SUPERVISION!: It’s More Than You Think - PowerPoint Presentation

Slide1

SUPERVISION!:

It’s More Than You Think

Kenneth smith,

lcsw

,

lcas

, ccs

ksmithlcas@gmail.comSlide2

Learners will be able to define supervision and the roles of the supervisor/supervisee

Learners will be able to describe the ethical and legal issues involved with supervision

Learners will be able to integrate Christian spiritual faith with accepted supervision practicesQuestion: 1. What comes to mind when you think of “supervision?”

Workshop Learning Objectives:Slide3

WHY HAVE SUPERVISION?

Usually a requirement for social work (or other) licensure

Malpractice prevention/ensuring good ethicsProfessional growth/expanding knowledgePositively affects morale/provide quality support

Staff retention/affects job satisfactionImproved client outcomes?Slide4

DEFINING SUPERVISION:

SUPER (Over) VISION (Seer)

“

Clinical supervision is a disciplined, tutorial process wherein principles are transformed into practical skills with four overlapping foci: administrative, evaluative, clinical and supportive (Powell, 2004)

“Supervision is an intervention that is provided by a senior member of a profession to a junior member of that same profession. This relationship is evaluative, extends over time, and has the simultaneous purpose of enhancing the professional functioning of the junior member; monitoring the quality of professional services offered to their clients; and serving as a gatekeeper of those who are to enter the profession.” (Bernard and Goodyear , 1998)

ROLES OF THE SUPERVISOR: Teacher, Consultant, Mentor, Coach

CHARACTERISTICS OF A GOOD SUPERVISOR: Empathetic, Genuine, Good communicator, Flexible, Extensive clinical and ethical knowledge, Knows strengths and limitations, Passionate about role and wanting the best for their supervisees. “The supervisor models excitement, empathy, and curiosity,” (Powell, 2004) …..AND the supervisor of faith seeks to please God!

Slide5

SUPERVISION IS:

A dynamic process between the supervisor and supervisee

Focused on the supervisee’s development (increase and improve skills, increase and improve confidence, increase and improve ethical decision making, etc.)

Teaching, mentoring, monitoring progressFocuses on the ‘gatekeeper” role

SUPERVISION IS

NOT:

Case management focus on the client

Providing therapy for the supervisee

Gripe session about clients or co-workersSlide6

CRUCIAL ISSUES INVOLVING SUPERVISION:

Supervision should be an

essential and prioritized part of all social work settingsEvery social worker has the right to receive competent supervision

Supervisors (and the supervision process) should have the full support of the organization’s leadershipThe supervision process is where competent and ethical practice is developed and enhanced, not only individually, but organizationally.

AND MOST IMPORTANTLY!: Clinical supervision is a set of

separate and codified skills

different from clinical work. Clinical social workers who aspire to become supervisors MUST obtain specific training in supervision. There is

no guarantee

that even a highly competent clinical social worker will become a competent supervisor.Slide7

BEFORE SUPERVISION BEGINS:

Pre-supervision interview questions to ask:

A) Tell me about your professional journey so far

B) What are your short term and long term goals?

C) What do you consider to be your strengths? Weaknesses? Clinical skills and training? What are some modalities you’d like to be competent in?

D) How do you see yourself utilizing supervision?

E) If had supervision before: What liked about it? Wish were different? What were some of your growth goals? Did you accomplish them? If not, what got in the way? May I contact your previous supervisor?

2. Allow yourself to be aware of any red flags/gut feelings that this may not be a good match! If so, address them with the potential supervisee. Example: “As we were talking , I became a bit concerned that………………………….., how do you think we can address this? “ (Listen carefully for their answer) You

may decide

to decline to be their supervisor.Slide8

THE SUPERVISION CONTRACT

How often, time, place, length of session

Boundaries: (cell phone policy, notification policy, etc.)

