Providing Clinical Supervision for Home-Based Family Therapists Module

Module Sections:

Introduction and Pre-Test

Welcome to the Providing Clinical Supervision for Home-Based Family Therapists Course

Welcome!

The purpose of this course is to provide supervisors with different theoretical approaches to supervision as well as ways of conducting supervision in order to learn what home-based family therapists need to feel supported. Likewise, this module will help clinical supervisors understand their role in the supervisory process while learning how to develop their personal philosophy of supervision.

Supervision differs from consultation in that consultation is a peer like exchange between therapists, whereas supervision is when a qualified therapist monitors professional development and socialization of partially qualified clinicians. According to Bernard and Goodyear (2009), “clinical supervision is an intervention that is provided by a senior member of a profession to a junior member or members of that same profession. This relationship is evaluative and hierarchical, extends over time, and has the simultaneous purpose of enhancing the professional functioning of the junior member, monitoring the quality of professional services offered to the clients she sees, and serving as a gatekeeper for the particular profession.” However, the situation does not necessarily have to be between junior and senior people. Likewise, supervisors do not have to be from the same profession. Supervisors serve as quality control agents and ensure that supervisees are not harming clients and that clients receive adequate care. Likewise, supervisors make sure therapists acquire and maintain sufficient clinical skills because supervisors are responsible not just for client’s welfare but also for the supervisee’s professional development. 


Module Objectives

  • Clinical supervisors will review the different definitions of clinical supervision including their role in this process.
  • Clinical supervisors will learn about different theoretical approaches to supervision.
  • Clinical supervisors will review different ways of conducting clinical supervision.
  • Clinical supervisors will learn what home-based family therapists need in order to feel supported and to provide quality in-home family therapy.
  • Clinical supervisors will learn about how to develop their personal philosophy of supervision.

Scope of the Issue

 Importance of the Supervisory Relationship

The quality of the relationship between supervisor and trainee is probably the single most important factor for effective supervision. The supervision relationship should begin with discussion about structure, systematic review, planning time to cover all areas, deciding who is responsible for raising each topic and how and when the supervision process will be reviewed. Supervisors should have ground rules, be flexible, have learning objectives, and include record keeping and liaison with the program director. Training for supervisors is valuable and necessary.

Relationship is at the heart of an intense interpersonal process like therapy or supervision. It seems tempting and all too easy to focus on supervisory techniques, teaching psychotherapeutic skills, concrete details such as contracting, and philosophies of supervision, rather than the risky and uncharted territory of the supervisory relationship. Supervisees think of little else until a positive supervisory relationship is assured, then and only then can they turn their attention to some of these topics. Two other issues in the supervisory relationship is power and dual relationship.

It is hard to reassure supervisees that there is no hierarchy, or that blurred relationship boundaries are safe, unless they experience safety and security in the supervisory relationship.

Collaborative supervision involves,

“face to face ongoing dialogues between a supervisor and therapist where goodwill prevails; the learning is mutual and intense; the power relations are transparent; and the emphasis is on meeting standards of the profession, ensuring the well-being of clients served by the supervisory participants.”

Supervision promotes standardization within the profession; ensuring conformity to the goals and ethical practices; and transmitting skills, knowledge, and attitudes of the profession to the therapist. Goodwill and collaboration cannot develop unless all participants feel relatively free and willing to voice their ideas and opinions. The extent to which an individual expresses an opinion is mediated by the amount of power located within the context and by the sense of trust the therapist and supervisor each have in the words and actions of the other. A hallmark of a collaborative stance to supervision is the ongoing discussion with therapists about the supervision process, including revisiting past supervision experiences, examining the present, planning the future, and paradoxically, attempting to ensure that our enthusiasm for collaboration is not imposed.

The supervisor is the master therapist – the person with the answers, with the vision, and with the rightful power to normalize and discipline. Collaborative supervision has led us to pay particular attention to issues of leveling hierarchy and making the power relations between supervisor and therapist transparent. Collaboration means to work with. Power is an ever-present ingredient of all relationships, whether they are collaborative or non-collaborative.

