Nine
THE ADVANCED STAGE OF SUPERVISION
Near the termination of training in postdegree supervision, it is expected that supervisees at this level of development would be able to practice independently, so the relationship in supervision should almost automatically become more peerlike and collegial. This is definitely true when providing clinical supervision to already licensed or highly experienced professionals. Therefore, the main task for supervisors at this stage is to build a collaborative relationship with supervisees so they are working together with supervisees more as partners or colleagues.
In other words, at this point, a supervisor would want to stop doing things for their supervisees and begin to work with them. What does this mean? It means that the relationship moves from supervisor-directed to supervisee-directed, where supervisees are in reality supervising themselves. In fact, self-supervision (self-monitoring, self-awareness, and self-evaluation) should be the “universal supervisory goal” for all clinical supervisors from the beginning of supervision (Todd & Storm, 1997, p. 17). What this entails is supervisors having to shift from the expert-teacher role to the consultant one. Supervisors who are committed to the consultant role would ask supervisees at the beginning of supervision how they would like supervision to go rather than telling them what will happen. For example, supervisors could inquire “How do you see the goals and priorities for supervision at this point in your development?” Or “What is the most useful part that I can play in your development now?”
Rapid Reference 9.1 lists the tasks of the advanced stage of supervision.
DEVELOPING A COLLABORATIVE RELATIONSHIP
Collaboration, as a concept, refers to a mutual coordinated effort of two or more people to solve problems and be more effective in service to clients (Staton & Gilligan, 2003). The object of collaboration is to pool ideas and information and come up with solutions that are better than those arrived at by individuals by themselves. The heart of the collaborative process is that influence, resources, and power are shared equally among collaborators. As a result, truly building a collaborative relationship with supervisees requires a shift in approach on the part of supervisors and a willingness to let go of their power and authority, which is not always an easy task.
Rapid Reference 9.1
Tasks of the Advanced Stage of Supervision
• Promote independence and self-supervision
• Work collaboratively
• Endorse teamwork
• Encourage the use of consultation and peer support
• Model and teach self-care
• Continue self-exploration and understanding of limitations
• Champion lifelong learning and professional development
• Advocate for mental health services in the community
CAUTION
When supervising highly experienced supervisees at the advanced level, supervisors are advised to forgo a didactic teaching manner and avoid covering subjects well known by those at this level of development. Instead, the focus in supervision should be on innovations, research, new theories and intervention strategies, and the continuous integration of this new material into current practice (Campbell, 2001-2005).
Perhaps the best illustration of what is meant by a collaborative working relationship is to draw a comparison between consultation in the expert mode and consultation in a shared-power mode. For example, the supervisor working in the expert mode might state “After reviewing the case, it seems to me. . . . This is what I recommend you do. . . .” However, when working more collaboratively, the supervisor might instead ask the supervisee “What have you thought about doing with this client?” or “What have you already tried?” Even adding “What do you think about this suggestion?” at the end of any suggestion given to supervisees changes the dynamic to be more peerlike.
DON’T FORGET
Supervisors in the advanced stage need to get out of the way and turn over the goals, process, structure, and evaluative piece to supervisees.
Rapid Reference 9.2
Collaborative Skills
Brainstorming | Process comments |
Open-ended questions | Examination of parallel process |
Probes | Self-disclosure |
Empathic responding | Self-involving statements |
Solution-focused questions | Scaling questions |
Miracle questions | Imagining successful solutions |
A number of interpersonal skills are necessary for instituting a collaborative relationship with supervisees, most of which have already been discussed in other chapters. These include brainstorming, process comments, open-ended questions, probing, solution-focused questions, empathetic responding, and self-disclosure. Rapid Reference 9.2 contains a summary of collaborative skills.
One skill that is truly essential for the advanced stage of supervision is the use of process comments or process questions. Process comments are any how, what, where, and when statements that focus attention on the here-and-now relationship between supervisor and supervisee. The purpose of process comments is to improve relationships so they have a natural place in supervision. When used correctly, they come across like remarks that would be made by colleagues. For example, when a supervisor says to a supervisee “I am feeling stuck right now with you. How are you feeling now with me?” he or she is inviting supervisees to speak as an equal. If a supervisor says to a supervisee, “I notice we seem to be spending a great deal of time talking about…. Is that what you want?” this process comment establishes the peerlike quality of the relationship.
Rapid Reference 9.3 lists some other consultation-style questions for supervisors.
