CLINICAL SUPERVISION IMPLEMENTATION GUIDE

A. Psychotherapy-based Models of Supervision

Psychotherapy-based models of supervision often feel like a natural extension of the therapy itself. “Theoretical orientation informs the observation and selection of clinical data for discussion in supervision as well as the meanings and relevance of those data (Falender & Shafaanske, 2008, p. 9). Thus, there is an uninterrupted flow of terminology, focus, and technique from the counseling session to the supervision session, and back again.

1. Psychodynamic Approach to Supervision

As noted above, psychodynamic supervision draws on the clinical data inherent to that theoretical orientation (e.g., affective reactions, defense mechanisms, transference and countertransferece, etc.). Frawley-O’Dea and Sarnat (2001) classify psychodynamic supervision into three categories: patient-centered, supervisee-centered, and supervisorymatrixcentered. Patient-centered began with Freud and, as the name implies, focuses the supervision session on the patient’s presentation and behaviors. The supervisor’s role is didactic, with the goal of helping the supervisee understand and treat the patient’s material. The supervisor is seen as the uninvolved expert who has the knowledge and skills to assist the supervisee, thus giving the supervisor considerable authority (Frawley-O’Dea & Sarnat, 2001).

1. Supervisee-centered psychodynamic supervision came into popularity in the 1950s, focusing on the content and process of the supervisee’s experience as a counselor (Frawley-O’Dea & Sarnat, 2001; Falender & Shafranske, 2008). Process focuses on the supervisee’s resistances, anxieties, and learning problems (Falender & Shafranske). The supervisor’s role in this approach is still that of the authoritative, uninvolved expert (Frawley-O’Dea & Sarnat), but because the attention is shifted to the psychology of the supervisee, supervision utilizing this approach is more experiential than didactic (Falender & Shafranske).
2. The supervisory-matrix-centered approach opens up more material in supervision as it not only attends to material of the client and the supervisee, but also introduces examination of the relationship between supervisor and supervisee. The supervisor’s role is no longer one of uninvolved expert. Supervision within this approach is relational and the supervisor’s role is to “participate in, reflect upon, and process enactments, and to interpret relational themes that arise within either the therapeutic or supervisory dyads” (Frawley- O’Dea & Sarnat, 2001, p. 41). This includes an examination of parallel process, which is defined as “the supervisee’s interaction with the supervisor that parallels the client’s behavior with the supervisee as the therapist” (Haynes, Corey, & Moulton, 2003).

2. Cognitive-Behavioral Supervision

As with other psychotherapy-based approaches to supervision, an important task for the cognitive-behavioral supervisor is to teach the techniques of the theoretical orientation. Cognitive-behavioral supervision makes use of observable cognitions and behaviors—particularly of the supervisee’s professional identity and his/her reaction to the client (Hayes, Corey, & Moulton, 2003). Cognitive-behavioral techniques used in supervision include setting an agenda for supervision sessions, bridging from previous sessions, assigning
homework to the supervisee, and capsule summaries by the supervisor (Liese & Beck, 1997).

3. Person-Centered Supervision

Carl Rogers developed person-centered therapy around the belief that the client has the capacity to effectively resolve life problems without interpretation and direction from the counselor (Haynes, Corey, & Moulton, 2003). In the same vein, person-centered supervision assumes that the supervisee has the resources to effectively develop as a counselor. The supervisor is not seen as an expert in this model, but rather serves as a “collaborator” with the supervisee. The supervisor’s role is to provide an environment in which the supervisee can be open to his/her experience and fully engaged with the client (Lambers, 2000). In person-centered therapy, “the attitudes and personal characteristics of the therapist
and the quality of the client-therapist relationship are the prime determinants of the outcomes of therapy” (Haynes, Corey, & Moulton, 2003, p. 118). Person-centered supervision adopts this tenet as well, relying heavily on the supervisor-supervisee relationship to facilitate effective learning and growth in supervision.

