Supervision Boot Camp

Supervision Boot CampHow to be a Super-1:

AKA Supervision 101

BHECN presents:

How to be a Super- 1 !

Dr. Chasek and her Super FriendsDr. Marley DoyleDr. Cate Jones-HazledineDr. Tara Wilson Dr. Alison Grennan

June 10, 2021

Welcome to BHECN!

2021 | Behavioral Health Education Center of Nebraska

Marley Doyle, M.D.

• Director of BHECN

• Director of the Adult Outpatient Division

• Associate Program Director for the Creighton-

UNMC Psychiatry Residency

• Co-chair of the Graduate Medical Education (GME)

Steering Committee

• Joint appointment with the UNMC OB/GYN

Department and provides consultation to the Olson

Center for Women’s Health.

The Behavioral Health Education Center of Nebraska (BHECN, pronounced “beacon”) was created by the Legislature to address the shortage of behavioral health professionals in rural and underserved areas. BHECN recruits & educates students in behavioral health and trains & retains professionals in the workforce.

By increasing the number of behavioral health professionals, improving accessibility of behavioral health care, and building competence of the workforce, we are improving the health of all Nebraskans.

Learn more at unmc.edu/bhecn

About BHECN

Keep up with the latest events and trainings from BHECN:facebook.com/BHECN

Why Supervision?

Defining Supervision

The Role of the Clinical Supervisor

“The role of clinical supervisor is broadly viewed as one of the more important training functions in the field of mental health” Stoltenberg & McNeill (2010), (p.263).

What is Clinical Supervision?

An intense interpersonally focused one-to-one relationship in which one person is designated to promote the development of therapeutic competence in the other person. ACA Definition

Who is a Supervisor?

ACA Definition:

Counselors who are TRAINED to oversee the professional clinical work of counselors and counselors‐in‐training.

ACA Code of Ethics: F.2.a. Supervisor Preparation NBCC Code of Ethics Counselor Supervision C.a-i.

Counselors who have the Credentials by State regulation to supervise.

Who is a Supervisee?

ACA Definition

– A professional counselor or counselor‐in‐training whose counseling work or clinical skill development is being overseen in a formal supervisory relationship by a qualified, trained professional.

Responsibilities: Supervision Defined

“An intervention provided by a more senior member of a profession to a more 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 more junior person(s), monitoring the quality of professional services offered to the client(s) she, he, or they see(s), and serving as a gatekeeper for those who are to enter the particular profession.”

Bernard & Goodyear (2009, pg 7).

NE Dept. of Health and Human Services Regulation and Licensure : Mental Health

Qualified Supervisor means an individual who assumes the responsibility of supervision during the 3,000 hours of post‐master’s experience.

For mental health practice licensure, a qualified physician, a licensed psychologist, a licensed mental health practitioner, or a similar license/certification in another jurisdiction, who:

– Holds a current active license; and

– Has not had his/her license disciplined, limited, suspended, or placed on probation during the 1year immediately preceding the application for a provisional license. At least 1 year must have elapsed following completion of any disciplinary terms and conditions. If any of these actions are taken by the Department during the supervisory agreement period, the supervisor must terminate the supervision immediately and notify the Department. (p. 14)

NE Definition of Supervision: Mental Health

Supervision means the successful completion of 3,000 hours of supervised experience after receipt of the master's degree and during the 5 years immediately preceding the application for licensure and/or certification.

The supervised experience must:

1. Focus on raw data from the applicant's clinical work which is made directly available to the supervisor through such means as written clinical materials, direct observation, and video and audio recordings;

NE Definition of Supervision: MH

2. Include a process which is distinguishable from personal psychotherapy or didactic instruction; and

3. Consist of at least 1,500 hours of direct client contact in a setting where mental health services are being offered during which:

a. The supervisee apprises the supervisor of the diagnosis and treatment of clients;

b. The clients' cases are discussed;

c. Ethical principles of the profession are discussed;

NE Definition Supervision: MH d. The supervisor provides the supervisee with oversight and guidance in treating and dealing with clients; and

e. The supervisor evaluates the

supervisee's performance. (p 16)

NE Dept. of Health and Human Services Regulation and Licensure : LADCClinical Supervision is supervision directed towards enhancing and promoting the clinical skills and competencies of persons who are earning the 6,000 hours of clinical work experience by providing alcohol and drug counseling pursuant to 172 NAC 15‐004.

