Theories and Models of Supervision

Ultimately, clinical supervision is a process of individualised learning for supervisees working with clients. The systematic manner in which this individualised learning or supervision is applied is usually contained and presented in the form of a “model.” Knowledge of supervision models is considered fundamental to ethical supervision practice. There are three primary models of supervision that are presented below. These are: (1) developmental models, (2) integrated models, and (3) orientation-specific models.

Developmental Model

The underlying premise of developmental models of supervision is the notion that individuals are continuously growing. In combining our experience with hereditary predispositions we develop strengths and growth areas. The objective of supervision from this perspective is to maximise and identify growth needed for the future. Thus, it is typical to be continuously identifying new areas of growth in a life-long learning process as a clinical practitioner.

Studies revealed that behaviour of supervisors changed as supervisees gained experience, and the supervisory relationship also changed. There appeared to be a scientific basis for developmental trends and patterns in supervision. In general, the developmental model of supervision defines progressive stages of supervisee development from beginner to expert, with each stage consisting of discrete characteristics and skills.

For example, supervisees at the beginner stage would be expected to have limited skills and lack confidence as counsellors, while middle stage supervisees might have more skill and confidence and have conflicting feelings about perceived independence/dependence on the supervisor. A supervisee at the expert end of the developmental spectrum is likely to utilise good problem-solving skills and be deeply reflective and intuitive about the counselling and supervisory process (Haynes, Corey, & Moulton, 2003, Jones, 2008).

Developmental supervision is based on the following two assumptions:

1. In the process of becoming competent, the counsellor will progress though a number of stages that are qualitatively different from each other;
2. Each stage requires a qualitatively different environment for optimum growth to occur.

Stoltenberg and Delworth (1987) described a developmental model with three levels of supervisees: beginning, intermediate, and advanced. Within each level the authors noted a trend. The beginner supervisee would tend to function in a rigid, shallow, imitative way and then over time move toward more competence, self-assurance, and self-reliance.

Areas of focus in the observation of development includes the supervisees development in (1) self-and-other awareness, (2) motivation, and (3) autonomy. For example, a beginner psychotherapist who was beginning supervision for the first time would tend to be relatively dependent on the supervisor for client diagnoses and in establishing plans for therapy.

Intermediate supervisees would tend to have dependence on their supervisors for only the more difficult clients. Resistance, avoidance, and/or conflict is typical of the intermediate stage of supervisee development, because self-concept is easily threatened. Advanced supervisees function far more independently, seeking consultation when appropriate, and take responsibility for their correct and incorrect decisions.

For supervisors employing a developmental approach to supervision, the key is to accurately identify the supervisee’s current stage of development and provide feedback and support appropriate to that developmental stage. While doing this, it is also important to facilitate the supervisee’s progression to the next stage (Stoltenberg & Delworth, 1987).

To this end, a supervisor uses an interactive process, often referred to as “scaffolding” which encourages the supervisee to use prior knowledge and skills (the scaffold) to guide them on to the development of new knowledge and skills. As the supervisee approaches mastery of each stage of development, the supervisor gradually moves the scaffold to incorporate knowledge and skills from the next stage. Throughout this process, not only is the supervisee exposed to new information and counselling skills, the interaction between supervisor and supervisee also fosters the development of advanced critical thinking skills and effective reflective practice principles.

It is important to note that while the developmental process of the supervisee appears linear, it is not. This is because in reality a supervisee may be in different stages simultaneously. For example, the supervisee may be predominately at an intermediate level overall, but experience the attributes of a beginner when faced with a new, more complex and challenging client situation. The table below offers an overview of the typical attributes found within each of the three primary levels of development within the supervisee.

The Developmental Model for Supervision (Stoltenberg, McNeill, & Delworth, 1998)

Integrated model

Because up to 75% of psychotherapists view themselves as “eclectic”, integrating several theories into a consistent practice, some models of supervision have been designed to employ a multiple therapeutic orientation while others aim to be used across any theoretical orientation. For example, Bernard’s Discrimination Model purports to be “a-theoretical” (Bernard & Goodyear, 1992).

