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The supervision of psychotherapy: theory, research, and what I think I have learned from 30 years of doing it

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Title: The supervision of psychotherapy: theory, research, and what I think I have learned from 30 years of doing it


1
The supervision of psychotherapy theory,
research, and what I think I have learned from
30 years of doing it
  • James E. Maddux
  • Department of psychology
  • Center for the advancement of well-being
  • George Mason UniversitY
  • Fairfax, virginia, usa
  • jmaddux_at_gmu.edu

2
Borrows GREATLY from...
  • Joint presentation with Jonathan Mohr, University
    of Maryland.
  • Joint presentation with Stephen M. Saunders,
    Marquette University

J
3
USEFUL RESOURCES
  • FUNDAMENTALS OF CLINICAL SUPERVISION BY JANINE
    BERNARD RODNEY GOODYEAR (2009, PEARSON)
  • CRITICAL EVENTS IN PSYCHOTHERAPY SUPERVISION AN
    INTERPERSONAL APPROACH BY NICHOLAS LADANY, MYRNA
    FRIEDLANDER, MARY LEE NELSON (2008, AMERICAN
    PSYCHOLOGICAL ASSOCIATION)
  • .
  • Nicholas Ladany (2005) in Koocher, Norcross,
    Hill (Eds.) Psychologists Desk Reference.

4
USEFUL RESOURCES
  • Bradley, L.J. Ladany, N. (Eds.). (2001).
    Counselor supervision. Philadelphia
    Brunner-Routledge.
  • Falender, C.A., Shafranske, E.P. (2004).
    Clinical supervision A competency-based
    approach. Washington, DC American Psychological
    Association.
  • Watkins, C.E. (Ed.). (1997). Handbook of
    psychotherapy supervision. New York Wiley.

J
5
OVERVIEW
  1. What is supervision and why is it important?
  2. Models of supervision
  3. Best practices based on THEORY, research, and
    experience.
  4. Suggestions and tips based on my own experiences.
  5. Time for questions and discussion

6
UNFORTUNATELY
  • NOT MUCH RESEARCH ON WHAT MAKES GOOD SUPERVISION.
  • WHAT I WILL PRESENT IS BASED ON A COMBINATION OF
  • THEORY
  • RESEARCH
  • BEST PRACTICES (APA SUPERVISION GUIDELINES)
  • MY OWN 30 YEARS OF EXPERIENCES

7
QUESTIONS FOR YOU
  • Who has been supervised as a therapist in
    training?
  • Who has been a psychotherapy supervisor?
  • Who has received formal training in psychotherapy
    supervision?

J
8
QUESTIONS FOR YOU
  1. GOOD EXPERIENCE AS A SUPERVISEE?
  2. BAD EXPERIENCE AS A SUPERVISEE?
  3. GOOD EXPERIENCE AS A SUPERVISOR?
  4. BAD EXPERIENCE AS A SUPERVISOR?
  5. AS A SUPERVISOR, WHAT ARE YOU GOOD AT?
  6. HOW WOULD YOU LIKE TO IMPROVE?

9
WHY IS SUPERVISION IMPORTANT?
  • Third most common activity among practicing
    psychologists in the u.s.
  • Required for licensure in us.
  • Essential part of professional self-regulation
    (Gate-keeper role).
  • Can have a impact on more people than providing
    direct services.
  • It's fascinating and fun--and a great way to
    learn.

10
WHAT IS SUPERVISION?
  • "Supervision is an intervention provided by a
    more senior member of a profession to a more
    junior member or members of that same
    profession.
  • SENIOR DOES NOT MEAN OLDERBUT MORE EXPERIENCED
  • Bernard Goodyear (2009)

11
SUPERVISION IS EXPERIENTIAL LEARNING
  • DELIBERATE PRACTICEAIMED AT IMPROVING SPECIFIC
    SKILLS.
  • FEEDBACK FROM AN EXPERT
  • THAT IS IMMEDIATE, CLEAR, AND CONSISTENT
  • PROVIDES CLEAR UNDERSTANDING OF WHAT AN INCORRECT
    RESPONSE IS
  • AND WHAT A CORRECT RESPONSE IS.
  • MORE LATER ON EVALUATION FEEDBACK

12
SUPERVISION VERSUS CONSULATION
  • SUPERVISION IS
  • IMPOSED OR REQUIRED (USUALLY).
  • HIERARCHICAL (CLEAR POWER DIFFERENCES)
  • EVALUATIVE JUDGMENTAL
  • EXTENDS OVER TIME
  • WIDE-RANGING.

