Clinical Supervision

vs. Administrative
Mary Hubbard
CADC-II, CAS-II, M-RAS, CCS
Clinical Supervision Clinical Supervision
vs. Administrative vs. Administrative
Mary Hubbard,
CADC-II, CAS-II, M-RAS, CCS
Objectives
Describe components of clinical
and administrative supervision
Understand the principles of clinical
supervision p
Identify the need for an AOD clinical
supervisions and its impact on the
workforce
Describe one method of Clinical
Supervision
Types of Management Skills
Visionary Human Technical
Future
Pulse of the
C i
Understanding
people
M i i
The How To
Understanding
h l k Community
Determining
goals and
methods to
achieve
Mission
Motivating
Leading
Management
Clinical
the real work
Operations
Budget
Paperwork
Manager
Boss
Leader
Coach
Leadership Roles
DecisionMaker
Supervisor
TrafficCop
Delegator
Facilitator
Servant
RoleModel
Visionary
Leadership Styles
Autocratic
Directive
Participative
I tA t d Input Accepted
Democratic
Team Approach
Laissez-Faire
Supervision - Types
Supervision in employment setting
Supervision (management) for the purpose of
employee evaluation and performance
improvement
Supervision as part of training and
development p
Supervision under an experienced counselor or
clinician for the purpose of increasing counseling
knowledge, skills and practice
Supervision under an experienced accountant,
QA, HR director for the purpose of increasing
knowledge, skills and practice in that area of
expertise
Different Hats
Trainer / teacher (most fundamental level)
Most important with new
counselors/employees
Employer / manager (business role)
Must set up clear boundaries early /
contracts
Facilitator (most delicate role)
Facilitate movement to next levels of
competence
Facilitate self-efficacy and self-confidence
Facilitate self-evaluation
Colleague / fellow member of the profession
Understand the principles of clinical
supervision
Supervision is a key ingredient in
counselor training
Counselor training and competencies
revolve around the 12 core functions
and TAP 21 Practice Dimensions.
Research shows that effective clinical
supervision leads to improved
Clinical skills for both
Therapeutic relationships
Therapy outcome
Clinical Supervision What is it?
(2)
Clinical supervision is the most appropriate
learning medium for the counselor because it
is a learning by doingprocess rather than a
distant, classroom type of experience.
Supervision provides us with an ongoing
assessment of our skills and areas of clinical
strengths and weaknesses.
Powell 1980
Supervision
Effective supervisors observe, mentor,
coach, evaluate, inspire, and create an
atmosphere that promotes self-
motivation, learning, and professional
development..
Such supervision is key to both quality
improvement and the successful
implementation of consensus- and
evidence-based practices
Screening
Intake
O i t ti
CrisisIntervention
ClientEducation
R f l
12 Core Functions
Orientation
Assessment
TreatmentPlanning
Counseling
CaseManagement
Referral
ReportsandRecord
Keeping
Consultation
Professional Practice Dimensions
(TAP 21-A)
The basic tasks and responsibilities that
constitute the work of an addiction
counselor.
I. Clinical Evaluation
II. Treatment Planningg
III. Referral
IV. Service Coordination
V. Counseling
VI. Client, Family and Community Education
VII. Documentation
VIII. Professional and Ethical Responsibilities
Respect
Disclosure
Warmth
Potency
Traits to Role Model and Mentor
Concreteness
Immediacy
Genuineness
Empathy
Confronting
SelfActualization
What are KSAs?
A competency is comprised of:
KNOWLEDGE - what we need to
know in order to develop proficiency.
SKILLS the behaviors needed for SKILLS - the behaviors needed for
effective performance.
ATTITUDE - the state of mind
consistent with professional practice
TAP 21-A
The Application of Supervision
Theories, roles and models of
counseling
Development stages of counselor
and supervisors
Evidence Based Supervision
Application to practice
Incorporate gender and culture
Providing group supervision
Supervision Based on
Counselors
Level of Development
Supervision Based on Supervisors
L l f D l t Level of Development
See handout
Models of Supervision
Treatment-based models
Competency based models
Developmental models
Integrated models
Tailoring of the model to specific
cultural and diversity factors
Range of Supervision Types
Evidence Based Supervision
Modeling
Didactic
Participatory
Reflective
Objectives
Describe components of clinical
and administrative supervision
Identify the need for an AOD
clinical supervisions and its clinical supervisions and its
impact on the workforce
Describe one method of Clinical
Supervision
Critical Issues Supervisees
Need for Professional Integration
Competence (skill and technique)
Emotional Awareness (know oneself, aware of
feelings, countertransference)
Issues of autonomy (self-directedness)
Issues of identity (theoretical consistency)
Issues of respect for individual differences Issues of respect for individual differences
(tolerance, non-judgmental acceptance of others)
Issues of purpose and direction (structuring a
therapeutic direction, setting appropriate goals)
Issues of personal motivation (awareness of the
satisfactions and personal meanings inherent in
counseling)
Issues of professional ethics
Critical Issues Supervisees Must
Address for Professional Integration
Issues of purpose and direction
(structuring direction, setting
appropriate goals)
Issues of personal motivation Issues of personal motivation
(awareness of the satisfactions and
personal meanings inherent in work)
Issues of professional ethics
Tangible Benefits of Supervision
Improved service to clients
Higher practitioner job satisfaction
Less burnout
Decreasedstaff turnover Decreased staff turnover
Lower administration costs
New skills learnt
Improved staff communication
Improved client outcomes? needs
research
Objectives
Describe components of clinical
and administrative supervision
Identify the need for an AOD
clinical supervisions and its clinical supervisions and its
impact on the workforce
Describe one method of
Clinical Supervision
Motivational Interviewing:
A Definition
Motivational interviewing is
a person-centered,
directive
method of communication
for enhancing intrinsic motivation to
change
by exploring and resolving
ambivalence.