Clinical Supervisor is the person directly responsible for supervising the 6,000 hours of clinical work experience set out in 172 NAC 15‐004 and who holds the credential specified in 172 NAC 15‐004.01, item 3e.

NE Dept. of Health and Human Services Regulation and Licensure : LADC

The clinical supervisor must hold one of the following credentials:

(1) Licensed Alcohol and Drug Counselor as defined in 172 NAC 15-002; or

(2) A reciprocity level alcohol and drug counselor credential issued by a member jurisdiction of the IC&RC/AODA, Inc. or its successor (for clinical work experience obtained outside the State of Nebraska); or

(3) The highest level alcohol and drug counselor credential issued by a jurisdiction that is not a member of the IC&RC/AODA, Inc. or its successor if the credential is based on education, experience, and examination that is substantially similar to the license issued in this state as determined by the Board (for clinical work experience obtained outside the State of Nebraska); or

(4) Physician or psychologist licensed under the Uniform Licensing Law,

NE Dept. of Health and Human Services Regulation and Licensure : LADC

The clinical supervisor must:

(1) Be formally affiliated with the program or agency in which the work experience is gained;

(2) Not be a family member; and

(3) Provide at least 1 hour of evaluative face‐to‐face clinical supervision for each 40 hours of paid alcohol and drug counseling work experience. Face‐to‐face clinical supervision may include interactive video conferencing/phone conferencing up to 50% of the time. The format for supervision must be either one‐on‐one or small group. Methods of supervision must include case review and discussion, physical review of written records, and direct observation of a counselor’s clinical work.

Legal and Ethical Issues: Respondeat Superior Latin, [Let the master answer.] A common-law doctrine that makes an employer liable for the actions of an employee when the actions take place within the scope of employment.

The common-law doctrine of respondeatsuperior was established in seventeenth-century England to define the legal liability of an employer for the actions of an employee. The doctrine was adopted in the United States and has been a fixture of agency law. It provides a better chance for an injured party to actually recover damages, because under respondeat superior the employer is liable for the injuries caused by an employee who is working within the scope of his employment relationship.

Cornell Law School

ACA Code of Ethics

Section F: Supervision, Training and Teaching

– Outlines counselor supervision and client welfare, credentials, informed consent and client rights, Supervisor responsibilities, competence, and evaluation.

• ACA Code of Ethics, 2014

Risks-Liabilities-Responsibilities

You are responsible for the supervisee’s clients and as such are liable for the work the supervisee does with the clients.

You are also responsible for the training and growth of the supervisee.

Ethical and Legal Issues

Supervisors are responsible for training in three broad areas.

– Ethical knowledge and behavior

– Competency‐legal issues in practice

– Personal functioning

Types of Supervision

Two main types of supervision:• Student Supervision (pre-licensure)

• Master’s Level student practicums• Master’s Level student internships• Doctoral Program “externships”• Pre‐doctoral internships (sometimes students are provisionally licensed

at this point)• Supervising Provisionally Licensed Providers

• PLMHP• PLP (sometimes called a post‐doctoral fellowship)• State determined limits on the number of providers one can supervise

Student Supervision

• Issues:• Amount of supervision time varies, depending on training level

and requirements of different programs (typically 1 – 3 hours per week)

• Many students (especially Master’s Level Practicum) may not have had any prior clinical experience

Issues, Tasks, and Challenges

Student Supervision• Basic tasks are:

• Creating a comfortable supervision environment• Helping supervisees establish an ethical and

professional beginning clinical identity• Basic ethical issues • Professionalism• Introduction to clinical experiences

• Challenges can include• Accurately identifying amount/type/context of

previous clinical experience • Identifying when students are ready to proceed

to more clinical responsibility, and if re-training or additional coursework might be needed

This Photo by Unknown Author is licensed under CC BY‐SA‐NC

Supervising Provisionally Licensed Providers

• Issues:• Sometimes provisional providers have been students under

your supervision previously, sometimes they are new to your practice

• Match is important• Does the supervisee’s theoretical orientation align with

yours?• Do their supervision needs (structured vs. organic)

make sense with what you provide?