Supervisors in administrative and clinical roles are in dual relationships with their supervisees. These supervisors, wearing two hats, need to be very clear which hat they are wearing. If this is left unclear, supervisees may end up relating only to supervisors as administrators, or clinical supervisors may become stuck in their administrative role. Supervisees may feel constrained in their degree of openness with each other and the material each feels comfortable bringing to supervision sessions. Supervisees may be concerned about the ability of a supervisor/administrator to fire them or recommend raises and promotions. Supervisors in administrative roles may also have access to considerable information from outside the supervision process and may feel unsure what and/or how much information to share with supervisees.


Pre-Test

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Providing Clinical Supervision for HBFT Pre-Evaluation


Establishing Common Ground

Role of the Clinical Supervisor

Role of the Clinical Supervisor

Supervisors must:

  • Help the clinical fully understand, utilize, and manage the context
  • Equip clinicians with knowledge of their role and challenges faced
  • Assist supervisees in negotiating and balancing tasks
  • Safety issues must be monitored and adjusted as treatment progresses
  • Help clinicians understand how to create emotional and physical safety concerns
  • Help clinicians explore ethical issues involving boundaries and confidentiality
  • Teach clinicians how to empower families by monitoring their tendency to do things for the family
  • Monitor his or her own tendencies to disempower clinicians

Role of the Clinical Supervisior Continued

In an agency context, both must contend with multiple roles and multiple realities. Supervisors need to be aware of their own roles at different agency levels such as administration, supervision, and the provision of direct service. The agency supervisor has to contend with the realities of the client, referral sources, the agency, the supervisory relationship, the supervisee, plus the supervisor’s own reality. Isomorphism becomes a key concern for the systemic agency supervisor. Juggling multiple realities also places the systemic agency supervisor in the sometimes uncomfortable role of having to decide which reality will prevail to provide the best client care.

Systemic supervision requires continually evaluating the supervisory relationship as well as assessing how the supervisory relationship fits into the larger agency context. Understanding and applying the concept of isomorphism is central to supervision in an agency context. The multiple levels and realities of the agency context make isomorphism easier to observe. Isomorphism refers to the replication of similar patterns at all levels of a system.

Managing Multiple Realities: Agency supervisors must deal with multiple realities. Assists supervisees in negotiating clients’ realities, as well as managing the documentation and case management realities called for in agency guidelines. If conflicts arise within these realities, supervisors must determine which reality will prevail.

Wearing Two Hats – Administrative and Clinical Supervisor: Agency supervisory relationships frequently are dual relationships. This clinical supervisor is being asked to be both a peer and a supervisor to other team members. To be able to function adequately in both roles, the agency needs to include supervisors in administrative decisions that affect supervisors and their supervisees. If this does not occur, supervisors may not be perceived as having authority sanctioned by the agency.


Models of Supervision

It was believed that because the master was quite good at the work he or she would be equally good at teaching/supervising. This is not the case. Clinical supervision and counseling have much in common. The two tasks also utilize separate and distinct skills. A master clinician may not always be a master supervisor without the addition of training and competency in supervisory knowledge and skills.

Clinical knowledge and skills are not as easily transferrable as the master-apprentice model implies. Observing experienced clinicians at work is without question a useful training tool but is not sufficient. Development is facilitated when the supervisee engages in reflection on the counseling work and relationship as well as the supervision itself. Clinical supervision is now recognized as a complex exchange between supervisor and supervisee with supervisory models/theories developed to provide a frame for it.

Theory is a way to bridge science and practice of supervision. How we think about what we do as clinical supervisors, that which guides our practice. Theorizing guides the interventions, techniques, and strategies we choose in supervision and guides what information we attend to and what information we ignore.

Clinical supervision started as the practice of observing, assisting, and receiving feedback. Supervision follows the framework and techniques of the specific psychotherapy theory/model. As the need for specific supervisory interventions became evident, supervisory models developed within each of these psychotherapy theories/models to address this need.