David
by Michelangelo
PerformanceEvaluation/MIWay
1. Ask what they like about their style, what are
they doing well?
2. Reflect and confirm strengths you agree with
3. Ask what do they see they need to improve
on? on?
4. Reflect and confirm what you agree with.
5. Add your thoughts on two specific things you
would like work on over the next --- time
6. Ask them what they think about your
thoughts.
The 8 Stages of Learning M.I.
1. Overall Spirit
2. Client-centered Interviewing
Skills (OARS)
3. Recognizing Change Talk
4. Eliciting Change Talk (ECT) g g ( )
5. Rolling With Resistance
6. Consolidating Commitment
7. Developing A Change Plan
8. Transition and Blending With Other Methods
Miller, W. R., &Moyers, T. B. (2006). Eight stages in learning motivational
interviewing. Journal of Teaching in the Addictions
How do you learn MI?
1. Take a 2 -3 day class
(www.mhsinc.org/calendar) or
www.motivationalinterviewing.org
2. Read more - Tip 35: Enhancing p g
Motivation for Change in Substance
Abuse Treatment www.samhsa.gov
3. Practice using the spirit and skills
4. Practice with feedback (coding,
consultation)
TOOL Box
Individual Style Yours
Individual style Theirs
Learning Style
Decision Making procedure
Evaluation tools
Systematic Supervision
Clarity of differences
Professional Self-Evaluation
Is my style working?
Is my management/ supervision
effective?
C I di t h ill d ll? Can I predict who will do well?
What can I do to get better
results?
How can I improve my
approach?
Would This Be Said?
Excellent manager
Excellent counselor/clinician/supervisor
Helps staff learn and grow
Models highest ethics
L d b l Leads by example
Demands excellence, not perfection
Takes care of his/her people
Is humble
Has character and integrity
Whatisthenorm?
Isitrelatedtowork?
Isthereapower
difference?
Do they feel free to say
Alwaysconsiderthe
liability
Alwaysconsiderthelong
term
Always consider the effect
Ethically - am I allowed to..?
Questions to ask
Dotheyfeelfreetosay
no?
WouldIdoitwith
everyone?
Whatlevelofsupervision
aretheyin?Doesthat
changetheanswer?
Alwaysconsidertheeffect
ontheclient
Alwaysconsidertheeffect
onthesupervision
relationship
What Counts?
40% of outcome is related to the client
Stages of change
Setting
15% of outcome is related to
technique/skill technique/skill
35% of outcome is related to the
therapeutic relationship
The rest is related to extra ordinary
factors
Questions?
Full WRM-TA CCS Course
Describe one definition of clinical supervision
Describe counselor competencies
Identify two models of clinical supervision
Strategies and tools for clinical supervisors to
use to help a counselor to develop and grow.
Utilize MI for assessment and evaluation tools
Define the ethics of supervision
24 hours/three days
BBS, APA and AOD approved
Instructors: MH, AOD and Medical
How MHS provides CCS
1. Required Training in MI and Clinical
Supervision
2. Required direct observation video tape
supervision review in individual and group
supervision
3 All levels of leadership are in monthly 3. All levels of leadership are in monthly
supervision (Senior VP, VP, and Program
Manager)
4. Individual coaching, supervision or
mentoring if needed.