13
SUPERVISION VERSUS CONSULATION
  • CONSULTATION TYPICALLY IS
  • FREELY SOUGHT--NOT IMPOSED.
  • NON-HIERARCHICAL (BETWEEN EQUALS).
  • NON-EVALUATIVE.
  • MORE OFTEN A ONE-TIME EVENT.
  • MORE PROBLEM-SPECIFIC.
  • FREEDOM TO "TAKE IT OR LEAVE IT."

14
SUPERVISION VERSUS PSYCHOTHERAPY
  • SIMILARITIES
  • IT INVOLVES EXAMINATION OF THOUGHTS, FEELINGS,
    AND BEHAVIOR THAT ARE PROBLEMATIC.
  • REQUIRES A STRONG WORKING ALLIANCE.
  • A MAJOR GOAL IS PERSONAL GROWTH

15
SUPERVISION VERSUS PSYCHOTHERAPY
  • BUTIN SUPERVISION
  • THE OVER-RIDING GOAL IS HELPING THE SUPERVISEE
    BECOME MORE EFFECTIVE WITH CLIENTS.
  • TO PROVIDE "THERAPY" THAT HAS BROADER GOALS IS
    UNETHICAL
  • CREATES A DUAL RELATIONSHIPCONFUSING
    POTENTIALLY HARMFUL
  • SUPERVISION IS EVALUATIVE BY DEFINITION AND BY
    NECESSITY.
  • DIFFERENCE IS, OF COURSE, A FINE LINE.

16
SUPERVISION IS A COMPLEX ACTIVITY THAT HAS
MULTIPLE GOALS
  • SUPERVISEE PROFESSIONAL DEVELOPMENT
  • CLIENT WELFARE
  • PROTECTION OF PUBLIC
  • PROTECTION OF PROGRAM AND PROFESSIONGATEKEEPER
    ROLE
  • Especially important when there are no laws
    regulating practiceor weak laws.

17
MOST DIFFICULT BALANCE TO STRIKE
  • CLIENT WELFARE VERSUS SUPERVISEE DEVELOPMENT.
  • HOW MUCH DO YOU TELL THEM WHAT TO DO?
  • VERSUS
  • LETTING THEM USE THEIR OWN JUDGMENT?
  • LETTING THEM MAKE MISTAKES?

18
MODELS OF SUPERVISION
  • MOST Models based on theories of psychotherapy
  • you supervise the way you do therapy.
  • WILL DISCUSS FOURNOT MUTUALLY EXCLUSIVECAN BE
    INTEGRATED

19
Person-centered models (e.g., Carl Rogers)
  • Belief in growth potential.
  • Emphasis on conditions THAT FACILITATE THE
    SUPERVISORY RELATIONSHIP.
  • Empathy, genuineness, warmth
  • Providing these facilitates trust required for
    supervision.
  • Supervisor is also modeling these skills for
    supervisee.

20
ADVANTAGES OF Person-centered models
  • Most CONCERNED WITH BEING supportIVE of
    supervisee
  • Less didactic directive than other models
  • ENCOURAGES AUTONOMY
  • Emphasizes but also normalizes fears/anxiety
  • This is difficult for you. Is this harder than
    you expected?
  • It is difficult to confront patients.
  • I remember how nervous I was when
  • Can be EASILY integrated other models

SJ
21
Cognitive-behavioral models
  • Psychotherapy is a set of teachable, learnable
    skills.
  • Skills can be CLEARLY defined and measured.
  • Supervision should have specific goals
  • aND should address specific THOUGHTS BEHAVIORS.
  • What do to more of? What to do less of?
  • includeS examinATION OF superviseeS thoughts and
    beliefs that interfere with THEIR WORK WITH
    CLIENTS

22
COGNITIVE-BEHAVIORAL MODELS
  • Challenge maladaptive beliefs of trainees
  • Technique Stop tape and ask trainee
  • What were you thinking and feeling when you made
    that response?
  • HOW DID THAT AFFECT YOUR BEHAVIOR?
  • HOW WELL DID THAT WORK?
  • What could you think differently next time that
    might help you respond more effectively?