B. Developmental Models of Supervision

In general, developmental models of supervision define progressive stages of supervisee development from novice to expert, each stage consisting of discrete characteristics and skills. For example, supervisees at the beginning or novice stage would be expected to have limited skills and lack confidence as counselors, while middle stage supervisees might have more skill and confidence and have conflicting feelings about perceived independence/dependence on the supervisor. A supervisee at the expert end of the developmental spectrum is likely to utilize good problem-solving skills and be reflective about the counseling and supervisory process (Haynes, Corey, & Moulton, 2003). For supervisors employing a development approach to supervision, the key is to accurately identify the supervisee’s current stage and provide feedback and support appropriate to that developmental stage, while at the same time facilitating the supervisee’s progression to the next stage (Littrell, Lee-Borden, & Lorenz, 1979; Loganbill, Hardy, & Delworth, 1982; Stoltenberg & Delworth, 1987). To this end, a supervisor uses an interactive process, often referred to as “scaffolding” (Zimmerman & Schunk, 2003), which encourages the supervisee to use prior knowledge and skills to produce new learning. Throughout this process, not only is the supervisee exposed to new information and counseling skills, but the interaction between supervisor and supervisee also fosters the development of advanced critical thinking skills. While the process, as described, appears linear, it is not. A supervisee may be in different stages simultaneously; that is, the supervisee may be at mid-level development overall, but experience high anxiety when faced with a new client situation.

1. Integrated Development Model

One of the most researched developmental models of supervision is the Integrated Developmental Model (IDM) developed by Stoltenberg (1981) and Stoltenberg and Delworth (1987) and, finally, by Stoltenberg, McNeill, and Delworth (1998) (Falender & Shafranske, 2004; Haynes, Corey, & Moulton, 2003). The IDM describes three levels of counselor development:

• Level 1 supervisees are generally entry-level students who are high in motivation, yet high in anxiety and fearful of evaluation;
• Level 2 supervisees are at mid-level and experience fluctuating confidence and motivation, often linking their own mood to success with clients; and Level 3 supervisees are essentially secure, stable in motivation, have accurate empathy tempered by objectivity, and use therapeutic self in intervention. (Falender & Shafranske)

As noted earlier, the IDM stresses the need for the supervisor to utilize skills and approaches that correspond to the level of the supervisee. So, for example, when working with a level-1 supervisee, the supervisor needs to balance the supervisee’s high anxiety and dependence by being supportive and prescriptive. The same supervisor when supervising a level-3 supervisee would emphasize supervisee autonomy and engage in collegial challenging. If a supervisor was to consistently mismatch his/her responses to the developmental level of the
supervisee, it would likely result in significant difficulty for the supervisee to satisfactorily master the current developmental stage. For example, a supervisor who demands autonomous behavior from a level-1 supervisee is likely to intensify the supervisee’s anxiety.

2. Ronnestad and Skovholt’s Model

In the most recent revision (2003), the model is comprised of six phases of development. The first three phases (The Lay Helper, The Beginning Student Phase, and The Advanced Student Phase) roughly correspond with the levels of the IDM. The remaining three phases (The Novice Professional Phase, The Experienced Professional Phase, and The Senior Professional Phase) are self-explanatory in terms of the relative occurrence of the phase in relation to the counselor’s career. In addition to the phase model, Ronnestad and Skovholt’s (2003) analysis found 14
themes of counselor development. These are:

1. Professional development involves an increasing higher-order integration of the professional self and the personal self
2. The focus of functioning shifts dramatically over time from internal to external to internal.
3. Continuous reflection is a prerequisite for optimal learning and professional development at all levels of experience.
4. An intense commitment to learning propels the developmental process.
5. The cognitive map changes: Beginning practitioners rely on external expertise, seasoned practitioners rely on internal expertise.
6. Professional development is long, slow, continuous process that can also be erratic.
7. Professional development is a life-long process.
8. Many beginning practitioners experience much anxiety in their professional work. Over time, anxiety is mastered by most.
9. Clients serve as a major source of influence and serve as primary teachers.
10. Personal life influences professional functioning and development throughout the professional life span.
11. Interpersonal sources of influence propel professional development more than ‘impersonal’ sources of influence.
12. New members of the field view professional elders and graduate training with strong affective reactions.
13. Extensive experience with suffering contributes to heightened recognition, acceptance and appreciation of human variability.
14. For the practitioner there is a realignment from self as hero to client as hero.

C. Integrative Models of Supervision

Haynes, Corey, and Moulton describe two approaches to integration: technical eclecticism and theoretical integration.