Another task of the advanced stage is to encourage self-evaluation and self-monitoring by supervisees. The simplest suggestion to encourage self-evaluation by supervisees is to insert a scaling question during the review of a client case. For example, ask supervisees to rate on a scale of 1 to 10 how they feel they are doing with a particular client (or goal or solving a problem). Then ask them to identify one thing they need to do differently to move just 1 point up the scale.
Another means to encourage self-evaluation is for supervisors to comment on changes they have observed in a supervisee. “I notice a change in the type of questions you are asking now in supervision. Six months ago, you would be asking me to tell you what my take is on this client and what I would do with him or her. Now you come into supervision telling me what you perceive the issues are and how you plan to proceed. To me, this indicates major growth on your part. How do you see it?”
Rapid Reference 9.3
Consultation-Style Questions for Supervisors
• “What do you want from supervision?” or “What do you want from me?”
• “As you are talking about this client, what are you most aware of?”
• “What was your goal for this session with the client?”
• “Help me to understand. When the client did that, what happened to you?”
• “What do you think is going on between you and this client?”
• “How might the client’s gender or race be affecting the problem? Your relationship with the client?”
• “Where were you going with that line of questions?”
• “Let me play devil’s advocate here. What do you think might have happened if you had tried. . . .”
• “As you are talking about this client, what comes to you that you might have done differently?”
PROMOTING TEAMWORK
There is a large body of research and writing spanning decades that reinforces the importance of teamwork in organizations as a means to increase productivity, job satisfaction, and morale. In the area of mental health, promoting teamwork has many advantages for overworked and underpaid clinical supervisors in agencies, hospitals, community centers, and schools. Fostering teamwork, while sometimes not easy, will be well worth the effort.
To be a considered a team, team members must actively participate in decisions concerning the setting of shared team goals, planning, and problem solving. There needs to be a commitment by all members to the team goals and an interdependence and accountability among these members as they work toward these goals. In other words, people in a team may have separate assignments but depend on each other to get the work done successfully.
Lots of lip service is given to teamwork in organizations. Expressions such as “We are all a team here,” and “We all need to pull together,” and “Everyone is equal” have become standard management clichés. Hiring outside consultants to come in for team-building workshops and sending supervisors to team-building trainings has almost become mandatory. But how many organizations actually support and reward real teamwork is questionable, and younger employees soon become jaded as they learn quickly the difference between the teamwork talk and the teamwork walk.
Organizational climate and environmental factors are crucial to the success of any team-building efforts on the part of clinical supervisors. For example, in toxic environments, where staff members don’t feel safe because they are constantly fending off criticism and blame, building collaboration and a teamwork model is almost impossible (Rubin, 2000). However, there are a large number of situations in which team building could be a success and add immeasurably to the effectiveness of clinical supervision.
There are a number of suggested strategies that can be employed by clinical supervisors to build an authentic work team. First, in order to create a sense of interdependence among team members and a shared commitment to mutual goals, supervisors have to be facilitators and encouragers—not directors—of group process, and use whatever authority they have to promote a win-win situation for all team members. Second, individuals have to understand the interconnectedness of their work to others on the team and see the rewards for working collaboratively. If the team is to be made up of supervisees from a number of different organizations, identifying a common goal for the team is absolutely essential to success but might require considerable effort to keep everyone on target.
For example, in a school setting, depending on the size of the district, the team might be made up of a psychologist, one or two counselors, the school nurse, a social worker if available, and other ancillary staff such as diagnosticians or special education support staff. The identified common goal for the team might be helping students, and each team member’s job could be viewed as a part of that greater goal. Through sharing of information and open dialogue, new ideas could be generated that could benefit everyone.
To get everyone onto the same page, supervisors should start their team-building efforts with an open discussion on a number of topics, such as identifying team goals and what benefits each person will receive from a collaborative teamwork model. To facilitate understanding and personal accountability, supervisors might wish to emphasize the shared aspect of each team member’s work, what factors are in team members’ control and which are not, and how each person’s effort fits into the larger picture. Supervisors should also inquire of each team member what gives meaning to his or her work, how he or she likes to make decisions, and what motivates him or her to do a better job. Through the process of collecting such material, group consensus could be reached on how to use this information to build the team structure. Rapid Reference 9.4 lists six steps to build teamwork.