Models of Supervision Continued

  • Psychotherapy based supervision models 
    • Psychotherapy based models of supervision often feel like a natural extension of the therapy itself. “Theoretical orientation informs the observation and selection of clinical data for discussion in supervision as well as the meaning and relevance of those data” (Falender & Shafaanske, 2008, p9).
  • Cognitive Behavioral supervision
    • Cognitive behavioral supervision makes use of observable cognitions and behaviors- particularly of the supervisee’s professional identity and his/her reaction to the client. Cognitive behavioral techniques used in supervision include setting an agenda for supervision sessions, bridging from previous sessions, assigning homework to the supervisee, and capsule summaries by the supervisor.
  • Person Centered Supervision
    • Carl Rogers developed person centered therapy around the belief that the client has the capacity to effectively resolve life problems without interpretation and direction from the counselor. Person centered supervision assumes that the supervisee has the resources to effectively develop as a counselor. The supervisor is not seen as an expert in this model, but rather serves as a collaborator with the supervisee. The supervisor’s role is to provide an environment in which the supervisee can be open to his/her experience and fully engaged with the client.
    • In this therapy “the attitudes and personal characteristics of the therapist and the quality of the client therapist relationship are the prime determinants of the outcomes of therapy” (Haynes, Corey, & Moulton, 2003, p.118). Person centered supervision adopts this tenet as well, relying heavily on the supervisor and supervisee relationship to facilitate effective learning and growth in supervision.
  • Developmental Models of Supervision
    • For supervisors employing a developmental approach to supervision, the key is to accurately identify the supervisee’s current stage and provide feedback and support appropriate to that developmental stage while facilitating the supervisee’s progression to the next stage.
    •  As the supervisee approaches mastery at each stage, the supervisor gradually moves the scaffold to incorporate knowledge and skills from the next advanced stage. The supervisee is exposed to new information and counseling skills, but the interaction between supervisor and supervisee also fosters the development of advanced critical thinking skills. A supervisee may be in different stages simultaneously; that is the supervisee may be at mid-level development overall but experience high anxiety when faced with a new client situation.
    • The developmental models of supervision suggest that supervisees pass through a number of predictable, universal stages in their growth as clinicians, or in their supervisory relationships. Each stage is characterized by particular needs, conflicts, or tasks the clinician must resolve to continue her growth.  Suffer from lack of empirical evidence.
  • Social-Role Models
    • Supervision model that is not directly tied to a particular counseling theory are the social role models. These are more descriptive in nature and attempt to provide a schema for organizing the various things that supervisors do.
      • Bernard’s (1979) discrimination model suggests three functions and three roles of supervision organized in a 3x3 celled matrix. The functions are to help supervisees master skills of process, conceptualization and personalization. The roles are those of teacher, counselor, and consultant. Each cell represents a different way a supervisor might help supervisees master needed counseling skills, based on a specific supervisory situation. Lanning (1986) add a fourth function or skill set of professional behavior.
      • Holloway (1995) proposed a comprehensive model of supervision that had five functions of supervision:
        • monitor and evaluate
        • instruct and advise
        • model
        • consult
        • support and share.
      • She also proposes five tasks or areas of focus for supervision: Counseling skills, case conceptualization, professional role, emotional awareness, and self-evaluation. She calls this 5x5 grid the process matrix and suggests that supervisors can use the matrix to evaluate the effectiveness of particular combinations of focus and method. Holloway’s model also considers the impact of four broad contextual factors on the supervision process: the supervisor, the supervisee, the client, and the setting where supervision occurs. She notes the central role relationship between supervisor and supervisee plays in the supervision process.

Supervision Formats

Case Consultation – “Stories about stories”

Goal is to present information in order to get specific ideas about therapy. Therapists present case demographics, diagnoses, medications, a brief social history, and account the current course of treatment, any dilemmas currently encountered. A plan is formulated – often this model is used when searching for treatment modality options

Case consultation advantages over live supervision - They argue that while live supervision can capture the therapeutic moment and provide a view into the actual therapy process, it cannot accomplish other important things. Live supervision does not allow time to discuss the assumptions of the therapist, nor does it have the luxury of discussing the larger political, social, and cultural context of the therapy. People do not use live supervision primarily because the facilities are not available.

With case consultation, there is time to discuss the architecture, how therapy is constructed, as well as the contextual elements defining the therapeutic endeavor.  

Beginning therapists often appreciate case consultation because the less immediate format gives them an opportunity to discuss other issues, such as the structure of their jobs, relationship with co-workers, or other contextual concerns affecting their work. Case consultation allows them a chance to cover a variety of questions and /or concerns that may arise about their caseload, but do not require in-depth supervisory attention. Supervisors can take the time to ask about other aspects of therapists’ caseload. More experienced therapists often seek out case consultations because they offer them the opportunity to consider several alternative approaches simultaneously. Experienced therapists frequently report that their goals for supervision is the integration of their preferred ideas, beliefs, and methods from several therapy models into their unique approach to therapy.

