Clinical Supervision Fundamentals

The Models of Clinical Supervision

Bernard and Goodyear defined clinical supervision like this: “Supervision is an intervention that is provided by a senior member of a profession to a junior member or members of that same profession. This relationship is evaluative, extends over time, and has the simultaneous purposes of enhancing the professional functioning of the junior member(s), monitoring the quality of professional services offered to the clients …..”

Powell, D. & Brodsky A. defined clinical supervision like this: “Clinical supervision is a disciplined, tutorial process wherein principles are transformed into practical skills, with four overlapping focuses administrative, clinical, evaluative and supportive.”

Clinical supervision is multi-faceted and has multi-purposes which all culminate to one goal to acquire positive outcomes with clients. There is the philosophy of clinical supervision and then there is the proper way to do the process. It could be left open so that each supervisor adopts his or her model of supervision but then the results would not be uniform or follow conform to some specific industry standard.

Since the models of clinical supervision follow the different ways people learn, consider the four types of learners or four ways in which people learn.

  • Wholistic;
  • Verbaliser;
  • Analytic;
  • Imager.

Clinical supervisors conduct clinical supervision by operating from a model and a theory of psychotherapy or an integration of two or more theories. No matter which it is, if analyzed, the particular model is guiding you by creating and articulating a personal supervision model. This gives you a clearer understanding of why you engage in the psychotherapy the way you do and why you teach, train and coach supervisees the way you do. The model that you follow will become the model that the supervisee will follow.26

 Developmental Model of Clinical Supervision

The development model is divided into four stages of Child, Adolescent, Early Adulthood and Maturity.  The Developmental Model also has three unnamed levels through which the counselors pass through.

  • Level 1 is the counselors who are newly entering the field and they are trying to assimilate and rationalize the theories with which they have to work with patients.
  • Level 2 is generally one or two years later when the supervision experience has become a reality and with that instruction has become much more comfortable with the skills to use and has broadened their range of skills.
  • Level 3 finds the counselor with such a balanced view and understanding of the realm of mental health issues that he or she can readily empathize with the client all the while entering into a more collegian relationship with the supervisor.

The Developmental Model suggests that as adults we go though the same levels of growth as a child.  The growth is continual but it may present itself in fits and starts and varying growth patterns. The object is to maximize and identify growth in the present for not only the present but for the future. Life is a continuing learning experience that leaves markers of growth for us to evaluate that we are mentally and emotionally evolving.

Studies of the clinical supervision relationship have revealed that the behavior of supervisors changed also as supervisees gained knowledge, experience and expert skills. The developmental model starts with the supervisee as the beginner, then advancing to the intermediate and advanced, similar to the graded levels in school. The supervisee may begin with a rigid and imitative way much like the first grader walks into school on the /first day of classes. Then as he or she moves toward feeling more competent in evaluating clients, etc self-assurance and self-reliance emerge.

The negative responses of this stage could be resistance to having a decision challenged by the supervisor, avoidance of telling the supervisor everything for fear he or she could criticize it, or conflict because the supervisor is suggesting a different type of therapy. This is not unusual because the supervisee is “walking” for the first without a prop to hold onto so can wobble over at any point in time.

The developmental model showcases eight growth areas for the supervisee to strive for.

  • assessment
  • client conceptualization,
  • individual differences,
  • interpersonal assessment,
  • intervention,
  • professional ethics,
  • skills competence,
  • techniques,
  • theoretical orientation,
  • treatment goals and plans.

If the supervisor is able to maneuver through the methodology of the model, he or she will find that the supervisees will better be able to identify their own strengths and growth areas and will see how each of the supervisees become responsible for their life-long development as both therapists and supervisors.

Integrative Model of Clinical Supervision

In the integrative model, the supervisor will take on all the roles of a teacher when lecturing and presenting and teaching new concepts. Supervisors may act as counselors when they assist supervisees in noticing their own “blind spots”. Supervisors may relate in a “consultant role” as colleagues do during co-therapy. Each of the three roles is task-specific and can be beneficial for all parties concerned and in all aspects of the supervisory relationship.

Each of party in the supervisory relationship have habits of attending to some roles and issues. When the supervisor identifies his or her customary practice or natural way of working, then he or she can then consciously attend to the other two categories whether it be consultant or teacher or counselor. In this way, the supervisor chooses interventions geared to the needs of the supervisee instead of your own preferences and learning style.