J
23
COGNITIVE-BEHAVIORAL MODELS(FROM BECK ET AL,
2008)

Structure of therapy sessions 1. Mood check 2.
Set agenda 3. Bridge from last session 4.
Prioritize agenda 5. Discuss problems 6.
Homework 7. Summary/Feedback
Structure of supervision sessions 1. Check in 2.
Set agenda 3. Bridge from last session 4.
Prioritize agenda 5. Discuss cases, problems 6.
Homework 7. Summary/Feedback
JS
24
ADVANTAGES OF COGNITIVE-BEHAVIORAL MODELS
  • Emphasis on specific skills.
  • TEACHES SELF-MONITORING AND SELF-REFLECTION
  • Takes an incremental rather than entity view of
    psychotherapY TRAINING.

25
Psychodynamic models
  • AttenTION to the relationship
  • Between therapist client
  • Between supervisor supervisee
  • What is it like for you to be in supervision?
  • What is it like for you during our
    interactions?
  • When I criticize you, what are your feelings?

J
26
Advantages of PSYCHODYNAMIC MODEL
  • Focuses on supervisees concerns and anxieties.
  • Focuses on supervisees feelings toward client
    supervisor.
  • Deals with transference and counter-transference
    issues.

J
27
Developmental models
  • NOT LINKED TO A SPECIFIC THEORY OF THERAPY
  • Supervisees go through different stages of
    development.
  • A different supervisory approach is needed for
    each stage.
  • Stages based on
  • Self-other awareness.
  • Motivation.
  • Autonomy

28
Simplified integrative model
  • Good therapy consists to a large degree of
    specific behaviors or skills.
  • These behaviors can be defined, taught, learned,
    and measured.
  • You have to have goals. You have to know what
    needs to be learned.
  • Self-efficacy beliefs must be developed along
    with skills.
  • A STRONG WORKING ALLIANCE TRUST ARE ESSENTIAL

29
Simplified integrative model
  • Everyone learns at a different pace.
  • People move back and forth between stages
    depending on the challenge.
  • So you have to adjust your approach person to
    person and moment to moment.
  • You are constantly modeling, so practice what you
    preach.
  • Feelings can help or hurt. You must attend to
    themTHE CLIENTS, THE SUPERVISEES YOURS
  • you must attend to the relationshipSYOU
    SUPERVISEE AND SUPERVISEE CLIENT.

30
SUPERVISORY RELATIONSHIP
  • Necessity of a good supervisory alliance
  • Without trust and openness, then none of the
    tasks of supervision are possible
  • Can put clients/patients at risk

J
31
SUPERVISORY RELATIONSHIP
  • WHAT THE RESEARCH SAYS
  • SUPERVISORY ALLIANCE PREDICTS
  • SUPERVISEE WILLINGNESS TO SELF-DISCLOSE
  • CLIENT PERCEPTION OF THERAPEUTIC ALLIANCE
  • SUPERVISORY ALLIANCE RELATED TO
  • SUPERVISOR ETHICAL BEHAVIOR
  • USE OF EFFECTIVE EVALUATION PRACTICES
  • SUPERVISOR SELF-DISCLOSURE (PROFESSIONAL)

32
SUPERVISORY RELATIONSHIP
  • The alliance between the supervisor and the
    supervisee is the responsibility of the
    supervisor
  • Explicit attention to relationship issues
    facilitates the development of an alliance
  • Need transparency regarding roles and role
    conflicts, evaluation processes, expectations and
    requirements, etc.
  • WILL RETURN TO THIS LATER

J
33
  • BUILDING A GOOD SUPERVISORY RELATIONSHIP
  • WHAT CAN THE SUPERVISOR DO?

J
34
Creating an STRONG supervisory alliancE WHAT
CAN HELP?
  • ATTENTIVE
  • DEPENDABLE
  • Non-authoritarian
  • COLLABORATIVE (IN SETTING GOALS, EVALUATION)
  • Empathic Supportive
  • ENTHUSIASTIC MOTIVATING
  • RESPECTFUL OF BOUNDARIES
  • TRUSTHWORTHY
  • OPEN TO NEW IDEAS.
  • FLEXIBLE.