Case consultation limitations – can never fully substitute for live supervision because it cannot capture or reveal all the important details that provide color and richness to the story of therapy.

Case consultation relies on the accounts given by the therapists but this can be used to the supervisor’s advantage to explore the perceptions, assumptions, and predispositions constraining therapists. Case consultation offers supervisors the opportunity to explore, take apart, and reconstruct therapists’ accounts of events. Consequently, supervisors hope to expand therapists’ future therapeutic possibilities which can result in a more rewarding story.


Supervision Formats Continued

Live Supervision – Present in session or video-audio tapes

Supervisors who endorse live supervision assume supervisees can best learn some therapy skills by practicing them during therapy sessions with supervisory support…learning is accelerated.

Advantages - Live supervision provides quality control for clients because clinical errors can be avoided or corrected. Clients are generally positive about the experience. Some supervisees report liking the safety net provided by live supervision. They note it allows them to be more creative and increases their comfort in trying new behaviors.

Critiques of live supervision - that it can be intrusive, pushy, and dehumanizing for supervisees and clients. Supervisors reported that they felt overly responsible for their supervisees’ therapy, and found it difficult to allow their supervisees to proceed at their pace and conduct therapy their way. More experienced supervisees were apprehensive about potential power and control issues with their supervisors.

Synoptic supervision 

Supervision in which supervisees summarize several of their therapy sessions with a case, than from live supervision. Synoptic supervision taps what therapists think, live supervision accesses what they do and once a month sporadic supervision shows their overall professional development.


Confidentiality

  • Dimensions of confidentiality that the supervisor must safeguard:
    • The supervisee must keep confidential all client information except for the purposes of supervision.
    • The supervisee must also be informed that any discussions that take place in supervision are also confidential.
    • The supervisee has a right to privacy— Supervisees must understand what will happen to information that they divulge in supervision.

JOURNAL: What are you thought on confidentiality in supervision? Does your agency have a policy around this? How do you address confidentiality with your supervisees in supervision?


Ethics

There are generally accepted ethical responsibilities of supervisors to clients, supervisees, and to the profession and public at large.

  • Clinical supervisors have accepted ethical responsibility for the following:
    • Clients
      • Supervisors protect clients’ welfare, rights, and best interests. They are accountable for ensuring that clients receive informed, reasonable care and ensure that supervisees accurately inform clients about their credentials and their participation in supervision.
    • Supervisees
      • Supervisors prevent supervisees from being “in over their heads” and make themselves available. Supervisors provide timely and adequate supervision and are accessible during emergency situations. They assess therapists’ readiness for supervision by screening potential supervisees for their knowledge and competency, while helping supervisees present their abilities honestly and accurately to clients. Supervisors provide timely feedback and evaluations, as well as inform supervisees about their preferred ideas about supervision and therapy, and the nature of the supervision context.
  • Supervisors who provide ethically-informed supervision:
    • Take a proactive stance to help their supervisees and themselves develop ethical awareness and to make decisions consistent with ethical values. Supervisors maximize clinical and supervisory effectiveness and minimize vulnerability for clients, supervisees, and themselves.
    • Use their greater professional experience and knowledge to guide supervisees in anticipating possible difficulties in the future and in assessing various possibilities and alternatives.
    • Help supervisees avoid inadvertent unethical decisions by not walking in the shoes of the therapists but by being responsible and accountable, ethically and legally, for providing supervision consistent with the professions’ standard of care for supervision.

To increase the likelihood that supervisory responses will be beneficial to supervisees and clients while preventing harm to all, it is prudent for supervisors to ensure that all parties are informed and consenting consumers of supervision. Clearly delineated contracts assist supervisees in making informed decisions and also contribute to supervisors treating supervisees fairly. Having documentation of supervision with supervisees also promotes accountability of all involved. Careful assessment and serious consideration of the complications and potential for confusion and harm in multiple relationships assists supervisors to determine precautionary steps to implement when multiple relationships are contemplated.


Ethics Vignette

Susanne supervises Jim at the agency. They listen to an audiotape of Jim’s session with an exhausted mother of a willful 5-year old girl. The mother describes with frustration and helplessness how her daughter refuses to listen to her, especially when she calls her in from playing in the yard. Susanne nods approvingly when she hears Jim tell the mother that she needs to assert her parental authority. Her approval quickly turns to alarm when she hears Jim and the mother plan to lock the child out of the house for an extended period of time to “teacher her a lesson” and help her become more compliant.