Supervising Provisionally Licensed Providers

• Basic Tasks are:• Providing structure and support for more

independently practicing providers• Helping providers transition from student to

professional identities• Challenges can include:

• Providing the “right” amount of scaffolding for providers to feel comfortable and still grow.

Issues, Tasks, and Challenges

Models of Supervision

What makes supervision super? And who determines it?• The supervisor• The supervisee• Or the client

But First….

Supervisee

Client

Supervisor


Just as the therapeutic relationship is a key factor that influences counseling effectiveness, so is the supervisory relationship.

Importance of the Therapeutic and Supervisory Relationships

Strong supervisory relationship

Strong therapeutic alliance

Effective treatment


Model: Systematic manner in which supervision is applied

Various models available to represent various supervision routines, beliefs, and practices

(Leddick, 1994)

What is it?


Provides• Direction• Intentionality• Purpose

Serves as a roadmap

Why do we need them?


Three Types of Models• Models Grounded in Theory (Orientation-specific Models)• Developmental Models• Social Role Models (Integrated Models)

(Bernard & Goodyear, 2009, Leddick, 1994)

Types of Models


Applying theoretical orientation to the supervisory relationship.

Behavioral- Learning problems, identifying the problem, selecting techniques, creating goals, using reinforcement, etc.

Client Centered- Empathy, Unconditional Positive Regard, Genuineness, etc.

Orientation-Specific Models

Orientation-Specific Models of Supervision

Benefits• Supervisor knows the theory well given their experience • When supervisor and supervisee share the same

orientation, modeling is maximizedDrawbacks• May be limiting• When orientations clash, resistance, conflict, and negative

parallel process may be present

Pros and Cons


• Embraces the developmental aspect of the novice helping professional’s identity

• Maximize and identify growth needed • As the supervisee develops, the behaviors of the supervisor

and the supervisory relationships evolves

• Three overarching levels• Beginning, Intermediate, and advanced

Developmental Models


Beginning• Supervisee may be dependent on the supervisor with regard

to diagnosis and treatment planningIntermediate• Supervisees becoming more independent• May embrace feedback for difficult clients but may be

hesitant to accept feedback for others• Resistance, conflict, and/or avoidance might be present in

the SR

A closer look at each level


Advanced• Supervisees function independently• Seek consultation when needed• Accept responsibility for their decisions

A closer look at each level (cont.)


Processes• Awareness• Motivation• Autonomy

Each Level includes:

Growth Areas• Intervention• Skills competence• Assessment techniques• Interpersonal assessment• Client conceptualization• Individual differences• Theoretical orientation• Treatment goals and plans• Professional ethics


• Designed to be employed with multiple therapeutic orientations

• A-theoretical• Attention to 3 supervisory roles and 3 areas of focus

Integrated Models

Discrimination Model

Supervisory Roles• Teacher• Consultant• Counselor

Areas of Focus• Process• Conceptualization• Personalization

Roles and Foci


TeacherFocuses on some knowledge or expertise that supervisor wishes to transmit to counselor

CounselorPlaces priority on the supervisee’s personal needs, with the belief that this focus will allow the supervisee to overcome the nervousness or self‐doubt that impedes natural development

ConsultantFocuses on a relationship with the supervisee that is explorative in nature and assumes that the supervisee has the ability to express his/her supervision needs

(Bernard, 1979, p. 64)

