[Amazon.com: Essentials of Clinical Supervision (Essentials of Mental Health Practice): 9780471233046: Campbell, Jane M.: Books](https://www.amazon.com/Essentials-Clinical-Supervision-Mental-Practice/dp/0471233048) My notes 1. Being good as a therapist doesn't necessarily mean will be good at supervision—different role. 2. Overlapping and different function as Administration Manager (which follow a Business Management model) and Clinical Supervisor (which follows Ethical, professional guidelines) 3. Consider the legal and ethical implications of being a Clinical Supervisor. Cannot practice outside of the area of expertise or scope. 4. Establish Contracts, Roles and Responsibilities—the power difference. 5. Supervisors need to be professional and be prepared for it. Give timely feedback in written, oral form. Give due process for the supervisee to learn and make adjustments. # Chapter 3 - Models of Clinical Supervision 1. No-Model -- The Supervisor doesn't have a model, winging it. Based on their own supervision experience. They say "Look for me when you got a problem". Reactive. Not proactive. 2. Expert Model -- Like the traditional model in the Medical community... "I know everything". Authority and leadership. Consider the pros and cons when supervises are already experienced—the need for a more collaborative approach. 3. One-Size-Fits-All Model -- For supervisors who think that supervision is "Extra work" they ignore the different needs of different people. 4. Supervisee-as-Patient model -- Mistaking supervisee as a "patient needing to be treated", interpreting their behaviour as a DSM Axis 2 issue. Not respectful, and overly interpretative and assessments of behaviours. The danger of seeing relationship problems in supervision as a sign of pathology on the supervisee part. **How to create a personal model of supervision?** 1. Be aware of the assumptions that guide the process of change. For example, 1. "*Each discipline makes different assumptions that guide practice, training, and delivery of service. In general, psychiatry, nursing, and clinicalpsychology subscribe to a medical model of disease and illness, marriage and family therapy supports a systems viewpoint, counseling follows a relationship and strength-based foundation , social work adheres to a case management model, and substance abuse treatment for the most part subscribes to a support model. These differences among disciplines can have an immense influence on the supervisory process and, if not acknowledged and understood, can contribute to many misunderstandings and difficulties." # Models of Supervision ## Parallel Process Model, or Isomorphism 1. A viewpoint is that "parallel process refers to a relationship dynamic found in supervision in which a supervisee’s experience with clients will be reflected in the relationship with his or her supervisor (Doehrman, 1976)." 1. For example, when a supervisee feels overwhelmed and stuck in assisting a particular client, he or she may similarly present himself or herself in supervision." 1. isomorphism is the term family systems therapists use to describe a similar relationship phenomenon between systems and structures (Raichelson, Herron, Primavera, & Ramirez, 1997; Storm et al., 2001) 1. "How you relate to the supervise, they will relate to their client similarly." ## Interactional Supervision Developed in social work by Lawrence Shulan (1993). It look at the reciprocal nature of relationships. "When the supervisory relationship is going well, the clients will receive excellent service. When supervision is not going well and there is anger or dissatisfaction, the client will suffer as a result." ## Relationship Models (Campbell, 2000; Kaiser, 1997; Kaiser & Barretta-Herman, 1999) Relationship model view supervision as a complex relationship impacted strongly by issues of safety, trust, the use of power and authority, dual relationships, multicultural differences, and other contextual variables such as organizational climate, guidelines, and resources ## Interpersonal Process Recall (IPR) - This is what we have used. During the supervision session, to review the recorded session. Asked what are the thoughts/feelings when patient said or do that. - Kagan, 1980a; Kagan & Kagan, 1997). Norm Kagan developed IPR while training beginning counselors at Michigan State University. - The goal of IPR is to provide clinical supervisors a model for the facilitation of trainees understanding of themselves and client dynamics. ## Developmental Models - Different people at different time will have different needs. Therefore, important to take all these into consideration when setting goals, planning, selecting roles/style. - Supervisor complexity model (SCM ); Stoltenberg, McNeil, and Delworth (1998) titled their developmental model the integrated developmental model (IDM) , and Bernard (1997) chose the name discrimination model for hers. # Chapter 4 - Formats of Clinical Supervision It could be individual, group, peer, or team supervision. methods: Live observation, co-therapy, videotaping, written exercises, demonstrations and role-playing etc. **The goal of Supervision Formats, Methods and Techniques.** What will be the intent here? 1. Improve knowledge, skills, and self-awareness of supervisees 2. Increase objectivity to avoid bias and impaired judgment 3. Improve monitoring and control of supervisees' activities 4. Facilitate independent functioning and decision making ==Remember to orientate supervisees to the purpose and goals for each format, and provide supervisee's safety== ## Individual Supervision Format **How to Structure an Individual Supervision Session** ==How would you like to use our supervision time today as to be of best benefit to you?”== 1. Think ahead to the purpose and goals for the session. 2. Include the supervisee in planning for the session. 3. Ask the supervisee what they need most from the session. 4. Create a structure for the session: Start with successes, not problems. 5. Create questions to stimulate thinking. 1. “What are your feeling responses to the client?” 2. “How was it for you to sit with this client?” 3. “How connected do you feel to this client?” 