JS
35
Creating an STRONG supervisory alliancE WHAT
CAN HELP?
  • Provide clear and simple conceptual framework
  • Work to reduce anxiety, including your own.
  • Normalize mistake making (e.g., self-disclosure)
  • ASK FOR FEEDBACK (How are we doing?)
  • Practice what you preach (Be a good model)
  • MODEL GOOD PROFESSIONAL ETHICS
  • TO DO ALL OF THIS, YOU MUST VIEW SUPERVISION AS A
    IMPORTANT PROFESSIONAL ACTIVITY.

SJ
36
INITIAL QUESTIONS TO ASK TO DEVELOP TRUST
RAPPORT SET GOALS
  • What are your previous experiences with
    supervision?
  • What was helpful?
  • What was not helpful?
  • What are your goals?
  • What are your expectations?
  • What are your fears? Concerns?

J
37
INITIAL QUESTIONS TO ASK TO DEVELOP TRUST
RAPPORT SET GOALS(ADAPTED FROM CAMPELL, 2006)
  • WHAT WOULD YOU LIKE TO GET OUT OF SUPERVISION
    WITH ME?
  • DO YOU HAVE SPECIFIC AREAS OF IMPROVEMENT IN
    MIND?
  • WHAT WOULD HAVE TO HAPPEN IN HERE TO MAKE THIS
    WORTH YOUR TIME EFFORT?
  • WHAT IS THE MOST IMPORTANT THING YOU WOULD LIKE
    TO GET FROM THIS EXPERIENCE.
  • HOW CAN I BE OF MOST HELP TO YOU?
  • WHAT PARTICULAR NEEDS OF PARTICULAR CLIENTS CAN I
    BE HELPFUL WITH?

J
38
THE GOLDEN RULE OF SUPERVISION(CAMPBELL, 2006)
  • Treat supervisees in the same way you wish to be
    treated and the same way you wish them to treat
    clients.

S
39
STRUCTURING A SUPERVISION SESSION
  • SUPERVISEE MUST COME PREPARED!
  • WHICH CLIENTS DO YOU WANT TO DISCUSS TODAY?
  • WHY THOSE CLIENTS?
  • HOW MUCH TIME DO YOU WANT TO SPEND ON EACH ONE?
  • WHICH ONE DO YOU WANT TO START WITH?
  • WHAT SPECIFIC CONCERNS DO YOU HAVE ABOUT YOUR
    LAST SESSION WITH THIS CLIENT?
  • PLAY A SECTION OF THE TAPE THAT WAS A PROBLEM FOR
    YOU.
  • TELL ME AT WHAT POINTS YOU WERE STUCK OR
    UNCERTAIN OR WHERE YOU THINK YOU WENT WRONG.
  • WHAT COULD YOU HAVE DONE DIFFERENTLY?
  • WHAT DIFFERENCE WOULD THAT HAVE MADE?

40
SUPERVISEE SHOULD BE REQUIRED TO
  • BRIEFLY STATE THE CLIENTS OVERALL GOALS.
  • BRIEFLY STATE THE GOALS FOR THAT SESSION.
  • STATE THE REASON FOR SELECTING THAT PART OF THE
    SESSION FOR REVIEW.
  • BRIEFLY SUMMARIZE WHAT HAPPENED BEFORE THAT
    SECTION (SET THE STAGE).
  • EXPLAIN WHAT HE/SHE WAS TRYING TO ACCOMPLISH IN
    THAT SECTION OF SESSION.
  • CLEARLY STATE THE SPECIFIC HELP DESIRED FROM THE
    SUPERVISOR.