1. Technical Eclecticism

Technical eclecticism tends to focus on differences, chooses from many approaches, and is a collection of techniques. This path calls for using techniques from different schools without necessarily subscribing to the theoretical positions that spawned them. In contrast, theoretical integration refers to a conceptual or theoretical creation beyond a mere blending of techniques. This path has the goal of producing a conceptual framework that synthesizes the best of two or more theoretical approaches to produce an outcome richer than that of a single theory. (Haynes, Corey, & Moulton, p. 124).

2. Bernard’s Discrimination Model

Today, one of the most commonly used and researched integrative models of supervision is the Discrimination Model, originally published by Janine Bernard in 1979. This model is comprised of three separate foci for supervision (i.e., intervention, conceptualization, and personalization) and three possible supervisor roles (i.e., educator, counselor, and consultant) (Bernard & Goodyear, 2009). The supervisor could, in any given moment, respond from one of nine ways (three roles x three foci). For example, the supervisor may take on the role of educator while focusing on a specific intervention used by the supervisee in the client session, or the role of counselor while focusing on the supervisee’s conceptualization of the work. Because the response is always specific to the supervisee’s needs, it changes within and across sessions.

3. Systems Approach

In the systems approach to supervision, the heart of supervision is the relationship between supervisor and supervisee, which is mutually involving and aimed at bestowing power to both members (Holloway, 1995). Holloway describes seven dimensions of supervision, all connected by the central supervisory relationship. These dimensions are: the functions of supervision, the tasks of supervision, the client, the trainee, the supervisor, and the institution (Holloway). The function and tasks of supervision are at the foreground of interaction, while the latter four dimensions represent unique contextual factors that are, according to Holloway, covert influences in the supervisory process. Supervision in any particular
instance is seen to be reflective of a unique combination of these seven dimensions.

D. Reflective Supervision:

The three building blocks of reflective supervision—reflection, collaboration, and regularity—are outlined below. {The author ‘s description reflects a child/family context.}

1. Reflection

Reflection means stepping back from the immediate, intense experience of hands-on work and taking the time to wonder what the experience really means. What does it tell us about the family? About ourselves? Through reflection, we can examine our thoughts and feelings about the experience and identify the interventions that best meet the family’s goals for self-sufficiency, growth and development.

Reflection in a supervisory relationship requires a foundation of honesty and trust. The goal is to create an environment in which people do their best thinking— one characterized by safety, calmness and support. Generally, supervisees meet with supervisors on a regular basis, providing material (like notes from visits with families, videos, verbal reports, etc.) that will help stimulate a dialogue about the work. As a team, supervisor and supervisee explore the range of emotions (positive and negative) related to the families and issues the supervisee is managing. As a team, they work to understand and identify appropriate next steps.

Reflective supervision is not therapy. It is focused on experiences, thoughts and feelings directly connected with the work. Reflective supervision is characterized by active listening and thoughtful questioning by both parties. The role of the supervisor is to help the supervisee to answer her own questions, and to provide the support and knowledge necessary to guide decision-making. In addition, the supervisor provides an empathetic, nonjudgmental ear to the supervisee. Working through complex emotions in a “safe place” allows the supervisee to manage the
stress she experiences on the job. It also allows the staff person to experience the very sort of relationship that she is expected to provide for clients and families.

2. Collaboration

The concept of collaboration (or teamwork) emphasizes sharing the responsibility and control of power. Power in an infant/family program is derived from many sources, among them position in the organization, ability to lead and inspire, sphere of influence and network of colleagues. But most of all, power is derived from knowledge—about children and families, the field, and oneself in the work. While sharing power is the goal of collaboration, it does not exempt supervisors from setting limits or exercising authority. These responsibilities remain firmly within the supervisor’s domain. Collaboration does, however, allow for a dialogue to occur on issues affecting the staff person and the program.

3. Regularity

Neither reflection nor collaboration will occur without regularity of interactions. Supervision should take place on a reliable schedule, and sufficient time must be allocated to its practice. This time, while precious and hard to come by, should be protected from cancellation, rescheduling, or procrastination. That said, everyone working in infant/family programs knows that there are times when scheduling conflicts or emergencies arise, making it necessary to reschedule supervision meetings. When this happens, set another time to meet as soon as possible. If the need to reschedule arises frequently, it makes sense to consider why this is happening. Is the selected time an inconvenient one? Is the supervisor or the staff member overburdened, or is either having difficulty with time management skills? Is there some tension in the staff/supervisory relationship prompting either party to postpone their meeting?

