SUPERVISION ITS MORE THAN YOU THINK KENNETH SMITH

SUPERVISION!: IT’S MORE THAN YOU THINK KENNETH SMITH, LCSW, LCAS, CCS KSMITHLCAS@GMAIL. COM

Workshop Learning Objectives: • 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 practices • Question: 1. What comes to mind when you think of “supervision? ”

WHY HAVE SUPERVISION? • Usually a requirement for social work (or other) licensure • Malpractice prevention/ensuring good ethics • Professional growth/expanding knowledge • Positively affects morale/provide quality support • Staff retention/affects job satisfaction • Improved client outcomes?

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!

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 progress • Focuses on the ‘gatekeeper” role SUPERVISION IS NOT: • Case management focus on the client • Providing therapy for the supervisee • Gripe session about clients or co-workers

CRUCIAL ISSUES INVOLVING SUPERVISION: • Supervision should be an essential and prioritized part of all social work settings • Every social worker has the right to receive competent supervision • Supervisors (and the supervision process) should have the full support of the organization’s leadership • The 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.

BEFORE SUPERVISION BEGINS: 1. 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.

THE SUPERVISION CONTRACT • How often, time, place, length of session • Boundaries: (cell phone policy, notification policy, etc. ) • Grievance policy • Fees (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)

BRIEF OVERVIEW OF SUPERVISION MODELS Identifying a defined model gives you clarity: I. Developmental models II. Competency based models III. Treatment based models IV. BLENDED/INTEGRATED MODEL (Powell)

STAGES OF THE SUPERVISEE

LEVEL 1 • Focused on basic skills • Lacks self awareness • Mixture of anxiety and enthusiasm • Does not know what does not know • Follows a role model • Tunnel vision • Thinks categorically • Difficulty confronting and self disclosing • Looking for “cookbook” answers • Lacks integrated ethics • Dependent, with self focus • Limited treatment planning skills • Has difficulty conceptualizing • Follows one theory

SUPERVISING LEVEL 1 • Expose to various modalities • Use role plays, presentations • Be sensitive to anxiety • Help increase conceptualization skills • Promote reasonable autonomy • Address strengths first • Encourage some risks • Give them some control • Introduce ambiguity • Be sensitive to learning styles • Balance support with uncertainty • Counsel out of the field if necessary

LEVEL 2 • Focuses more on client • Gradually becomes more assertive • Greater awareness, frustration, confusion • Less inclined to ask for recommendations • May seem like regressing • Better articulates clinical issues • Balances uncertainty with idealism • Increased cultural awareness • Frustrated with difficult clients • Uses more eclectic theory • Has dependence/autonomy conflicts with supervisor • Ethical thinking is better shaped

SUPERVISING LEVEL 2 • Focus less on technique • More consultative role • Possible confrontation and challenges to your experience/competence • Encourage independence • Realize the supervisee may know there’s something wrong, but lacks skills to fix it • Both accept and clarify ambivalence • Increased awareness of transference/countertransference • Ready to see more variety of clients

LEVEL 3 • Understands client diversity • Is non-defensive • Knows own limits • • Forging own style Can move smoothly from assessment to concept to interventions • Able to think clearly about ethical issues • Not disabled by doubts • Functions more autonomously • Autonomy, motivation, awareness • Able to appropriately use self • Can work with all styles of supervisors

SUPERVISING LEVEL 3 • Level 3 worker needs a Level 3 supervisor! • Challenge to continue to grow and stay motivated • Be a facilitator, supporter, reality tester, sharer of experiences • Uses self disclosure when helpful • Still likely have some weak areas • “Wisdom” as opposed to “knowledge”

SUPERVISORS HAVE LEVELS TOO!!

SUPERVISOR LEVELS 1 AND 2 LEVEL 1 LEVEL II • Mechanical, structured • Mixture of confusion, conflict • Strives to present as an “expert” • Frustrated easily • Highly motivated • Loses objectivity • Invested in supervisee to use one’s own model • Blames supervisee • Focuses on supervisee • Best with Level 1, okay with Level 2 • Not a good match for Level 2 or 3 workers

LEVEL 3 SUPERVISOR • Works autonomously • Good sense of self and others • Practices healthy boundaries, knows role • Able to supervise all levels • Better able to pick and choose who to supervise • Flexible 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. ”

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.

DUSCSUSSION POINTS DURING SUPERVISION • What do you need from our time today? (Should have an agenda) • Any follow ups to previous sessions • Safety 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!

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.

“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)

OTHER DIFFICULT ISSUES • Projecting blame • Excessive need for control • Narcissism (superiority covering inferiority) • Super sensitive to perceived failure or criticism • “Resistance” can look the same as a client’s! • Others? ?

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.

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!

ETHICAL DECISION MAKING (Blanchard and Peale, 1988) THE THREE “ACID TESTS” 1. Is it legal? Will I be violating either civil law or company policy? 2. Is it balanced? Is it fair to all concerned in the short term and long term? Does it promote win-win relationships? 3. 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.

PREVENTION OF LEGAL ACTION: • Ask, am I doing this for the benefit of my client or some other ulterior motive? • 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 flags • Obey ALL policies and procedures Can you the name the top four reasons for being sued? ?

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?

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. ”

• 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 (Holladay, 2008) He modeled humility: Phil 2: 6 -8

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 situation • Sharing of wins and setbacks • Developing increased variety of interventions (Wahking, 1990)

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)

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 theological themes in the lives of their clients • Tracking progress on the Levels: Powell and Wahking

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.