One
INTRODUCTION TO CLINICAL SUPERVISION
Clinical supervision is an increasingly important area of specialization in the mental health field. It has become the primary means by which the entire allied health field is now taught (Getz, 1999; Neufeldt, 2003; Storm, Todd, Sprenkle, & Morgan, 2001). Extensive graduate course work is followed by mandatory hours, even years, of clinical supervision both within and outside a degree program. After graduation, most states require several thousand hours of supervised experience in order to become licensed for independent practice. In fact, for those specializing in substance abuse treatment, most professional training occurs through supervision of on-the-job experience, and not in the classroom. It is under the tutelage of an experienced practitioner that professionals, regardless of their discipline, learn the skills necessary to become competent, ethical, and effective helpers.
Additionally, clinical supervision is increasingly at the forefront of malpractice prevention. Agencies, hospitals, schools, and private practice settings are concerned about liability, and thus many are moving to mandatory clinical supervision for all employees regardless of level of education or years of experience in order to assure the highest standard of care possible for clients.
Yet even as clinical supervision grows in importance, specialized training in this area lags behind (Kaiser & Barretta-Herman, 1999; Saccuzzo, 2002; Scott, Ingram, Vitanza, & Smith, 2000). Most are promoted to supervisor because of excellent clinical skills and ability to do the work rather than because they have formal training in clinical supervision. Moreover, few receive ongoing training in supervision or supervision of supervision by practicing clinical supervisors (Baronchok and Kunkel, 1990; Page, Pietzak, & Sutton, 2001). Instead, most supervisors today rely mainly on their own background and experience as supervisees and utilize the same structure and methods their supervisors used with them (Campbell, 2001-2005). Though this is a rich tradition, there is a growing concern that supervisors are simply perpetuating the mistakes of their own supervisors and that clinical supervision as a specialization is floundering (Campbell, 2001-2005; Steven, Goodyear, & Robertson, 1998; Whiston & Coker, 2000 ; Worthington, 1987). Without any training, supervisors may be unprepared for the many changes and demands now being placed on them.
THE NATURE OF SUPERVISION
Why should clinical supervisors require specialized training? Shouldn’t the fact that supervisors are usually highly successful and skilled practitioners automatically make them effective supervisors? The answer is no. Just because one is a skilled practitioner with clients does not necessarily mean one can be a good supervisor.
Supervision is a different relationship than counseling and therapy. Succinctly put, the primary purpose of clinical supervision is to review practitioners’ work to increase their skills and help them solve problems in order to provide clients the optimal quality of service possible and prevent any harm from occurring. Therefore, it is a teaching and training role as well as a monitoring function. Because the goal of supervision is to support ethical practice with clients, practitioners at all levels of education and experience can profit from supervision. The supervisory relationship may be voluntary (sought out) or involuntary (required by law), may extend over a definite period (as in the case of graduate internships or licensure), or be required indefinitely as part of employment. Always, however, the fundamental purpose of supervision remains the same.
What sets clinical supervision aside from other types of relationships, such as psychotherapy or consultation, is the presence of an evaluative component. Evaluation may be emphasized and central to the relationship or may be under-emphasized depending on the context, purpose, and developmental needs of supervisees. For example, clinical supervision required of experienced licensed practitioners would have a different evaluative structure and purpose than supervision of prelicensed practitioners. However, the role of the supervisor is always to evaluate the quality of care being given to clients and to make suggestions for improvement when necessary.
Another important but frequently overlooked variable that needs to be considered is the fact that clinical supervision, for the majority of supervisees, is not voluntary. It is required to obtain a graduate degree, a certificate, a license to practice, to keep employment, and for malpractice prevention. The evaluative component along with the nonvoluntary nature of supervision cast issues of power, trust, safety, and control into the center of the clinical supervision experience and the supervisory relationship. This attribute also distinguishes supervision from consultation in that suggestions made by a consultant for client care are recommendations, not requirements.
Unique ethical and legal issues must also be addressed. Ethically, and by law, clinical supervisors are responsible for the actions of supervisees with clients. This fact turns clinical supervisors into not just teachers and trainers but also monitors of ethical practice in the mental health field and protectors of the community in which they live. They are responsible for overseeing the quality of client services and to prevent incompetent, impaired supervisees from serving the public. Accordingly, the role of the clinical supervisor is one of impressive responsibility and new challenges that should receive increased consideration as an area of specialized training.
DON’T FORGET
The primary task of a clinical supervisor is to protect clients from harm while promoting the competency of supervisees. The nonvoluntary nature of the relationship along with the evaluative component makes supervision a relationship of unequal power.
FACTORS THAT CREATE DIFFICULTIES FOR SUPERVISORS
Clinical supervision is a balancing act between the needs of the supervisee and the needs of the client. This balancing act can be difficult and stressful or exciting and fulfilling depending on a number of variables. Such things as the purpose of supervision, level of competence, background and training of supervisees and supervisors, role clarity, organizational needs and organizational climate, and commitment of time and resources can all contribute to the ease or hardship of managing this complex relationship. Clinical supervision can be particularly daunting for new supervisors if they have no training or skills in clinical supervision and do not clearly understand their role, purpose, and function. Additionally, the amount and type of support given by an organizational system to clinical supervisors may help or hinder the supervisory process.
The first requirement for success as a clinical supervisor is to understand the function and purpose of supervision and how supervision is different from other relationships. Second, supervisors need to understand the ethical and legal issues that affect the supervisory relationship. Third, they need to acquire a model for supervision, learn to set goals, create structure, and use suitable methods and techniques, understand the pitfalls and problems inherent in supervision, and focus time and attention on building the supervision relationship. Last, supervisors have to find time for supervision.
