MakingaCaseforClinicalSupervision

LearningObjectives

Participantswill:1. Understandscopeandcomponentsofclinicalsupervision

2. LearnhowtoincorporatetheCommonfactorsApproachtoclinicalsupervision

3. Articulatethevalueofclinicalsupervisionintreatmentsettings

SexualContact

• VulnerableAdult(VA)reportedsexualrelationshipwithastaffperson(SP),anintern,afterhe/shelefttreatment• SPreportedhavingacrushonVAwhiletheywereinthesamecollegeclasses• SPpursuedVAviaemailandphonemessages• VAmetSPandhadsex• SeniorstaffhadnoknowledgethatinternknewVApreviouslyalthoughSPsaidhe/sheinformedsupervisorofthis

• SPreportedVAcontactedSPaboutdifficulttimesandSPmetVAatacafétodiscusdifficultiesseveraltimes• SPreportedVAbecameaggressivewhenSPsuggestedtheyshouldnotcommunicatefurther• SPreportedVAcontinuedtobeharassingandaPetitionforHarassmentRestrainingOrderwasfiledbySPagainstVA• SPdeniedhavingasexualrelationshipwithVA• VAprovideddescriptionofidentifyingtattooonSP’sbodythatindicatesitwaslikelythattherewassexualcontactbetweenVAandSP• ItwasnotdeterminedwhethersexualabuseoccurredbecausetheVAwasnolongeraclientofthefacilityanditwasnotdeterminedthatSPactedasacaregiverinhis/herroleatfacility

AllegationsofNeglect

• VA’sillnesshistoryindicateditwaslikelytheVAwouldrequirecontinuedsupportstodevelopandmaintainsobriety• SP’sinteractionslikelyhinderedVA’sabilitytohaveconsistentunderstandingofthetherapeuticrelationshipwhichcouldimpacttheVA’sabilitytoaccessservicessuccessfullyinthefutureandnecessarytomaintaintheVA’sphysicalormentalhealthorsafety

Theseguysareinbigtrouble!

CasePresentation-MaltreatmentofaVulnerableAdult

• “Anysexualcontactorpenetrationbetweenafacilitystaffpersonorapersonprovidingservicesinthefacilityandaresident,patient,orclientofthatfacility.”

• “Thefailureoromissionbyacaregivertosupplyavulnerableadultwithcareorservices,includingbutnotlimitedtofood,clothing,shelter,healthcareorsupervisionwhichisreasonableandnecessarytoobtainormaintainthevulnerableadult’sphysicalormentalhealthorsafety,consideringthephysicalandmentalcapacityordysfunctionofthevulnerableadult…..”

NAADACCodeofEthics

• TheCounselingRelationship:….theaddictionprofessionalislikelytoencounterindividualswhoarevulnerableandexploitable….theaddictionprofessionalseekstosupport….ratherthantotakeunfairadvantage.• Clientself-determination:Theaddictionprofessionalrecognizesthatthereareclientswithwhomhe/shecannotworkeffectively.Insuchcasesarrangementsforconsultation,co-therapyorreferralaremade.Inrelationshipswithclients,students,employeesandsupervisors

he/shestrivestodevelopfullcreativepotentialandmature,independentfunctioning

NAADACCodeofEthics

• DualRelationships:Addictionprofessionalswillprovideservicesonlyincontextofaprofessionalsetting.Becausearelationshipbeginswithapowerdifferential,theaddictionprofessionalwillnotexploitrelationshipswithcurrentorformerclients,currentorformersuperviseesorcolleaguesforpersonalgain,includingsocialorbusinessrelationships.Theaddictionprofessionalwillnot,underanycircumstances,engageinsexualbehaviorwithcurrentorformerclients.

DeterminingResponsibility

• “..the..responsibilitybetweenthefacility,othercaregivers,andrequirementsplaceduponemployee,including….theadequacyofcaregiversupervision….”• “whetherthefacilityorindividualfollowedprofessionalstandardsinexercisingprofessionaljudgement.”• TheinvestigationdeterminedthattheSPwasresponsibleforthemaltreatmentandnottheagencyaswellbecausetheSPhadreceivedtrainingonReportingofMaltreatmentofVulnerableAdultsAct.

DeterminingRecurringand/orSeriousMaltreatment

• ItwasdeterminedthatthesubstantiatedmaltreatmentforwhichtheSPwasresponsibleforwasnotseriousandwasnotrecurring.

• TheSPwasnotdisqualifiedfromprovidingdirectcareservicesbutwasnotifiedthatanyfurtherreportswouldmeetthecriteriaof“recurring”andwouldresultindisqualification.

• Whowerethepotentialvictimsinthissituation?

• Whatmighthavemadeadifference?

• Keepthesethoughtswhileweforgeaheadmakingacaseforclinicalsupervision.

• Let’sseehowwecanthehelpSPnotmakethisorsimilarmistakesinthefuture.

WhatisClinicalSupervision?

