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Clinical supervisors conduct clinical supervision by operating from a model of psychotherapy. Your personal model is based on a theory of psychotherapy or an integration of two or more theories. You may not be able to clearly describe why you do what you do, but a model of some type is guiding you.
Creating and articulating your personal supervision model gives you clearer understanding of why you conduct psychotherapy the way you do and why you teach, train and coach supervisees to model your approach to counseling and psychotherapy. This chapter will describe the importance of leading by example with authenticity and alignment. You will also be introduced to various models of supervision that will assist you in clarifying your own model and preparing a formal description of your personal supervision model.
Inclusive leadership involves modeling and living out inclusive principles and practices in your day-to-day activities as a clinical supervisor. Let's explore clinical supervision skill #3 in more detail.
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Inclusive leadership is leading others by your personal example. It's walking the talk. Modeling inclusion is a process that requires you to practice alignment and authenticity.
Authenticity is a relational state of being projecting the impression of “What you see is who I am at this moment.” It is practicing being authentic and genuine. When we are authentic, what others see is what they get, second-guessing and assumptions are unnecessary. The receiver is not left with a sense of being “conned,” tricked or manipulated.
The sender does not leave the impression of having worn various “masks” throughout the dialogue. Integrity, character and genuineness are clearly present in the interaction. There is an absence of counterfeiting, fakery and illusion. The receiver isn’t left with a sense of wonder about what the sender is really like as a person. There is congruence between what is said and what is heard. Authenticity builds trust, respect and confidence between inclusive supervisors and their supervisees and between supervisees and their clients.
Alignment is a state of being that projects the impression of “What you see is how I am at this moment,” to the receiver during conversations. The receiver is getting clear messages about why the sender holds certain beliefs, values, judgments or opinions in the moment. The sender is congruent in both verbal and nonverbal communications. The receiver is truly seeing and hearing what the sender is experiencing in the moment. The sender’s message is delivered with vulnerability, responsible risk-taking, and appropriate levels of self-disclosure.
When you begin to conceptualize and articulate your personal clinical supervision model, keep in mind this third clinical supervision skill. By practicing role modeling and leading by example with genuineness and authenticity, you will be making a significant contribution toward creating and maintaining an inclusive workplace.
All your supervisees can be motivated, inspired and challenged to do their best work in an inclusive environment. You can contribute to their sense of empowerment, personal value, and self-worth by challenging them with stretch assignments, providing them with adequate resources, and coaching and developing them in the process of continuous learning and continuous skills improvement. They will be enthusiastic contributors to the organization's mission, vision and success.
Clinical supervision models have been classified into three types, Developmental, Integrated and Orientation-Specific (Liddick, 1994). Let's begin by reviewing the developmental models.
The basic premise supporting the developmental models is a belief that each one of us is engaged in a process of continual skills learning and continual competence improvement. When you reflect on what went well and what could have been done differently you learn from your life experiences.
The primary focus is on the counselor's growth. The supervisor’s central role is helping the counselor in moving through the stages of counselor development at an appropriate rate.
Rigazio-DiGilio has described four systemic cognitive developmental supervision orientations. These are Sensorimotor/Elemental, Concrete/Situational, Formal/Reflective, and Dialectic/Systemic (Rigazio-DiGilio, 1997).
Sensorimotor/Elemental Orientation
The Sensorimotor/Elemental orientation is described as using direct sensory experience requesting help organizing information into hypotheses, clarifying intense emotional exchanges and developing structured plans for sessions. The supervision environment in this orientation is a structured one created by the supervisor's directive style.
The supervision objectives in this orientation are:
Sample supervision modalities and techniques in this orientation include:
Concrete/Situational Orientation
The Concrete/Situational orientation is described as being able to describe events and articulate cause and effect transactions which permit predictability, requesting help accomplishing interventions and developing treatment plans, and frequently seeking validation. The supervision environment in this orientation is a coaching relationship created by the supervisor's semi-directive style.
The supervision objectives in this orientation are:
Sample supervision modalities and techniques in this orientation include:
Formal/Reflective Orientation
The Formal/Reflective orientation is described as analyzing situations from multiple perspectives and using reflective and circular reasoning, requesting help deciphering typical patterns within or across cases or in relation to self, and seeking assistance in examining theoretical and therapeutic themes. The supervision environment in this orientation is consultative in nature and it is created by the supervisor's consultative style role in the process.
