Seven
THE BEGINNING STAGE OF SUPERVISION
All supervisory relationships have a beginning, and all supervisors and supervisees whether they know each other or not share common concerns from the beginning about the future of that relationship. New supervisors will wonder if they have the skills and expertise to be successful. Supervisees will worry about being treated fairly and with respect. Each is asking, “Will I be heard and understood? Will my competencies be valued? Will I be safe? Is this experience going to be valuable?” Answering these needs in a positive manner is a necessary requirement for the beginning stage of supervision.
Supervisors must be active from the start to build a collaborative working relationship. Because the supervisory relationship is so central to a successful supervision experience, much time and attention must be given to cultivating it. Don’t assume everyone, even a very experienced supervisee, knows why he or she is there and what is expected of him or her. Just as therapists have to explain to clients the therapeutic process in order reduce client anxiety and ask clients what their goals are for therapy in order to build a working relationship, supervisors need to do the same thing with supervisees. Supervisors need to work resolutely at the beginning to build understanding and agreement concerning expectations and tasks, reduce anxiety, and create a safe place for supervision to take place.
DON’T FORGET
Beginnings are important. If supervisors do not take time to establish the context for supervision, time and energy will be wasted as supervisees seek information and understanding about the goals and purpose of supervision.
DON’T FORGET
The quality of the supervisory relationship is critical to the success of clinical supervision. It is more important to emphasize relationship issues rather than techniques, especially in the beginning of the supervisory relationship. Spend more time on developing skills and less time on managing.
To accomplish these objectives, the most important task for supervisors becomes setting the stage for supervision through orientation, where all supervisees are informed of the expectations, goals, requirements, tasks, structure, and timing for supervision; the procedures for evaluation and monitoring; and provisions to assure the safety of supervisees through ethical and fair treatment practices. Significant barriers to building trust, such as dual relationships, multicultural differences, and the evaluation process, should be discussed openly and in some detail during this orientation.
CAUTION
Before beginning supervision, it is important to review with supervisees the specific supervision requirements, such as licensure requirements, ethical codes and standards that apply, as well as the final evaluation forms.
The supervision informed consent agreement and the supervision contract, or a combination of both, are basic tools for the building of the supervisory relationship (see Chapter 6 for a discussion and examples of an informed consent agreement and contracts for supervision). Additionally, during this introductory process, supervisors will need to use all of their rapport-building skills and relationship knowledge in order to establish an open and safe environment. Anderson et al. (2000) found the more open the supervisory environment, the more respect, support, and encouragement are communicated and the more available and involved the supervisor, the better the supervision experience. Rapid Reference 7.1 lists the tasks of the beginning stage of supervision.
One helpful approach to building an effective relationship is to use a developmental perspective. Following the premise that supervisor, supervisee, and the supervisory relationship will grow and change over the course of supervision and that inexperienced supervisees will have different needs than those more advanced, embracing the developmental perspective can be helpful in several ways. First, taking into account the developmental level of supervisees as to skill and experience will assist in goal setting, planning, selecting methods and techniques, evaluation procedures, time management, and monitoring. Inexperienced supervisees take more time and need more structure, direction, and close monitoring than experienced supervisees who will want more autonomy and self-monitoring. Second, understanding the changing relationship needs of supervisees as time passes will also help supervisors be more effective. For example, in the beginning of supervision, attention needs to be paid to establishing safety, whereas later in time, the focus shifts to challenging and giving corrective feedback. Last, the developmental perspective will aid supervisors with evaluation. Ownership and participation in the evaluation process shifts from supervisor to supervisee as skill and experience level increases so that in the advanced stage, supervisees are involved in self-supervision and self-evaluation.