JOURNAL: How would you handle this? What questions would you ask? Does this qualify as child abuse? What are your responsibilities as a supervisor?


Forming a Unified Framework

Myths about Clinical Supervision

Myths about Clinical Supervision

  • Supervisees are already anxious so monitoring/recording sessions overwhelms therapists and their clients and is counter therapeutic.
    • Some supervision theories portray supervisees as so anxious that it is detrimental to them and hinders their performance in sessions. The corollary that goes with this myth is that monitoring and recording therapy sessions is debilitating to the supervisee therapist as well as the client. Most supervisees are not overly anxious. Recording is not an issue as long as they understand the purpose of the confidential recordings. If clients understand that the purpose of recording is to train the counselor and to improve the quality of treatment, they usually want it.
  • Supervisors (or supervisees) do not need to monitor sessions.
    • Myth is that as supervisors we get a sufficient understanding of what is happening with supervisees, that we do not need to monitor directly what goes on in their sessions. Unfortunately the data suggest otherwise. Supervisees often miss or are unaware, misinterpret, or inaccurately recall that which transpires in the therapy session.
    • Parallel process (isomorphism) is another factor to consider. Parallel process occurs in supervision when supervisees are not aware that they are interpersonally engaging the supervisor in the same process that their clients engaged them in in therapy. It is unclear how supervisors can monitor potential racial microaggressions without observing what takes place during sessions.
    • Supervisees can benefit from reviewing recordings of the session from self-supervision. From a more behavioral learning perspective, supervisees need to not only monitor their own in-session behaviors, but also receive detailed feedback from a supervisor to learn and refine the specific interventions and skills of being a practitioner.
    • Supervisees need to record their sessions and both the supervisee and supervisor review those recordings. As a supervisor, we need to observe, monitor, or oversee and provide feedback on in-session behaviors and interactions.
  • Supervision is all about the using the right theory and techniques.
    • Good supervision is about the relationship not the theory or techniques. The majority of supervision models attend minimally to the supervisory relationship. The most well-known of the theories of the supervisory relationship is Bordin’s (1983) model of the supervisory working alliance which consists of three dimensions: agreements on tasks, agreements on goals, and the emotional bond. Supervisory relationship is directly related to supervisee outcome such as therapist’s skills, the supervision process may be more complex than previously postulated, the supervisory working alliance mediates burnout and enhances vigor and mediates vicarious traumatization, the supervisory alliance is a major predicator of satisfaction in both the US and south Korea Supervision.
  • Clinical supervisors are doing a good job protecting clients and supervisees from harm.
    • Evidence suggest that many supervisors are providing inadequate supervision, some of which is harming clients, and that far too many supervisors are harming their supervisees. “Inadequate clinical supervision subsumes harmful clinical supervision. All harmful supervision is by definition inadequate supervision. Inadequate and harmful supervision are established using 2 criteria – self-identified and de facto. Self-identified inadequate or harmful supervision occurs when a supervisee declares that he or she has received such supervision. De facto harmful or inadequate supervision is defined more objectively, and pertains to the supervisor’s actions, inactions, and effects thereof.
    • Inadequate clinical supervision occurs when the supervisor is unable or unwilling to enhance the professional functioning of the supervisee, monitor the quality of the professional services offered to the supervisee’s clients, or serve as a gatekeeper to the profession. Inadequate supervision is the supervisor’s failure to adhere to the minimal standards of supervisory practice. De facto inadequate supervision is defined as the supervisor’s failure to provide the minimal level of supervisory care as established by his or her discipline or profession or law or when the supervisor clearly violates accepted ethical standards.
    • Harmful supervision is supervisory practices that result in psychological, emotional, and or physical harm or trauma to the supervisee. 2 essential components of harmful supervision are the supervisee was genuinely harmed in some way by the supervisor’s behaviors or the supervisor’s behavior is known to cause harm, even though the supervisee may not identify the actions as harmful.

Supervisory Needs of Home-Based Therapists

  • Important supervisor/supervision traits:
    • Give freedom to choose own therapy model
    • Provides information on community resources
    • Deals with issues of client’s safety
    • Provides specific intervention strategies and techniques
    • Uses supervisee’s personal biases to facilitate personal growth
  • Supervisors:
    • Assist in the therapist’s style
    • Emphasizes basic skills
    • Teaches how to handle specific issues
    • Teaches techniques to engender trust in relationships
    • Revises and gives constructive feedback on documentation
    • Encourages development of therapist’s personal style.

