Scope of the Issue
What Is Supervision?
Supervision involves a supervisor and a supervisee relationship focused on overseeing and supporting a therapist's work (White & Russell, 1995). The American Association for Marriage and Family Therapy (2002) suggests that supervision must include a sustained relationship between a therapist and supervisor involving face-to-face meetings focused on exploring the therapist's development and provide oversight to the therapist's caseload. The National Association for Social Workers (2008) defines supervision as "regular accountability to a supervisor for your assigned work and must have been received as an employee within an agency or organizational setting." According to the American Psychological Association (2000), "The [supervisor] provides appropriate professional role models and engages in actions that promote the interns' acquisition of knowledge, skills, and competencies consistent with the program's training goal."
Goals of Supervision
The primary role of supervision is to provide a gate-keeping function that ensures public safety, protects the integrity of the profession, and enhances clinician welfare (Russell, DuPree, Beggs, Peterson, & Anderson, 2007). The self-reflective activity of supervision is initiated and facilitated by the supervisor-supervisee relationship. Each has a distinct role, and when they collaboratively work together, the relationship is designed to enhance and perfect the work of therapy over time.
The supervisor-supervisee relationship is intended to accomplish the following goals:
- Ensure an appropriate level of care that minimizes the risk and maximizes the benefits of the therapy process
- Evaluate the therapy and supervision processes
- Guide and evaluate the clinician's professional and conceptual development
- Promote therapist's self-care
Each of the goals will be addressed in greater detail throughout this module. The goals are accomplished through specific, incremental tasks.
Tasks of Supervision
The tasks performed within supervision facilitate accomplishing goals of the supervisory process. Supervisors review clinical cases through consultation or direct observation. The supervision process focuses on supporting clinician's work through the following tasks: review of documentation, providing administrative oversight, addressing ethical and legal issues, attending to self-of-therapist, therapist self-care, contextual issues, and developing clinical and professional skills.
Supervision employs varying degrees of consultation and observation of the therapist's cases: discussion of a case focusing on a therapist's report of a case, review of video or audio recording, or the supervisor joins an in-home session for live observation. Each experience provides varying levels of support. The supervisor is able to explore the therapist's conceptualization, case management, and relationship with the client system.
Documentation review provides an opportunity to examine the therapist's written expression of reflections about the therapy progress extending from initial to final assessment of the process. The therapist uses the first three types of documentation to describe the client system, give legal authorization for the work to occur, and provide clients feedback on the current status of the presenting issues.
- Client information
- Releases of information
- Client self-report instruments
The remaining elements of the documentation reflect the progressive conceptualization, planning, and articulation of the therapeutic focus and ways to measure outcome.
- Assessments (formal and informal)
- Treatment plan
- Progress notes
- Termination summary
- Reports to agencies and other providers on the therapeutic team
The documentation provides the therapist with a means to reflect upon the progress at each point in the therapy process and then to forecast subsequent steps that will facilitate client's change.
- Additional supervisory tasks focus on specific aspects of the therapy and supervision processes:
- Review the clinician's use of integrated theories and models of therapy
- Review ethical issues informing therapist decision-making (Storm & Haug, 2002)
- Consider varying contextual issues that intersect and influence the clients' process of change (Lappin & Hardy, 2002; White & Russell, 1995)
- Examine the challenges the self-of-the-therapist issues that impact the therapist's role, the therapist's relationship with the client system, and effectiveness of therapy
- Raise questions to increase therapist's awareness of the isomorphic effects among the client, therapist, and supervisor roles (Liddle, 1991)