Rapid Reference 7.1
The Beginning Stage of Supervision
Goal: To establish an effective supervisory relationship with supervisees
Tasks for supervisors
• Build the working alliance
• Orient supervisees to supervision—the tasks, goals, and expectations
• Create a supportive environment and build a safe place to learn
• Work actively to reduce anxiety
• Discuss openly the barriers to trust (dual relationships, multicultural differences, and evaluation)
• Validate differences in perspective and approach
• Normalize mistake making and encourage risk-taking
• Focus on successes, not just failures
Tools
• Relationship- and rapport-building skills
• Informed consent agreement and supervision contract
• Orientation session
Developmental issues also come into play in the beginning of supervision from another direction, the developmental level and experience of the supervisor. If the supervisor is new to supervision or relatively new to the field, it can sometimes be difficult to establish expertise and authority. In fact, Rau (2002) recommended inexperienced supervisors should view themselves more in a collaborative role with supervisees and, in the beginning, seek to find a common ground, rather than attempt to establish their authority. What this tactic means is that new supervisors must acknowledge their newness to the role of supervisor, solicit support and cooperation at the start, and ask supervisees what they would like to get out of supervision rather than tell them what will happen.
BUILDING THE WORKING ALLIANCE
The supervisory relationship, while similar in some ways to counseling and psychotherapy, is by its nature a different relationship with a different purpose. Although good counseling and psychotherapy skills are definitely an asset in building rapport and creating a positive environment, supervision should not be confused with therapy. The term supervisory working alliance has been coined to capture the essence of the relationship (Bordin, 1983). The supervisory working alliance is a collaborative relationship of change based on a mutual agreement on the goals and tasks of supervision along with a strong emotional bond of caring, trust, and respect. Research findings suggest that the quality of the working alliance is correlated to greater supervisee satisfaction (Chen & Bernstein, 2000; Ladany et al., 1999). Further, and perhaps more important, a study by Patton and Kivlighan (1997) found that the quality of the supervisory working alliance was predictive of the supervisee’s counseling alliance with his or her clients.
In order to move forward in the working alliance, the goals for supervision must be clearly delineated. Supervisees must understand the purpose of these goals and how mastering them will improve their own success and effectiveness as professionals. In other words, they need to understand what is going to happen and how they fit in. They must also develop trust in the supervisor and his or her willingness to provide for their safety while learning. Thus, establishing the working alliance is a critical part of the orientation and contracting phase of supervision. When there is disagreement on the tasks, a misunderstanding about the value of these tasks, a lack of trust, or any combination of these, it is hard to move forward in supervision.
DON’T FORGET
Supervisors have to create an atmosphere of trust and a commonality of goals and purpose in order to be successful.I.
DON’T FORGET
There are three elements important to build the working alliance:
• Explanation of tasks and goals for supervision
• An agreement on the meaning of these goals and tasks
• A sense of liking and caring between supervisor and supervisee
A number of issues may adversely affect the development of the working alliance: distrust in the supervisor, dual relationship issues, role confusion and conflict, anxiety concerning evaluation procedures, and misunderstanding of the value of the goals and tasks required. A lack of investment by supervisors in supervision, a harsh and unfriendly style, and excessive criticalness and dogmatism also impact trust and the working alliance. It takes trust for supervisees to open themselves to supervision, to hear feedback, and to take risks, and it takes the supervisor’s relationship skills and ability to convey understanding, caring, and respect to develop that trust. Having empathy and compassion for supervisees and a belief in supervisees’ abilities and strengths to achieve mastery are all part of the formation of trust. In actual fact, Muse-Burke, Ladany, and Deck (2001) found across the board that facilitative conditions such as empathy, genuineness, warmth, trust, and positive regard are common to virtually all effective supervisors regardless of their theoretical model of practice.
Rapid Reference 7.2
Tips for Building the Working Alliance
• Establish mutuality and collaboration to accomplish tasks
• Use self-disclosure to foster openness, honesty, and willingness to admit mistakes
• Talk openly about the hierarchy of power and the means available to resolve problems
• Include supervisees in setting goals, planning, and the evaluation process
Rapid Reference 7.2 summarizes tips for building the working alliance.
