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Clinical Supervision: Models, Role, Legal & Ethical, & Transference
On the last track, we discussed the contracting process, and the five main benefits provided from contracting. These benefits are, both parties become actively involved in the supervision process, a contract provides a clear perception of goals, the supervisor and supervisee create a clear picture of what their work looks like together, contracting creates mutuality and guards against the abuse of power, and contracts minimize covert agendas. I also provided you with a supervisee six-point approach assessment regarding development of a supervision contract.
On this track, we will discuss taking a reflective approach to supervision. Do you ever feel like saying to your supervisee, "move over; let me take over"? I find that the biggest difficulty for me in training supervisees and supervisors in the reflective process is to step back when a dilemma is presented, and not answer the supervisee’s questions directly. Have you felt, as I have, the temptation to act as a therapist first, and give ‘brilliant’ advice to solve the supervisee’s problem?
Clearly, this is most difficult for the beginning supervisor, who feels pressure to generate answers and perform credibly by being helpful. When the goal of supervision is to train the supervisee in the reflective approach, the supervisor can instead encourage the reflective process, rather than showing the supervisee how the ‘best’ therapy might look. At the end of this track, I will describe how I encouraged the reflective approach in my supervisee, Laura, while not robbing her of the opportunity to grow.
Dimension #1 - In the first reflective dimension, attention is focused simultaneously on the interaction between the client and therapist. Also in the first dimension of reflectivity, attention is focused on the therapist’s own actions, emotions, and thoughts. This includes active and critical inquiry into the supervisee’s covert and overt behavior during the session as well as the intention of the supervisee to examine his or her actions.
Dimension #2 - The second dimension of a reflective approach to supervision and in their session with a client is, maintaining openness to alternatives for interpretation. This second dimension of reflectivity also involves the willingness to become vulnerable and try out new ideas both in a supervisory session and in sessions with clients.
Laura: Reflective Learning Case Study
Three Dimensions of Reflective Learning
--1. Intention to Examine One's own Actions
After Laura had described the session more completely, I directed her to focus on her feelings experienced during the session. For example, when Laura stated, "I had never heard of anything like this before, and wanted to know if it was normal," I stated, "so you were worried?" Laura admitted that she had felt worried and uncomfortable during the session, and restated that she felt concerned that her patient may be exhibiting signs of psychosis.
I took this opportunity to ask Laura questions that revolved around the meaning she made of the experience in the session with her client, and to encourage her to discuss actions she was considering taking.
As we have discussed, it is important when training supervisee to use reflection both with clients and with future supervisees, to encourage thought and discussion about the nature of an interaction. In Laura’s case, I specifically asked, "What was the nature and feeling of your interaction with your client?" Laura stated, "I don’t connect with her as well as with my other clients."
I rephrased Laura’s own concerns and presented them to her for clarification, saying "so it sounds like your client may not have had a good relationship history, and may be hard to form a relationship with." Laura stated, "yes, but I think she’s a good client to work with. She always answers questions and tries to be clear, and she comes to all of her appointments."
--2. Maintaining Openness to Alternatives
--3. Ability to Use Theory and Past Experiences to Refine Technique
Laura stated that she felt that she was using a combination of inter-personal theory and psychodynamic theory, which I affirmed, as I felt it was an accurate description of her experience. I also asked Laura, "besides these theories and your experience with this client, what else do you use to understand her? Are there any past experiences that may have helped you?" Laura stated, "well, I think I’m not very judgmental, I can ask about things outside of my experience and not have a strong reaction. I think that helps. And I’m very curious- one time I met a homeless man in New York, and I ended up talking to him for quite a while because his experiences were so different, and I kept having questions."
Clearly, this allowed Laura not only to reflect on frames of reference in her own life that helped her create a strong counseling image, but also to reflect on her strengths as a counselor, allowing her to gain confidence.
Finally, before ending my supervising session with Laura, I asked her to reflect on her experience discussing the client with me, ensuring that she had gotten what she needed from our interaction.
In my experience, practicing this pattern in interacting with supervisees helps them to develop a reflective process of thinking about difficulties with clients that helps them long after our relationship ends. I also find this essential to use when training supervisors, as the novice supervisor’s attempts to encourage reflectivity in their supervisees helps them to use reflectivity when improving their skills of supervision, and create better interactions with their supervisees. Would you agree?
On this track, we have discussed the reflective approach to supervision, and methods to encourage the growth of the reflective process in supervisees and trainee supervisors. The three dimensions of the reflective approach are the intention to examine one’s own actions, maintaining openness to alternatives, and the ability to use theory and past experiences to refine clinical technique.
On the next track, we will discuss the three common perspectives in multi-cultural counseling. We will also discuss techniques by which to encourage the growth of multicultural counseling skills within supervisees.
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