41
USING AUDIO VIDEO RECORDINGS OF SESSIONS
  • Essential
  • VIDEO IF POSSIBLE.
  • You need to see as well as hear what goes on in
    the session.
  • Cannot rely on supervisees report
  • NOT HAVING SAMPLES OF THERAPY SESSIONS TO SEE AND
    HEAR EASILY LEADS TO ABSTRACT THEORETICAL
    DISCUSSIONS
  • AND VAGUE SUGGESTIONS

S
42
HOW TO USE RECORDINGS OF SESSIONS.
  • You don't need to listen to an entire session.
  • You can teach more through a micro-examination of
    just five minutes HERE AND THERE.
  • REQUIRE SUPERVISEE TO REVIEW RECORDING BEFORE
    SUPERVISION.
  • ASK SUPERVISEE TO PLAY A SECTION WHERE HE/SHE HAD
    DIFFICULTY.
  • AND A SECTION WHERE IT WENT WELL.
  • The opening minute or two of a therapy session
    are crucial.
  • USE INSTANT REPLAY
  • FOCUS ON GENERAL PRINCIPLES AND SKILLS.

43
REVIEWING BRIEF SECTIONS OF AUDIO- OR VIDEO
TAPES(ADAPTED FROM CAMPBELL, 2006)
  • AS YOU WATCHED THAT SEGMENT, WHAT WERE YOU MOST
    AWARE OF?
  • HOW ARE YOU FEELING AT THIS POINT?
  • WHAT WERE YOU THINKING FEELING RIGHT THEN WHEN
    THE CLIENT SAID THAT?
  • WHERE DID YOU WANT TO GO WITH THAT COMMENT? WHAT
    WAS YOUR GOAL?
  • WHAT DO YOU WISH YOU HAD SAID INSTEAD?
  • WHEN THE CLIENT BEGAN TO TALK ABOUT ____, YOU
    CHANGED THE TOPIC. WHAT WAS GOING ON?

S
44
WHAT TO DO IF CONFLICTS ARISEAND THEY WILL!
  • conflict IS INEVITIBLE BECAUSE
  • Supervisor is supportive, but
  • also must evaluate
  • Supervisee wants to learn, BUT
  • also wants to demonstrate he/she is competent
  • AND AVOID APPEARNING INCOMPETENT

45
POSSIBLE CONFLICTS in SupervisION
  • Supervisor perceived as unempathic, uncaring,
    unfair, unavailable, unmotivated
  • Supervisee seems unmotivated
  • Role confusion Friends or boss/employee?
  • Diversity/Multicultural issues impacting
    relationship
  • Inappropriate self-disclosure by supervisee with
    clients or with supervisor
  • Inappropriate self-disclosure by supervisor.

JS
46
POSSIBLE CONFLICTS IN SUPERVISION
  • Excessive agreement and compliance with
    supervisor
  • Excessive anxiety during supervision.
  • Non-disclosure by supervisee hiding potentially
    negative information
  • Resistance or defensiveness in response to
    feedback.
  • Disagreement over TREATMENT strategies.

JS
47
THINGS SUPERVISEES SOMETIMES HIDE OR FAIL TO
DISCLOSE
  • Negative or overly positive feelings about
    clients (fear, anger, attraction)
  • Negative feelings about supervisor
  • Mistakes during sessions
  • Anxiety about working with clients
  • Anxiety about being supervised/evaluated

S
48
RED FLAGS (1)
  • Sudden change in supervisee behavior with clients
    or supervisor
  • Excessive anxiety
  • Reluctance to interact with clients or supervisor
  • Withdrawn, aloof, apathetic
  • Preoccupied with A PARTICULAR client
  • Late or misses supervision
  • Forgets tapes, progress notes
  • LACK OF PREPARATION

SJ
49
RED FLAGS (2)
  • Defensive in response to critical feedback
  • Angry towards clients
  • They are not cooperating
  • They are not making progress
  • Over-compliance with suggestions from supervisor

J
50
Ethical and legal issues
  • Responsible for client welfare and supervisee
    development.
  • Informed consent IS ESSENTIAL
  • INFORMED CONSENT OF CLIENT
  • INFORMED CONSENT OF SUPERVISEE.

51
Informed Consent of patient
  • CLIENTS/Patients must be told that therapist is a
    trainee being supervised
  • Basic ethical practice
  • Its the right thing to do
  • Its the smart thing to do!