The Discrimination model was originally developed as a conceptual framework to assist new supervisors in organising their supervisory efforts. The Discrimination model provides a tangible structure for the supervisor to use in selecting a focus for supervision and in determining the most effective way to deliver particular supervision interventions (Luke & Bernard, 2006).

Specifically, the Discrimination Model combines three supervisory roles of teacher, counsellor and consultant with three key areas of process, conceptualisation and personalisation. For example, supervisors might take on the role of “teacher” when they directly lecture, instruct, and inform the supervisee. They might then act as counsellors when assisting supervisees through blind spots, countertransference, vicarious reactions and other personal issues related to the psychotherapeutic process.

When supervisors relate as colleagues during supervision they might act in a “consultancy” role. This model also emphasises the care supervisors must take towards an unethical reliance on dual relationships. For example, the purpose of adopting a “counsellor” role in supervision is to identify unresolved issues of a personal nature that may cloud the supervisee’s judgements in their therapeutic relationship. However, if these issues require ongoing counselling, supervisees should be referred on to another therapist rather than work on those personal issues with their supervisor.

The Discrimination Model also highlights three areas of focus the supervisor should have with the supervisee to promote effective skill building: therapeutic process, case conceptualisation, and personalisation. Process issues are the first area of focus that aims to examine the process of supervision as well as the process adopted by the supervisee in their practice.

For example: Is the supervisee reflecting the client’s emotion? Did the supervisee reframe the situation? Could the use of paradox help the client be less resistant? Conceptualisation issues include how well supervisees conceptualise their case in the context of relevant theory and the presenting issues and problems of the client. It examines how well the supervisee can move from the bigger picture of the case to specific issues in the therapeutic process with the client. Such things clarify reasons supervisees have for the approach taken and skills applied with the client and the approaches and skills they may apply in the future.

Personalisation issues pertain to the supervisee’s use of themselves in therapy to ensure all involved are congruent, open and present in the relationship. For example, usual body language might be intimidating to some clients, or a supervisee might not notice the client is physically attracted to them. Ultimately, the Discrimination Model is primarily a training model. It assumes that each of us will have habits of attending to one supervisory role over another and to focus on one area of supervisory practice over another. Thus it encourages a broader focus of approach from the supervisor than what they might otherwise apply naturally.

Orientation Specific Models

Counsellors who adopt a particular brand of therapy (e.g. Adlerian, solution-focused, behavioural, etc.) often believe that the best “supervision” is the analysis of practice for true adherence to the therapy. Systemic therapists argue that supervision should be therapy-based and theoretically consistent.

One advantage of the psychotherapy-based supervision model is found in the context of the supervisee and supervisor sharing the same theoretical orientation, thus allowing modelling to be maximised as the supervisor teaches the supervisee on the specific theory and how it is integrated in to the practice skills specifically (Bernard and Goodyear, 1992). Issues can arise between the supervisor and supervisee in the context of an orientation specific approach to supervision particularly if they do not share the same theoretical orientation.

Psychoanalytic: Psychoanalytic supervision is by far the oldest form of psychotherapeutic supervision. This is because from its inception, psychoanalysis has addressed the concept of supervision. A psychoanalytic orientation to supervision encourages the supervisee to be open to the experience of supervision that aims to mirror therapy whereby the supervisee learns from the supervisor the analytic attitude that includes such attributes as patience, trust in the process, interest in the client, and respect for the power and tenacity of client resistance.

An assumption of the psychoanalytic supervision model is that the most effective way a supervisee can learn these qualities is for them to experience these qualities from their supervisor in the supervisory relationship. Ekstein and Wallerstein (cited in Leddick & Bernard, 1980) described psychoanalytic supervision as occurring in four stages; the opening stage, the mid-stage, the working stage and the last stage. During the opening stage, the supervisee and supervisor size each other up for signs of expertise and weakness. This leads to each person attributing a degree of influence or authority to the other.

