertension (Farber, 1990)

emotional symptoms

including despair (Kestnbaum, 1984), boredom and cynicism (Friedman, 1985), withdrawal, and depression (Jayaratne & Chess, 1983).

interpersonal problems

, both in the workplace as well as with family and friends (Kahill, 1988).


Risk Factors

Unrealistic therapeutic expectations

Allowing personal issues to interfere in professional practice (loss of boundaries)

Working with clients with particularly severe or traumatic issues

Working in a community agency

Being new to the field

Being male



Supervisors as ‘Back Braces’

‘Strengthening the Core Muscles’


Myths of Individual Coping,Realities of Organizational Policy Kyle Killian 2007

“Stop blaming the victim for lack of life balance”

- Agencies to take responsibility for burnout by:

Better distribution of caseloads to ensure lower numbers of trauma clients per counsellor

Reduced caseloads and more reflective supervision

Better policies to give frontline staff an increased sense of control, efficacy & support

Clearly defined teams (Borrill 2000)

Participation in political advocacy


Role of Supervisor’s in the Prevention of BurnoutRosenberg, T. Pace M., PhD 2010

In-service training on burnout

Setting expectations about self-care

Limit-setting around client numbers and administrative duties

Prioritizing supervision, peer meetings and

support groups

Modeling self-care, case consultation and self awareness

Including person of the Therapist issues in supervision including: unresolved FOO issues, therapist’s need to be liked, over-involvement & feeling personally responsible for client-change


General Functions of Supervision The Role of Supervision in Social Work (An Irish Study 2010 Jeanne Marie Hughes MSW)

Prevent stress and burnout

in a profession dedicated to paying attention to someone else’s needs (Hawkins and Shohet 2006)

Contains or manages anxiety

and helps to cope with the demands that the work entails (Brearer 1995)

Supports reflective practice

on the use of discretion and judgment (Gould and Baldwin 2004)

Educates, supports and manages

(Kadushin 1992, Morrison 2003)

Teaches, guides, counsels and directs

(Page/Wosket 1994)


learning, provides an opportunity

to plan and evaluate work


supports workers


promotes good standards

of practice and

protection of the public

(McGuiness 1993)


‘Great Supervisors’

Non-judgmental and accepting

of the supervisee’s inexperience and mistakes

Accessible and Available regularly

for conversations (weekly) (answer questions, offer advice and provide feedback)

Collaborative as well as directive


of their abilities and potential

Trustworthy and respectful

of their information and learning process


of their expertise and experience


of professional practices, boundaries and conduct

Culturally sensitive and Informed


Great Supervisor’s Build Resiliency in Supervisees

By building trusting, safe relationships

By being present and modeling positive communication skills

By being open and receptive to mistakes in themselves and others

By modeling self care

By being reflective and mindful in their interactions with supervisees


Components of Quality Supervision

Individual Supervision: 1.5 hours bi-weekly

(.5 administration, 1.0 clinical)

Individual Training per learning Goals

Group/Team Supervision

Specific Training as a Team/Agency

Peer Consultation- Formal and Informal

Professional Consultation

Supervision of Supervision

Employee Assistance Program


According to the Literature

Addiction Counselling Competencies (98) The Knowledge, Skills, and

Attitudes of Professional Practice

, TAP (Technical Assistance

Publication) 21 US Dept. of Health and Human Services, SA and MH

Services Administration, Centre for Substance Abuse Treatment 2008

Clinical Supervision Handbook A Guide for Clinical Supervisors for

Addiction and Mental Health

, CAMH, 2008

Clinical Supervision and Professional Development of the Substance

Abuse Counsellor TIP ( Treatment Improvement Protocol) 52,


Dept. of Health and Human Services, SA and MH Services

Administration, Centre for Substance Abuse Treatment 2009

Competencies for Substance Abuse Treatment Clinical Supervisor

TAP 21-A

US Dept. of Health and Human Services, SA and MH Services

Administration, Centre for Substance Abuse Treatment 2008


The ‘Yin and Yang’ of Supervision

Supervision 101


Roles, Stages, Power, Relationship, Parallel Process, Reflective Practice


Structuring SupervisionThe Yin/Yang Continuum (Jay Reeve-

Supervisory Practices

Technique- Based Process- Based


- New to the field - Focus on clinical

or position Experience

- Crisis management - Parallel Process

- Manualized treatment - Development of

Anxiety producing own therapeutic style

situations (ethical, SI/HI, policies etc)


Above all else,


In Taoist philosophy, truth does not lie in one pole or the other, in


or in



Instead, the task of the sage

is to provide what is lacking for balance and integration..

