Home / ECS3399 - SECTION 5: MODELS OF SUPERVISION

ECS3399 - SECTION 5: MODELS OF SUPERVISION

Section 5: Models of Supervision

As previously noted, there are a substantial number of different models of supervision in the literature. To some degree, these models can be characterized as falling into several different general areas, with the understanding that there may be considerable overlap between different models and areas, so that some models may fit into more than one category. The general areas are as follows:

Developmental Models of Supervision

Integrative Models of Supervision

Process Models of Supervision

Competency Based Models of Supervision

Social Role Models of Supervision

Function Models of Supervision

Psychotherapy Based Models of Supervision

The central focus for any single model (with the exception of the integrative models, which draw from several sources) may highlight or emphasize one or more specific elements of the supervisory process. In fact, there are numerous dimensions of supervision, of which each of these different central foci might be considered just one component. To supervise in an effective manner, a person needs to consider all of the following: the roles, functions, tasks, systems, competencies, supervisory processes, and the developmental process for the supervisee moving through different stages. These are represented in the various groupings.

Looking at supervision through a primarily developmental lens may cause the supervisor to de-emphasize the actual tasks that are involved in clinical work. Likewise, a focus on the roles and functions of supervision may cause the supervisor to lose sight of the larger developmental processes. The emergence of integrative models of supervision represents an attempt to pull together all of the different dimensions of supervision into a single model, with varying degrees of success.

Supervisors who wish to work in the real world will likely want to draw the most useful concepts from a number of different models – the ones that best fit their actual supervisory situation. For that to happen, however, they will first need to have a general overview of a number of the models to see what they offer. Each of the models will presented with reference to the source material that will then allow the trainee to pursue further the models that make the most sense to them.

Following that, there will be some deeper exploration into the most widely used integrative model, to see how the central concepts are expanded for better applicability. Then further integration with the Performance Management model will be undertaken, so that supervisees understand how to fill some of the gaps left by the integrative model in question. To support this effort, some scenarios will be presented to move the models from a more abstract perspective to something that more closely approximates the real world.

The Developmental Models

The Developmental Models emphasize different stages of supervisees’ development (novice to expert), suggesting that each stage of supervisees’ development consists of specific supervisees characteristics and skills that require supervisor interventions appropriate to each level. Supervisors who use developmental approaches must first identify the supervisee’s stage of development. Once that is determined, the supervisor will provide the right kinds and levels of feedback and support appropriate to that stage, while also working with the supervisee to create a development plan that will help the supervisee move forward to the next stage

Here are the two most important developmental models for our purposes, with information about how to access more information on the model. The Stoltenberg et al. Integrated Development Model (IDM) is the most researched developmental model of supervision. It will be studied in more detail later in this section.

Integrated Development Model (IDM) (Stoltenberg, McNeill & Delworth, 1998)

For more information, see: Stoltenberg, CD, McNeill, B & Delworth, U, IDM Supervision: An Integrated Model for Supervising Counsellors and Therapists, 1998, San Francisco: Jossey-Bass

Loganbill, Hardy & Delworth Model

For more information, see: Loganbill, C, Hardy, E, & Delworth, U, Supervision: A Conceptual Model, The Counseling Psychologist, 1982, 10 (1), https://doi.org/10.1177/0011000082101002

The Loganbill, Hardy & Delworth model addresses four elements of the supervisory situation: supervisor, supervisee, their relationship, and the environment or context in which the supervision is occurring. Developmental issues in supervisory assessment include (a) Competence, (b) Emotional Awareness, (c) Autonomy, (d) Theoretical Identity, (e) Respect for Individual Differences, (f) Purpose and Direction, (g) Personal Motivation, and (h) Professional Ethics. They propose three different stages: (a) Stagnation, (b) Confusion, and (c) Integration that are roughly similar to the 3-stage model of Stoltenberg and Delworth’s IDM. This is not surprising, as Delworth was a contributor to both models.

Supervisees in the first stage, the Stagnation Stage, tend to have a constricted thought pattern, with limited flexibility in terms of case and client conceptualization, as their aptitudes are limited. The authors describe resistance as being present during this stage, as the supervisees sort through their own attitudes towards their selves and anxiety about their clinical limitations. During this first stage, dependency on the supervisor can be high.

The authors name the second stage Confusion, and as supervisees begin to expand their clinical vocabulary and skill sets, this period can be marked by instability, disorganization, and conflict. Supervisees may fluctuate between feelings of incompetence and feelings of high competence, as some of their skills begin to generate positive results. As the supervisee begins to move towards a higher degree of independence from the supervisor, conflict can be generated as issues of dependency evolve, and confusion exists about whether dependency or independence will predominate.

The third stage, as the authors describe it, is Integration, as the supervisee’s clinical aptitudes allow for increasingly flexible and informed ways of approaching the clinical work. The supervisee’s view of him/her self is increasingly realistic, and the threat to self-esteem from concerns about competence recede. Issues of dependency and independence are more settled, and supervisees are likely to have more realistic view of supervision and its limitations.