• Yourdefinition• Benefits• Whathaveyourexperiencesbeenasasupervisororsupervisee• Whatwashelpful?• Whatwasn’thelpful?• Whatwouldyouchange?

SomeDefinitionsofClinicalSupervision

“…Adisciplinedtutorialprocesswhereinprinciplesaretransformedintopracticalskillswithfouroverlappingfoci:administrative,evaluative,clinicalandsupportive.”Powell&Brodsky,2004,p.11

ClinicalSupervision

….isaninterventionprovidedbyaseniormemberoftheprofessiontoamorejuniormember..Thisrelationshipisevaluative,extendsovertime,andhassimultaneouspurposesofenhancingtheprofessionalfunctioningofferedtoclients..andservesasagatekeeper

Bernard&Goodyear,p.82004

ClinicalSupervision

…isasocialinfluenceprocessthatoccursovertime,inwhichthesupervisorparticipateswiththesuperviseetoensurequalitycare.Effectivesupervisorsobserve,mentor,coach,evaluate,inspire,andcreateanatmospherethatpromotesself-motivation,learningandprofessionaldevelopment.Theybuildteams,createcohesion,resolveconflictandshapeagencyculture,whileattendingtoethicalanddiversityissuesinallaspectsoftheprocess.Suchsupervisioniskeytobothqualityimprovementandthesuccessfulimplementationofconsensus- andevidence-basedpractices.

TAP-21A,2007,p.3

ModelsofSupervision

• Competency-based Skillsandlearningneeds,SMARTgoalsetting• Treatment–based Traintoaparticulartheoreticalapproach• Developmentalapproaches Understandthatcounselorsneeddifferentinterventionsastheyprogress• Integratedmodels Blendabovemodels

Tip52

TheRelationship

Teacher Coach

ConsultantMentor

TheRelationship

• Teacher-learningexperiences,provideinformation,challenges,neworrenewedmethods• Mentor-learningexperiences,rolemodel,guide,challenge-non-clinicalcounseling

• Consultant-ethics,problemsolving,protectingclientsandagency

• Coach-identifystrengthsandopportunitiesforimprovement

GeneralSupervisionGoals

Toensurequalitypatientcare,protecttheclients,institution,professionandcounselor

GeneralSupervisionGoals

Topromotecounselorprofessionalgrowthanddevelopment

GeneralSupervisionGoals

Tomonitorthecounselor’sperformanceasa“gatekeeper”throughobservationandevaluation

GeneralSupervisionGoals

Toempowercounselorstoengageincontinuousprofessionalandethicaldevelopment

CommonFactorsApproachtoClinicalSupervision

• Originatedinclinicalandcounselingpsychologyfirst,byNealE.Miller,HansEysenck,JeromeFrank,CarlRogersandothers• Proposesthatdifferentevidencebasedpracticessharecommonfactorsthataccountforeffectiveness• Somemostoftenstatedcommonfactorsinpsychotherapyare:a. Anexpectationtobehelped-hopeb. Thetherapeuticrelationshipc. Arationalorconceptualschemethatprescribesagivenritualorprocedureforresolvingthemd. Theactiveparticipationofbothpatientandtherapistincarryingoutthatprocedure

CommonFactorsinSupervision• AsdefinedbyGeorgiosK.Lampropoulos,MA,BAinTheClinicalSupervisorVol.21(1)2002

• TheSupervisoryRelationship

a.Thehumanrelationship- empathy,authenticity,warmth,unconditionalpositiveregard,

b.TheWorkingAlliance-contract,goals,tasks

c.TransferenceandCountertransferenceandattachmentstyles

CommonFactorsinSupervision

SupportandRelieffromTensionandAnxiety

a. Regardingskills,performanceandevaluationb. Mutualunderstandingthatsupervisionisa“safeplace”to

discussmistakesandthatsuperviseesareindevelopmentc. Importanttomatchsupporttostageofdevelopment

StagesofSuperviseeDevelopment

• DependentonSupervisor

• Dependency-autonomyconflict

• ConditionalDependency

• MasterCounselor

• Encourageautonomywithnormativestructure-instruction,self-awareness• Highlyautonomouswithlownormativestructure-support,clarification,lessinstruction• Autonomouswithstructureprovidedbythecounselor• Canfunctionadequatelyinmostsituations,supervisioncollegial

Kagan’sInterpersonalProcessRecall(IPR)

Counselorreviewstapedinterview• Counselorandsupervisorexplorepossibleperceptions/biasesthatcounselormightnotbeawareof• Counselorpracticesexpressingthoughtsorfeelingsaboutclientinasafeenvironment• Counselormaydiscoverareaofneededpersonaldevelopment• Counselormaychangebehaviorandattitudetowardclient

Self-exploration,AwarenessandInsight

• SelfMonitoring

• Cognitivequestioning

• UseofKagan’sInterpersonalProcessRecallmethod

CommonFactors:InstillationofHopeandRaisingExpectations

HowwillIeverbecomeacounselorwithsomuchtolearn?