When they think they know the answers

People are difficult to guide

When they know that they don't know

People can find their own way

Tao Te Ching (S. Mitchell, trans.), Harper Perennial; 1991.


The Many Hats of the Supervisor



Directive Collaborative


Isomorphism and Parallel Process in Supervision

Origins in the psychoanalytic concepts of transference and counter transference

Transference occurs when the counselor recreates the presenting problem and emotions of the therapeutic relationship within the supervisory relationship

Counter-transference occurs when the supervisor responds to the counselor in the same manner that the counselor responds to the client.

Thus, the supervisory interaction replays, or is parallel with, the counseling interaction.


Conversations about Parallel Process

Can increase self awareness and professional growth

Easier for the more experienced counsellor because of their confidence in their knowledge and methods of intervention

Can cross the line into therapy so supervisee permission is always required

Supervisor should always pay attention to how the therapeutic relationship and client issues are presented by the counselor in the supervisory session and use the awareness as an intervention in facilitating growth in the counselor, thereby helping the client


What Works in Therapy: Project MATCH and the AllianceBabor, T.F., & DelBoca, F.K. (eds.) (2003). United Kingdom: Cambridge, 113.Treatment Matching in Alcoholism Treatment

The largest study ever conducted on the treatment of problem drinking:

Three different treatment approaches studied (CBT, 12

Three different treatment approaches studied (CBT, 12-

-step, step, and Motivational Interviewing)

Difference in outcome between approaches..

The client rating of the therapeutic alliance was the best predictor of:


reatment participation;

Drinking behavior during treatment;

Drinking at 12-

month follow up


The Clinical Responsibility of the Supervisor



Anything the supervisor can do to reinforce the therapeutic alliance will improve outcome. Sound clinical supervision, including reflective practice on ‘use of self’ and the person of therapist, needs to be a priority for every clinical setting.


Supervision Chain of Impact


The Supervisory Relationship

The relationship is the key to successful supervision (Pritchard 1995). Trust is central to the supervisory relationship. Supervision cannot proceed in a climate of mistrust. Supervisor and supervisee must work to establish a trusting climateSupervisor must be diligent to avoid using information learned in the supervisory process against the supervisee (Munson 2002)


Power in Supervision: Recommendations for Supervisors and SuperviseesMurphy, M. 2005

The results of this study highlight that positive uses of power can enhance the supervisory relationship.

“it is imperative for supervisors to model appropriate uses of power for supervisees, so that they will appropriately use power with their clients. - empowerment in the supervisory relationship isomorphically results with empowerment in the therapeutic relationship”

Open Discussions of power include

a) using the term Power in discussions

b) talking about power at the first supervision session, and

c) revisiting power as a discussion topic throughout the supervisory relationship.


Why Be Reflective?

To Improve the quality of servicesTo avoid clinical responses that can lead to unintended and negative consequences in sessionsTo replenishes counsellor reserves.To Avoid robotic practice, decisions, interventions.To builds confidence and creativity.To Strengthen: practice…service…advocacy…administrationTo foster empowerment, thoughtfulness, respect.


Objectives of Reflective SupervisionModelling Empowering Relationships

Supervisor and clinician form a trusting relationship

Establish consistent, predictable meetings and times

Ask questions that encourage details about the emerging relationship and the supervisee’s reactions

Listen, emotionally present, teach/guide, nurture/support

To Integrate emotion and reason

To foster the reflective process to be internalized by the supervisee

To explore the parallel process and to allow time for personal reflection

To attend to how reactions to the content affect the process


Use of Self Model

‘Use of Self’ and ‘Person of the Therapists’ is a process through which therapists and counsellors learn how to use their personal emotional and cognitive reactions and knowledge of self in order to: inform conceptualizations of their clients struggles create a therapeutic relationship that is collaborative and conducive to corrective relating with the aim of overcoming difficulties and facilitating personal growth.


Examples of ‘Use of Self’ in Supervision

1) Feeling stuck around a separated couple and wanting them to reconcile.2) Feeling powerless with a supervisee who wasn’t setting clear boundaries with a client

Being triangulated in FOO because of cutoffs in own family between siblings

Inaction on the part of the E.D. to establish a policy around domestic violence


3) Anger at a client for frequent calls between sessions.

4)Dislike of a client for crying repeatedly in sessions.