This model is useful in terms of generating awareness of the different areas of competence that will be a focus of the supervision.

The Ronnestad and Skovholt Model

For more information, see: Skovholt, TM & Ronnestad, MH, The Evolving Professional Self: Stages and themes in therapist and counsellor development, 1992, Chichester, UK: Wiley

Ronnestad and Skovholt’s Developmental Model identifies 6 phases of development. The first three phases of this model (The Lay Helper, The Beginning Student Phase, and The Advanced Student Phase) are very similar to the 3 stages of the IDM. The remaining three phases (The Novice Professional Phase, The Experienced Professional Phase, and The Senior Professional Phase) occur as the clinical professional moves into career practice. This model has the advantage of viewing the developmental process over a longer time horizon.

The learning process will take place over the course of four phases representing the developmental process of counseling supervision: contextual orientation, trust establishment, conceptual development, and clinical independence.

Key understandings:

Focus of supervision will be on helping the supervisee move through 6 stages of development of their clinical skills and abilities: The Lay Helper, The Beginning Student Phase, The Advanced Student Phase, The Novice Professional Phase, The Experienced Professional Phase, and The Senior Professional Phase.
Ronnestad and Skovholt identify 14 main themes of supervisee development, which are the focus of the supervisory work:

Professional development involves an increasing higher-order integration of the professional self and the personal self
The focus of functioning shifts dramatically over time from internal to external to internal.
Continuous reflection is a prerequisite for optimal learning and professional development at all levels of experience.
An intense commitment to learn propels the developmental process.
The cognitive map changes: Beginning practitioners rely on external expertise, seasoned practitioners rely on internal expertise.
Professional development is long, slow, continuous process that can also be erratic.
Professional development is a life-long process.
Many beginning practitioners experience much anxiety in their professional work. Over time, anxiety is mastered by most.
Clients serve as a major source of influence and serve as primary teachers.
Personal life influences professional functioning and development throughout the professional life span.
Interpersonal sources of influence propel professional development more than ‘impersonal’ sources of influence.
New members of the field view professional elders and graduate training with strong affective reactions.
Extensive experience with suffering contributes to heightened recognition, acceptance and appreciation of human variability.
For the practitioner there is a realignment from self as hero to client as hero.

The Littrell, Lee-Borden & Lorenz Model

For more information, see: Littrell, J. M., Lee-Borden, N., & Lorenz, J. (1979). A developmental framework for counseling supervision. Counselor Education and Supervision, 19(2), 129-136.

http://dx.doi.org/10.1002/j.1556-6978.1976.tb02021.x

The Littrell, Lee-Borden & Lorenz Modelis a four-stage model that emphasizes relationship building, teaching/ counselor role, collegial role, and self-supervision.

In their abstract, the authors “propose a comprehensive developmental framework that incorporates the four supervision models (counseling/therapeutic, teaching, consulting, and self-supervising). The framework reflects the changes that occur during supervision and offers the supervisor and the trainee a means of conceptualizing the developmental stages of supervision.

Task-Focused Developmental Models

Task-focused developmental models use the premise that supervision can be broken down into manageable tasks. The integrative/social role model suggests seven central tasks of clinical supervision: creating the learning relationship, teaching, counselling, monitoring, evaluation, consultation and administration.

Carroll Integrative/Social Role Model

For more information, see: Carroll, M, Counseling Supervision: Theory, Skills, and Practice, (1996), London: Cassell

The Process Developmental Models

Process developmental models focus on the processes of supervisee’s work. The most well-known of these models is the Bernard and Goodyear’s reflective model, where the use of reflection is central to the learning process. Stoltenberg and Delworth’s model is also sometimes described as a process developmental model.

Bernard and Goodyear’s Reflective Model

For more information, see: Bernard, J. M., & Goodyear, R. K. (2009). Fundamentals of clinical supervision (4th ed.). Needham Heights, MA: Allyn & Bacon

Stoltenberg and Delworth Developmental Model

For more information, see: Stoltenberg, DC & Delworth, U, Supervising Counsellors and Therapists, 1987, San Francisco: Jossey-Bass

Integrative Models

Integrative models of supervision rely on more than one theory and technique and typically are viewed as consisting of two approaches to integration: technical eclecticism and theoretical integration.

Technical eclecticism: The application of techniques from many different schools while not necessarily adhering to the theories behind the techniques.
Theoretical integration: A approach that develops a conceptual and/or theoretical framework integrating and synthesizing the most useful aspects of more than one theoretical approach in order to a more complex and more applicable model beyond what a single model could create.

Bernard’s Discrimination Model and Holloway’s Systems Approach to Supervision are the most recognized of the integrative models. Holloway’s model is also frequently categorized along with other process models, due to a good deal of overlap between categories.