Anxiety and the Working Alliance
Anxiety is a natural response to supervision and may play a significant role in shaping the working alliance and the quality of the supervisory relationship (Bischoff et al., 2002; Campbell, 2000; Fitch & Marshall, 2002). Supervisors need to consider its impact on the supervisory relationship and how to best work with it. Supervisees may feel anxious about their performance and ability to be successful working with clients. Additionally, they may also be concerned about the quality of the relationship with the supervisor. “Will I be liked?” and “Will I be seen as competent by my supervisor?” are typical beginning concerns.
The supervisee’s level of anxiety may vary depending on issues of power and choice, personality factors, developmental stage, the purpose of supervision, familiarity with the supervisor, and the importance of the evaluative component. For example, postdegree supervisees seeking licensure may experience supervision differently from those just starting out in the field. Postdegree supervisees who are also employees may be concerned about job safety and job performance along with anxiety about obtaining their license. They may experience low choice in selecting a supervisor and considerable role confusion. All of these considerations, if not addressed, can influence open communication, self-disclosure, and trust.
The hierarchical nature of supervision is another area that can create anxiety and interfere with the working alliance. Anxiety might also be fueled by the supervisee’s previous experiences in supervision, confusion about his or her role as a supervisee, and the supervisor’s expectations. The existence of multiple relationships, or role conflict, in clinical supervision on both the part of the supervisor and supervisee can also generate considerable anxiety and confusion (Bordin, 1983; Herlihy & Corey, 1997; Kaiser, 1997; Ladany & Friedlander, 1995; Ladany, Waterman, Molinaro, & Wolgast, 1999). For example, the clinical supervisor may also be the administrator or major professor of a graduate program. Supervisees may be former peers, colleagues, and, in some cases, especially in the substance abuse field, former clients.
Another contributing factor to anxiety is the fact that supervisees are encouraged to be open, honest, and truthful about their mistakes and to be willing to discuss their limitations at the same time their supervisor is evaluating their competence and suitability for the profession. Bordin (1983) called this role ambiguity. This same confusion may occur for supervisors as they try to avoid providing therapy to supervisees while being ethically bound to explore personal issues if they interfere with quality of care or are potentially harmful to clients. If areas of confusion about role and expectations are not addressed properly, the working alliance can suffer (Ladany & Friedlander, 1995).
Issues about privacy of communication can also contribute to anxiety. Privacy in clinical supervision may be limited. For example, when supervision is delivered in a job setting, supervisors are going to exchange information with administrators and other supervisors. If supervision is required for licensure, a final evaluation must be sent to a licensure board. Thus, supervisors need to think about the extent of privacy and strategize how to protect a supervisee’s confidentiality to the best of their ability so as to create a safe environment for self-disclosure. This information should be part of orientation and included in the informed consent agreement for supervision.
ORIENTATION
One of the best ways to minimize anxiety and improve the working alliance is to begin any supervisory relationship with a well-thought-out orientation experience that includes an open discussion of supervision goals, expectations, evaluation procedures, as well as plans to address any relationship problems as they arise. The use of a written informed consent agreement, a supervision contract, or both might be a part of this introduction (see Chapter 6 for a complete discussion of informed consent agreements and contracts for supervision). Rapid Reference 7.3 outlines the main responsibilities for supervisees as they participate in clinical supervision.
DON’T FORGET
Three main responsibilities of supervisees in supervision:
• To protect clients from harm
• To actively participate in supervision
• To be open, honest, and truthful about what they don’t know and forthcoming about mistakes
Rapid Reference 7.3
Supervisee’s Responsibilities in Clinical Supervision
This list could also be included as part of a supervision contract or informed consent agreement.