Fear of client taking action on professional ethics

Feeling powerless with emotional pain

Withdrawal as a protective move


How Personal Can Supervision/Training Get?Aponte 2004

1. Supervisees present their personal histories and information about their life circumstances2. Although supervisors may inquire about what they believe is relevant, Supervisees are free to reveal only what they wish to reveal3. Supervisees and fellow team/group members are bound by confidentiality for all personal information revealed in the context of supervision.4. Supervisors and supervisees are not to assume a treatment contract (with all that implies) under the guise of supervision 5. Supervisees may pursue personal treatment outside the context of supervision, and Supervisors may assist in this pursuit as appropriate.


‘To Thy Own Self Be True’-Building or Revisiting Your Philosophy of SupervisionBeginning with ‘The Self’ of the Supervisor: Modelling Authenticity


Have a Supervisory Road Map: A Philosophy of Supervision

A template for conducting supervision sessions.

A roadmap of your principles, knowledge and behaviours as they relate to supervision.

Build a dynamic ‘Philosophy of Supervision’ that clarifies your values, insights and beliefs in this moment and review and update annually.


Components of a Philosophy of Supervision



Change and Components of Supervision

Developmental Stages of Supervision

Gender issues


Ethical Issues

Self of the Supervisor


Using a ‘Collage’ to defineYour Philosophy of Supervision

“I suggest that (Supervisees) avoid reifying human predicaments into symptoms…. All of this is mostly a matter of cleaning out enough psychological "debris" so that supervisees can sit comfortably, listen carefully, and think creatively. When I supervise, I give example after example of interventions that challenge clients' suppositions and help them explore new terrain. Then I hope for the best. Perhaps Marsha Linehan, the inventor of Dialectical Behavior Therapy, put it best when she advised new students to stop trying to act like therapists: "If they would act like themselves, they would be better off. . . . All you are trying to be is simply one human being trying to help another human being. That's all this is." Unfortunately, the(diagnostic) category obscures that fact.”

Jay Efran, Ph.D., Temple University.


Supervisee-Centred Supervision Robert Taibbi: Clinical Director and Supervisor for 30 years

“The administrative stuff plays second fiddle to your real job though: helping the supervisee--from scared beginners to confident (sometimes overconfident) pros to burned-out timeservers--figure out what they need and how to weave together their strengths, skills, and personalities into a unique and personal clinical style. Obviously, you need good supervisory skills, but you must apply those skills in creative ways at different times with different staff because one size definitely doesn't fit all in this work. It's the relationship between supervisor and supervisee (rather than a set of skills, per se) that's the key to helping him or her learn what it really means to be a therapist and practice therapy.”


Using a ‘Collage’ to defineYour Philosophy of Supervision

“I suggest that (Supervisees) avoid reifying human predicaments into symptoms…. All of this is mostly a matter of cleaning out enough psychological "debris" so that supervisees can sit comfortably, listen carefully, and think creatively. When I supervise, I give example after example of interventions that challenge clients' suppositions and help them explore new terrain. Then I hope for the best. Perhaps Marsha Linehan, the inventor of Dialectical Behavior Therapy, put it best when she advised new students to stop trying to act like therapists: "If they would act like themselves, they would be better off. . . . All you are trying to be is simply one human being trying to help another human being. That's all this is." Unfortunately, the(diagnostic) category obscures that fact.”

Jay Efran, Ph.D., Temple University.


My Personal Supervision Philosophy


- power to as opposed to power-over


to the client system and the agency


in that the supervisee needs to be centred and grounded in their ‘use of self’


- frontline staff as the backbone of the service


of the Unique Talents of the ‘professional part’ of the clinician


by client feedback and the literature


of ‘the Person’ of the Clinician


- building on talents and abilities

Mistake Friendly

- aware that we learn through trial and error


Exercise #2‘The Person’ of the Supervisor

In groups of 3 or 4, identify the following:The major models of therapy, counselling or change process that you value.A life experience that you have had that informs your experience of supervision.b) 2-3 Personal Strengths you bring to your Supervisory Rolec) 5- 8 adjectives that best describe your values in regard to your supervisory practices.


The Methods and Tools of the ‘Yang’of Supervision


Methods and Tools of Reflective, ‘Use of Self’, ‘The Person of’ Supervision

CONTENTLearning Contract*Feedback Forms*Evaluation Tools*Genogram* Cultural Genogram*Professional Genograms*



Self Supervision

Reflective Conversations

Supervision of Supervision

Outside Supervision, Consultation and Training


Mindfulness and Supervision

Mindfulness is intentionally being aware of what really is in the current moment

Jon Kabat-Zinn

The aim of supervision of clinical work ought to be

supervision of the therapist’s own self-supervision



Confucius said, Give a man a fish and you feed him for a day; teach him to fish and you feed him for a hundred years