Rapid Reference 9.4
Six Steps to Build Successful Teamwork
1. Share your vision.
• Get people excited about goals
• Sell your passion
2. Communicate expectations.
• Ground them in expectations
• Prepare them for hardships
3. Demonstrate respect for differences.
• Promote feedback
• Provide safe ways to give feedback
• Thank people who speak up and give ideas, even if they sound critical
• Manage conflict
4. Ask for discipline and pride.
• Explain the supervisee’s role in accomplishing goals
• Reward competence and hard work
• Ask supervisees how they would like to be rewarded
5. Use teamwork to resolve problems.
• Bring problems back to the team
• Serve in a facilitator role
• Spread authority around
• Use the brainstorming model
Leadership style is another consideration. Logically, an authoritarian style of leadership would not be conducive to creating the kind of atmosphere of equality and collaboration required for teamwork. At the same time, supervisors, as team leaders, have ultimate responsibility for the team’s actions. This places supervisors in a delicate balancing act between managing whatever the current situation is with the team members’ current level of skills and at the same time attempting to inspire members to take risks, try out new things, and grow.
At the center of this leadership question is how decisions will be made in the team group. Supervisors who wish to work in the team-building model have to pay close attention to this detail. Traditionally with teams, decision making is regarded as a team task; therefore, supervisors should promote the use of consensus building and compromise along with brainstorming as primary problem-solving strategies. However, these methods all take time, and there may be many circumstances, such as a crisis, when a supervisor’s quick action is required, and there is no time for group input. In order to avoid any detrimental effects from this state of affairs on overall team morale, supervisors need to clearly delineate ahead of time to team members what these circumstances might be and then later ask for feedback from team members around any actions that were taken.
Putting It Into Practice
Examples of How Supervisors Can Challenge Consensus
• “Let me play devil’s advocate. You all nodded in agreement when I suggested we change the way crisis calls are handled. But what I want to know is what are some of the potential problems you see if we implement this strategy?”
• “I notice as a pattern in our team meetings that you readily agree with all my suggestions, just like you did now, and this makes me uncomfortable. I am wondering about this fact. Are all my ideas that great, or is something going on that I need to hear about? Is there something I am doing that makes you feel unsafe to disagree?”
CAUTION
If supervisors continually make quick decisions about problems and ignore input from team members, this strategy can have long-term repercussions. It will create resentment and disillusionment with the teamwork model. For example, “Oh, yes; he says all the time we are a team but when problems occur, he is going to tell us what to do and how to do it. We don’t really have any say.”
Additionally, consensus building and compromise only work when power between people on the team is equal (Kormanski, 1999). Otherwise, the team members may indicate agreement with the person in power but underneath harbor unexpressed concerns about the problem solution, which if not uncovered, can lead to subsequent difficulties.
As noted earlier, from the beginning of supervision, supervisors are responsible for creating a safe, respectful work environment. This means that supervisors apply all of their rapport-building skills, such as paraphrasing, empathic responding, self-disclosure, reflection of feelings, and open-ended questions, to build a safe environment for open discussion of problems and differences in the team.
Another equally important part of team building is motivation. Rewarding team members for efforts made on the team’s behalf is one of the best-known means to spur teamwork. For those in the helping professions where monetary rewards are seldom available, just publicly thanking team members for their hard work is an excellent incentive. In addition, many of today’s workforce would prefer time off or more autonomy on the job as rewards rather than the traditional one of money. As a consequence, supervisors might consider rewarding extra hard effort by team members with the gift of time—a day or a half day off, permission to come to work an hour late or go home early. Naturally, asking team members what type of team-member behavior should receive extra notice and what would be a suitable reward in their eyes for this effort will lay the groundwork for increasing motivation.
DON’T FORGET
Rewarding excellence and hard work is also a key component of motivation and team building. Be sure to publicly praise and thank a team member who did an exceptional job in some situation, team members who demonstrated the team spirit by working together to solve a problem, a team member’s particular idea that contributed to the success of the team, and any situation where sacrifice by an individual team member led to the greater good of the team.
In the advanced stage, when working with supervision groups, the supervisor would definitely want to function more as a facilitator of the group process rather than group leader. In order to facilitate teamwork, supervisors will need to have genuine positive regard for everyone on the team. Supervisors need to be congruent and have consistency between what they say and what they do, both verbally and nonverbally. They model for the team through their behavior how to treat people with dignity and respect, no matter the circumstances. For example, if there is one person dominating the meeting, try redirecting the conversation to include others. “I wonder what the others of you think about what Sam is saying?” Or compliment the person for their input, and then move conversation back to whatever is the group task.
