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Clinical Supervision: Models, Role, Legal & Ethical, & Transference
On the last track, we proposed a five-step method of resolving conflict: observation; thoughts; feedback; desires; and next time
On this track, we will examine the various types of supervisees that are resistant to improvement: the "Yeah, but" supervisee; the silent supervisee; the "I'll try" supervisee; and the irrelevant supervisee.
4 Types of Supervisees that are Resistant to Improvement
Type # 1 -
The "Yeah, but" Supervisee
You might say, "Cheryl, you have to complete your client progress notes by the end of the week" and Cheryl might say, "Yeah, but, it's just so difficult for me to grasp the key points of what happened during the session." After we review a couple sessions, Cheryl would state something like, "Yeah, but, it's just hard for me to find the time to do them." As you can see, this type of supervisee can easily turn a conversation into a never ending cycle of "yeah, buts."
Solution for "Yeah, but" Supervisees, 2 Parts
As you can see, the key here with your "yeah, but" supervisee is placing the responsibility back on to the supervisee, you leave no opportunity open for a "yeah, but" to sneak in. How? You ask for their solution. If they come back with a "yeah, but," you tell them to think about it, it's their responsibility. Sound like this will work for you and your "yeah-butter"? In summary, the key with your "yeah, but" supervisee is to place responsibility back on them by asking them to think of a solution.
Type # 2 -
The Silent Supervisee
Obviously, the silent supervisee is one who either cannot or will not respond to questions regarding their performance. Sometimes, more timid supervisees, when confronted with inadequacy, might feel anxious about discussing their competency and understandably freeze. This type of silent treatment can be easily rectified by asking gently after a silence, "Are you feeling OK?" or, "Do you need a minute?" This will let your supervisee know that you're not trying to be intimidating and that you do care about his or her wellbeing.
On the other hand, some supervisees fall into the second category and might use silence as an intimidation tactic. The supervisee deliberately remains silent as a visible act of defiance. I feel such passive-aggressive behavior must be addressed and, if necessary, reprimanded, in order to facilitate a productive working relationship. Marilyn, a supervisee, was not convinced of the importance of the family systems model used by the out-patient facility. Marilyn continually needed to be coached about the use of the genogram and continually had to be reminded to add a genogram to her clients' records.
As you know, a genogram is a diagram used in family therapy
to depict family relationships extended over at least three generations. Here's
what would happen. Marylin continually needed to be reminded regarding simple
facts such as the diagram used circles to represent females and squares to represent
males with horizontal and vertical lines connecting accordingly. When her supervisor,
Carl addressed Marilyn about this problem, Marilyn refused to answer.
When Marilyn still refused to answer, Carl said, "If you are refusing to discuss this situation with me, it is a very serious matter." Finally, as a last resort, Carl asked one more time, "Are you refusing to respond to my question?" After Marilyn still refused to respond, Carl explained that within twenty-four hours, he was going to have to note Marilyn's behavior in her upcoming supervisee assessment and that any chance Marilyn had of remaining at the facility would probably be slim.
He ended by saying, "I hope we can resolve whatever it is that is causing you lack of response and I hear from you within twenty-four hours." So with the silent passive-aggressive supervisee, a time limited ultimatum seems to be an effective strategy. In summary with your silent type, if timid, provide support; if passive-aggressive, end with an ultimatum.
Type # 3 - The "I'll
A good example is found in Katie. Katie was an "I'll try" type of supervisee. However, her supervisor, Mitchell, noticed that Katie promised she would try to be more positive during her co-leading of a Twelve-Step meeting. However, her behavior seemed to not improve. You might look into your "I'll Try-er's" rational. Katie confided with Mitchell that her husband had an alcohol problem. However, she felt that her husband was not an alcoholic. Since she was in denial about her husband's addiction, she was extremely negative about some of the cornerstones of the twelve step philosophy.
Mitchell congratulated Katie on her self awareness but stated, "Therapists
need to put the clients well-being in the forefront beyond their own need to express
their feelings." During the meeting, she showed negative body language by
folding her arms across her chest, rolling her eyes, and verbalizing a "tsk"
sound of disapproval.
Katie thought for a moment and said, "I could lean forward a little when a client is relating something that is obviously important to them. Also, I could make more eye contact with them." The next session Katie had with her group she visibly improved. As you can see, by directly asking them how, you can be better assure that your "I'll try" supervisee will consider the situation and a change of behavior more carefully. Thus in summary, the key with your "I'll try" supervisee is to get specifics by asking "how"
Type #4 -
The Irrelevant Supervisee
Technique: "Separately and First"
Dan was a supervisee who would divert the topic away from the conversation. Lawrence, his supervisor, noticed this and employed the use of the phrases "Separately and First" to cope with Dan's digressions. Here's how it worked. Dan stated, "Preparatory reviewing? They never taught me that in school. They were too focused on assessments." In response, Lawrence said, "As far as your college education goes, I'd like to talk about that separately. However, first, I need for you to agree to begin to take your own preliminary preparation more seriously."
The important words here of course are "separately" and "first", hence. Avoid using the word "later", because, if the topic truly is irrelevant, there should really be no need to talk about it later. Also, be aware that you don't dismiss their topic as unimportant or unconnected, as, again, this will only lead to conflict.
On this track, we have examined various types of supervisees that are resistant to improvement: the yeahbut supervisee; the silent supervisee; the "I'll try" supervisee; and the irrelevant supervisee. Also, we presented various techniques for overcoming difficult conversations with these supervisees.
On the next track, we will present three main ethical issues involved in the supervision of a therapist: proper knowledge and skill; avoiding dual relationships; and fair and balanced assessment evaluations.
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