Bernard’s Discrimination Model

For more information, see: Bernard, JM, The Discrimination Model, in CE Watkins, ed, Handbook of Psychotherapy Supervision, 1979, NY: Wiley, also Bernard, JM and Goodyear, RK, Fundamentals of Clinical Supervision, 1997, Boston: Allyn and Bacon

The discrimination model focuses on three key skills to be developed during the supervisory process: intervention (or process) skills, conceptualization skills, and personalization skills. Process or intervention is primarily concerned with skills in managing communication in the clinical interactions. Conceptualization skills are concerned with how well supervisees can integrate theory and practice, to understand what a case is about, what theories and understandings related to the case, and how that will translate into choices of intervention. Personalization is concerned with how well supervisees manage the use of self in therapy, including the management of emotional material, contagion, countertransference, in ways that keep the focus on the client and use empathy, understanding, and person to person emotionally attuned interactions to create a therapeutic environment.

This model denotes three roles for the supervisor to assume: teacher, counselor, or consultant. Depending upon the needs of the supervisee in the developmental areas, the supervisor will assume one of these three roles. As the clinician develops and becomes more independent, the role of the consultant will become increasingly dominant.

It is important to note that the definition of the role of counselor is not to be confused with the role of therapist. The role in this model is to help the supervisee address the challenges of managing his/her personal, internal and emotional reactions to providing clinical services, including transference and countertransference, but not for the supervisor to assume clinical responsibility for the mental health needs of the supervisee.

Holloway’s Systems Approach to Supervision (SAS) Model

For more information, see: Holloway, E, Clinical Supervision: A Systems Approach by Elizabeth L. Holloway, 1995, Thousand Oaks, CA: Sage Publishing

In Holloways systems approach, the relationship between the supervisor and the supervisee is the main area of focus. The relationship should be collaborative in nature and oriented towards empowerment for both parties. Holloway notes a number of different dimensions of supervision, all connected by the central supervisory relationship.

The dimensions that Holloway notes are as follow: a) the functions of supervision, b) the tasks of supervision, c) the client, d) the supervisee, e) the supervisor, and f) the institution or context in which the supervision is occurring. The primary areas for the supervisory process will be the function and tasks of supervision. The other four dimensions represent the context that will have indirect, but important influences in the supervisory process.

Holloway recommends that five systemic influences and relationships be considered: (1) the supervisory relationship (including phase, contract and structure); (2) the characteristics of the supervisor; (3) the characteristics of the institution in which supervision occurs; (4) the characteristics of the client, and (5) the characteristics of the supervisee (aptitudes, personal strengths, etc.).

Other Noted Integrative Models

Ward and House’s Reflective Learning Model

For more information, see: Ward, C & House, R, Counseling Supervision: A Reflective Model, Counselor Education & Supervision, Sep 1998, Vol. 38, Issue 1

The primary mode of engaging in the Reflective Learning Model is through generating opportunities to reflect on both the clinical work and the supervisory interactions. Reflective supervisory dialogue tends to focus on thematic approaches to understanding the counseling sessions rather than content patterns: the themes of the sessions, not just the facts from the content. This encourages the development of multiple hypotheses about clinical material and interventions.

There is also a very strong orientation towards continuous self-assessment on the part of the supervisee, both in terms of competencies for managing the clinical work, and in terms of what learning needs are present to fill any gaps in those clinical aptitudes. The supervisory work will have an orientation to open-ended questions that support and direct reflective work. This will encourage supervisees to reflect on their "visions of professional learning", with a goal of increasing the capacity for critical assessment, decreased self-judgment, and an increased orientation towards taking well-considered and appropriate professional risks.

Greenwald and Young’s Schema-focused Model

For more information, see: Greenwald, M & Young, J, Journal of Cognitive Psychotherapy; New York Vol. 12, Iss. 2, (1998): 109-126.

This model is based upon ideas from Schema Focused Therapy, and it is oriented towards directing and encouraging the supervisee to assess and uncover the client’s schemas from a cognitive, experiential, behavioral and interpersonal perspective. The supervisee is also encouraged to explore his/her own schemas to understand where they might interfere with clarity towards the client and his/her schemas.

There are three main areas of focus within the supervisory process: case conceptualization and treatment planning, role playing for skill building, and focus on the supervisee’s own schemas about self, treatment, and the supervisory process.

Case conceptualization, case strategy, case implementation, resolving technical case problems, working on counseling relationship issues, providing support and personal help for the supervisee, and discussing conceptual and treatment issues.

