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Clinical Supervision 201: Ethical Dilemmas and Other
Challenges Presented by:
Thomas Durham JBS International
The presentation will begin shortly.
Clinical Supervision 201: Ethical Dilemmas and Other
Challenges Presented by:
Thomas Durham JBS International
Using GoToWebinar
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ü Asking Questions
ü PowerPoint Slides
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ü www.naadac.org/education/ webinars
ü www.myaccucare.com/ resources/webinars
6/12/12
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Presented By
Obtaining CE Credit • The education delivered in this webinar is FREE to all professionals.
• 1 CE is FREE to NAADAC members and AccuCare subscribers who attend this webinar. Non-members of NAADAC or non-subscribers of AccuCare receive 1 CE for $15.
• If you wish to receive CE credit, you MUST complete and pass the “CE Quiz” that is located at: (look for name of webinar)
▫ www.naadac.org/education/webinars
▫ www.myaccucare.com/resources/webinars
• A CE certificate will be emailed to you within 21 days of submitting the quiz and payment (if applicable).
• Successfully passing the “CE Quiz” is the ONLY way to receive a CE certificate.
Define at least four ethical dilemmas faced by clinical supervisors
Describe at least three significant factors in the evaluation process with counselors
Describe the approach most conducive to productive supervision at each of the three levels of counselor
development
Demonstrate improved time management in order to effectively balance administrative and clinical
supervision duties
Webinar Objectives
✓
✓
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Clinical Supervision: Keys to Success
www.naadac.org/education/webinars Broadcasted: December 2012 Access the archived recording.
Presenter
Thomas G. Durham, PhD, LADC, CCS Senior Trainer and Curriculum Specialist
at JBS International
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Introduction
Module 1
Brief Review of Material Covered Previously in CS 101
1. Definitions and competencies
2. The supervisory relationship
3. Applying theoretical models to
supervision
4. Observation and live supervision
5. Developing leadership skills
Assessing One’s Experience in Clinical Supervision
• What is your philosophy of treatment? • What impact does your philosophy of treatment
have on your model of supervision? • What methods do you use in supervision? ▫ Do you have a repertoire to draw from? ▫ Do you always do the same thing?
• How would you rate your supervisor? ▫ What rating would you give yourself?
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Overview of Today’s Topics
• Ethical and Legal Issues in Supervision
• Monitoring Counselor Performance
• Individualized Supervision
• Practical Issues in Supervision
Ethical and Legal Issues in Supervision
Module 2
Underlying Assumptions
• Ethical decision-making is a continuous and active process
• There are no “cook book” answers:
▫ Answers to ethical dilemmas are elusive
▫ Ethical standards are not easy to follow
▫ Each situation is unique
• Simple fact: people make mistakes
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Audience Polling Question #1 Which of the following do you think
are most important regarding the ethical responsibilities of a clinical
supervisor?
Clinical Supervisors Are:
• Gatekeepers for ethical and legal issues • Responsible for upholding the highest standards • Role models for staff • Responsible for maintaining awareness of and
responding to ethical concerns
Astute Clinical Supervisors
“help integrate solutions to everyday legal and ethical issues
into clinical practice”
Source: Center for Substance Abuse Treatment. (2009). Clinical supervision and professional development of the substance abuse counselor. Treatment Improvement Protocol (TIP) Series 52. DHHS Publication No. (SMA) 09-4435. Rockville, MD: SAMHSA
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Ethical Obligations
• Give counselors a framework for decision making
• Promote ethical thinking for counselors
• Monitor the ethical conduct of counselors
Ethical Decision-Making
• Whose interests are involved and who can be harmed? ▫ Who are the potential winners and losers? ▫ Whose interests, if any, are in conflict?
• How are primary stakeholders involved, affected or harmed? • Whose interests, if any, are in conflict? • What universal values can be applied? ▫ Are any values in conflict?
• What laws, standards, policies, historical practices, or cultural teachings should guide the decision?
Source: White, W.L. & Popovits, R.M. (2001). Critical incidents: Ethical issues in the prevention and treatment of addictions. Bloomington, IL: Lighthouse Institute.