CAUTION
In today’s world of hype and spin, actions speak louder than words. Behaviors such as interrupting, ignoring, sarcasm, and belittling all will defeat any teamwork model. Thus, give supervisees your full attention when they speak, and be sure to thank them for asking questions and letting you know their concerns. When a supervisee makes a suggestion or points out a problem, say, “I am glad you brought that point up,” or “Thanks for the suggestion. What do the rest of you think?” rather than “We have tried that before,” or “You must be kidding!”
Also important to building safety in the team is how conflict and confrontation are to be managed. Again, just as with counseling and therapy groups, clinical supervisors model how conflict and problem member behaviors should be handled. Therefore, if any members of the team are in open conflict or if someone is irritable and aggressive, puts others down, or says nasty things, supervisors must quickly intervene. If they don’t, supervisees will not feel safe, and any team feelings will dissolve.
DON’T FORGET
The two main tasks of a group facilitator are to develop group cohesion and manage harmful conflict. From inception, teams will need to set clear guidelines for group-member interactions and work jointly with the leader to prevent any kind of harmful exchanges.
Putting It Into Practice
Case Example
Erik was a new school psychologist in a moderate-sized school district. Once a month all of the allied health service staff got together at his office for a team meeting. The team was made up of Erik (the only school psychologist and male team member), three counselors, a school social worker, a school nurse, and a special education counselor. None of the members of the team had supervisory responsibilities over anyone else on the team. These team meetings were mandatory under current administrative guidelines.
Erik was confused about the purpose for the team and after several meetings, he was dissatisfied with the experience. He also became cognizant of the fact that everyone in the team looked to him for leadership, and whenever members brought up problems for group discussion, they received very little feedback. If there were any differences in opinion, the group quickly squashed the discussion by changing the topic of conversation. Erik became determined to address these issues at the next meeting. When he did so, other team members chimed in with their dissatisfaction, the fact they also were unclear about the purpose of the group, and uncomfortable with the lack of a designated leader and set guidelines.
From this discussion, the team moved to an agreed-upon structure for the team meetings, with a rotating leadership position and basic guidelines for decision making and handling disagreements. Within short order, the team came up with a solution to a shared problem of shrinking resources in the district. Team members realized that most of their time was being spent on a relatively small group of students who appeared repeatedly with various needs. By calling and e-mailing each other to share information, members were able to avoid much of the duplication of service and leave time and energy for other needs.
Teaching Point: As a result of Erik’s willingness to speak up, the team became more effective. By identifying the source of his dissatisfaction and taking a risk to share this with the group, improvements were made and the value of the time spent by the team more meaningful. Not only were new solutions to old problems created but also members began to feel much needed support for their efforts, which resulted in an increase in job satisfaction.
IMPORTANCE OF PERSONAL AND PROFESSIONAL DEVELOPMENT
One area that is sometimes overlooked in clinical supervision is an active program of personal and professional development. Supervisors serve as models for the importance of self-care and continuous growth and development by sharing their own professional growth experiences, such as workshops or conferences attended, what they are reading at the moment that excites them, current research, and new ideas for practice. They also should invite supervisees to go with them to various professional activities, such as lunch programs, grand rounds, CEU seminars, or conferences. Additionally, many supervisees would benefit from encouragement from their supervisors to give a presentation at a state or national conference. This activity could be done in tandem with the supervisor or with other supervisees.
Another important area of professional growth that sometimes is not discussed at all in supervision (and may be controversial in some settings) is the role personal psychotherapy plays in professional development. Some graduate programs require students to engage in therapy as part of their program requirements, but many times, supervisors avoid the topic altogether or look upon psychotherapy as something only needed for situations of severe impairment. However, because ethical codes and standards strongly advise all practitioners to be continuously involved in self-monitoring and seek out therapy as a means to maintain clearness and objectivity, the topic should be integrated into supervision from a growth perspective, not just if deficits are uncovered. Certainly, in many ways, in order to minimize the risk of countertransference or their own personal problems negatively impacting clients, engaging in personal counseling or psychotherapy is an ethical strategy. Supervisors who believe in this standard and are involved in their own personal psychotherapy should share its benefits with their supervisees. (Note that it is not necessary to share the exact issues discussed with the therapist or insights gained, just the value of the activity in professional practice.)

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