Different Modes of Clinical Supervision

In the context of ongoing professional development after original training, clinical supervision is a key factor in aiding psychotherapists to function in complex work environments (Lambie & Sias, 2009).  Supervision is a process that allows ongoing observation and intervention to a supervisee while they are putting into practice skills they have learned.

It is the process of supervision that promotes; the supervisee’s development, the refinement of the supervisee’s counselling skills, the monitoring and enhancing of the therapeutic relationship and the client’s welfare (Tromski-Klingshirn & Davis, 2007).

Clinical supervision has been defined as “an intervention provided by a more senior member of a profession to a junior member or members of the same profession. The purpose is to enhance the professional functioning of the more junior professionals (Getz, 1999). In this article, we explore a range of different modes of supervision.

Modes of supervision

Clinical supervision can occur in a variety of settings. Generally there are four primary modes of supervision delivery. These are listed below.

1. Individual
2. Dyadic
3. Group
4. Live

1. Individual: As the name implies, individual supervision is conducted on a one-on-one basis between the supervisor and supervisee. Typically, the supervisee is prepared to discuss counselling sessions that have occurred. Discussion centres on the sessions conducted by the supervisee as a context for supervisee learning and development.

2. Dyadic: Dyadic supervision is generally conducted in the same way as individual supervision, but the supervisor works with two supervisees at the same time.

3. Group: In group supervision, a designated supervisor works with a group of counsellors. The unique aspect of group supervision is that members are not only influenced by the supervisor, they also are influenced by (and influence) others in the group. Interventions are incorporated to capitalise on, and account for, this interrelatedness.

4. Live: Live supervision occurs as the supervisee is acting as counsellor. Supervisors interact with the supervisee “in the moment” and therefore directly affect the counselling process.

Supervision Interventions

There are a variety of supervision interventions that can be incorporated into the supervision process. Borders and Leddick (1987) listed six reasons for choosing different supervision methods:

• the supervisee’s learning goals
• the supervisee’s experience level and developmental issues
• the supervisee’s learning style
• the supervisor’s goals for the supervisee
• the supervisor’s theoretical orientation
• the supervisor’s own learning goals for themselves in the supervisory experience

Each mode of supervision lends itself to a variety of interventions. Some of the more popular interventions are presented below.

Individual & Dyadic Supervision

1. Self-Report: Self report is one of the widely used supervisory methods. This entails the supervisee reporting to the supervisor on the process of counselling that has taken. This approach has the supervisor relying on the supervisee to report pertinent information and experiences encountered in their counselling sessions with clients.

Thus, the effectiveness of this method is only as good as the observational and conceptual abilities of the supervisee and the insightfulness of the supervisor to be able to pick up accurately on what might be occurring in the counselling sessions. Because of this, self-reporting is not the method of choice for beginning counsellors-in-training.

2. Process Notes: This entails the supervisee writing case notes following interactions with clients and then submitting them to the supervisor. This is not a literal account of what occurred in therapy, rather an introspective reflective description of the experience from the supervisee’s perspective.   The use of progress notes can provide a means of controlling the type of information offered in supervision.

This allows the supervisor to track the progress of the supervisee. The discussion of these notes in supervision can create a productive and meaningful supervisory environment. However, like other self-report methods, it is dependent on the supervisee’s ability to accurately observe internal and external occurrences.

3. Audiotape: Through this supervisory process the supervisee audio records their sessions (with the client’s or guardian’s permission). Audiotapes can be incorporated into supervision in a variety of ways. In some instances, tapes can be submitted to the supervisor prior to the scheduled supervision meeting. In other instances, supervisees can pre-cue tapes to particular sections and then play those key aspects of the tape for the supervisor in the supervisions session.

Often in training programs, tape scripts and written analysis of the audiotape are submitted by the supervisee in addition to the actual tapes. In regard to taped sessions, it is important to note that there can be resistant reactions from both supervisees and clients to the notion of taping the session. Therefore, resistance to taping must be acknowledged and respected and must be addressed with clients and the supervisee in a sensitive and ethical manner.

It is important that supervisors and supervisees work together in addressing the process of introducing audio taping into client sessions, because generally, the more comfortable the supervisee is with taping, the more comfortable the client will tend to be. Although supervisees are often hesitant to embark on what seems like a very disclosing process, with practice, it can become a valuable tool for both supervisees and supervisors.

4. Videotape: Videotape has become the technology of choice in supervision. Many of the processes used with audiotapes are used with video. Obviously, videotape provides the opportunity of “viewing” the counselling session thus being able to observe the interaction between client and supervisee counsellor. While there are many advantages to videotaping sessions, there are also cautions.

For example, there can be a tendency for trainees to “perform” while being videotaped or both the client and supervisee can become too self-conscious, thus limiting the authenticity of their interactions. Supervisees and clients need to be given the time and opportunity to become comfortable in the process of being videotaped.

5. Live Observation: In live observation, supervisors watch (commonly through a one-way mirror or in the room) the supervisee conduct the counselling sessions. When observing live the supervisor does not typically interfere with the counselling session (exceptions would include crisis situations). Both live observation and live supervision provide a more complete picture of the supervisee’s skills than audio or videotape, while also allowing the supervisor to intervene in the case of an emergency.