Source: Bradley, L, Gould, L and Parr, G, Supervision-Based Integrative Models of Counselor Supervision, in Counselor Supervision: Principles, Process and Practice, Bradley, L and Ladany, N, eds, 2000, Philadelphia, Brunner-Routledge

Powell and Brodsky’s Blended Model of Supervision

For more information, see: Powell DJ, Brodsky A. Clinical Supervision in Alcohol and Drug Abuse Counseling: Principles, Models, Methods. San Francisco: Jossey-Bass; 2004. (Rev ed)

Key understandings:

The Blended model combines insight-oriented approaches with skills-oriented approaches
There are six essential areas that are the focus of the supervisory work:

Self. Each supervisor develops an idiosyncratic style of supervision, largely based upon his or her personality profile and model of counseling.
Philosophy of counseling. Supervisors articulate their philosophy or model of counseling, describing what they do in counseling, what models and techniques they use, and at what times and/or circumstances.
Descriptive dimension. The blended model uses a version of Bascue and Yalof’s Descriptive Dimensions, which outline 10 different dimensions of theory and practice critical to understanding individual beliefs about practice and supervision: the Influential Dimension(Influenced at an affective or cognitive level); the Symbolic dimension (latent versus manifest content); the Structural Dimension (planned versus spontaneous actions); the Replicative Dimension (supervisory work a parallel process to therapy versus a discrete process from therapy); the Therapist in Treatment Dimension (training and personal therapy related versus unrelated); the Information Gathering Dimension (direct observation versus indirect methods of information transfer); the Jurisdictional Dimension (supervisee responsible for client care versus supervisor responsible for client care); the Relationship Dimension (hierarchical versus facilitative stance); the Strategy Dimension (theory versus technique)
Stages of counselor development. This model adapts the IDM model of Stoltenberg et al. and other developmental approaches to clinical supervision.
Contextual factors. The blended model uses the work of Holloway (1995) and other contextual models of clinical supervision, addressing factors affecting supervision, such as age, race, gender, ethnicity, recovery–nonrecovery, disciplines, academic background, and the like.
Affective–behavioral axis. The model views supervision along a continuum, blending affective and behavioral changes for the counselor in supervision.

The Social Role Models

Social role model approaches to clinical supervision focus on the roles, tasks, foci and functions of clinical supervision. Holloway’s Systems Approach and Hawkins and Shohet’s Double Matrix Model are the two most frequently cited in this category.

Holloway’s Systems Approach to Supervision (SAS) Model

For more information, see: Holloway, E, Clinical Supervision : A Systems Approach by Elizabeth L. Holloway, 1995, Thousand Oaks, CA: Sage Publishing

Please note this model has been covered in preceding paragraphs.

The Double-Matrix (or Seven Eyed Supervisor) Model

For more information, see: Hawkins, P and Shohet, R, Supervision in the Helping Professions, 2006, Berkshire: England, Open University Press

The “Seven-Eyed Model” of supervision is called such because it recommends seven areas of focus for exploration in supervision: (1) content of therapy session; (2) supervisee’s strategies and interventions with clients; (3) the therapy relationship; (4) the therapist’s processes (e.g., countertransference or subjective experience); (5) the supervisory relationship (e.g., parallel process); (6) the supervisor’s own processes (e.g., countertransference response to the supervisee and to the supervisor-client relationship), and (7) the wider context (e.g., organisational and professional influences).

Competency-Based Models

Competency-based models of supervision focus on developing the most important competencies related to clinical practice. For supervisors whose challenges lie in bringing their supervisees’ competencies up to an adequate level quickly, these models might be a good place to focus.

Falender & Shafranske’s Competency Based Supervision

For more information, see: Falender, C & Shafranske, E, Clinical Supervision: A Competency Based Approach, 2004, Washington, DC: APA Publications

As noted by the authors, “Competency-based supervision is defined as an approach that explicitly identifies the knowledge, skills, and values that are assembled to form a clinical competency and develops learning strategies and evaluation procedures to meet criterion referenced competence standards in keeping with evidence-based practices and requirements of the local clinical setting.”

Source: Falander, C and Shafranske, E, Competence in Competency-Based Supervision Practice:Construct and Application, 2007, Professional Psychology: Research and Practice, the American Psychological Association, Vol. 38, No. 3, 232–240

The authors further go on to issue some recommendations for successful use of Competency-Based Supervision:

Recommendations for Competency-Based Supervision

The following recommendations will assist in implementation of competency-based supervision practice.

The supervisor self-assesses on clinical and supervision expertise and competency issues (Falender, Cornish, et al., 2004).
The supervisor engages with the supervisee to facilitate development of a viable supervisory relationship, leading to the emergence of a working alliance (Bordin, 1983; Falender & Shafranske, 2004).
The supervisor commits to the practice of supervision integrating the following superordinate values: integrity in relationship, ethical values-based practice, appreciation of diversity, and science-informed (better stated now as evidence-based) practice (Falender & Shafranske, 2004).
The supervisor delineates supervisory expectations, including standards, rules, and general practice (Falender & Shafranske, 2004; Vespia, Heckman-Stone, & Delworth, 2002).
The supervisor identifies setting-specific competencies the supervisee must attain for successful completion of the supervised interval. A competencies document (Hatcher & Lassiter, 2005) provides a prototype.
The supervisor collaborates with the supervisee in developing a supervisory agreement or contract for informed consent, ensuring clear communication in establishing competencies and goals, tasks to achieve them, and logistics (Falender & Shafranske, 2004; Falvey, 2002; Sutter, McPherson, & Geeseman, 2002).
The supervisor with the supervisee links the original competencies document to the contract or agreement and to the evaluation procedures so that expected competencies are stated and assessed and ongoing feedback is given on progress. A competencies document (Hatcher & Lassiter, 2005) provides a prototype.
The supervisor reviews supervisee work with audio or video review and supervisee case notes.
The supervisor facilitates inquiry leading to supervisee self-awareness and reflective practice as features of the evaluation process (Falender & Shafranske, 2004).
The supervisor models and engages the supervisee in self-assessment and development of metacompetence from the onset of supervision and throughout.
The supervisor provides ongoing feedback, verbal and written, and encourages and accepts feedback from supervisee.
The supervisor maintains communication and responsibility for observing problems in the supervisory relationship