• To provide service to clients in an ethical manner and adhere to ethical standards of one’s profession
• To seek to become the best professional possible
• To take supervision seriously: prepare, participate, attend
• To avoid all dual relationships with clients that may be harmful and to agree never to engage in a sexual relationship with clients
• To follow rules of confidentiality and protect clients from harm
• To work always within the limits of competency, skill, and training
• To seek supervision immediately in crisis situations
• To be honest reporting mistakes and identifying areas of bias or where one lacks competence
• To submit documentation of clinical work in timely and accurate form
• To be open to supervision, suggestions, and feedback
• To accept referral to outside help such as counseling, psychotherapy, support groups, or more training if need indicated
• To provide supervisor with honest feedback about supervision and supervisory process
• To seek consultation and guidance on how to proceed in cases of impairment or unethical behavior of supervisor
DON’T FORGET
When orienting supervisees to supervision, be sure to do the following:
• Discuss expectations, goals, needs, evaluation methods, and documentation
• Explain your role and function and that of supervisees
• Use an informed consent agreement and contract as basis of discussion
• Ask supervisees what they need and want from supervision
Creating a structured orientation plan with an outline of introductory information to be obtained from any and all supervisees, regardless of experience, along with topics to be covered in the first session may be useful to avoid difficulties and overcome anxiety, especially for beginning supervisors.
Assessing Supervisees’ Preparedness for Supervision
Because supervisees may come from a variety of backgrounds, the supervisor needs to take time to go over the supervisee’s previous training and work experiences before the orientation. Moreover, with graduate interns and postdegree supervisees, it is important not to confuse experience or graduation from a highly regarded program with clinical competency. As a consequence, supervisors need to find ways to quickly establish a supervisee’s actual baseline of skill and expertness. This necessity is further bolstered by the ethical and legal requirement that supervisees not be asked to function with clients outside the parameters of their knowledge and skill.
There are a number of sensible methods for assessing the supervisee’s basic skills and knowledge base, the most common being a review of a supervisee’s graduate school transcript or a resume of work background if the supervisee is more experienced. One other easy and effective method to quickly evaluate the knowledge level of new supervisees is to request a short, structured written summary of their education and experience. This summary could include the following: a brief description of their preferred theoretical model and philosophy of working with clients; a summary of the type of clients they have seen; a description of any specialized training or skills they’ve developed with particular populations; a summary of their previous supervision experience (good or bad); an assessment of strengths and weaknesses; and a statement of their goals and expectations for supervision. This assignment could easily be adapted for paraprofessionals and become part of the selection process.
DON’T FORGET
Supervisors should be prepared the same as supervisees to share information about their background and experience, preferred model, and areas of expertise.
CAUTION
When supervising a known colleague or former peer, don’t ignore the collection of background information or active review of knowledge and skills. It could prove harmful at a later date.
Additional material could be collected from supervisees who have experience, such as a sample of client progress notes, a case review sheet, or an audio- or videotape. The snapshot technique described in Chapter 5 is also an excellent suggestion for this purpose. The most practical suggestion, however, is to give prospective supervisees a written case vignette and ask them how they would address certain issues with this particular client scenario. If questions remain, these same supervisees could be asked to participate in a short role-play of a client situation, which should also be revealing.
How to Structure Orientation
Because of time constraints and with so much material to cover, any orientation needs to be well planned and include both written materials as well as formal discussion. For example, during the screening stage, much of the background material suggested in the previous section could be collected. Supervisees could be given a packet of materials to review along with a copy of the informed consent agreement or supervision contract.
At the first meeting, supervisors need to go over the expectations, goals, tasks, ground rules, and structure for supervision, including record-keeping requirements, evaluation procedures, and the means available to supervisees for resolving problems. Thereafter, the focus of orientation will vary for each supervision setting based on client needs; organizational setting; role of the supervisee ; and the supervisee’s level of development, skills, and expertise. On-site supervisors may want to stress organization issues in contrast to those off-site who may need to thoroughly discuss procedures for communication and the handling of crises. Supervision of a colleague or coworker necessitates emphasis on dual relationship issues and evaluation procedures, whereas the focus with a graduate intern might be on program requirements. Depending on the educational level of supervisees, services provided, and the client population, a number of additional sessions may have to be devoted to a systematic review of the code of ethics, laws, and regulations. Rapid Reference 7.4 gives a step-by-step list of topics for the first supervision meeting.