Group Supervision

Group supervision is a situation involving two or more clinicians in a clinical supervision process. Supervisors of group supervision must attend to a variety of group dynamics. These dynamics include the relationship between the supervisor and each supervisee, the relationship between group members and the individual clinical needs of each supervisee’s case.

As such, group supervision activities tend to focus on dyadic presentation, case conferencing, individual conferencing and group development. Case presentation is a typical group supervision intervention. This is where the supervisee brings their professional experiences to the group for discussion. Both the group members and the supervisor can provide feedback (Smith, Mead & Kinsella, 1998; Government of WA, 2005; Bransford, 2009).

Live Supervision

Live supervision is increasingly becoming a very common mode of supervision. It is distinct from individual, dyadic and group supervision because live supervision is conducted by the supervisor during the supervisee’s session with the client (Corey, Corey & Callanan, 2007).

The paradigmatic shift with live supervision consists of two components: 1) the distinction between therapy and supervision seems less pronounced than in traditional supervision and 2) the role of the supervisor is significantly changed to include both coaching and co-therapist dimensions. Ultimately what this means is that the supervisor interacts with the supervisee in some form while the supervisee is conducting the counselling sessions.

Because live supervision requires a co-ordinated response from the supervisee and the supervisor, all the methods used to produce live supervision require pre-session planning and post-session debriefing.  It is also essential that the supervisor is sensitive to the supervisee’s anxiety and vulnerability that can be evoked through this of this form of supervision, particularly in the context of the supervisee’s counselling sessions being interrupted, shared or co-facilitated by the supervisor in some form.

Processes of live supervision do increase the practical demands of supervision in time, cost of facilities, and organising appointment schedules. Thus such things need to be considered if choosing to adopt live supervision strategies.

Five examples of live supervision strategies are listed below.

1. Bug-in-the-ear: This entails supervisees wearing a wireless earphone, through which the supervisor can be heard. Therefore the supervisor can coach the supervisee throughout the session with the client while they observe through double sided glass or listen through an audio device. The benefit of this is that there is no interference with the flow of the therapy session. An obvious disadvantage is that it can be distracting to the supervisee if overused (Smith, Mead & Kinsella, 1998).

2. In Vivo: The supervisor is in the room with the supervisee and client.  The supervisor does not engage in direct therapy, but instead the supervisee consults with the supervisor in the presence of the client.

3. The Walk-In: The supervisor enters the room at some deliberate time and interacts with the supervisee and the client and then leaves.

4. Phone-ins and Consultation breaks: As the name implies, the supervisor either phones in information, feedback or instruction to the supervisee counsellor or knocks on the supervisee door and the supervisee steps out of the room to talk with the supervisor. In these instances, the client is not aware of what is being discussed between the supervisee and the supervisor.

5. Computer assisted live supervision: This entails the supervisee receiving information through a computerised medium such as email, instant messaging and video conferencing. This provides an instant contact between the supervisor and the supervisee. The computer assisted methods have the distinct advantage of proving an immediate and direct feedback that can reinforce appropriate therapeutic behaviour (Smith, Mead & Kinsella, 1998).

Live supervision has not been without critics. This is because, if not handled effectively by the supervisor, it can actually decrease the supervisee’s initiative and creativity and impact negatively on the therapeutic relationship due to untimely intrusions from the supervisor.

Specifically, the four main concerns over live supervision include the following; 1) it can encourage supervisee dependence, passivity or a mechanical approach to therapy; 2) it can be invasive of the sessions privacy and disrupt the timing and overall flow of process in the session; 3) it can evoke negative reactions from the client to the call-ins or the therapist stepping out; 4) Boundary blurring between the supervisees and supervisors responsibilities (Smith, Mead & Kinsella, 1998).

In consideration of all these concerns, when managed correctly live supervision can provide a profound learning experience for supervisees and a protective environment for clients.

References

1. Bransford, C.L. (2009). Process centred group supervision. Clinical and Social Work Journal, 37, 119-127.
2. Corey, G., Corey, M.S. & Callanan, P. (2007). Issues and Ethics in the Helping Process (7th ed.). Belmont, CA: Thompson Brooks/ Coyle.
3. Getz, H.G. (1999). Assessment of clinical supervisor competencies.  Journal of Counselling and Development, 77, 491-497.
4. Government of Western Australia (2005). Clinical Supervision framework for Western Australia health services and clinics. Perth: Department of Health, Government of Western Australia.
5. Lambie, G.W. & Sias, Shari, M. (2009). An integrative psychological developmental model of supervision for professional school counsellors in training.  Journal of Counselling and Development, 87, 349-356.
6. Smith, R.C., Mead, D.E. & Kinsella, J.A. (1998). Direct supervision: Adding computer assisted feedback and data capture to live supervision. Journal of Marital and Family Therapy, 24, 113-125.
7. Tromski-Klingshrim, D.M. & Davis, T.E. (2007). Supervision: Supervisees perceptions of their clinical supervision: A study of the dual role of clinical and administrative supervisor. Counsellor Education and Supervision, 46, 294-304.

Source: www.mentalhealthacademy.com.au