The Competency Cube Model, a 3-D model

For more information, see: Rodolfa, E, Bent, R, Eisman, E, Nelson, P, Rehm L, and Ritchie, P, A Cube Model for Competency Development: Implications for Psychology Educators and Regulators, 2005, Professional Psychology: Research and Practice, Vol. 36, No. 4

The competency cube views competencies along a three-dimensional framework, where foundational competencies, functional competencies and stages of professional development each represent one dimension. Foundational competencies include such things as : a) reflective practice – self-assessment, b) scientific knowledge–methods, c)relationships, d) ethical–legal standards–policy, e) individual/cultural diversity, and f) understanding of interdisciplinary system.

Functional competencies include such items as a) assessment–diagnosis– case conceptualization skills, b) intervention skills/approaches, c) consultation skills, d) research– evaluation, e) supervision–teaching, and f) management–administration.

Stages of development are listed as a) graduate education, b) internship, c) postdoctoral training or residency, and d) continuing competency. These stages of development do not seem to be as thorough or forward moving as some of the developmental models, that examine at least three levels that would otherwise be covered in this model under continuing competency.

The Objectives-Based Approach (OBAS), a 3-D model (Gonsalvez, Oades & Freestone, 2002

For more information, see: The Objectives Approach to Clinical Supervision: Towards Integration and Empirical Evaluation, Gonsalvez, C, Oades, L & Freestone, J, 2011, Australian Psychologist

Within this approach, objectives are defined in terms of clear, measurable outcomes (learning outcomes). Within a field as complex as mental health practice, definitions of clear objectives represent a distinct challenge, but one worth undertaking if it allows for better focus on the learning that will better support reaching objectives. This model is relatively new and research validation difficult to find. However, its focus on objectives may be helpful in terms of integration with the Performance Management model.

The Function Models

The function models of supervision focus on the different supervisory functions, with special emphasis on the administrative,educational, and supportive functions undertaken by the supervisor. Alfred Kadushin elaborated these three separate functions, which were later expanded upon by Hawkins and Shohet in their description of the different functions of supervision.

Kadushin’s Social Work Supervision Model

For more information, see: Kadushin, A. (1992) Supervision in Social Work (3rd. edn.), New York: Columbia University Press. Revised fourth edition published 2002

Hawkins and Shohet Model of Supervision

For more information, see: Hawkins, P. & Shohet, R. (1989; 2007) Supervision in the Helping Professions. An individual, group and organizational approach, Milton Keynes: Open University Press/Maidenhead: Open University Press

The Process Developmental Models

The Hawkins and Shohet Model is a process model of supervision with seven points to focus on:

1. The client and how they are presenting.

2. The intervention (techniques and strategies)

3. The therapeutic relationship

4.The reaction of the therapist/supervisee

5. The supervisory relationship (parallel process)

6. The reactions of the supervisor

7. Wider contextual issues (system or organizational)

Deeper Exploration of an Integrated Developmental Model

In this section, core information about the major models of supervision will be explored, with examination of integration with principles of Performance Management, as well as discussion of how these models fare in real-life applications, where ideal states are often hard to find. As a starting point, the examination will begin with the models that are best validated and most frequently used.

Stoltenberg & Delworth’s Integrated Development Model (IDM)

For more information, see: Stoltenberg, CD, McNeill, B & Delworth, U, IDM Supervision: An Integrated Model for Supervising Counsellors and Therapists, 1998, San Francisco: Jossey-Bass

The Stoltenberg and Delworth Integrated Development Model is the most studied developmental model in the literature. It puts forth the idea that there are three developmental levels or stages to be addressed over eight dimensions of practice. Supervisors will assess the developmental level of the supervisee according to their formulation and then apply the skills and approaches that correspond to the developmental level of the supervisee.

