Providing Clinical Supervision for Home-Based Family Therapists Module

Module Sections:

Using Strategies and Techniques

Supervising the Home-Based Therapist

Supervising the Home-Based Therapist

Just as home based therapy is not merely office-based therapy in the home, supervision of home-based counselors is not the same as supervision of office-based counselors.

Case consultation is inadequate. Home based supervisors need opportunities to observe the counseling process and to play an active role in the home-based process. Use live, debriefing, and/or video-audiotaped sessions to have first-hand access to the counselor’s work. As the therapist develops, less structure and less active approaches may be appropriate but regardless of developmental level supervisors must be able to have eyes on the counseling process individually or by proxy.

Immersion training, for new or inexperienced therapists, allows for the monitoring of the counselor’s behavior by the senior counselor in addition to the supervisor – means by which to evaluate case conceptualizations, identification, and prioritizing of treatment issues and intervention skills.

  • Supervision should focus on four areas
    • Session management
      • Discuss balancing scheduling and pacing
      • Discuss interruptions and distractions
      • Discuss ways to shift the focus of the session
    • Using the home environment
      • Maintain focus by using probing questions
      • Focus on how the environment reflects the structure of the family
    • Systems thinking
      • Identify the most salient treatment needs and monitoring progress
      • Develop a strategy for transitioning services to the next provider
    • Safety issues
      • Provide ongoing safety assessments
      • Address safety of the family
  • Focus of Supervision for Inexperienced Therapists
    • Utilizing the Home-based modality
    • Monitoring abilities
    • Safeguarding client families
  • Focus of Supervision for Experienced Therapists
    • Issues of safety
    • Systems thinking
    • Using the home environment
    • Managing the sessions
  • Additional Forms of Supervision
    • Group: therapist presents a case for group feedback
    • Field supervision: therapists ride along with different colleagues to observe
      • This provides the observed therapist with feedback on a family and the observing therapist with a different perspective of how to work with a given family. For both it helps to alleviate the isolation in which HBFTs often work and in cases where there is a safety concern, there is the added security of having another therapist in the home.

**Essential component of effective supervision of HBFTs involves paying specific attention to the impact of the therapist’s worldview on their clinical work. By providing services in the home the therapist is in a position where an appreciation of cultural influences can be incredibly helpful and a lack of appreciation can be debilitating to the therapy process. Supervisors can help therapists to understand the interaction between their own cultural beliefs and those of the client families. In group supervision therapists can draw on the perspectives of the group to enhance understanding of the client’s experiences.**