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Supervision: Enhancing Supervisees Clinical Skills
Supervision continuing education social worker CEUs

Section 15
Getting the Most Out of Clinical Supervision:
Strategies for Mental Health

CEU Question 15 | CEU Answer Booklet | Table of Contents | Supervision
 Social Worker CEUs, Psychologist CEs, Counselor CEUs, MFT CEUs

Active Participation
Participation in each supervision session begins with taking an active role in establishing a tentative agenda for the meeting. Offering to update the supervisor on the status of follow-ups to directives or suggestions, crisis or emergency cases, or other important pending matters is a useful first step. Additionally, requesting time for specific questions or challenging cases is also helpful. Providing this information accomplishes a number of things. It lets supervisors know that MHC students are sensitive to supervisors' concerns (i.e., vicarious liability) and respectful of supervisors' expertise.

It also helps supervisors make decisions about how to utilize time in the session and what topics to initiate. Finally, it helps to ensure that students are more likely to get their needs met. By being active in structuring the meeting, students can help to reduce the frustration that results when one or both parties feel that essential matters were not addressed.

Being prepared for the various roles (i.e., teacher, counselor, and consultant) that supervisors might slip into and out of when addressing the aforementioned topics can also help to reduce potential confusion and frustration in MHC students. When supervisors provide feedback about performance, teach or model techniques, explain the rationale behind interventions, or provide interpretations of counseling interactions, they are trying to instruct students from the teaching role (Stenack & Dye, 1982). Operating from the counseling role, supervisors are trying to facilitate students' self-growth as it relates to their professional development. Questioning students about their feelings (e.g., whether in response to supervision, counseling sessions, or trying specific counseling interventions) and providing opportunities to explore affective responses, defensive reactions, worries, and personal strengths are all appropriate supervision interventions from the counseling role (Stenack & Dye). From the consulting role, supervisors focus on the client in order to generate information and ideas about treatment. Accordingly, supervisors encourage students to discuss client problems or motivations and brainstorm alternative conceptualizations or interventions. Rather than directing the interactions and providing answers, as is done in the teaching role, supervisors in the consulting role encourage student choice and responsibility by providing options and alternatives instead of answers (Stenack & Dye). Understanding the purposes of each of these supervisor roles can prepare MHC students for responding in a complementary fashion from the respective roles of student, client, and counselor.

Taking Initiative
In addition to merely responding to interventions from supervisors, MHC students can also consider initiating topics from the role of student, client, or counselor, depending on their developmental needs. In other words, MHC students who want specific feedback about the quality of their conceptualizations or interactions might consider using the following student-role statements or questions: I am uncertain about whether I am going in a useful direction with this client. Can you give me some ideas about how to avoid giving advice when clients keep asking? Would you mind reviewing my paperwork to see if my treatment plans are improved? Can you tell me how to work with addictions, or can you suggest where to find a resource?

MHC students can initiate discussions about personal reactions and feelings by moving into the client role with the supervisor. A transition into the client role could be facilitated by the following questions and statements: I have a hard time paying attention to this client. Could you help me explore the anger that I am feeling toward the client's parents? For some reason, I am reluctant to confront this client, and I would like to figure out what is blocking me. This dream I had about my client contained some powerful images that I am having trouble interpreting. I find that I cannot stop worrying about my clients once I get home with my family. Sometimes in our supervisions sessions, I feel like I will never know enough to work with clients on my own. When I work with this client, he or she reminds me so much of my older brother or older sister. How can I ensure that these feelings will enhance rather that inhibit my work with this client?

Still other comments and questions from students, in the counselor role, can invite supervisors to move into a consultant role. Examples include the following: I am puzzled by the client's presenting symptoms, particularly in light of previous diagnoses. Can we spend some time discussing better ways to establish trust with this client? What do you think the client is trying to communicate by holding the sofa pillow when she talks? What kind of stress management techniques might work best with this client? I cannot really make sense of what keeps the client so stuck in this pattern of behavior.

Monitoring Self and Reactions
Three common occurrences in supervision are worth noting: counselor anxiety, transference and countertransference, and parallel process. Normalizing anxiety as an inevitable part of supervision is an important aspect of preparing MHC students for the supervision process (N. Berger & Graff, 1995; S. S. Berger & Buchholz, 1993; Bernard, 1994). Liddle (1986) identified five possible sources of threat for MHC students: (a) evaluation anxiety, (b) performance anxiety, (c) personal problems or internal conflicts, (d) deficits in the supervisory relationship, and (e) fear of negative consequences for trying new or risky counseling interventions. Accepting anxiety as a natural part of the process can make it easier for students to explore feelings of anger, defensiveness, or disinterest as possible reactions to underlying anxiety by asking themselves what they might be anxious about. Additionally, understanding common sources of anxiety can help students cope with their anxiety. Coping strategies suggested by Liddle included cognitive restructuring of counselor self-statements, rehearsing positive self-statements, reframing vulnerability as an opportunity for growth, assessing student strengths, and relying on outside social support systems. Students might also consider the following strategies: discussing with supervisors anxious feelings the moment they occur in supervision sessions, asking supervisors how they coped with anxiety during their training, and asking for specific feedback and evaluation if uncertain about the supervisor's opinion of their counseling abilities and progress.

