Competency-based Clinical Supervision: A PowerPoint Presentation, PPT - DocSlides

Competency-based Clinical Supervision: A Transtheoretical (or Metatheoretical) Approach

Carol Falender, Ph.D.

Edward P. Shafranske, Ph.D., ABPP

American Psychological Association Task Force on Supervision Definition

Competency-based supervision is

a

metatheoretical

approach that explicitly identifies the knowledge, skills and attitudes that comprise clinical competencies, informs learning strategies and evaluation procedures, and meets criterion-referenced competence standards consistent with evidence-based practices (regulations), and the local/cultural clinical setting (adapted from Falender & Shafranske, 2007). Competency-based supervision is one approach to supervision; it is

metatheoretical

and does not preclude other models of supervision. (APA, 2014)

Transtheoretical or Metatheoretical

Our use of

transtheoretical

differs significantly from

Prochaska

and Norcross (2007), and refers to its application as a framework for any other model of clinical supervision as well as on its own (Falender & Shafranske, in press). As such it offers a

metatheoretical

approach across different models of supervision.

Gonsalvez

& Calvert (2014) described competency-based models as

transtheoretical

as they can be integrated with other models (psychotherapeutic and developmental) and provide a molecular model, “starting with the end in mind” (p. 202)

Competency-based Clinical Supervision

Competency-based clinical supervision entails an intentional, systematic approach to the multiple competencies— knowledge, skills, and attitudes

It includes observation, collaborative

self-

assessment and feedback on the assessment; experiential learning and skill development, instruction

, modeling, and mutual problem solving;

ongoing assessment, feedback

and

evaluation, role

modeling

Competency-based Clinical Supervision

Competency-based supervision’s intentional, systematic approach is in contrast to psychotherapy-driven or other supervision approaches are not comprehensive in all the components essential to clinical supervision

Essential is the interplay of self-assessment, supervisor collaborative assessment and feedback with the collaborative development of a training contract articulating discrete competencies to be attained and means to achieve those.

The Learning Cycle (Falender & Shafranske, 2016)

Shafranske & Falender, in press

The Learning Cycle

Complexity of Supervision

Supervisor competence—to make valid entrustment decisions about supervisee

Competence clinical practice under supervision

(e.g., populations, theories, assessment, interventions, models, multiculturalism, context, research, evidence-base)

Competence in clinical supervision

(e.g., competencies outlined in APA Supervision Guidelines)

Clinical Supervision, Training, and Professional Development Research Center, at Pepperdine University

Three Studies on Counterproductive Supervision that frame essential need for change in clinical supervision

i

. Q-sort by current graduate students

i

i. Q-sort by experts in clinical supervision

Iii. Q-sort by practicing supervisors

Study (Wall, 2009) found high frequency of non-adherence to ethical practices affected alliance

Four studies on impact of supervisory alliance on supervisee disclosure

Current Graduate Students (rank order)

Cultural Insensitivity

Inadequate Understanding of Performance Expectations for Supervisee and Supervisor/Role Conflict

Failure to Address Needs of Supervisee

Supervisor Supervision Approach and Supervisee Learning Approach Mismatch

Additional Counterproductive Experiences

Inadequate Attention to Ethics, Ethical Lapses, and Unethical Behavior

Boundary Crossings/Violations

Supervisor/Supervisee Theoretical Orientation Mismatch

Inappropriate Supervisor Self-Disclosure

We are Very Poor at Self-Assessment

Self-assessment bias

25% of mental health professionals viewed their skill to be at the

90

th

percentile

when compared to their peers, and none viewed themselves as

below average (defying statistical probabilities)

Review of therapist lack of skill in identifying clients who got worse

Walfish

, McAlister, O’Donnell, & Lambert, 2012

Like Lake

Wobegon

…all the children are above average?

Expert performers actively sought more feedback than moderate performers (

Sonnentag

, 2000)

We do not systematically teach supervisees self-assessment or provide feedback to increase accuracy

We believe a core component of competency-based supervision is competence of the supervisor to assess supervisee “

entrustability

” and to systematically address the multiple aspects of clinical supervision as they relate to clinical practice

Complexity of Supervisor Competence

Concept of “

Entrustability

” of supervisee

Competence

Reliability/conscientiousness

Truthfulness and honesty

Recognizing limitations and asking for help

Empathy, openness towards patients

Skill in

intercollegial

/Interprofessional collaboration

Habits of self-evaluation, reflection, development

Responsibility

Knowing how to deal with mistakes by self and others

Ten Cate et al., 2016

Vignette

Dr. Hass, a 57 year old Caucasian male, prefaced supervision that has been supervising for over 20 years, and launched right in with Alberta, a 27 year old self described “African-American digital native.” In response to Alberta’s persistent efforts to structure supervision, Dr. Hass told her he simply works from theory and all else falls into place. He finds goals cumbersome, and urged her simply to begin discussing her client cases. Quickly he began reflecting about several aspects of client dynamics and they have only covered the one case in the first three weeks, her efforts notwithstanding. He refers to her as “Amanda.”