Grievance policyFees (if applicable)Duties and responsibilities of supervisor/supervisee

Method of rating (both supervisee and supervisor) and documentation

Done in accordance with the license requirements

Many sample contracts are available for download (Powell, TIP 52 SAMHSA)Slide9

BRIEF OVERVIEW OF SUPERVISION MODELS

Identifying a defined model gives you clarity:

Developmental models

Competency based models

Treatment based models

BLENDED/INTEGRATED MODEL (Powell)Slide10

STAGES OF THE SUPERVISEESlide11

LEVEL 1

Focused on basic skills

Mixture of anxiety and enthusiasmFollows a role model

Thinks categoricallyLooking for “cookbook” answersDependent, with self focusHas difficulty conceptualizing

Lacks self awareness

Does not know what does not know

Tunnel vision

Difficulty confronting and self disclosing

Lacks integrated ethics

Limited treatment planning skills

Follows one theorySlide12

SUPERVISING LEVEL 1

Expose to various modalities

Be sensitive to anxietyPromote reasonable autonomy

Encourage some risksIntroduce ambiguityBalance support with uncertainty

Use role plays, presentations

Help increase conceptualization skills

Address strengths first

Give them some control

Be sensitive to learning styles

Counsel out of the field if necessarySlide13

LEVEL 2

Focuses more on client

Greater awareness, frustration, confusionMay seem like regressing

Balances uncertainty with idealismFrustrated with difficult clientsHas dependence/autonomy conflicts with supervisor

Gradually becomes more assertive

Less inclined to ask for recommendations

Better articulates clinical issues

Increased cultural awareness

Uses more eclectic theory

Ethical thinking is better shapedSlide14

SUPERVISING LEVEL 2

Focus less on technique

Possible confrontation and challenges to your experience/competence

Increased awareness of transference/countertransferenceReady to see more variety of clients

More consultative role

Encourage independence

Realize the supervisee may know there’s something wrong, but lacks skills to fix it

Both accept and clarify ambivalenceSlide15

LEVEL 3

Understands client diversity

Knows own limitsForging own styleNot disabled by doubts

Functions more autonomouslyAble to appropriately use self

Is non-defensive

Can move smoothly from assessment to concept to interventions

Able to think clearly about ethical issues

Autonomy, motivation, awareness

Can work with all styles of supervisorsSlide16

SUPERVISING LEVEL 3

Level 3 worker needs a Level 3 supervisor!

Be a facilitator, supporter, reality tester, sharer of experiences“Wisdom” as opposed to “knowledge”

Challenge to continue to grow and stay motivated

Uses self disclosure when helpful

Still likely have some weak areasSlide17

SUPERVISORS HAVE LEVELS TOO!!Slide18

SUPERVISOR LEVELS 1 AND 2

Level 1

Mechanical, structured

Strives to present as an “expert”Highly motivated

Invested in supervisee to use one’s own model

Not a good match for Level 2 or 3 workers

Level II

Mixture of confusion, conflict

Frustrated easily

Loses objectivity

Blames supervisee

Focuses on supervisee

Best with Level 1, okay with Level 2Slide19

LEVEL 3 SUPERVISOR

Works autonomously

Good sense of self and othersPractices healthy boundaries, knows roleAble to supervise all levels

Better able to pick and choose who to superviseFlexible approaches that fit the supervisee

The supervisor MUST continue to grow in skills by seeking “supervision of their supervision,”, attending workshops, learning how to self evaluate, allowing supervisees to evaluate them, and MOST IMPORTANTLY-don’t be afraid to say, “I don’t know, I’ll find the answer.” Slide20

THE SUPERVISORY RELATIONSHIP

Falender

and Shafranske(2004)

Just as any other professional social work or therapeutic situation, the

relationship between supervisor and supervisee is the most crucial component!

A positive alliance must be developed that consists of rapport, trust, respect, and caring that leads to congruence/genuineness, and a willingness on the part of both persons to be honest and open.

There is a positive correlation between effective alliance and supervisory disclosure. Otherwise, there is an increased risk for the supervisee to withhold perceived errors, negative reaction to clients, and, most importantly, negative reactions to the supervisor.Slide21

DUSCSUSSION POINTS DURING SUPERVISION

What do you need from our time today? (Should have an agenda)

Any follow ups to previous sessionsSafety issues: Any clients at risk for suicide or self harm? Any ethical or boundary issues? Any “reportable” issues?

Case discussions: (After giving brief background) What concerns you about this client? Frustrates you? What do you think is working well, why? What theory and/or techniques applies to this clients? What do you hope to accomplish in the next session, why? What does the client see as the important issues? What do they want? Any buttons being pushed? Any cultural issues? Transference/countertransference?