The supervision objectives in this orientation are:
Sample supervision modalities and techniques in this orientation include:
Dialectic/Systemic Orientation
The Dialectic/Systemic orientation is described as challenging assumptions supporting conceptualizations, requesting help organizing thoughts and questions into appropriate treatment plans, seeking assurance that treatment plans are adequate because of recognition of limitations inherent in any one particular choice. The supervision environment in this orientation is collaborative and it is created by the mutual engagement of the supervisor and supervisees in a collegial venture.
The supervision objectives in this orientation are:
Sample supervision modalities and techniques in this orientation include:
Rigazio-DiGilio (1997) identified three core therapeutic assumptions and three core supervisory implications common to four major integrative therapy models extended to the supervision process. The first model is an outgrowth of the metaframeworks perspective developed by Breulin, Schwartz, and Mac Kune-Karrer. The second model is based on Systemic Cognitive-Developmental Therapy (SCDT) developed by Rigazio-DiGilio, Anderson, Daniels, & Ivy. The third model is an application of the Integrative problem-centered therapy approach developed by Catherall & Pinsof. And the fourth model is derived from a mythological perspective formulated by Bagarozzi, Anderson and Holmes.
Core Therapeutic Assumptions
1. Understanding human, systemic, and eco-systemic development and functioning requires a holistic and recursive perspective.
The metaframeworks perspective looks at the biopsychosocial continuum for an understanding of development and functioning. The Systemic Cognitive-Developmental Therapy (SCDT) looks at how an individual's, a system's and an ecosystem's worldview may be co-constructed within a person-environment dialectic transaction over time. The focus in Integrative problem-centered therapy is on how an individual and systems develop an understanding of the world through a progressive process of learning which leads to increasingly accurate approximations of reality. The fourth model, the mythological perspective looks to personal themes and stories constructed by individuals, systems and ecosystems over the life span (Rigazio-DiGilio, 1997).
2. Nonadaptation is viewed from a health and/or developmental perspective.
All four models operate from the belief that deficits are nonexistent. Pathological functioning is not assumed and interventions are based upon removing constraints or blocks to adaptive functioning (Rigazio-DiGilio, 1997).
3. School-specific models are insufficient to deal with the wide variety of presenting issues or client types encountered by therapists.
All four models acknowledge the limitations of individual school models and they believe that different therapeutic interventions may be indicated for similar presenting problems based on the client's developmental, historical and sociocultural factors. The primary focus of treatment is always upon the client's individual needs (Rigazio-DiGilio, 1997).
Core Supervisory Implications
1. Understanding supervisee growth and functioning requires a holistic and recursive perspective.
Each of the four models embraces the dialectic reality of the supervisory relationship. Preconceived ideas about time, duration, frequency and outcomes are exchanged for openness and attentiveness toward the coconstruction of new realities from within continually changing and shifting perspectives and meanings in the moment as the interaction evolves between the supervisor and supervisee (Rigazio-DiGilio, 1997).
2. Supervisory impasses are reflective of incongruities between supervisee need and supervisory context.
A common assumption underlies the four models. Supervisees begin the supervisory process with a skill set of therapeutic competencies and a desire to enhance or modify them. This skill set contains a unique combination of potentials and constraints that are accessible throughout the supervisory process. A critical part of the growth process is the activation of these constraints. The supervisor's primary role is to nurture and cultivate an environment that encourages an examination of these constraints and the identification of adaptive change avenues (Rigazio-DiGilio, 1997).
3. Integrative frameworks organize various therapeutic perspectives, affording supervisees multiple reference points and options for growth.
Each of the four integrative models guide supervisors in organizing and accessing many assessment and treatment strategies enhancing their abilities to understand supervisees and facilitate each supervisee's growth and adaptation in the process of learning, applying and refining a comprehensive, broad-based method in their work with clients. When supervisees participate in integrative supervision, they learn both a specific unifying framework and a unique art of constructing, enhancing, and refining these frameworks over time and in response to their environments (Rigazio-DiGilio, 1997).
Transgenerational Supervision Models
The transgenerational models of family functioning and marital and family therapy are also referred to as intergenerational and multi-generational models. The primary focus is three-fold: current patterns of interaction, emotional dynamics, and organizational structure in clinical families (Roberto, 1997).
The distinguishing characteristics of transgenerational schools are (1) valuing historical information, (2) presupposition that past behavior and relations patterns influence both present and future patterns, and (3) desired therapeutic outcomes extend beyond symptom reduction or control (Roberto, 1997).
The most common transgenerational models are Natural Systems Theory (Bowen Model), Family Symbolic Process (Symbolic Experiential Model, Whitaker), and the Contextual Model by Boszormenyi-Nagy.