Ethical Dilemmas Facing Supervisors
• Only game in town
• Promotion from the ranks
• “Two hatter” issues for
supervisors in recovery
• Self disclosure
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Self Disclosure
• What is the purpose? • What are the benefits to the supervisee? • What potential harm is there to the supervisee? • Whose agenda is it: yours or the supervisee’s? • What might work better?
Five Primary Ethical Issues Critical to Clinical Supervision
1. Vicarious liability 2. Dual relationships and boundary control 3. Informed consent 4. Confidentiality 5. Supervisor ethics
Monitoring Counselor Performance
Module 3
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Evaluation of Counselors • First step: Building a collaborative relationship • Two types of evaluations: ▫ Formative – ongoing status of skill development ▫ Summative – formal rating of job performance
• Goal of CS: To ensure quality • Two important tasks of CS: ▫ To educate counselor on what to expect in
supervision ▫ To evaluate counselor progress on a regular basis
Factors in the Evaluation Process • Emphasis on hierarchical differences • Social distance increases • Demands exercise of authority • Demands subjective appraisal • Is an indirect evaluation of the supervisor • Negative feelings may be evoked:
ü Fear of failure, sense of criticism, performance anxiety
ü Focus on self, need to be “right,” need for approval ü Motivational stimulus
• Blurring of distinction between feedback and criticism
Annual Performance Evaluation Expectations for performance
ü Review position description
ü Review goals and objectives for preceding year
Evaluate actual performance
ü Review degree of variation from expectations
Set new goals and objectives
ü Develop expectations for coming year
ü Revise position description as warranted
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Issues Supervisors Face in the Evaluation Process • Remembering the negatives • Don’t own their value-based judgments • Feedback is not always clear or direct • May be tackling too many problems • May give only negative criticism • May remember only the previous month • May prefer to stay in comfort zone and
downplay the truth
Assessment of Cognitive Skills
1. What were you hearing your patient say?
2. What were you thinking about your observations?
3. What were your alternatives to say or do
at this point?
4. How did you choose from among the alternatives?
5. How did you intend to proceed with your selected response?
Primary Means of Assessment
Self-assessment ü Verbal reports ü Self-inventory
Progress notes ü Critical thinking ü Cognitive skills
Peer assessments ü Case presentations
Supervision ü Observation
Clients ü Client surveys
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Audience Polling Question #2 Which of the following methods
gives you the most significant information on a counselor's skill
level?
Self-Efficacy
• Supervisee’s self-perception of abilities, perceived confidence
• Efficacy expectancy: individual’s belief in his/her ability to perform tasks
• Outcome expectancy: expectation that certain behaviors lead to specific outcomes
• Research: supervision promotes efficacy expectancy, self-efficacy
Guidelines for Useful Feedback
• Clear in expectations ü Descriptive and not judgmental
ü Specific and not general
• Written evaluation • Regular, direct observation • Timely, not distant
• Positive and negative feedback • Match to developmental stage • Encouragement, support, self-evaluation
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What can Enhance “Good” Feedback?
• Supervisor demonstrates expertise
• Information gathered through direct observation
• Alternatives offered to supervisee
• Given in a supportive and trusting relationship
Feedback Least Preferred by Supervisees
• Unannounced observations
• No feedback
• Vague
• No suggestions or specifications for improvement
• Perfunctory or indirect delivery
• Information withheld
• Hurtful delivery
Reasons for Difficulty Giving Feedback
• Misperception that feedback disturbs relationship
• Seen as potentially punitive
• Unidirectional process
• Lack of clear definition of competency
• Lack of time, experience
• Fear of liability, damaging a person’s career, reputation
• Interpersonal issues
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Individualized Supervision
Module 4
Individuality and Developmental Issues
Eight domains of supervisee development 1. Intervention skills competence 2. Assessment techniques 3. Interpersonal assessment 4. Client conceptualization 5. Individual differences 6. Theoretical orientation 7. Treatment plans and goals 8. Professional ethics
Source: Stoltenberg, C. & McNeil, B. (2009). IDM supervision: An integrative model for supervising counselor s and therapists (3rd ed.). New York: Routledge.