5. (Parallel Process Isomorphic Process)
How to access MHS workshops
and courses
To discuss a CCS course in your area contact Mary
Hubbard @ mhubbard@mhsinc.org
To attend the courses/workshops on MHS calendar go to
http://www.mhsinc.org/calendar
To schedule an MI or gender class in your area contact To schedule an MI or gender class in your area contact
Colleen Marshall cmarshall@mhsinc.org
To attend the WRM-TA school for Counselors contact Alma
Linares at alinares@mhsinc.org
For any of the above call 858-583-2600- training
department- Lorena Duarte @ lduarte@mhsinc.org
More Information
www.motivationalinterviewing.org
A guide for Probation and Parole:
Motivating Offenders to Change g g
US Dept J ustice www.nicic.org
Tip 35: Enhancing Motivation for
Change in Substance Abuse
Treatment
www.samhsa.gov
800-729-6686
Resources
http://www.treatment.org/Taps/tap21/T
AP21Toc.html
Technical Assistance Publication
(TAP) TAP 21- Addiction Counseling
Competencies: The Knowledge Competencies: The Knowledge,
Skills, and Attitudes of Professional
Practice
TIP Treatment Improvement
Protocol: Knowledge Application
Programs
Resources
Gallon s. (2205) Clinical Supervision
Training manual Portland Oregon
Norwest Frontier ATTC
J ames Maddux, Ph.D. and J onathan
Mohr, Ph.D.
Southern Coast ATTC
Powell D revised edition (2005),
Clinical Supervision in AOD
Counseling: Principals, Models and
Methods. New York: Lexington Books
References and Resources
Bernard, J . M., & Goodyear, R. K. (1998).
Fundamentals of clinical supervision (2
nd
ed.).
Boston: Allyn and Bacon.
Cox, L.J . Interactive Evaluations: Some
Process-Oriented Questions for the Supervisor,
in Practical Applications in Supervision. Pg 3-85.
Litt ll J M L B d N &L J A Littrell, J . M., Lee-Borden, N., & Lorenz, J . A.
(1979). A developmental framework for
counseling supervision. Counselor Education
and Supervision, 19, 119-136.
Loganbill, C., Hardy, E., & Delworth, U. (1982).
Supervision: A conceptual model. The
Counseling Psychologist, 10, 3-42.
References and Resources
Rodenhauser, P. (1994). Toward a multidimensional
model for psychotherapy supervision based on
developmental stages. J ournal of Psychotherapy
Practice and Research, 3, 1-15.
Stoltenberg, C. D. & Delworth, U. (1987).
Supervising counselors and therapists. San
Francisco: J ossey and Bass.
Watkins, C. E. (1995a). Psychotherapy supervision
in the 1990s: Some observations and reflections.
American J ournal of Psychotherapy, 49, 568-581.
Watkins, C. E. (1995b). Psychotherapy supervisor
and supervisee: Developmental models and
research nine years later. Clinical Psychology
Review, 15647-680.
Supervisor Developmental Model
Developmental
Level
Characteristics
To Increase
Supervision
Competence
Level 1
Is anxious regarding role
Is nave about assuming the role of
supervisor
Is focused on doing the right thing
May overly respond as an expert
Is uncomfortable providing direct
feedback
Follow structure and
formats
Design systems to
increase organization
of supervision
Assign Level I
counselors
Level 2
Shows confusion and conflict
Sees supervision as complex and
multidimensional
Needs support to maintain motivation
Overfocused on counselors deficits
and perceived resistance
May fall back to being a therapist with
the counselor
Provide active
supervision of the
supervision
Assign Level 1
counselors
Level 3
Is highly motivated
Can provide an honest self-appraisal of
strengths and weaknesses as
supervisor
Is comfortable with evaluation process
Provides thorough, objective feedback
Comfortable with all
levels

Source: Stoltenberg, Delworth, & McNeil, 1998
TIP52,Page11
Counselor Developmental Levels

Developmental
Level
Characteristics
Supervision Skills Development
Needs
Techniques
Level 1
Focuses on self
Anxious, uncertain
Preoccupied with performing the right
way
Overconfident of skills
Overgeneralizes
Overuses a skill
Gap between conceptualization, goals,
and interventions
Ethics underdeveloped
Provide structure and
minimize anxiety
Supportive, address strengths
first, then weaknesses
Suggest approaches
Start connecting theory to
treatment
Observation
Skills training
Role playing
Readings
Group
supervision
Closely monitor
clients
Level 2
Focuses less on self and more on client
Confused, frustrated with complexity of
counseling
Overidentifies with client
Challenges authority
Lacks integration with theoretical base
Overburdened
Ethics better understood
Less structure provided, more
autonomy encouraged
Supportive
Periodic suggestion of
approaches
Confront discrepancies
Introduce more alternative
views
Process comments, highlight
countertransference
Affective reactions to client
and/or supervisor
Observation
Role playing
Interpret
dynamics
Group
supervision
Reading
Level 3
Focuses intently on client
High degree of empathic skill
Objective third person perspective
Integrative thinking and approach
Highly responsible and ethical counselor
Supervisee directed
Focus on personal-
professional integration and
career
Supportive
Change agent
Peer supervision
Group
supervision
Reading

Source: Stoltenberg, Delworth, & McNeil, 1998
TIP52,Page10