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Clinical Supervision: Models, Role, Legal & Ethical, & Transference
We will look at clinical mental health supervision from the point of view of four different models.
The second model of clinical supervision that we will outline is the six-part mode of Observation, Planning, Teaching, Individual Meetings, Group Training, and Review.
The third models are the type of supervisor observation i.e. video and the behind the mirror.
The fourth model of clinical supervision to be outlined are what I termed "problematic models" sense when these models are used they can create problematic or non efficient/effective communication. These brief examinations or explorations will be followed by more detailed examples of how the developmental model can be applied in actual supervision situations.
So let’s outline the four developmental model of clinical mental health supervision Relational, Six-Part, Observation, and Problematic.
Practitioner's Stage - Relational Developmental Model
Clinical supervision under this model is ‘consultation with a more seasoned practitioner in the field in order to draw on their wisdom and expertise. This model has a focus on the developmental and educative functions and clarifies the different stages that practitioners go through in their professional development– the novice worker, the advanced beginner, competent worker, very experienced worker to expert. This model is used when there is respect for the supervisors’ skill base and ability to impart information for the purposes of learning.
- WA Department of Health. Clinical Supervision Framework for WA Mental Health Services and Clinicians. Department of Health, July 2005, p1-12.
The Six-Part Model for Clinical Supervision
This six-part model includes Observation, Planing, Teaching, Individual Meetings,
Group Training, and Review. The six-parts have been adopted State wide in Idaho as the model to be implemented by all provider agencies which provide clinical mental health services on behalf of the State of Idaho through contracts with the Department of Health and Welfare, monitored by Business Psychology Associates (BPA). Clinical Supervision as defined by this model includes:
- Porter, John. The "How To" Manual For Clinical Supervision in IDAHO. Idaho Department of Health & Welfare, April 2011, p1-58.
Video and Behind the Mirror Supervision Models
This section will discuss two models of supervision. The two models we will discuss are the video supervision model and the live or "behind the mirror" supervision model. Regarding supervision behind the mirror, we will also discuss group training, sharing information with clients, protecting the supervisee, and gender issues in supervision.
Choosing a Training Model
Supervisors may choose what kind of group they want for a training atmosphere. There are teaching approaches in which the training group is reflective and no one is responsible for failure. This approach is peer supervision. There are also those who believe that training should involve cotherapy, with the supervisor being in the room with the supervisee rather than behind the mirror. Others believe that because ultimately the supervisee must face a client alone, why not begin doing that from the start? What other training methods have you tried? What do you currently believe is the most effective method for supervision training?
Video Supervision Model
Video Supervision vs. Describing
Introduction after the fact
The Model of Supervision Behind the Mirror
Reflection of Therapy Focus
One example of this would be if the supervisee is trying to help parents be firm with a violent child. For this to occur, the supervisor must first take charge as the expert behind the mirror. By "taking charge", I simply mean that the supervisor needs to know his or her therapeutic stance when training supervisees so that the supervisee may become an expert in helping clients. This is, of course, necessary even in training programs where there is no actual mirror. Do you agree that behavior in a therapy session may be a reflection of what has happened behind the mirror?
Group Training Supervision Model
Rules for Behavior
Ask yourself, if you have group supervisee meetings, how do you set the stage for a positive supportive attitude among supervisees? Also, remember that the role you play as supervisor may be reflected in the therapy stance the supervisee takes with his or her clients. Do you feel you were more of a "pal" with your last supervisee group? Did you notice your supervisees being more of a pal with their clients?
An Obvious Ethics Violation
Competition Among Supervisees
I have found that one problem with the supervisor opening up the discussion so that everyone can contribute is that the comments and suggestions from the other supervisees can be disorganized, judgmental, and overwhelming. This may create a defeatist attitude for the supervisee who has conducted the session. Since clearly you can’t control ahead of time what is going to transpire in a group discussion, I find it most effective for comments to be made to the supervisor and then edited and communicated to the supervisee.
Model for Working with Experienced Supervisees
Mary, age 51, had previously been in private practice in another state for a number of years, and joined me in a training program to meet our state licensure requirements. Due to her relative experience in private practice, Mary disagreed with me on ideology and interview techniques. However in contrast, Mary was placed as a beginner in conducting sessions with more than one person, since in private practice she only dealt with individuals and never with couples, family members, etc. How would you deal with a supervisee in this scenario?
Friendly versus Strict versus Reaction Models for Supervisors
Regarding therapy supervision, do you agree that supervision should be structured, focused, and educational in nature? This portion of the course will expand on methodology to do this. In addition, both the supervisor and supervisee are responsible for the content and structure, although the recommended structure of the supervision session is similar to a cognitive therapy session. I have found that during a typical weekly supervision session, which is usually 60 minutes in length, at least one client that your supervisee is working with should be discussed in depth.
How do you acknowledge your limitations as a supervisor? Here is an exercise to think about your possible limitations as a supervisor regarding three problematic approaches. These three problematic approaches are the Friendly Supervisor, the Strict Supervisor, and the Reaction Supervisor. As I clarify each of these, ask yourself which one of the three categories, if any, do you fall into? To clarify, the Friendly Supervisor is amiable and easygoing, but as a consequence, may not provide substantial feedback to the supervisee. Do you find yourself having the need to be liked by your supervisee? Secondly, the Strict Supervisor is rigid and believes in "my way or the highway". Do you feel you may be too authoritarian with your supervisee? Finally, the Reaction Supervisor focuses too much on the supervisee’s personal feelings about his or her client. Do you feel you are too much in a therapy role with your supervisee?
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