Key understandings for this model:

The focus of supervision will be on helping the supervisee move through 3 stages of development of their clinical skills and abilities, from novice, through intermediate, to expert, with increasing amounts of autonomy and independence assumed by the supervisee.
Stage 1 trainees tend to be highly anxious and need supervisors to provide specific direction on technical aspects of clinical work; stage 2 trainees are more ready to shift the focus off their own emotional state to the client and the client's worldview; stage 3 trainees are increasingly independent and secure and are more able to deeply empathize with the client and more readily bring what they know about theory and research into a given clinical situation.
The supervisor needs to accurately identify the stage of development presented by the supervisee and shift his role and actions to align with the needs of the supervisee at each stage of development.
The supervisor will use the process of scaffolding to build each successive level of knowledge and skills upon what has already been acquired by the supervisee, with the ultimate goal of developing advanced critical thinking about the process of providing clinical treatment.
Supervisees may be at multiple stages of development at the same time, with different aspects of treatment developing at different rates of speed.
There are eight essential growth area domains (dimensions) that are the focus of the supervisory efforts:

Interventions skills competence - aptitudes in effective therapeutic interventions
Assessment techniques - administering appropriate mental health assessments, including mental status, substance use, and formalized tools and measures
Interpersonal assessment - using personal skills in conceptualizing client issues
Client conceptualization - understanding how the client’s personal and family history, social environment and personality influence wellness and functioning
Individual differences - competence in dealing with issues related to cultural competence and personal and cultural differences: racial, ethnic, abled/disabled, gender and sexual orientation, or other differences
Theoretical orientation - the depth of understanding related to various theories related to the development of mental health concerns
Treatment plans and goals - the ability to determine appropriate intervention strategies within a cohesive plan based upon identified goals

Key tasks:

Understand how to develop a therapeutic relationship in order to set the framework for successful clinical work: support and acceptance for the client within their own roles, identities and narratives, trust for the co-creation process
Teach the key techniques and tools of clinical work as noted in the 8 essential growth area domains
Teach the key techniques and tools of use of the self as a vehicle for change: self and other awareness concerning fears, anxieties and uncertainties, and how certain behaviors affect the client and others, emotional and behavioral self-control, motivation.

Built into the Stoltenberg and Delworth model, there are three essential structures that inform the focus of supervisee training: 1) awareness of self and others; 2) motivation towards the developmental process, and 3) development of the balance between dependency and autonomy, with the supervisee expected to increase autonomy and decrease dependency over time. When the supervisee has reached level 3 in each of these structures, he/she is considered to be at the fourth (or 3i) level in the formulation.

During stage 1, it is expected that - within the awareness of self and others structure - the supervisee will have high levels of self-focus that interfere with the capacity to remain focused on the client and that make it more difficult for the supervisee to engage in accurate self-evaluation. In the motivation structure, motivation and anxiety will be focused on performance concerns and acquiring the right clinical skills. Autonomy will be limited, as the supervisee will likely be very dependent upon the supervisor in the dependency-autonomy structure. Problems with sustaining confidence will be likely, so positive reinforcement for change efforts will be very helpful.

During stage 2, there will be some improvements in each of these three structures, but also vacillation between a) self-aware and other-aware states, b) more confident states and less confident states, and c) more autonomous states and more dependent states. Enmeshment and confusion with clients may be more likely, as well as resistance towards the supervisory process, as the conflict between autonomy and dependency and confidence and lack of confidence play out in complex ways.

During stage 3, there will much more improvement in each of these three structures, as the supervisor is more able to remain in other-aware states, more confident states, and more autonomous states. The supervisory relationship and the supervisory process moves increasingly towards a consultancy position, as the supervisee assumes more independence in the performance of the clinical work.

Stage 1 Responsibilities

The model outlines different goals and responsibilities at each stage of development for the supervisor and supervisee. The goals of the beginning stage include a) developing the supervisory relationship, b) assessing the competencies of the supervisee, c) beginning to educate the supervisee in key areas, such as i) ethics and liability concerns, ii) documentation expectations, and iii) important considerations about the relationship between the employee and the organization where the work is occurring. Goals for the supervisee will be collaboratively developed early in the process, and a supervisory contract and other supervisory agreements will be reached.

During this stage, the supervisor will monitor the early experiences of the supervisee carefully and provide consistent oversight and/or observation of the clinical interventions. Direct feedback, with a focus on education and development will be provided. The supervisor will take charge of providing adequate structure for the supervisory sessions and will limit the supervisee’s autonomy until the supervisee demonstrates sufficient competence to warrant increased independence. The supervisor will also be prepared to step in to assist with critical or high-risk situations and review supervisee documentation, and document supervisory activities appropriately to create an accurate record.

The supervisee will be expected to a) seek and accept direction at this first stage and b) have honest discussions of strengths and weaknesses. The supervisee will be expected to c) provide the supervisor with clear, honest and thorough information. Following the goals set collaboratively with the supervisor, the supervisee will be expected to d) engage in safe and prudent interactions with clients within the limits of his/her competence and training, and within the structure provided by the supervisor.

The supervisee is expected to e) provide the supervisor with information about his/her needs, wants and expectations of the supervisory process, and f) be prepared to address the normal anxieties of this stage openly in supervision. The supervisee is also expected to g) ask questions and h) propose hypotheses about the clinical work so that the supervisor can ascertain progress and needs in this area.

Stage 2 Responsibilities

The goal of the second stage is primarily related to fostering increasing independence in the supervisee’s practice. However, this goal is often made more difficult by conflict between the supervisee and supervisor about how quickly the supervisee is ready to move to independence.