CAUTION
If you are promoted to clinical supervisor in your work setting and now you are supervising former peers, do not skip orientation and jump immediately into a review of cases. Take time to discuss the new state of affairs, and process everyone’s thoughts and feelings about the new situation. Be sure to collect ideas from everyone on how to enhance the supervision experience.
CREATING A SAFE PLACE
The basic ethical premise of clinical supervision is that supervisees will be open to supervision; they will seek guidance, be open to corrective feedback, and be honest and truthful in supervision, including admitting what they don’t know, owning their mistakes, and be willing to make themselves vulnerable. This premise underlies most traditional supervision activities, specifically the heavy reliance on self-report in case consultation as the primary means for supervision. However, studies indicate that supervisees’ willingness to be open and honest depend on a number of variables. For example, Ladany et al. (1996) found 44 percent of trainees surveyed withheld information about clinical mistakes due to concern about the supervisor’s evaluation of their competence, whereas Webb and Wheeler (1998) found greater rapport with supervisors correlated to a willingness on the part of supervisees to self-disclose mistakes.
Rapid Reference 7.4
Preparing for the First Supervision Session
1. Discuss by phone or in person the purpose, requirements, needs, administrative details (i.e., logging, record keeping, evaluation), and expectations for clinical supervision.
2. Obtain information from supervisee: Request resume, transcripts, or other documents required by the graduate school, licensing board, or national certification organization, such as supervision contract, evaluation forms, logging forms for hours, license forms, etc.).
3. Read copies of ethical codes, standards, and requirements for particular license or discipline. Have supervisees do the same.
4. Describe your background and experience, including special skills and supervision model. Provide supervisees with a copy of your supervision certificate or credentials.
5. Discuss goals for supervision.
6. Explain time, location, frequency, methods, and fees, if any.
7. Review informed consent agreement or supervision contract or both; sign and date.
8. Obtain a copy of supervisee’s malpractice insurance (if desired).
9. Discuss ethical issues as they relate to supervision (vicarious liability, negligence, monitoring, and confidentiality) and crisis management strategies.
10. Bring up areas of potential conflict such as dual relationships, monitoring needs, differences in discipline, model, or to client care and how to resolve them.
11. Provide supervisee with any necessary forms (evaluation forms, logs, sample record keeping, case review sheets, etc.).
DON’T FORGET
Golden Rule of Supervision
Treat supervisees in the same way you wish to be treated and the same way you wish them to treat clients.
Other studies point to the supervisors’ sensitivity to needs and concerns of supervisees, their openness to consider different points of view or a low level of dogmatism and criticalness, as well as how important evaluation is to the relationship (graded internships) as significant factors that also influence supervisees’ openness in supervision (Bischoff et al., 2002; Daniels & Larson, 2001; Fitch & Marshall, 2002; Halgrin, 2002; Magnuson et al., 2000; Steven et al., 1998).
Consequently, another task in building a successful working relationship with supervisees is to create a sense of safety and trust. Supervisees need to feel a sense of worth, belongingness, safety, and security. If they don’t feel safe and don’t trust the supervisor, then it is hard to build the working alliance. Likewise, if supervisees are afraid to make decisions or be honest, it is hard for them to learn and grow. Because supervision is a relationship of unequal power and supervisees, especially beginners, can be very anxious, supervisors need to focus considerable time and energy on a strategy to build trust and establish an atmosphere where supervisees feel free to take risks and discuss openly their deficits and problems with the work.