In addition to anxiety, transference and counter transference can be the root of confusing, difficult, and sometimes negative interactions between supervisees and supervisors alike (Pearson, 2000). If unrecognized, such unconscious processes increase the potential for ineffective supervision or conflict within the supervisory relationship (Pearson). Recognizing these processes requires a willingness by MHC students to engage in serious personal reflection. Students' expectations for what should be happening in supervision can be influenced by current and prior relationships with other authority figures, including parents, teachers, and bosses. For instance, if students perceive their supervisors as overly critical, aloof, uncaring, smothering, stifling, or untrustworthy, they need to examine the degree to which they have had similar feelings toward other authority figures. Students might also ask others who have worked with the supervisor about their experiences and perceptions. When students realize that their reactions are unique or exaggerated compared to others' reactions and that they have reacted similarly to other authorities, transference is the likely explanation. With such a realization, students are more likely to act constructively rather than react negatively.

Parallel process (Friedlander, Siegel, & Brenock, 1989) is another unconscious phenomenon that is less familiar to MHC students. Parallel process occurs when supervisees unconsciously present themselves to the supervisor in much the same fashion that the client presented to the supervisee. Thus, the supervisee unconsciously replicates the conflict of the client (S. S. Berger & Buchholz, 1993). S. S. Berger and Buchholz argued that MHC students who understand parallel process may be able to observe themselves more effectively and may be more receptive to related interventions by the supervisor. Because parallel process is often subtle, making it difficult to detect, MHC students can be alert to situations in which their responses, reactions, or needs in supervision are atypical for themselves and ask the following: What client am I currently discussing or reminded of? To what degree could the client be feeling similar to the way I am feeling now? Do you have any insights regarding my description of the client and how it compares to your and my feelings in this situation.
- Pearson, Quinn, Getting the Most Out of Clinical Supervision: Strategies for Mental Health; Journal of Mental Health Counseling; Oct 2004; Vol. 26; Issue 4.
The article above contains foundational information. Articles below contain optional updates.

Personal Reflection Exercise #8
The preceding section contained information about getting the most out of clinical supervision. Write three case study examples regarding how you might use the content of this section in your practice.

Online Continuing Education QUESTION 15
Normalizing anxiety as an inevitable part of clinical supervision is an important aspect of preparing MHC students for the supervision process. What five possible sources of threat for MHC students did Liddle identify? Record the letter of the correct answer the CEU Answer Booklet

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Table of Contents

The article above contains foundational information. Articles below contain optional updates.
Suicide Intervention Training for Counselor Trainees: A Quasi‐Experimental Study on Skill Retention
The authors used a quasi‐experimental design to explore the effect of Applied Suicide Intervention Skills Training on 126 counselor trainees. Results showed that after 3 months, trainees had retained improvements in measured response skills and self‐reported attitudes. The authors discuss the developmental benefits of incorporating similar training into counselor education. Implications for skill measurement are also considered.
Examining Predictors of Counselor‐in‐Training Intentional Nondisclosure
This study explored factors that best predict intentional nondisclosure by counselors‐in‐training (CITs) during onsite supervision, including social judgment about one’s supervisor, the supervisory working alliance (SWA), and supervisee attachment styles. Stepwise regression in a sample of 146 CITs revealed that the SWA and supervisee attachment avoidance predicted 60% of the variance in intentional nondisclosure.
Pedagogy in Counselor Education: 2011–2015 Update
This research update includes a quantitative content analysis of 133 peer‐reviewed articles regarding teaching and learning published in 21 journals of the American Counseling Association and its divisions between January 2011 and December 2015. The authors discuss the focus areas, pedagogical foundations, and methodologies of the articles in comparison with the findings of the original 2001–2010 study.
Telling of Institutional Oppression: Voices of Minoritized Counselor Educators
The authors use the results of an intersectional critical qualitative inquiry to illustrate the encounters 6 minoritized counselor educators had with institutional forms of oppression. Their findings depict the insidious nature of institutional oppression and suggest that counselor educator experiences may be improved by peer mentorship programs and by the organizational advocacy and accountability efforts of bodies such as the Association for Counselor Education and Supervision.
Counselor Educators' Experiences Preparing Preservice School Counselors: A Phenomenological Study
The authors conducted a phenomenological study to explore the experiences of 32 school counselor educators preparing preservice school counselors. Analysis of data from 3 focus groups revealed 3 themes: breadth versus depth, balancing specialties and professor partiality, and preparation versus practice. These results highlight the need for collaboration across counseling specialties at the preservice level.

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