In the second stage, the supervisor will move from a position of providing more direct clinical direction and education to a position of designing opportunities for the clinician to take the lead in examining case material and attempting to integrate knowledge into practice. This may take the form of a) role play b) providing clinical and ethical dilemmas, c) scenario analysis, working with the supervisee to explore various theoretical approaches and ideas, while evaluating treatment options for their likely applicability and effectiveness.

During this stage, the supervisor may choose to allow the supervisee to struggle with decisions and their consequences and encourage more shared decision making, with appropriate oversight as needed. Plans of action will be more collaboratively developed, and the supervisee will be given more responsibility for determining how to use supervisory time.

The supervisee will be given increased responsibility and independence, within the boundaries set by their level of competence. They will be expected to consult with the supervisor when direction and more expert knowledge is needed to address cases effectively. They will be expected to identify relevant questions to ask and come to supervision prepared to initiate appropriate topics for study and discussion. They will also be expected to provide feedback to the supervisor about the supervision process and make recommendations for improvements.

Stage 3 Responsibilities

During stage 3, the supervisor will move more into the role of an expert consultant, allowing and encouraging the supervisee to assume near full responsibility for the clinical work and the supervisory relationship. The supervisor will listen to the supervisee, following his/her lead, providing summative evaluation of the processes and explore other treatment options when appropriate or when asked.

At stage 3, the supervisee will assume primary responsibility for cases, but will continue to use the supervisor as a sounding board and as a guide when complexities arise that the supervisee has not been able to find a viable strategy on his/her own. The supervisee will continue to provide the supervisor with guidelines on what is and is not needed in supervision.

Source: Haynes, R, Corey, Ga, and Moulton, P, Clinical Supervision in the Helping Process, 2003, Pacific Grove, CA: Thomson

Integration with Performance Management

When a model of supervision is presented as a cohesive theoretical approach – without reference to actual supervisees - it can appear as though the movement through the stages of development are predictable and the tasks and responsibilities of the supervisor easily defined, designed and implemented. This is not how the real world works. Supervisees bring complications and complexities to the supervisory work that cause the models to break down and require that other tools be brought into the interactions to allow for both learning and work performance to continue forward.

The field of mental health can turn into a very process-oriented profession, and supervisors can become so wrapped up in the process elements that the gritty details of how to operationalize the actual tasks and actions can sometimes be insufficiently in focus. It is for that reason that the first model addressed was Performance Management. The points of focus - and the systems and structures - of Performance Management bring to the table other essential elements for addressing the messy world of real people as supervisees. In preparation for examining how other models of supervision integrate with the Performance Management model, a supervisee situation closer to real life will be presented.

Supervision Scenario at Stage 1 for Performance Management Integration

Felicia H. is a clinical social worker and a CAC who works as supervisor in an agency that provides both substance abuse programs and EAP services within a major urban area. Both parts of the agency offer services to a number of immigrant groups, and the agency has a contract to provide substance abuse services to clients referred through the court system and through several companies' Drug-free Workplace Programs. One of her most pressing concerns has been to locate a professional who is able to work with some of her immigrant clients in their native tongue, without which services to this group will be nearly unworkable. After a very long search process, she is able to secure a clinician, Mo L., who is from this cultural background, has a clinical license at the associate, but not independent level, perhaps the only professional in the city who is fluent in both the language and culture of this population. His graduate work was at a college that is not extremely highly regarded, where much of the course work was conducted in an online format, and there are some very obvious gaps in his knowledge base, including some limitations in his knowledge of substance abuse treatment. Felicia is very clear that Mo is in Stage 1 of the developmental process, and she approaches the supervisory work accordingly. The development/learning plan has a concentrated focus on filling in Mo’s aptitude deficiencies, but Felicia is kept very busy in her own clinical tasks and has only limited time to provide the level of oversight and support that Mo seems to need. Very early in his tenure, Mo begins to run into conflicts with some of the clients – even those from his own cultural background. Felicia recommends to Mo that he consider securing his own therapist to help support him and the difficult transference issues that appear to be getting raised in the course of his conducting treatment, but Mo is insulted by this and begins to get increasingly resistant to any supervisory input from Felicia. What are the supervisory concerns that are raised by this situation, and what options does Felicia have for addressing them?

To examine how the Stoltenberg and Delworth developmental model intersects and integrates with Performance Management in a situation like this, the nature of the agreements between the supervisee and the organization will be revisited:

Agreement about the exact nature of the job description, including tasks and responsibilities, and the supervisee’s role at the organization.

Agreement about standardsfor the performance of the employee/supervisee’s essential tasks and secondary responsibilities, such as relationships with other people in the organization or professional comportment in the workplace. This component also requires the following:
Agreement about the measurement of performanceand the tools used for measurement.
Agreement about what performance criteriaare to be used to determine if the employee/supervisee fails to meet, meets, or exceeds expectations, and the margins of error present in each of these areas.