Other (relationship issues, burnout issues, etc.) Personal issues should be referred to a therapist!Slide22

METHODS OF SUPERVISION

Case formulation/conceptualization done on individual or group basis: Helps with clinical and critical thinking skills, but could become too client focused and always risk intentional or unintentional non-disclosure or withdrawal of material

Review of records/documentation: Helps develop skills, but gives incomplete picture of what is going on

Cofacilitation: Allows for more direct observation of the supervisee and supervisor can model techniques and approaches, but is time consuming and alters the dynamics of the session

Videotape: Can see the body language as well as the interventions, but need to find the right context and can be anxiety producing

Observation (either being present or through a one-way mirror): Gives a most complete picture of the supervisee, but risks the supervisee and the client “putting their best foot forward” and is often the most anxiety producing. My goals for observations: A) Tell you what you did well, B) Tell you what you can add or do differently next time, C) Discuss where you go from here.Slide23

“Red flags” that indicate problems in the supervision process

Supervisee:

Consistently shows up late for sessions

Looks bored or distracted during session

Presents to session with no agenda/non-disclosure/withholds material

Fails to follow through on directions/suggestions OR is too pleasing

Supervisor:

“Dreads” the upcoming session

Internally “judges” the supervisee

The first two under “supervisee”

Withdraws feedback from supervisee

Transference/countertransference issues! (Authority issues)Slide24

OTHER DIFFICULT ISSUES

Projecting blame

Excessive need for controlNarcissism (superiority covering inferiority)Super sensitive to perceived failure or criticism

“Resistance” can look the same as a client’s!Others??Slide25

CONFRONTATION OF THE SUPERVISEE

Done with respect and with the supervisee’s best interests in mind

Directly describe the supervisee’s behavior (“I have noticed that you….”)

Clarification (playing the curious card) “I’m curious about something, I have noticed that….can you fill me in on what that is all about for you?”Point out discrepancies (playing the confusion card) “I’m confused, you have told me supervision is important to you, yet I notice that….., what do you think?”

MUST be honest if you have doubts about their appropriateness for the profession (taking gatekeeper role seriously) “You seem to be struggling and I have serious concerns about your……At this point, we need to think about our options.” “At this point, I, unfortunately, need to recommend that you……

DON’T let the above be a surprise! It should be the end of a process. Slide26

ETHICAL AND LEGAL ISSUES

“

Supervisors are responsible for exercising reasonable oversight with respect to ethical conduct of those whom they supervise. These responsibilities involve the supervisor in issues such as informed consent, confidentiality and its limits, the duty to warn, boundaries, dual relationships, social and sexual intimacies with clients, misrepresentation, and professional credibility. The same principles of respect, fairness, nonexploitation, and the clarity of expectations govern the supervisory relationship as the counseling relationship. (Powell, 2004)

Supervisors need to be aware of and be familiar with their profession’s Code of Ethics as well as the rules for their profession’s licensing boards.

The practice of ethics is continual process!Slide27

ETHICAL DECISION MAKING (Blanchard and Peale, 1988)

THE THREE “ACID TESTS”

Is it legal? Will I be violating either civil law or company policy?

Is it balanced? Is it fair to all concerned in the short term and long term? Does it promote win-win relationships?

How will I feel about myself? Does it make me feel proud? What if it were published in an newspaper? Would I feel good if my family knew about it?

Other skills: identify the specific ethical issues and conflicting values; identify the people and organizations involved, i.e. what principles, codes, standards, and policies are involved; identify options and the pros/cons of each option; “spread the wealth,” i.e. get others involved; make a decision and document it and reason why; monitor the results.Slide28

PREVENTION OF LEGAL ACTION:

Ask, am I doing this for the benefit of my client or some other ulterior motive?

Document, document, document! (And have supervisor look over it)Seek frequent supervision and consultation

Obtain training in ethics (usually required by licensing boards)Be aware of any warning signs or red flagsObey ALL policies and procedures

Can you the name the top four reasons for being sued??Slide29

VICARIOUS LIABILITY

“

The supervisor assumes, in general, clinical responsibility much as if the client were under his or her own personal care. Supervisors are ultimately legally responsible for the welfare of clients counseled by their supervisees. Supervisors are legally and ethically responsible to be informed and to be aware of the actions of their supervisees; they must make a reasonable effort to supervise and monitor the activities of their supervisees.” (Powell, 2004)

“The supervisor may be held liable for damages caused by the negligence of the supervisee solely as a result of the supervisory relationship.”

Did the supervisor make a

reasonable effort

to supervise? Slide30

CHRISTIAN THEOLOGICAL AND BIBLICAL ISSUES

Scripture is clear on the value of developing “wisdom.” An entire book of the Bible, Proverbs, is devoted to seeking and practicing wisdom. Wisdom is developed by “taking advice (Proverbs 12:15, 13:10).” Proverbs 3:13, “Blessed are those who find wisdom and gain understanding.”