Psychodynamic/Psychoanalytic Supervision Models
A psychodynamic approach to human behavior focuses on interactions between the mind, body, and environment with specific attention on the interplay among individual internal experiences, conflicts, structures, functions, and processes. A psychoanalytic approach is a subset of the psychodynamic approach and it can be classified into three general categories, (1) classical psychoanalytic, (2) self-psychological, and (3) object relations (Reiner, 1997).
The psychodynamic/psychoanalytic supervision models have a great deal of overlap with their respective treatment models. Just as the therapist is a teacher to the client through a therapeutic alliance, the supervisor's primary objective is to function as a teacher to the therapist through a learning alliance. Because the supervisor is also required to assess and evaluate the supervisee's competence, conflicts may arise between the assessment/evaluation process and the collaborative learning process.
It is also more difficult to maintain clear boundaries between treatment and training because of the necessity to speak to countertransference issues with the supervisee. Ekstein and Wallerstein (1958) clearly differentiate this boundary by stating that the supervisee's personal problems are addressed in supervision with a goal of enhancing the therapist's skills and abilities in treating the client system instead of focusing on resolution of the therapist's inner conflict.
Systemic Supervision Models
These models are often characterized as systems purists. Each model applies its theoretical constructs for therapy to the supervision process. The main theories include: Structural Therapy -- major theorists: Minuchin, Montalvo, Guerney, Rosman, Schumer, Baker Stern, Todd, early Haley, and Fishman. Strategic Therapy:-- Major theorists are: Haley, Erickson, and Madanes. The Mental Research Institute (MRI) Brief Therapy Model (Jackson, Satir, Riskin, Haley, Weakland, Watzlawick, Fisch, and Bell), Milan Group (Palazzoli-Selvini). Functional Family Therapy -- Major theorists include: Barton and Alexander.
Postmodern Models of Family Therapy Supervision
The term postmodernism is frequently used to describe the process of moving away from the search for and our beliefs in ultimate foundations for the various aspects of our lives. In the recent twentieth century we saw this movement in many aspects of our world. An increasing appreciation for multiple points of view and for co-existing realities spread globally. Many of us experienced an expanding awareness of worth and value in all cultures combined with dissatisfaction toward rigidity and inflexibility in all areas of life. There has been a sharpening awareness of the effects of our own and others' psychological makeup on our perceptions and beliefs. This has broadened our realization of the influence of individual points of view and their usefulness (Gardner, Bobele, Biever, 1997).
Several postmodernism applications to clinical supervision are appearing in the literature. The leading theorists in describing postmodern applications to supervision issues are: Goolishan, Anderson, Rambo, Swim, White, Epston, Doan, Amundson, Stewart, Parry, Biever, Gardner, and Bobele. (See Resources section).
Social Constructionism
Social constructionism has also heavily influenced postmodern applications to supervision models. Social constructionism promotes the idea that meanings are developed through social interactions and social consensus (Gergen 1985; Saleebey, 1994). The general concept is that all understandings are negotiated in social interactions and they are directly connected to and embedded within the context of the immediate conversation. Meanings are the end product occurring over time as a result of social interactions. The primary emphasis is on the crisscrossing of ideas and meanings during conversations. Anderson and Goolishan (1988) describe this crisscrossing as intersubjective or "…an evolving state of affairs in which two or more people agree (understand) that they are experiencing the same event in the same way…It is understood that agreement is fragile and continually open to renegotiation and dispute" (Anderson & Goolishan, 1988, p.372).
Because conversations are fluid, dynamic processes, evolving over time, meanings become transitory. Individual messages are never complete, clear or enduring because the potential for new interpretations being expressed always exists (Anderson & Goolishan, 1988). Supervisors, supervisees and clients are continually in the process of constructing new meanings about themselves and one another as they participate in conversations. For the supervisee, the focus becomes directed toward shifting meanings. "Supervision from a postmodern perspective invites the supervisee to pay attention to the ways in which therapeutic 'realities' are created through language that is ever shifting in meaning. No one story tells the whole story" (Stewart, 1994, p.6).
Valuing the adoption of a "not knowing" position is prevalent in most social constructionist theories in terms of a supervisee's circumstances. From this position, knowledge is the result of social interactions between people so supervisory expertise is believed to reside in the process of managing the conversation. The emphasis is on the absence of "pre-knowing" and withholding irrevocable conclusions based on data collected to support specific theories (Allen, 1993).
Supervisors look for differing perspectives from their supervisees and they perceive them as having value. Stewart emphasizes the supervisee's value and expertise: "We encourage supervisees to use a lot of ideas gained from years of experience by others, but we also encourage them to travel lightly -- to not let any one set of ideas or practices define the therapeutic moment" (Stewart, 1994, p. 6).