Individuality and Developmental Issues
Three overriding structures of supervisee growth:
1. Self- and other-awareness
2. Motivation
3. Autonomy And these can be measured across the 8 domains to assess a counselor’s level of development Source: Stoltenberg, C. & McNeil, B. (2009). IDM supervision: An integrative model for supervising counselors and therapists (3rd ed.). New York: Routledge.
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The Developmental Model of Clinical Supervision
Recognizes counselor growth is: • Multidimensional • Continuous • Individual focused
And generally can be assessed within three stages of counselor growth. Source: Stoltenberg, C. & McNeil, B. (2009). IDM supervision: An integrative model for supervising counselors and therapists (3rd ed.). New York: Routledge.
The Developmental Model of Clinical Supervision
• Level 1: Entry-level counselor ▫ Basic understanding of ethics ▫ Preoccupied with performance ▫ Basic skill level
• Level 2: Mid-stage counselor ▫ Confused; frustrated ▫ Challenges authority (dependence/autonomy) ▫ Gaining skills, but lacks proficiency
• Level 3: Advance counselor ▫ Responsible; highly ethical ▫ Integrative thinking and approach ▫ Highly skilled
Source: Stoltenberg, C. & McNeil, B. (2009). IDM supervision: An integrative model for supervising counselors and therapists (3rd ed.). New York: Routledge.
Audience Polling Question #3 Of the counselors that you
currently supervise, which level of skill do you most often see
demonstrated?
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Enhancing Motivation through an Individualized Approach
A review of the Principles of MI:
• Express Empathy
• Develop Discrepancy
• Roll with Resistance
• Support Self-Efficacy
Enhancing Motivation through an Individualized Approach
Setting the Stage for Enhancing Motivation
• Focus on competencies
• Provide person-centered interventions
• Establish a partnership for change
• Use empathy, not power
• Provide early interventions
Precontemplation
Contemplation
Action
Termination
Relapse Preparation
The Transtheoretical Model (Stages of Change)
Maintenance
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Phases of Change • Building motivation to change ▫ Eliciting self-motivating statements ▫ Tipping the motivational balance ▫ Questioning, affirming, reframing
• Strengthening commitment to change ▫ Recognizing change readiness ▫ Negotiating a plan for change
• Implementing the plan ▫ Commitment to action ▫ Developing, monitoring and updating goals
Identifying Growth Goals: The Individual Development Plan
• Mutual assessment
• Shared expectations
• Shared vision
• Focus on what is possible
• Vision to goal reality
Objectives for Goal Attainment
• Specific action steps
• Direction for skill development
• Expectations for the supervisory
relationship
• Benchmarks for evaluation
• SMART objectives
• A “living document” ▫ Updated as needed ▫ New goals added ▫ Modified to fit progress
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Practical Issues in Clinical Supervision
Module 5
Methods and Techniques
• Verbal reports • Verbatim reports • Role playing • Modeling • Written/file review
Methods and Techniques • Audio/videotaping • Webcam • Direct observation • Co-facilitation • Case consultation
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Audience Polling Question #4 Do you have the opportunity to use
any of these direct observation methods with your supervisees?
Finding Time to Do Clinical Supervision
• Add new components of a supervision model one at a time
• Have regularly scheduled times with supervisees
• Keep sessions as priorities on your calendar
• When conducting observations, make them brief
Impossible? NO – It can be done!
• Will lead to quality care and increased efficiency
• Be creative:
▫ Peer supervision
▫ Triadic supervision
▫ Group supervision
• Individualize according to need
• Goal: 1 hour per counselor per week
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Improving Time Management
• Find your “creative” time and schedule accordingly
• Find your non-productive time and use it wisely
• Arrange your schedule to increase your accomplishments
• Keep phone calls short: announce
goals up front
• Limit meetings, but document decisions/actions
• Delegate, delegate, delegate
Poor Time Management and Stress • Days never seem long enough to get things done • Lack of goals lead to lack of direction and time
wasters • Inadequate feedback (from all levels) causes worry • Time pressure leads to:
▫ Stress
▫ Inefficiency
▫ Job dissatisfaction
▫ Fatigue
▫ Sleep disturbances
Will a supervisor who has difficulty managing time and stress likely fail at supporting counselors who experience
similar symptoms?