Agreement about standards for conduct, including what behaviors and conduct are unacceptable in the workplace

Agreement about the appropriate rewards and consequences (when relevant) accruing to the employee/supervisee based upon his or her performance

Agreement about the level of support and supervision that will be given to the employee/supervisee in order to help improve performance

Within this model, done with the degree of organization and preparation shown in the paragraphs above, there is a substantial amount of preliminary work that can help clarify the agreements between the supervisee and the organization and supervisor before the clinical work is undertaken and problems emerge. This provides a much better foundation for addressing the actual supervisory situation.

The Stoltenberg and Delworth model does address this issue in a way, noting several key tasks that will factor into the developmental work. However, the model itself is not as thorough in explaining how to expand upon these items to create clearer and more precise definitions of what will be expected of the supervisee, especially with regard to what will constitute standards of performance in each of the areas described. Below are the general outlines of those key tasks.

Understand how to develop a therapeutic relationship in order to set the framework for successful clinical work: support and acceptance for the client within their own roles, identities and narratives, trust for the co-creation process
Teach the key techniques and tools of clinical work as noted in the 8 essential growth area domains (see below)
- Interventions skills competence
- Assessment techniques
- Interpersonal assessment
- Client conceptualization
- Individual differences
- Theoretical orientation
- Treatment plans and goals
Teach the key techniques and tools of use of the self as a vehicle for change: self and other awareness concerning fears, anxieties and uncertainties, and how certain behaviors affect the client and others, emotional and behavioral self-control, motivation.

The Performance Management model provides the right supplement to the developmental model, adding emphasis on the importance of better clarification concerning Specific Responsibilities, Results Expected (standards), and Specific Actions. These items fit more closely with some of the competency-based models of supervision.

The key point drawn from the Performance Management model is the degree to which the supervisor will make his/her job easier and more effective by spending additional time in determining and clarifying the specific responsibilities within the job, the competencies that are required to manage those responsibilities, the tasks assigned that will utilize those competencies, and the standards that will determine whether the job is being performed in an adequate manner.

This will occur while implementing a learning or development plan where the supervisor will assist the supervisee in sustaining motivation and securing the resources and the systems and structures necessary to strengthen his/her aptitudes. Under the Performance Management model, the supervisor will also come to agreement about the level of support and supervision that the supervisee can expect to receive in order to actualize these results, clarifying that the developmental work will be undertaken within an environment of support.

However, in a real-world environment, motivation for the learning process to move forward can also be generated through the application of rewards and consequences for meeting or not meeting work expectations. While it is important to help the supervisee contain his/her anxiety in the early stages of clinical practice, anxiety can be a mobilizing force for initiating active steps for change in spite of internal reluctance or resistance to engage in the hard work of change efforts. The prospect of losing a job and a paycheck is sometimes not only motivational, but also necessary to persuade supervisees to work at a level that takes care of the client’s needs.

Please note that if this issue has not been addressed early in the supervisory relationship - and has not been incorporated into the consent agreement with a very high level of clarity and specificity - then the supervisee’s response to the realities of being presented with and held to appropriate work performance expectations will be an obstacle to the supervisory relationship. Supervisors who go the extra mile to provide absolute clarity in these processes, using guidelines from the Performance Management model as a supportive system and structure, will improve the likelihood that this issue will not be a relationship killer.

It is important to note that these kinds of challenges do not just happen at stage 1 of the supervisory process. Please note the following scenario for how this issue may arise at later points in supervision.

Supervision Scenario at Stage 3 for Performance Management Integration

Jill C. is a supervisor at a large private mental health agency. Bob K. is a clinician who is currently being supervised by Jill. Bob is widowed and currently has two children in college, with two more set to begin college within the next two years. He also has primary financial responsibility for his disabled mother, who lives with him and requires expensive nursing care. For the past several years, he has been seeing at least twenty clients a week in private practice, in addition to 35-hours a week at his agency position. Jill has begun to see a noticeable decline in Bob’s level of performance in his agency work. He has been testy, at times, with his clients, and not as skilled in directing the flow of the group work. In line with the demands of practice ethics, Jill addresses her concerns with Bob about the fall-off in his clinical work. Bob says that he is not in a position to make any changes at this time. Managed care has reduced the amount he is able to charge his private clients, and he has been forced to work longer hours to make up the financial difference. If he wants to keep his family afloat, he can only envision working at least this hard until the children get through college. He acknowledges that the quality of his work probably suffers a little, but he is still a better clinician than most of his peers, and his clients still receive a generally high quality service from him. What are the supervisory concerns that are raised by this situation, and what options does Jill have for addressing them?

In a situation like this, there will need to be a much more structured approach to managing work performance problems in clinical supervision. In a later course, there will be a highly structured tool to manage this kind of work performance problem, with a significant amount of instruction on the planning and preparing, including tools and approaches, that will be essential to creating workable outcomes. These materials will follow in a very well-integrated way with the Performance Management model presented in this course.

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