J
52
Informed Consent of client
  • Protection against malpractice charges
  • Direct Liability e.g., you have not kept
    informed adequately by the supervisee and you
    suggest an intervention that leads to harm of the
    patient
  • Vicarious Liability Supervisors may be liable
    for any negligent acts of the supervisee
  • Failure to monitor supervisee performance is a
    significant ethical violation

J
53
INFORMED CONSENT OF CLIENT(DETAILS MAY DEPEND ON
SETTING)
  • SUPERVISEES TRAINING STATUS.
  • RATIONALE FOR AND BENEFITS OF SUPERVISION.
  • NAME AND CREDENTIALS OF SUPERVISOR.
  • SUPERVISOR CONTACT INFORMATION.
  • OBSERVATION METHODS (AUDIO? VIDEO?)
  • OTHERS WHO MAY BE OBSERVING (STUDENTS?)
  • NATURE OF CONFIDENTIALITY
  • LIMITS OF CONFIDENTIALITY.

54
INFORMED CONSENT OF SUPERVISEEThe supervision
contract(borrowed from stephen saunders)
S
55
SupervisION Contract
  • Explicit signed agreement regarding all aspects
    of supervision
  • Time, Place, DURATION
  • Goals
  • Theoretical orientations
  • Responsibilities of both parties
  • Possible outcomes
  • Evaluation procedures
  • Confidentiality ISSUES
  • ETHICAL AND LEGAL ISSUES
  • Payment?

S
56
SupervisION Contract
  • Useful for developing a good supervisory
    relationship
  • Useful in preventing (and resolving) problems
  • An important legal and ethical document

SJ
57
SUPERVISION CONTRACT
  • Multiple examples and templates available
  • Sutter et al. (2002) Professional Psychology
    Research and Practice, vol. 33, 495-498.
  • C. J. Osborn T.E. Davis (1996). Clinical
    Supervisor, vol. 14, 121-134.
  • Falendar and Shafranske, 2004

S
58
SUPERVISION CONTRACT SAMPLE LANGUAGE
  • ETHICAL AND LEGAL ISSUES
  • Supervisee must follow ethical and legal codes,
    guidelines and principles mandates pertaining
    to confidentiality will be respected and followed
  • Supervisor is responsible for the professional
    services provided by individuals under his/her
    supervision will assign to the supervisee only
    such tasks as supervisee is competent to deliver

J
59
SUPERVISION ContractSAMPLE LANGUAGE
  • Why supervision?
  • Supervision is being conducted for the purpose
    of .
  • Skill development
  • TO MEET Licensure REQUIREMENTS
  • ENHANCING Patient care
  • What activities are being supervised?
  • (e.g., Will supervise treatment using CBT for
    persons diagnosed with various disorders being
    seen at this clinic )

S
60
SUPERVISION Contract SAMPLE LANGUAGE
  • GOALS OF SUPERVISION
  • This supervisory arrangement is established for
    the purpose of establishing new competencies,
    increasing the supervisees sense of efficacy
  • for purposes of post-doctoral experience
    towards licensure as a clinical psychologist

S
61
SUPERVISION Contract
  • PROFESSIONAL STATUS LIMITATIONS
  • Supervisee Present level of training (perhaps
    detailing experience to date)
  • Supervisor Statement about supervisors Scope
    of Competence
  • Clinical training experience
  • Licensure
  • Special expertise
  • Training and experience in supervision

S
62
EVALUATION OF SUPERVISION
  • APA Ethics code
  • In academic and supervisory relationships,
    psychologists establish a timely and specific
    process for providing feedback to students and
    supervisees.
  • Information regarding the process is provided to
    the student at the beginning of supervision.
  • Psychologists evaluate students and supervisees
    based on their actual performance on relevant and
    established program requirements.

63
EVALUATION
  • Two types of evaluation
  • Formative feedback (ongoing)
  • Summative feedback (formal--at the end)
  • Two core problems
  • Defining competenceneed clear standards.
  • Conflicts with self-concept as a helper,
  • can lead to avoidance of evaluator role.
  • NEED TO Keep in mind gate-keeper role.

64
THE FUNDAMENTAL PRINCIPLE OF EVALUATION
  • A rating of poor performance at the end of
    supervision should never come as a surprise to
    the supervisee.
  • In other words, summative feedback should be
    consistent with ongoing formative feedback.