The primary goal in the supervision process, from a postmodern perspective, is the enhancement of a supervisee's ability to appreciate multiple perspectives and to develop new meanings that can be utilized in the process of facilitating therapy with clients. According to Anderson & Swim, "The goal of the supervision system is the development of a context for co-evolving new meaning, and thus learning and change" (Anderson & Swim, 1994, p. 2). Generally speaking, many postmodern supervisors seek to value, nurture and appreciate the uniqueness of each supervisee's experience, knowledge and training (Gardner, Bobele, Biever, 1997).
Any model of clinical supervision should include four primary components. These are a theoretical foundation, descriptive characteristics, developmental stages and influential contextual characteristics.
The theoretical foundation should include an underlying viewpoint about individuals, couples and families; the change process and how counseling effects change within individuals, couples and families. Supervision models should also include philosophical issues that help explain why supervisors engage in the process of supervision in specific ways.
Descriptive characteristics assist the supervisor with understanding how to put the theoretical underpinnings of the model into practice. Each model should include a discussion of the following characteristics:
Within any model, the counselor's stages of development and the supervisor's stages of development will play a critical role. First, consider the stages of counselor development.
Stages of Counselor Development
Ronnestad and Skovholt (1993) extensively described effective supervision of graduate student counselors at the beginning and advanced levels. They concluded, "There is reasonable validity to the perspective that what is good supervision depends on the developmental level of the candidate” (Ronnestad & Skovholt, 1993, p. 396).
When supervising beginning student counselors, high levels of encouragement, support, feedback and structure should be consistently provided. When supervising advanced students, it is critical to remember the complexity involved because of the student's tendency to vacillate between feelings of professional insecurity and incompetence.
Supervisors should assume responsibility for creating, maintaining and monitoring the relationship. Such a mediating role will provide structure within the supervisory relationship when students are in the midst of turmoil (Ronnestad and Skovholt, 1993).
Counselor development has been described by Stoltenberg & Delworth as organismic. They say that importance is placed on the transformation of events into meaningful information and then this is incorporated into previously existing knowledge. The developing counselor is perceived as emerging and moving toward a specific goal or desired end state (Stoltenberg & Delworth, 1987).
Stoltenberg and Delworth (1987) created the Integrated Developmental Model for Supervision (IDM) that synthesizes common elements of previous models into a comprehensive system. They identify the three basic structures of counselor development within each of the three developmental levels as autonomy, self and other awareness and motivation.
First Level: Counselor Development
The first level of counselor development is the journey's beginning. It can be characterized by following traits:
The best environment for Level One counselors includes:
Second Level: Counselor Development
The second level of counselor development is filled with trials and tribulations. It is characterized by the following traits:
The best environment for Level Two counselors includes:
Third Level: Counselor Development
The third level is filled with challenges and growth opportunities. It is characterized by the following traits:
The best environment for Level Three counselors includes:
Stages of Supervisor Development
Stoltenberg and Delworth's (1987) Integrated Developmental Model for Supervision (IDM) also identifies three levels of supervisor development. The first level is described as being characterized by:
The second level is described as being characterized by:
The third level is described as being characterized by:
Several contextual variables influence the supervision process. These include the supervisor, supervisee, client, work environment and the training program. These characteristics are situational and variable. Each of these variables will affect every other variable in the supervision process.
Evaluating and managing the various co-evolving relationships in a clinical supervision setting are important tasks for the clinical supervisor. The clinical supervisor must be able to evaluate and assess the dynamics occurring between the supervisee and the client system as the therapeutic relationship progresses from intake through termination. The supervisor's relationship with the supervisee and his or her relationship with the client system must also be evaluated and managed throughout the relationship's duration.
Self-awareness, maturity, openness to feedback and a willingness to grow and develop professionally are essential ingredients for both the supervisor and the supervisee. A collegial, collaborative, accountable relationship within which both parties can trust that they have one another's best interest at heart will provide the foundation for a fruitful and productive supervisor/supervisee relationship.
Both the supervisee and the supervisor must also share a common goal of being dedicated to delivering quality, competent counseling services to the client system with a genuine care and concern for the client's well being, safety and mental health.
What do you consider as most valuable in conceptualizing your personal model of supervision?
How would you describe your personal model of supervision?
What is your primary theoretical orientation toward clinical supervision?
How do you practice this orientation?
What are the strengths of your personal model?
What are the weaknesses?
How do you evaluate and manage the co-evolving relationships with your supervisees? With your supervisees and clients?