One easy place for supervisors to locate ideas on how to build a positive working relationship with supervisees is to review the work of Carl Rogers. Rogers believed that warmth, genuineness, empathy, positive regard, and unconditional acceptance are essential on the part of counselors in order to build trust with clients. “If I can provide a certain type of relationship, the other person will discover within himself or herself the capacity to use that relationship for growth and change, and personal development will occur” (Rogers, 1951, p. 33). His ideas continue to receive validation through research in psychotherapy where these same relationship variables, called common factors, have been found to be vital to successful outcome with clients (Norcross, 2002). Supervisors need to use the same rapport-building skills to facilitate a positive outcome in supervision.
DON’T FORGET
Being supportive of supervisees and building trust does not mean supervisors must always be warm, fuzzy human beings who never disagree with supervisees or give them any corrective feedback. Instead, it refers to how supervisors relate to supervisees and how they give them feedback—that is, by showing a basic respect for the supervisees’ needs and abilities.
For example, encouragers such as “Tell me more; I’m interested” or “Keep going; you’re on target” are simple ways to encourage discussion. Paraphrasing and summarizing are used to clarify understanding, while reflecting feelings and empathic responding usually indicate the supervisor is fully present in the relationship. Repeating significant words in a question, such as no one? or the whole time? helps elicit clarification of meaning. Most counselors and therapists learn early on in their training that open-ended questions are considered better than why questions because they sound less critical. The same is true for supervisors.
Rapid Reference 7.5 gives a list of supportive skills for supervisors.
Even though supervision is a different relationship from psychotherapy, research in supervision clearly supports the relevance of traditional rapport-building skills used in counseling and psychotherapy to supervision. If supervisors are open to supervisees’ thoughts, feelings, experiences, and viewpoints; have compassionate and genuine regard; and are willing to offer support and encouragement, a more trusting relationship can be formed (Bischoff et al., 2002; Magnuson et al., 2000). The bottom line is that when supervisees feel heard and understood by their supervisors, they are more likely to be motivated and open to feedback.
Occasionally supervisors in organizational settings rebel at such suggestions. They see no value in pandering to peoples’ need for encouragement and support. Instead, they think, “Why should I have to go out of my way to talk about successes or people’s strengths or to thank people for their efforts? After all, we are all adults here. These people are not clients. Everyone knows what is expected. We all have a job to do so just do it. I don’t have time for such nonsense.” However, there is some danger in this attitude. Supervisees who do not feel appreciated or safe avoid supervision, withhold important information, and, in times of need, run the opposite way. Additionally, and perhaps most importantly, studies are beginning to show a positive relationship between the relationship with supervisors and the relationship with clients (Freitas, 2002; Patton & Kivlighan, 1997). Supervisors model by their behaviors with supervisees in supervision how they wish them to behave with clients. For example, the more friendly and supportive supervisors were perceived to be by their supervisees, the less dominant and controlling supervisees were seen to be by their clients.
Rapid Reference 7.5
Supportive Skills
| Attending | Summarizing | Agreeing |
| Paraphrasing | Clarifying | Encouraging |
| Reflecting feelings | Open questions | Empathic responding |
| Reinforcement | Self-disclosure | Behavioral descriptions |
CAUTION
Ignore supervisees’ basic needs for safety and support at your own peril. You will not be able to rely on supervisees’ willingness to come to you with mistakes or to pitch in and help when things get tough.
Supervisors are sometimes confused about what being supportive means in terms of actual supervisory behavior. They interpret the recommendation to mean that all interactions with supervisees should be warm and friendly and should contain only positives and praise, avoiding altogether any corrective feedback or challenge to supervisees’ behavior with clients. These supervisors act as cheerleaders who continually repeat, “you are doing a great job” throughout supervision. While everyone likes to hear that they are doing a good job, most supervisees intuitively want more from supervision. They want to explore options and be challenged. Furthermore, a great number of outstanding supervisors are not particularly warm human beings but are still able to convey their appreciation for supervisees’ needs.
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