StructureGuidance

Createwonder&curiosityGoalsetting

Selfdisclosureofsupervisor’sdevelopment

ChallengecognitivedistortionsGroupwork

EncourageboundarysettingAcceptanceofclient’sstageof

changeandconditionEncouragecreativityFocusonstrengthsSelfAwarenessEncouragementIntegrateselfcare

Structure

SuperviseeSessionPlan• Name___________________________Date_______________• Goalsforsession• SpecificCaseConceptualization/Assessments• TherapeuticAlliance/Skills/Interventions/Effectiveness:• Ethical/ProfessionalIssues• Self-Knowledge/Awareness• Planforfollowingweekincludingself-careplan

S.M.A.R.TGoals

• IdentifywhatI wanttoachieve

• Ask,whatdoIneedtodotoSpecificallyachievewhatIwant?

• Ask,iswhatIplantodoMeasurable? HowwillIknowifIaccomplishedit?

• DecidehowIwillbeAccountable formyplan?

• Relevant?Realistic?Willthisactivityreallyhelpmeachievemygoal? Canitbedone?

• Timespecific? WhenwillIdothisactivity?

S.M.A.R.TGoals

NowwriteyourS.M.A.R.T. goal• Inorderto__________________I will__________________by oron_______ andbeaccountableto___________________.

ExposureandConfrontationofProblems

• Identifyproblemsandexploreeffectivealternativebehaviorsandskillsby• Roleplay• Instructionabouttheoriesandinterventions• Reframingproblem

AcquisitionandMasteryofNewKnowledge

MatchLearningstyles

Exposureandpracticeovertime

Supervisees’self-attributionofprofessionaldevelopment

ExerciseUsingCommonFactors

• Formgroupsofthree-onesupervisor,onesupervisee,oneobserver• Roleplayasupervisionsessionusingthecommonfactors• Whatsupervisionmodelsandcounselingtheoriesframeworkwereused?• Whatcommonfactorswereused?__Therapeuticrelationship__Support,relieffromtension__Workingalliance__Instillationofhope__selfexploration__ExposureofProblemsandcorrectiveaction__Acquisition/Masteryofnewknowledge__Others__________________

Howtoavoidfallingintotheiceinthefirstplaceoratleastnottwice!

Whatwouldyoudoasasupervisortodecreasethelikelihoodthatthemaltreatmentandpossiblesexualabuseofavulnerablefromhappening?

Whatarethebenefitsofeffectiveclinicalsupervision?

ReferencesandResourcesforfurtherLearning

AddictionTechnologyTransferNetwork(ATTC)NationalOffice,2022,ClinicalSupervisionFoundationspartOne,UniversityofMissouri

AddictionTechnologyTransferCenterNetwork.(ATTC)NationalOffice,2011 ClinicalSupervisionFoundationsPartOne,UniversityofMissouri,KansasCity, availableonline-www.ATTC.Telephone-816-235-6888

AddictionTechnologyTransferCenterNetwork.(ATTC)NationalOffice,2011 ClinicalSupervisionFoundationsPartTwo:Participant Workbook.UniversityofMissouri,KansasCity, availableonline-www.ATTC.Telephone-816-235-6888

AddictionTechnologyTransferCenterNetwork.(ATTC)NationalOffice,2011 ClinicalSupervisionFoundationsPartTwo:Trainer Guide,University ofMissouri,KansasCity, availableonline-www.ATTC.Telephone-816-235-6888

ReferencesandResourcesforfurtherLearning

Bernard,J.M.,andGoodyear,R.K.Foundations ofClinicalSupervision(3rd ed).Boston:Allyn&Bacon,2004

Campbell,J.M.EssentialsofClinicalSupervision.NewYork:JohnWileyandSons,2006

Lampropoulos,GeorgiosK.,MA,BAinTheClinicalSupervisorVol.21(1)2002

Morgan,MichaelandSprenkle,Douglas, CommonFactorsinSupervision,JournalofMaritalandFamilyTherapy, Vo.33.No.1,1-17/,Jan.2007.NorthwestFrontierAddictionTechnologyTransferCenterNetwork.(ATTC)2011,PerformanceAssessmentRubricsforAddictionCounselorCompetencies Portland,OR:Oregon HealthandScienceUniversity

Powell,D.J.and Brodsky,A.Clinical Supervisionin AlcoholandDrugAbuseCounseling:Principles,Models,Methods(Reviseded.)SanFranscisco:Jossey-Bass,2004

ReferencesandResourcesforfurtherLearning

U.S.DepartmentofHealthandHumanServices,(2009), ClinicalSupervisionandtheDevelopmentoftheSubstanceAbuseCounselorTIP52,(HHSPublicationNo.(SMA)09-4435)Rockville,MD:SubstanceAbuseandMentalHealthServicesAdministration

U.S.DepartmentofHealthandHumanServices,(2007),CompetenciesforSubstanceAbuseTreatmentClinicalSupervisors,(HHSPublicationNo.(SMA)07-4242)Rockville,MD:SubstanceAbuseandMentalHealthServicesAdministration