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Addressing Compassion Fatigue
Tension/preoccupation with trauma of working with people; Symptoms include:
• Loss of passion, purpose, vision
• Hard to communicate in relationships
• Hard to show empathy to others
• Lower creativity, humor, perspective
• Feeling of despair
Addressing Compassion Fatigue
More symptoms:
ü Physical, mental, spiritual exhaustion
ü Despite exhaustion, you keep giving
ü Blaming others for problems
ü Decreased productivity, sick days
ü Loss of resilience
Addressing Compassion Fatigue
Workplace enjoyment robbers:
• Competitive Pressures
• The need to do more, serve more
• Rapid change
• Overwhelming work burdens (too much to do and not enough time to do it all)
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Addressing Compassion Fatigue
• Secondary traumatic stress
• Burnout
• Counter-transference
“Counselors can’t counsel from beyond whom they
have become.”
- Carl Rogers
Overcoming Compassion Fatigue
1. Define purpose, values
2. Face what happened, accept the situation, make a decision, act
3. Recognize you’re wearing down
4. Adopt a new lifestyle to increase emotional resilience
5. Reconnect to the world
6. Self-reflection
7. Spend time alone
8. Form daily habits to re-energize
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Overcoming Compassion Fatigue (Cont’d)
9. Connect with friends & family
10. Don’t make any major decisions when fatigued
10. Forget the “if onlys” & negative self-talk
11. Set parameters on your job
13. Let go your idealism: you can’t save the world. In fact, you can’t save anyone!
14. Adhere to scheduled time off
15. Take a Fearless inventory: What makes you whole?
Source: Powell, D.J. (2011). Overcoming compassion fatigue: Care of the caregiver. Presentation at the Annual Clinical Preceptorship Program Conference, San Diego, CA.
Overcoming Compassion Fatigue: Promote Mindfulness
Lack of Mindfulness:
• Rushing through activities
• Careless attention
• Failure to notice subtle feelings
• Forgetfulness; on “auto pilot”
• Preoccupation with future/past
• Eating without being aware of
eating
Overcoming Compassion Fatigue: Promote Mindfulness
Mindfulness is:
• Being present in everyday living
• Slowing down • Taking compassionate action • Careful attention • Awareness of subtle feelings
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Exercise 1. List 5 accomplishments in your life
2. Pick one—Why is this so significant?
3. List your 10 core values
4. Put these values in priority order
5. List 5 significant people to you. Why are they significant?
6. When & where do you feel most alive?
7. What drains your energy?
8. List 3 “dreams” you have for the future
Source: Powell, D.J. (2011). Overcoming compassion fatigue: Care of the caregiver. Presentation at the Annual Clinical Preceptorship Program Conference, San Diego, CA.
“The curious paradox of change is that people only seriously consider change when they feel accepted for
exactly who they are.” --Carl Rogers
www.naadac.org [email protected]
Tom Durham - [email protected]
www.myaccucare.com [email protected]
Feel free to ask questions through
the Questions pane.
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Obtaining CE Credit • The education delivered in this webinar is FREE to all professionals.
• 1 CE is FREE to NAADAC members and AccuCare subscribers who attend this webinar. Non-members of NAADAC or non-subscribers of AccuCare receive 1 CE for $15.
• If you wish to receive CE credit, you MUST complete and pass the “CE Quiz” that is located at: (look for name of webinar)
▫ www.naadac.org/education/webinars
▫ www.myaccucare.com/resources/webinars
• A CE certificate will be emailed to you within 21 days of submitting the quiz and payment (if applicable).
• Successfully passing the “CE Quiz” is the ONLY way to receive a CE certificate.
Thank You for Participating!
www.naadac.org [email protected]
Tom Durham - [email protected]
www.myaccucare.com [email protected]