4. “ What is your plan of action [intervention strategy, treatment goal] with this client? ” 5. “Can you identify any multicultural issues that may affect your relationship with this client?” 6. “What did the client say or not say was the problem and how might this be important to success? ” 7. “What personal issues are you aware of that may affect working with this client?” 8. “Are there any ethical issues present in this client situation?” 6. Whenever possible, combine case consultation with other methods and techniques, such as a written case review sheet, role-play, or a short demonstration. 7. Include some time for a teaching component within each session (more on creating a topical focus for supervision follows) 1. Adding a topical learning component can enrich the experience, topics such as "addressing client resistance", "trauma, abuse, anger.." 8. Ask the supervisee at the end of each supervision session about the benefit of supervision that day.• 1. “What is one thing you will take away from supervision today?” 2. “How was supervision helpful to you?” 3. “What was missing? ” 4. “ What do we need to talk about more next time? ” 9. Document the session. Pros and Cons of Individual Supervision Considerations: About vicarious liability - should include other direct observation, review of case notes, taping. ## Group Supervision Format - Checking out perceptions, trying out new behaviors in a safe environment, seeing that one is not alone, learning to give and receive feedback, engaging in self-exploration, seeing alternative ways to solve problems, appreciating differences in perspectives on problems. - Reminder: This is not group therapy. - Supervisors need to be well-versed in group dynamics, group development and role of conflict in groups, and comfortable with confrontation. [[Group Dynamic]] - Watch out for the disadvantages: - Other disadvantages include using the group as a forum for complaints; scapegoating of members; splitting into subgroups that compete against each other; or, after time, becoming so internally focused on the group dynamics and group process that discussing client cases becomes secondary. All of these possibilities will result in poor monitoring of client care (Munson, 2002). # Structuring Group Supervision 1. Supervisor to set tone and create a safe forum for learning, establish rules/boundaries. What is the goal and purpose of the group. 2. Expectations and roles of supervisors and supervisees 3. Use of "I" statements, owning your own opinions, avoiding advice-giving, or telling people what they should do. Keep feedback specific. Avoid generalities and personality labelling, and be respectful of differences. 4. Useful questions supervisors can use during the contracting stage: 1. “What would you like to have happen here in this group? What do you hope to get out of being in this group? How can this group meet your needs? What would make this experience truly memorable ,or successful ? How do you want to use the time we have? How do you see my role in the group? ” 2. “On evaluation, how do you want this to go? Ideas? My role? Yours? What kind of input do you want me to consider? Do you want some way to give written feedback as well as verbal feedback to each other? Should this feedback be included in the evaluation piece?” 3. “How do you want to handle conflict? Members who don’t participate or who dominate the discussion? What about discussion of personal problems or conflicts between members? How do you want to handle those situations?” 4. “What actions by group members or by me could be harmful? How do you want to address such behavior? Any dos and don’ts here?” 5. “What about confidentiality? Do we want to set a rule that we will not discuss outside the group any material or personal information learned about each other in the group?” - Supervisors need to create safety. Manage conflict, and competition (between supervisees), very common. [[Good questions to moderate conflict]] ## Stages of Group Development - Read [[Group Dynamic]] - Five-stage developmental model for groups: forming, storming, norming, performing, and adjourning (Tuckman & Jensen, 1977). # Observation of Group Dynamics - Can appoint a group process observer. Track who communicate with who, and how. Tracking of communication dynamics. Patterns. - Track group member behavior and communication patterns for short time periods and then share his or her observations with the group as a means to encourage self-awareness, improve communication, track stages of group development, and advance the goals for the group (Treadwell, Kumar, Stein, & Prosnick, 1997). The observer may wish to monitor the level and type of participation by various group members or who talks to whom and how often. For example, one supervisee may speak directly to the person he or she thinks is most likely to disagree with his or her ideas, whereas another supervisee may address all remarks to the person perceived to have the most power and influence in the group. Sometimes supervisees may couch all remarks with disclaimers or use generalities and avoid addressing any remarks directly to group members because of concern for safety. The group observer could point out these behaviors as a means to facilitate discussion about safety, power, and influence in the supervision group - A Sociogram can be used to visualise how communication take place, and track over times the communication pattern. Number of interruptions, positive/negative comments, a plop (unresponded). Identify subgroups, who like who.. etc or any conflicts. - A sociogram is a useful tool to help examine group development (Treadwell et al., 1997) . Group theory has suggested that in the early stage of group development, most exchanges will be between the leader and individual members, whereas with more mature groups, the majority of interactions will be group oriented. A map of group interactions done over a period of months could show such changes in development and remind members of the importance of group-directed interactions as a measure of group cohesiveness. - ![[Screenshot 2023-07-31 at 4.19.05 PM.png]] -