Purpose of Each Role


Process SkillsOvert behaviors such as skills utilized when working with clients

Conceptualization SkillsConsiders supervisee’s ability to understand client, identify themes, apply theory, choose appropriate strategies based on client’s needs

Personalization SkillsUnderstanding one’s own feelings, values, beliefs, and attitudes (and client‘s)

(Bernard, 1979)

Purpose of Each Focus


• Important to diversify the approach to supervision to meet the needs of the supervisee

• Consider what function is the focus of the situation AND

• Consider what lens or role would be best to approach situation

• May vary based on • Client needs• Supervisee’s needs• Supervisee’s skill level• Supervisee’s development level

Situation Specific

Discrimination ModelCombining Roles and Foci


• Important not to overthink the process • Roles and Foci can change not only across sessions but

also within a session• Reflection on the supervisor’s part may be helpful when

feeling ‘stuck’• Am I teaching too much or not enough?

• Is the supervisee skilled enough in this function for me to take on a consultation role?

• Is there an underlying value or belief of the Supervisee’s that is interfering with the session?

In Action

Supervision Models

3 Types• Orientation Specific• Developmental• Integrative

Brief introduction provided, be sure to seek out additional information to enhance overall use of each model.

In Summary

Questions and Next StepsJune 10 How to be Super - 1

aka: Supervision 101Dr. Tina Chasek & her SuperFriends

July 8 Telephone Booths - Not Just for Quick Changesaka: Telehealth DecisionTree

Dr. Allison Grennan

August 12 Saving AllTheir Daysaka: Managing Suicidal & Self Injurious Clients

Dr. Cate Jones-Hazledine

September 9 Capes or No Capesaka: Professionalism in Dress and Interactions

Dr. Marley Doyle

October 14Gatekeeping: Are they part of the team or not?aka: Dealing with students/supervisees with dramaticallydifferent skilllevels

Dr. Tina Chasek

November 11 How to be Super - 2aka: Increasing Confidence & Competency

Dr. Cate Jones-Hazledine

December 9 Dealing with Rogue Reportersaka: Ethics in Supervision

Dr. Tara Wilson

References

Bernard, J. (1979). Supervisor training: A discrimination model. Counselor Education and Supervision, 19(1), 60-68.

Bernard, J. & Goodyear, R.K. (2009). Fundamentals of Clinical Supervision (4th Ed.). Person education, Upper Saddle River: New Jersey.

DePue, M. K., Liu, R., Lambie, G. W., & Gonzalez, J. (2020, April 30). Examining the Effects of the Supervisory Relationship and Therapeutic Alliance on Client Outcomes in Novice Therapists. Training and Education in Professional Psychology. Advance online publication. Http://dx.doi.org/10.1037/tep0000320

Lambert, M. J., & Cattani-Thompson, K. (1996). Current Findings Regarding the Effectiveness of Counseling: Implications for Practice. Journal of Counseling & Development, 74(6), 601–608. https://doi.org/10.1002/j.1556-6676.1996.tb02299.x

Martin, D. J., Garske, J. P., & Davis, M. K. (2000). Relation of the therapeutic alliance with outcome and other variables: A meta-analytic review. Journal of Consulting and Clinical Psychology, 68(3), 438–450. https://doi.org/10.1037/0022-006X.68.3.438

Questions?Dr. Tina Chasek 308-830-2597

[email protected]/bhecn

Supervision Boot Camp Websitehttps://www.unmc.edu/bhecn/education/online-training/supervision_boot_camp.html

Follow BHECN Facebook: https://www.facebook.com/BHECNTwitter: https://twitter.com/BHECN1LinkedIn: https://www.linkedin.com/company/29090187/admin/

Marley Doyle, M.D.

Director of [email protected]: @DrMarleyDoyle

More information about BHECN can be found atwww.unmc.edu/bhecn

Follow BHECN Facebook: https://www.facebook.com/BHECNTwitter: https://twitter.com/BHECN1LinkedIn: https://www.linkedin.com/company/29090187/admin/

Supervision Boot Camp

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Transcript of Supervision Boot Camp