Orientation-Specific Models

Counselors who adopt a particular brand of therapy oftentimes believe that the best “supervision” is analysis of practice for true adherence to the therapy. The situation is analogous to the sports enthusiast who believes the best future coach would be a person who excelled in the same sport at the high school, college, and professional levels. Psychoanalytic supervision occurs in stages.

  • Stage One — Supervisee and supervisor eye the other for expertise or weakness.
  • Stage Two — Each attributes a degree of influence or authority to the other.
  • Stage Three — Conflict, defensiveness, avoiding, or attacking.
  • Stage Four — Resolution leads to a “working” stage for supervision.
  • Stage Five — Silent supervisor encouraging supervisees towards independence.

Behavioral supervision views client problems as learning problems; therefore it requires two skills: 1) identification of the problem, and (2) selection of the appropriate learning technique.

Transgenerational Supervision Models

The transgenerational models can also be referred to as intergenerational and multi-generational models with a primary focus of patterns of interaction, emotional dynamics, and organizational structure. The distinguishing characteristics of transgenerational schools are:

  • valuing historical information,
  • belief that past behavior patterns influence both present and future patterns,
  • therapeutic outcomes extend beyond symptom reduction or control.

Psychodynamic/Psychoanalytic Supervision Models

A psychodynamic approach focuses on interactions between the mind, body, and environment, specifically to the relationship among individual internal experiences, conflicts, structures, functions, and processes. A psychoanalytic approach can be classified into three categories,

  • classical psychoanalytic,
  • object relations.
  • self-psychological, and

The psychodynamic/psychoanalytic supervision models provide more opportunity to blur the boundaries between treatment and training because of the necessity to speak to counter-transference issues with the supervisee. The boundaries should be differentiated by stating that when the supervisee’s personal problems are addressed, it should be for the express purpose of enhancing the therapist’s abilities and skills in treating the client rather than focusing on the resolution of the therapist’s personal conflict.

Social Role Models

The Social Role Model was propagated by Ekstein with the famous quote: “Supervision of psychotherapy: Is it teaching? Is it administration? Or is it therapy?” So the great question may have no answer or it may be all the answer options. Most believe that supervisors must assume different roles with supervisees chosen from a bank of options resembling the following:

  • Developmental stage;
  • Theoretical orientation;
  • Nature of specific issue.

Psychotherapy Based Models

Based on the use of specific theories of psychotherapy, this method adheres to Putney, Worthington, and McCullough. The psychotherapy-based theories, Rogerian theory, and behavioral theory have long been popular schools of supervision. In the 1980s, other schools gained in popularity.  The psychotherapy based model has three orientations:

  • Psychodynamic;

This philosophy is that counselor supervision is an extension of the idea that supervision is similar to counseling and psychotherapy making it a therapeutic process focused on intrapersonal and interpersonal dynamics in the relationships between all the parties in the clinical supervision relationship.

In this model, the supervisor often uses a parallel process as a context to teach and learn from. So if the parallel process is the environment within which the learning takes place, then internalization is the developmental process in which learning occurs.

Then interpersonal dynamics which exist between the supervisee and the client are important on a verbal and nonverbal communication level. The supervisee is to be a sensitive and effective communicator to the client all the while receiving and accepting explicit and implied communication from the client.

  • Behavioral;

The behavioral model of the Psychotherapy Based Models arose as a reaction to the Freudian emphasis on the unconscious. It originated from the theory, goals, skills, and practices of behavioral theory. Traditional behavior therapy is concerned with changing maladaptive behaviors with little or no emphasis on the causes of those behaviors whereas behavioral theory places the counselor’s role as comprised of discrete tasks with a required skill that can be behaviorally defined.

The skill behaviors include the supervisee’s feeling, thinking and acting behaviors. Each of these skill behaviors exist at difficulty levels ranging from fundamentally simple to advanced. Two of the most powerful principles to learning these skills is through modeling and reinforcement.

Cognitive model maintains that supervision should be focused, structured and education with all parties of the clinical supervision triad. This structure should include individual one hour supervision sessions weekly and supplemental group supervision sessions scheduled biweekly.

Cognitive behavioral techniques such as covert modeling, mental practice and cognitive modeling are applied and adapted to all the supervision sessions. Then there is also the cognitive behavioral interventions of cognitive restructuring, cognitive self-instruction and cognitive self-management which are actively utilized in this supervision model.

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