Scripture is clear that insight and positive action are acquired with the help of others. Ecclesiastes 4:9-10, “Two are better than one because they have a good return for their labor, if either of them falls down, one can help the other up.” Hebrews 10:24-25, “and let us consider how we may spur one another on toward love and good deeds, not giving up meeting together…”

Scripture is clear about the importance of loving and trusting relationships. Jesus commands us to “love one another (John 13:34).” I John 4:11 states, “Dear friend, since God loved us, we also ought to love one another.”Slide31

Scripture is clear that humility is an important virtue when practiced in the context of relationships (this includes professional relationships). I Peter 5:5, “In the same way, you who are younger submit yourself to your elders. All of you clothe yourselves in humility toward one another…” God “shows favor” to the humble (Prov. 3:34).

Scripture is clear that our ultimate motivation for doing anything (including professional roles) is to please God. II Corinthians 5: 9, “So we make it our goal to please Him….” I Thess. 2:4, ‘…..we are not trying to please people, but God, who tests our hearts.”

Scripture is clear about the value of honest communication. Ephesians 4:15, “speak the truth in love.” Ephesians 4:29, “Do not let any unwholesome talk come out of your mouth, but only what is helpful for building others up according to their needs, that it might benefit those who listen.”

Jesus modeled great supervision skills!

He served: Matthew 23:11-12; He encouraged: Luke 12:11-12

He challenged: Mark 8:29, John 21:15; He asked open ended questions: Mark 10:51

He communicated straight: Matt 5:37 He modeled humility: Phil 2:6-8

(Holladay, 2008)Slide32

CHRISTIAN THEOLOGICAL VALUES IN SUPERVISION

Improved quality of Christian service to clients and churches

Guidance through the three levels of a Christian supervisor (next slide)Increase intimacy with God and with others (peers)

Assurance of the backing of a more experienced social worker when facing a particularly difficult situationSharing of wins and setbacks

Developing increased variety of interventions

(

Wahking

, 1990)Slide33

THREE LEVELS OF A CHRISTIAN SOCIAL WORK SUPERVISEE (comparison to Powell’s levels)

LEVEL 1: “Disciple” Follow the recipe of an expert; soak up knowledge; obtain modeling of interventions; tapes/observation; situational anxiety; Goal is to

build competence.

LEVEL 2: “Apostle” Beginning to form habits of mind and heart; can think deeper; increased focus on relationships; becoming aware of themes; existential anxiety; Goal is to build proficiency

LEVEL 3: “Friend of Jesus” More embracing of true self; increased awareness of the mystical; increased acceptance of what is; more aware of the Holy Spirit’s presence; ontological anxiety; Goal is to

build expertise.

(

Wahking

, 1990)Slide34

CHRISTIAN/BIBLCIAL SUPERVSION INTERVENTIONS

Developing skills for doing spiritual assessments/inventories (Hodge, 1992)

Developing skills for recognizing mistakes (Smith, 1994)Developing skills for ethically performing Biblical/spiritual based interventions with clients, including the timing and scope of those interventions

Developing skills for recognizing the theological themes in the lives of their clientsTracking progress on the Levels: Powell and

WahkingSlide35
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SOURCES

Bernard, J.M. and Goodyear, R.K. 1992.

Fundamentals of Clinical Supervision.

Boston: Allyn & Bacon. Blanchard, K. and Pearl, N.V. 1988.

The Power of Ethical Management.

New York: Fawcett-Crest.

Falender

, C.A and

Shafranske

, E. P. 2004.

Clinical Supervision: A Competency Based Approach.

Washington, D.C.: American Psychological Association.

Holladay, T. 2008.

The Relationship Principles of Jesus.

Zondervan: Grand Rapids, MI.

Powell, David J. 2004.

Clinical Supervision in Alcohol and Drug Counseling. Jossey-Bass: San Francisco, CA.

Smith, K.G. “How Therapists Can Deal with and Learn from Mistakes.”

Journal of Psychology and Christianity. Volume 13, No. 1, pp. 76-83, Spring 1994.

Clinical Supervision and Professional Development of the Substance Abuse Counselor. 2009.

Treatment Improvement Protocol, TIP 52, SAMHSA.

Wahking

, H. 1990. “Making Effective Use of Clinical Supervision.” Network of Christian Counseling Centers, St. Petersburg, FL.