Strengths and What is Missing?

Conundrum

Essentially, study of clinical supervision is compromised without consensus on its definition, lack of formal training—and highly variable training if any—and debate whether supervision

is a

distinct professional practice

Movement towards agreement on definition?

First Step: Components

Self-assessment and collaborative assessment of supervisee competence and ongoing feedback

Supervisory relationship

Addressing strains and ruptures to relationship

Diversity and multiculturalism

Reactivity or countertransference, self-care

Legal and ethical standards/aspects

Addressing performance/competence problems

Support? Evidence?

Adoption of Competency-based Supervision model by multiple countries including Australia and New Zealand

Intersection of competency-based and psychotherapy model for Motivational Interviewing

Stein, Clair,

Soenksen

-

Bassett, Martin, & Clarke, 2015

Skill sets associated with client outcomes

Bearman

et al., 2015

Use of symptom checklists, therapeutic alliance associated with enhanced client outcomes

Do supervisors matter?

Rousmaniere

, Swift,

Babins

-Wagner, Whipple, &

Berzins

, 2016

Are we throwing away the baby with the proverbial bath water focusing so intensively on client outcomes and failing to attend to the therapist’s contributions?

Miller, Hubble, Chow, & Seidel, 2015

Or the supervisory contributions? (F & S)

Need to consider the therapist’s contribution—supervisee, supervisor AND systematic, intentional process

Future Directions

Train supervisees in role invocation—to be successful supervisees as an entrée into the supervision process (

Vespia

et al., Falender & Shafranske, 2012)

Train supervisors, use of supervisor competence assessment to ensure intentional, ethical supervision practice

Assess supervisor competence and develop a protocol for supervisors to self-assess and model development of their own goals for the training sequence

(2)

Track supervisee supervision outcomes and client outcomes as a matter of course—and use these as feedback to inform supervision/treatment

Through practice and guidelines adoption, increase value attached to clinical supervision in our profession, settings, and more generally

References

American Psychological Association. Board of Educational Affairs. (2014) Guidelines for clinical supervision for health service psychologists. Retrieved from:

http://www.apa.org/about/policy/guidelines-supervision.pdf

Bearman

, S. K., Weisz, J. R., Chorpita, B. F.,

Hoagwood

, K., Ward, A.,

Ugeuto

, A. M., & Bernstein, A. (2013). More practice, less preach? The role of supervision practices and therapist characteristics in EBP implementation.

Administrative Policy in Mental Health

,

doi

: 10.1007/s10488-013-0485-

5

Falender

, C. A., & Shafranske, E. P. (2007). Competence in competency-based supervision practice: Construct and application.

Professional Psychology: Research and Practice, 38

(3)

,

232-240.

doi:10.1037/0735-

7028.38.3.232

Falender, C. A. & Shafranske, E. P. (in press).

Supervision essentials for the practice of competency-based supervision.

American Psychological Association

.

Gonsalvez

, C. J., & Calvert, F. L. (2014). Competency-based models of supervision: Principles and applications, promises and challenges.

Australian Psychologist, 49

, 200-208.

doi

: 10.1111/ap.

12055

Prochaska

, J. O., & Norcross, J. C (2009). Systems of psychotherapy: A

transtheoretical

analysis (7

th

ed.). Belmont, Ca.: Brooks Cole

.

Shafranske, E. P., & Falender, C. A., (in press). Clinical Supervision. In J. C. Norcross, G. R.,

VandenBos

& D. K.

Freedheim

(Eds.),

APA Handbook of Clinical Psychology Volume V: Education and Profession

. Washington, DC: American Psychological Association.

Stein

, L. A. R., Clair, M.,

Soenksen

-Bassett, S., Martin, R. A., & Clarke, J. G. (2015). Studying process and proximal outcomes of supervision for motivational interviewing.

 Training and Education in Professional Psychology, 9

(2), 175-182.

doi:http

://

dx.doi.org

/10.1037/tep0000073

Ten Cate, O., Hart, D.,

Ankel

, F.,

Busari

, J., Englander, R., Glasgow, N,….Wycliffe-Jones, K. (2016). Entrustment decision making in clinical training.

Academic Medicine, 91

, 191-198.

doi

: 10.1097/ACM.0000000000001044

Walfish

, S., McAlister, B., O’Donnell, P., & Lambert, M. J. (2012). An investigation of self-assessment bias in mental health providers.

Psychological Reports, 110

, 639-644.

doi

: 10.2466/02.07.17.PR0.110.2.639-644