The mid-stage is characterised by conflict, defensiveness, avoiding, or attacking. Resolution of the mid-stage issues leads to a “working” stage for supervision. The last stage is characterised by a more silent supervisor encouraging supervisees in their tendency toward independence.

Behavioural: Behavioural supervision views client problems as learning problems. Therefore, supervision applies a process that requires two skills. These skills are: 1) being able to identify the problem, and (2) being able to select the appropriate learning techniques to train the client in how to deal with the problem (Leddick & Bernard, 1980).

Supervisees are encouraged to participate as co-therapists with the supervisor to maximise modelling and to increase the proximity of reinforcement when gaining clarity on what the problem is for the client and what are the most appropriate learning techniques to apply when teaching the client how to deal with the problem. Supervisees are often encouraged to engage in behavioural rehearsal prior to working with clients.

Interestingly, Carl Rogers (cited in Leddick & Bernard, 1980) drew from behavioural principles when outlining a program of graduated experiences for supervision in client-cantered therapy. While group therapy and a practicum was at the core of the supervisees experiences, the most important aspect of supervision Roger’s suggested was in the supervisors modelling of the necessary and sufficient conditions of empathy, genuineness, and unconditional positive regard.

Client Centred: Carl Rogers was concerned with the concept of supervision for trainee counsellors, as he observed from early recordings of therapy sessions that the usual forms of learning were not effective in teaching student counsellors the non-directive approach of person centred therapy. Supervisors soon became aware of this.

The client centred therapeutic approach rests on the fundamental belief in a phenomenological healing process activated by the core conditions or the therapeutic relationship. Thus the issue of giving advice or instruction becomes unessential. Therefore, client centred supervision is about stepping into the experience of the supervisee who chooses to be influenced by the supervisory relationship.

The successful client centred supervisor must therefore have a profound trust in the supervisee, believing they have both the ability and motivation to grow and explore the therapy and themselves. This trust given to the supervisee must mirror the trust that the supervisee should have with their clients or where they are then encouraged by the experience to do likewise. One challenge that can occur with pure client centred supervision is when the supervisee does not genuinely believe the client has the ability to move toward self-actualisation.

Cognitive Behavioural: Cognitive-behavioural supervision, proceeds on the assumption that both adaptive and maladaptive behaviours are learned and maintained through their consequences. As a result, supervision from a CBT orientation will be more systematic in approach to supervision goals and processes than some of the other supervisory perspectives. It consists of building rapport, skill analysis and assessment of the supervisee, setting goals (for the supervisee), implementation of strategies, follow-up and evaluation.

CBT supervisors accept part of the responsibility for supervisee learning, but define the potential of the supervisee in the context of their ability to learn, and therefore supervision is concerned with the extent to which the supervisee is able to demonstrate technical competency.

Microskill focused: Most supervisees require instruction in the many counselling strategies at some point in their supervision. During these instances the supervisor will most likely use the four steps of micro-training: 1) teach one skill at a time, 2) present the skill using modelling or demonstration, 3) practise the skill; 4) allow for mastery using ongoing practise and feedback.

References:

1. Bernard, J. M. and Goodyear, R.K. (1998). Fundamentals of clinical supervision .Boston, Massachusetts: Allyn and Bacon.
2. Leddick, G. R. & Bernard, J. M. (1980). The history of supervision: A critical review. Counsellor Education and Supervision, 27, 186-196.
3. Stoltenberg, C. D., & Delworth, U. (1987) Supervising counsellors and therapists. San Francisco, CA: Jossey-Bass.
4.  Stoltenberg, C., Mc Neil, B., & Delworth, U. (1998). IDM Supervision: An integrated developmental model for supervising counsellors and therapists. San Francisco: Jossey-Bass Publishers.

Source: www.mentalhealthacademy.com.au