What Therapists Learn from Live Supervision

When the live supervision is effective, the therapist has the opportunity to learn to do the following: modify interpersonal sequences that uphold maladaptive behavior; initiate sequences that may solve the problem; recognize that determining who starts, who upholds, and who finishes interpersonal sequences is not always obvious; block certain sequences in order to surface the unseen influence of decision making that curtail the problem-solving process; protect the new decisions and the productive sequence that follows; and motivate the unfolding of problem-solving sequences away from the session, encouraging participants to change inflexible positions, loosening rigid situations.

Live supervision serves well for modulating affective fluctuations that impasses problem solving, for surfacing and changing decisions that curtail resolution of family conflict, and for prompting impasse-breaking sequences among stalemated family members. 

JOURNAL: What live supervision capabilities do you have at your agency? How could this be implemented? What is the climate of your agency around live supervision?


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.**


Case Consultation Questions

  • Describe the Context
    • Does the neighborhood have a concentration of certain ethnic groups that the clinic serves?
    • What is the clinic’s reputation among its neighbors?
    • Is it known as a good place to go or is it seen as cold and indifferent?
    • Is it known as responsive to its setting or does the clinic ignore the people in its neighborhood?
    • What difference might that make to therapists or therapy?
  • Importance of Physical Appearance of Clients
    • Are they neat or slovenly?
    • Considerably overweight or underweight?
    • What conclusions do therapists draw from the body language and appearance of their clients?
  • Note Key Words and Phrases
    • Is there a history of this behavior in the therapist’s life that informs the current use of the term?
    • Are there degrees of this behavior, times when the behaviors strongly manifest themselves and times when they are barely apparent?
    • If that is the case, what words could be used to more accurately describe this continuum of behavior?
  • Review the Received Definition of the Problem
    • How have you arrived at a definition of the problem?
    • If the client says it is one thing and you think it might be something else, how have you negotiated this difference?
    • If there have been competing definitions between family members and one definition has been adopted, has it been the exclusion or detriment of someone else in the family?
    • Have you attempted to consolidate them into one global definition; or have competing definitions been acknowledged while attempting to work with each of them?

Dos and Don'ts

  • DO work to establish and maintain a solid working supervisory relationship.
  • DO use basic communication skills and active listening.
  • DO provide empathy and support.
  • DO strive to empower the supervisee.
  • DO foster the professional development of supervisees.
  • DO respect and maintain interpersonal boundaries.
  • DO use an informed consent and contract for clinical supervision.
  • DO monitor-observe in-session behaviors and give feedback.
  • DO pay attention to the –isms and other microaggressions.
  • DO focus on supervisee competencies vs impairments.
  • DO focus on supervisees attaining minimal level competencies.
  • DO document what transpires in supervision, problems encountered and resolved, intervention and skill competencies and deficiencies.
  • DO what you know is right.
  • DO work to bridge the science and practice of clinical supervision.
  • DO read the clinical supervision literature.
  • DO learn and use supervisory skills.
    • Trust yourself, trust your supervisees, trust the process of therapy, and trust the process of supervision.
  • Do NOT neglect diversity issues and the “-isms”
  • Do NOT avoid confronting fears and anxieties about being a man or woman in a position of authority, power, and privilege.
  • Do NOT provide inadequate or harmful clinical supervision.
  • Do NOT let somebody else continue to provide inadequate supervision or harm to their supervisees.

Applying the Framework

Personal Philosophy of Supervision

Personal Philosophy of Supervision

  • The supervisor’s philosophical and theoretical assumptions about supervision should be related to her/his practice of supervision.
    • What are your thoughts about treatment and supervision in relational terms?
    • What is your level of awareness about patterns and sequences of replication at various systems levels?
    • What is your theoretical orientation based on your philosophy of therapy and supervision as well as their connection?
    • What are your personal values, beliefs, life experiences, and theoretical assumptions and how do they impact your practice of supervision?
    • What is your rationale for your choice of supervisory methods and how do they facilitate achievement of supervision goals?

Post-Test

Click the link to respond to the following survey:

Providing Clinical Supervision for HBFT Post-Evaluation