(O’Hanlon & Wilk, 1987



Benefits of Mindful PracticeMindfulness and SupervisionAAMFT Supervision Bulletin 2010

Reduces anxiety and increases calm demeanor

Increases ability to be present and in the moment

Reduces internal ‘chatter’ and negative self talk

Increases self reflection and boundary setting

Allows easier transitioning between clients or supervisees

Increases clients/supervisee’s experience of being heard, validated and responded to


Goal: to increase therapeutic presence

Regular practice of mindfulness meditation

with MFT supervisees resulted in significant

improvement of in-session skills

Increased patience

Increased ability to attend to the client’s experience

Increased ability to attend to one’s own experience

Reduced reactivity and judgment

Better handling of challenges


Methods of Mindfulness Meditation:Practices that bring the clinician’s awareness fully into the present without judging or evaluating that experience


Body Awareness: Body Scan- what is your body telling you

Body Movement: dance, walk





Active Listening

Clarify Reception

Discover supervisee‘s

point of view

Explain your point of view

Discuss the alternatives

Co-construct new ideas

Process is lead by supervisor

The Reflective Supervisory Conversation

(Leonardo daVinci Institute, The Netherlands 2008)


Prompting Phrases for Reflecting Practice

“I’m wondering…”“Can we explore for a moment…”“What are your thoughts on…”“How would you approach…”“What are the possibilities you see in…”“How will your strengths…”“Can you tell me (a little more) about…”

“How would you describe…”

“What would happen if you tried…”

“How do you understand/Can you help me understand…”

“If you viewed this from ________’s perspective, what would you see…”

“What do you need from me today to feel supported…”



Chronicle families and major elements of their histories over a minimum of three generations(McGoldrick&Gerson,1985) Provide graphic annals of families membership, characteristics, and interpersonal relationshipsReflect the transmission of family patterns from generation to generation (Kuehl, 1995) and provide a provisional blueprint for change (Lieberman, 1979, p. 57).


Reflective Exercise #3 The Cultural GenogramConstantine 2003

In your small groups, discuss the demographic variables you use to identify yourself culturally including SES, race, ethnicity, religion, gender/sexual identity, education etc.

What worldviews (e.g., values, assumptions, and biases) do you bring to supervision based on your cultural identities?

What struggles and challenges have you faced working with supervisees who were from different cultures than your own?


Cultural Awareness Continuumin Supervision Cross,1989

Cultural Destructiveness-

superiority of dominant culture and inferiority of other cultures; active discrimination

Cultural Incapacity-

Separate but equal treatment- passive discrimination

Cultural Blindness-

Sees all cultures and people as alike and equal; discrimination by ignoring culture

Cultural Openness (Sensitivity)-

Basic understanding & appreciation of importance sociocultural factors in work with minority populations

Cultural Competence-

Capacity to work with more complex issues and cultural nuances

Cultural Proficiency-

Highest capacity for work with minority populations; a commitment to excellence and proactive effort


Culturally Responsive Supervision

Inclusive of the multiple awareness of self and other

Multi-cultural competence as a stated mutual goal of supervision

Strong working alliance in supervisory dyad supports trust and respect vital for risk-taking, development of self-awareness and multicultural sensitivity

Self awareness is a prerequisite for multi cultural competency (Richardson&Molinaro 1996)


Teaching Multicultural Competence


- acceptance and respect for cultural differences in supervisor/ therapist/client relationships

- adaptation of supervisory/therapeutic approaches to fit socio-cultural contexts

- self-awareness regarding the impact of values, attitudes, biases and cultural differences

acquisition of cultural knowledge and sensitivity

a multicultural experience in the world

provision of services to accommodate diversity in culture and socioeconomic status

reflection on beliefs and behaviors related to age, gender, ethnicity, power, religion/spirit

uality, context, etc.


Seek factual knowledge when faced with new cultural situations

Develop an open and sensitive working alliance with your supervisee

Practice Mindful awareness and teach it

Be aware that matching of supervisor and supervisee personal characteristics does not seem to be crucial in the creation of meaningful relationships

Recognize that the ability of the supervisor to discuss similarities and differences seems to be the critical dimension


The Professional GenogramMagnuson (2000)

to examine influences of professional

mentors, authors, and theorists.

parallel the family

genogram structure

feature a chronology of direct professional mentors, influential theorists and philosophies above

participant symbols

lines can be added to

illustrate relationships between the persons, philosophies,

and entities that are symbolized

provides a forum for

examining assumptions that inform the person-of the-professional


Reflective Exercise #4

With 3-4 other participants discuss what methods of Reflective Clinical Supervisory practice you are currently using and find helpful.

What other method or tool will you try next week?

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