This last task, finding time to supervise, is sometimes the hardest, particularly if the supervisor is still providing clinical services. Practitioners are constantly being asked to do more with less; at the same time there is increasing emphasis on the need for clinical supervision. Frequently, the clinical supervisor role is tacked onto the practitioner’s routine job duties. It is hard for these overtaxed individuals to monitor the supervisees’ quality of work and assist them to grow and develop while attempting to provide quality care to their own clients. In situations where supervisees are employees and are also receiving postdegree supervision for licensure along with their job, supervision can sometimes become even a more difficult and stressful balancing act. To find time for supervision, both supervisors and administrators have to understand the importance of clinical supervision and value it as a function not only in the organizational context but also in terms of society at large.
DIFFERENCES BETWEEN ADMINISTRATIVE AND CLINICAL SUPERVISION
Another factor that can add to difficulties and the stress level for clinical supervisors and supervisees alike is role conflict and role confusion. Dual relationships permeate supervision and are difficult to avoid. However, for countless numbers of mental health practitioners, the largest area of uncertainty and misunderstanding created by dual relationships is the overlap between clinical and administrative supervisory functions. Many clinical supervisors are required to serve in both capacities and sometimes knowing what to do is difficult at best as everyone attempts to sort out the various roles and relationships.
Although similar in certain respects, key differences do exist between the purpose and role of administrative and clinical supervisors. Understanding these differences will go a long way to clear up some of the bewilderment. The first point is to understand that administrative supervisors and clinical supervisors function under two separate models with different purposes, different missions, and different rule books. Administrators function under a business management model. The aim of an administrative supervisor is to keep an organizational system functioning in a healthy manner, accomplishing whatever is the organization’s mission. Administrative supervisors are involved in hiring, firing, promotions, raises, scheduling, unions, and other personnel duties. The focus of administrative supervision is on productivity, workload management, and accountability. Decisions are made in terms of benefit or harm to the organizational system, not individuals. Local, state, and federal regulations, such as Equal Employment Opportunity Commission (EEOC) Guidelines and the Disability Act, govern their actions.
Clinical supervisors function under a different model. The purpose of clinical supervisors is to help practitioners develop skills, overcome obstacles, increase competency, and practice ethically with clients. It is historically a teaching, training, mentoring, and monitoring position with an emphasis on developing and maintaining competence. The focus in clinical supervision is on the individual supervisee’s activities with clients. The vehicle for supervision is the review of client cases and the offer of suggestions and corrective feedback for improvement. Evaluation is ongoing and integral to the supervisory process as it is used to shape and direct learning. Even though a final summative evaluation is required in most types of clinical supervision, the essence of the supervisory process is continuous feedback throughout supervision, the intention of which is to help supervisees develop mastery and encourage ethical practice with clients.
In the administrative model, evaluation has a different intent and is mainly retrospective rather than formative. After a probationary term, the assumption is made that employees now have the necessary competencies to do the job. Once or twice a year, in what is titled a performance appraisal, employees are evaluated against a base line of these competencies and receive suggestions for improvement, warnings, or recognition for job excellence such as a promotion or a raise.
Another important area of potential confusion for clinical and administrative supervisors is differences between laws and ethical codes. As is well known to virtually everyone in the mental health field, ethical and legal standards frequently conflict. Clinical supervision as a specialized activity of the health professions falls under the ethical codes and standards for each discipline. Administrative supervisors, on the other hand, refer to laws, regulations, and management policy for their actions.
Obviously, a large area of overlap exists between the two functions of administrative and clinical supervisors, just as there is overlap between ethical codes and laws. Clinical supervisors are involved in a myriad of administrative tasks, such as documentation, time management, as well as monetary issues. Administrators, in turn, work extensively with their employees to help them increase skills. Both have to function within the laws of the community. Last, any unethical behavior on the part of a supervisee is cause for concern for both an administrator and a clinical supervisor.
However, there are many instances when the two functions contradict each other. Most prominently, successful clinical supervision is built on an important ethical premise that supervisees, in order to grow and learn, will be open, honest, truthful, and willing to admit mistakes. In return, clinical supervisors are expected to treat supervisees with respect and fairness; to maintain a commitment to growth and development; and to avoid bias, exploitation, and impaired judgment. This is the basis of ethical practice in supervision.
In the administrative model, complete openness and honesty may take on a different meaning and have very different consequences. Both supervisor and supervisees have to carefully weigh the impact of complete honesty in an organization, especially if they wish to continue to draw a paycheck.
It is therefore evident, if the supervisee is both an employee and receiving clinical supervision for an outside purpose, such as a graduate internship or license, or if the clinical supervisor is also the administrator, these dual roles can create some serious problems in supervision if not treated with care. Extra effort will be needed to manage the delicate balance between encouraging supervisees to take risks and make mistakes in order to grow and the impact of that learning process on clients.
CAUTION
There are differences in purpose and function between clinical and administrative supervision. Role conflict can sometimes lead to difficulties with supervisees.
RESEARCH IN SUPERVISION
A further difficulty facing clinical supervisors is the fact that as a specialization, clinical supervision lags well behind other areas in quality empirical research that will validate many of its assumptions and accepted practices (Davy, 2002; Ladany & Muse-Burke, 2001; Watkins, 1998). For example, only a few studies have attempted to connect the practice of supervision to actual client outcome (Freitas, 2002; Patton & Kivlighan, 1997). Most of the research and theoretical writing in this field is primarily created within and for academic settings. In the majority of cases the studies in the field of supervision consist of surveys of beginning masters- or doctoral-level students in on-campus settings during their first experience as supervisees or supervisors, and they rarely venture beyond that pool of subjects for their findings. Many of these studies also involve small numbers of subjects and hypothetical situations.
Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