J
65
EVALUATION TIPS
  • Discuss evaluation methods and criteria AT the
    beginning.
  • REVIEW THEM AS NECESSARY
  • Address the discomfort (of both of you).
  • Encourage and model self-evaluation.
  • Provide continual feedback.
  • SEEK CONTINUAL FEEDBACK (HOW ARE WE DOING? HOW
    IS THIS GOING FOR YOU?
  • INVOLVE SUPERVISEE IN HIS/HER OWN EVALUATION

66
EFFECTIVE FORMATIVE FEEDBACK BEGINS WITH
EFFECTIVE GOALS
  • Effective goals are
  • MUTUALLY AGREED ON
  • Clear
  • Specific
  • MEASURABLE
  • CHALLENGINGOUTSIDE OF COMFORT ZONE
  • BUT SEEM Achievable

67
QUALITIES OF EFFECTIVE FORMATIVE FEEDBACK
  • Immediate Address it as soon as you see or
    hear it.
  • Specific Refer to specific behaviors that
    person can change.
  • Clear and conciseshort and sweet
  • Encourage self-evaluation Ask supervisee what
    he/she could do differently.
  • offer concrete suggestions, not vague
    generalities..
  • Refer to research if possible.
  • Frequent and continualevery session and
    throughout the session
  • CONSISTENT
  • SHOULD INCLUDE GENEROUS SPECIFIC PRAISE.
  • INCLUDING SUPERVISEE SELF-PRAISE

68
FORMATIVE FEEDBACKSUPERVISION PROGRESS
NOTES
  • Date and session number of supervision
  • Identification of client(s) discussed
  • Follow-up on previous supervision/feedback
  • Progress made on goals (of patient)
  • Interventions suggested
  • Concerns raised
  • Goals for next client sessions

J
69
FORMATIVE FEEDBACKUSING AUDIO VIDEO
RECORDINGS OF SESSIONS
  • Essential
  • VIDEO IF POSSIBLE.
  • You need to see as well as hear what goes on in
    the session.
  • Cannot rely on supervisees report
  • NOT HAVING SAMPLES OF THERAPY SESSIONS TO SEE AND
    HEAR EASILY LEADS TO ABSTRACT THEORETICAL
    DISCUSSIONS
  • AND VAGUE SUGGESTIONS

S
70
HOW TO USE RECORDINGS OF SESSIONS.
  • You don't need to listen to an entire session.
  • You can teach more through a micro-examination of
    just five minutes HERE AND THERE.
  • REQUIRE SUPERVISEE TO REVIEW RECORDING BEFORE
    SUPERVISION.
  • ASK SUPERVISEE TO PLAY A SECTION WHERE HE/SHE HAD
    DIFFICULTY.
  • AND A SECTION WHERE IT WENT WELL.
  • The opening minute or two of a therapy session
    are crucial.
  • USE INSTANT REPLAY
  • FOCUS ON GENERAL PRINCIPLES AND SKILLS.

71
REVIEWING BRIEF SECTIONS OF AUDIO- OR VIDEO
TAPES(ADAPTED FROM CAMPBELL, 2006)
  • AS YOU WATCHED THAT SEGMENT, WHAT WERE YOU MOST
    AWARE OF?
  • HOW ARE YOU FEELING AT THIS POINT?
  • WHAT WERE YOU THINKING FEELING RIGHT THEN WHEN
    THE CLIENT SAID THAT?
  • WHERE DID YOU WANT TO GO WITH THAT COMMENT? WHAT
    WAS YOUR GOAL?
  • WHAT DO YOU WISH YOU HAD SAID INSTEAD?
  • WHEN THE CLIENT BEGAN TO TALK ABOUT ____, YOU
    CHANGED THE TOPIC. WHAT WAS GOING ON?

S
72
SUMMATIVE FEEDBACK
  • Sample summative evaluation

S
73
SUMMATIVE FEEDBACK
  • Sample summative evaluation

)
S
74
Group supervision
  • Group should be in addition to, not instead of,
    individual supervision
  • Dont use because you are overworked
  • Advantages
  • Students get more exposure to more clients
  • Students get exposure to other therapeutic styles
  • Students get opportunity to give and get feedback
    and support
  • Encourages team building
  • Encourages multicultural discussions

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Group supervision
  • Possible challenges
  • Time management one or two assertive or problem
    students may take up all of the time
  • Conflict between students
  • Making sure some students dont hide or get
    left behind
  • Overly critical peers
  • Client confidentiality (e.g., students talking in
    hallway about clients)
  • Supervisee confidentiality (i.e., no discussing
    with students not in the group)