It takes time to build a trusting relationship, to collaborate, and to share ideas, thoughts, and emotions. Supervisory meetings are an investment in the professional development of staff and in the future of the infant/family program. Staff will take their cues from leaders: do program directors make time for supervision? Do the program’s leaders “walk the talk”?

Excerpted from Parlakian, R. (2001). Look, listen, and learn: Reflective supervision and relationship-based work. Washington, D.C: ZERO TO THREE.

E. Reflective Supervision Infant Mental Health

Professionals who provide services to infants and young children and their families involved in child protective services face multiple daily challenges. Working with stressed and traumatized infants/young children and their families, as well as the systems charged with providing services and oversight, affects professionals on many levels. These early professionals (mental health providers, developmental specialists, early interventionists, home visitors, family educators, Head Start teachers, public health nurses, child welfare workers and others) in turn require support and ongoing professional development to provide perspective, increase their skills, and avoid burn-out. Reflective supervision, a practice that has evolved from the multi-disciplinary field of infant mental health, provides the support needed by practitioners who are exposed to the intense emotional content and life experiences related to their work with families. An ongoing professional development process, reflective supervision provides a way for professionals working with very young children to reach greater understanding of their own responses, as well as the babies and adults they work with, and as a result, facilitating quality practice and intervention.

For more information:

• Heller, S. S., & Gilkerson, L. (2009). A practical guide to reflective supervision . Washington,
  DC: Zero to Three.

F. References

• Bernard, J. M. (1979). Supervisor training: A discrimination model. Counselor Education and Supervision, 19, 60-68.
• Bernard, J. M., & Goodyear, R. K. (2009). Fundamentals of clinical supervision (4th ed.). Needham Heights, MA: Allyn & Bacon.
• Falender, C. A., & Shafranske, E. P. (2004). Clinical supervision: A competency-based approach. Washington, DC: American Psychological Association.
• Haarhoff, B., Gibson, K., & Flett, R. (2011). Improving the Quality of Cognitive Behaviour Therapy Case Conceptualization: The Role of Self-Practice/Self-
  Reflection. Behavioural and Cognitive Psychotherapy, 39(3), 323-339. doi:10.1017/S1352465810000871
• Holloway, E. (1995). Clinical supervision: A systems approach. Thousand Oaks, CA: Sage.
• Holloway, E., & Wolleat, P. L. (1994). Supervision: The pragmatics of empowerment. Journal of Educational and Psychological Consultation, 5(1), 23-43.
• Lambers, E. (2000). Supervision in person-centered therapy: Facilitating congruence. In E. Mearns & B. Thorne (Eds.), Person-centered therapy today: New frontiers in theory and practice (pp. 196-211). London: Sage.
• Liese, B. S., & Beck, J. S. (1997). Cognitive therapy supervision. In C. E. Watkins, Jr. (Ed.), Handbook of psychotherapy supervision (pp. 114-133). New York: John Wiley & Sons.
• Littrell, J. M., Lee-Borden, N., & Lorenz, J. A. (1979). A developmental framework for counseling supervision. Counselor Education and Supervision, 19, 119-136.
• Loganbill, C., Hardy, E., & Delworth, U. (1982). Supervision: A conceptual model. Counseling Psychologist, 10, 3-42.
• Ronnestad, M. H., & Skovolt, T. M. (1993). Supervision of beginning and advanced graduate students of counseling and psychotherapy. Journal of Counseling and Development, 71, 396-405.
• Ronnestad, M. H. & Skovholt, T. M. (2003). The journey of the counselor and therapist: Research findings and perspectives on professional development. Journal of Career Development, 30, 5-44.
• Skovolt, T. M., & Ronnestad, M. H. (1992). The evolving professional self: Stages and themes in therapist and counselor development. Chichester, England: Wiley.
• Stoltenberg, C. D. (1981). Approaching supervision from a developmental perspective: The counselor complexity model. Journal of Counseling Psychology, 28, 59-65.
• Stoltenberg, C. D., & Delworth, U. (1987). Supervising counselors and therapists . San Francisco: Jossey-Bass.
• Stoltenberg, C. D., McNeill, B., & Delworth, U. (1998). IDM supervision: An integrated developmental model for supervising counselors and therapists . San Francisco: Jossey-Bass. Ward, C. C