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Group supervision
  • Strategies for Group Supervision
  • Giving each student each week equal time is
    probably not feasible
  • Students needs will change from week to week
  • Suggest starting with check-in, i.e., ask each
    student what he or she needs from group,
    especially urgent needs
  • Beware students that decline every week
  • Highlight any shared concerns or issues
  • As a student presents, ask for reactions and
    suggestions from others

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INADEQUATE AND HARMFUL SUPERVISION
  • Just like psychotherapy, supervision can be
    inadequate and even harmful to supervisees and to
    clients
  • Ellis et al, 2014, THE COUNSELING PSYCHOLOGIST
  • Attempted to define inadequate and harmful
    supervision
  • Surveyed 363 supervisees

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INADEQUATE AND HARMFUL SUPERVISION
  • RESULTS
  • 93 reported receiving inadequate supervision
  • Mainly failure to observe and monitor sessions
    (40) and lack of a supervision contract (54)
  • 35.3 reported receiving HARMFUL supervision
  • Of these, 25 reported not feeling safe from
    exploitation

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EXAMPLES OF POTENTIALLY HARMFUL BEHAVIORS
  • Sexually inappropriate comments or behaviors
  • Physical, emotional, or psychological aggression
  • Boundary violations, including inappropriate
    self-disclosure
  • Exploitative dual relationships
  • Public humiliation (e.g., in group supervision)

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HOW TO CREATE A SAFE EVIRONMENT(ADAPTED FROM
CAMPBELL, 2006)
  1. Address at beginning possible sources of anxiety
  2. Be genuine, tolerant and respectful
  3. Be available, reliable and consistent
  4. Focus on strengths and successes, not just
    problems
  5. Model empathic responding
  6. Normalize mistake-making
  7. Encourage risk-taking
  8. Use humor

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SUMMARY
  • WHAT I THINK (OR HOPE) I HAVE LEARNED IN 30 YEARS

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FOUR BASIC ASSUMPTIONS
  • Good therapy is not "magic.
  • Good therapy is not "rocket science.
  • Good supervision is not "magic.
  • Good supervision is not "rocket science."

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21 SPECIFIC SUGGESTIONS
  1. Keep it simpleESPECIALLY AT THE BEGINNING.
  2. Review the basics over and over and over again
  3. Warn them about trying too hard to help (Never
    work harder than your client.)
  4. Focus on understanding rather than "helping"
  5. Kindness and patience are essential
  6. but so are courage and firmness
  7. Admit when you do not know something (don't fake
    it)

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  • Empathize
  • Don't be afraid of trainee's fears or yours
  • Address the supervisees emotions
  • But don't dont try to do therapy instead of
    supervision (may suggest they obtain therapy)
  • Discourage excessive and non-relevant
    self-disclosure
  • Self-disclose about your own experiences in
    supervision

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  • Check in often for understanding
  • Encourage both self-criticism self-praise
  • Praise often
  • Tell them what they are doing well
  • Be specific
  • Be specific with criticism suggestions
  • But first . . . ASK trainee to suggest what he/
    she could have done differently
  • "What could you do the next time
  • something like this happens?"

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  • Send them to the research literature
  • Push them out of their comfort zone
  • Collaborate
  • Avoid abstract theoretical discussions that are
    not tied to specific examples of what to do in
    therapy
  • Expect differences and conflicts Deal with them
    directly
  • Always keep in mind that you are always modeling
    how to do therapy how to be a professional.

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BEST PRACTICESAPA SUPERVISION
GUIDELINESAMERICAN PSYCHOLOGIST, JANUARY, 2015
  • Be competent in the areas of practice that you
    supervise. Know your limitations.
  • Seek training in supervision.
  • Be mindful of diversity issues.
  • Build and maintain a collaborative relationship.
  • Specify responsibilitIES of each party (contract)
  • Specify competencies and learning goals
  • Provide feedback that is ongoing, clear, and
    behaviorally-anchored
  • Seek and use feedback from supervisees
  • Be mindful of gatekeeper role
  • Be aware that client welfare is your highest duty

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  • QUESTIONS?
  • COMMENTS?
  • SUGGESTIONS?
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