A lecture about models of clinical supervision in mental health

1. Chapter Two
• Supervision Models
– Theory Driven
• Humanistic-Relationship Oriented
– Developmental
• Integrated Developmental Model
– Process
• Discrimination Model

2. Developmental Approaches to
Supervision
• Counselor skill levels change over time
• Change may be conceptualized in a number of
ways
– Psychosocial development
– Cognitive and Social learning theory
• Developmental Models help the supervisor to
identify the needs of the supervisee
– And how to best address them
• Developmental Models = “Case
Conceptualization” of the Supervisee

3. Integrated Developmental Model
• Three Structures that provide markers in
assessing professional growth
– Self/Other Awareness – Cognitive and Affective
• Is the Supervisee capable of “theory of mind” experiences
– Motivation – The Supervisee’s interest, investment,
and effort expended in clinical training and practice
– Autonomy – The degree of Supervisee independence

4. IDM: Four Stages of Development
• Level 1: Limited training and/or experience in the
field
– Motivation: Strong, very anxious, focused on skill
acquisition
– Autonomy: Dependent; needs structure, positive
feedback, little confrontation
– Awareness: High self-focus; limited self awareness;
anxious about evaluation

5. IDM: Four Stages of Development
• Level 2: Transitional; still student-intern level
– Motivation: Fluctuations in confidence
– Autonomy: Fluctuations; “adolescent” stage; may show
resistance to supervision
– Awareness: Greater empathic skills; May struggle with
balance
– Note: Can be a turbulent stage; similar to “middle stage of
psychotherapy;” helps to have a sense of humor

6. IDM: Four Stages of Development
• Level 3: Personalizing Approach to Therapy; new
professional
– Motivation: Consistent; some doubts, not
immobilizing
– Autonomy: Solid belief in competence; supervision is
collegial
– Awareness: Health self awareness; able to attend to
self and client needs simultaneously

7. IDM: Four Stages of Development
• Level 3i: Integrated: Level 3 Characteristics Across
most domains
• Domains:
Intervention skills Assessment Techniques
Interpersonal Assessment Client Conceptualization
Individual Differences Theoretical Orientation
Treatment Plans/Goals Professional Ethics

8. IDM: Facilitative Interventions
• Cathartic: Elicit Affective Reactions
• Catalytic: Open ended questions to elicit self
exploration or problem solving
• Supportive: Validations of the Supervisee

9. IDM: Authoritative Interventions
• Prescriptive: Advice and Suggestions
• Informative: Providing Information
• Confronting: Pointing out discrepancies in
Affect, Behavior, and/or Attitudes

10. IDM: Supervisee Schemata
• Knowing In Action:
– The Supervisee’s Automatic Responses, Behaviors,
Attitudes
• Reflection In Action:
– The Supervisee’s capacity to be aware of what is
occurring in the session
• Reflection On Action:
– The Supervision process supplements the RIA, which
may or may not have occurred

11. Supervision Process Models
• Simple or Complex Ways of understanding
how supervision occurs
– Psychotherapy based models are concerned with
passing on a particular approach to psychotherapy
– Developmental models are concerned with the
learning process of the supervisee

12. Discrimination Model
• Foci of Supervision X Role of the Supervisor
– Foci = Particular Skills of the Supervisee
• Intervention Skills
• Conceptualization Skills
• Personalization Skills
– Roles = Appropriate Posture to Accomplish
Supervision Goals
• Teacher
• Counselor
• Consultant

13. Focus and Role Interactions
Focus of
Supervision
Teacher Counselor Consultant
Intervention Skills Supervisor models
skills through role
play with
Supervisee
Supervisor may use
empathic responses
to elicit Supervisee
feelings
Supervisor provides
resources (e.g.
Mood Charts) for
Supervisee to use
Conceptualization
Skills
Supervisor reviews
transcripts with
Supervisee,
identifying client
Signs, Symptoms,
and Issues
Supervisor notes
Supervisee
Cognitive
Distortions and
Processes their
Impact on Therapy
Supervisor provides
resources
concerning theories
not well know to
Supervisee

14. Focus and Role Interactions
Focus of
Supervision
Teacher Counselor Consultant
Personalization
Issues
Supervisor, in
reviewing
recording, points
out exchanges that
indicate
incongruencies
Supervisor
empathically
explores
Supervisee’s
feelings in this area
Supervisor provides
feedback
concerning how
well (or poorly)
Supervisee handled
the relationship
from an ethical
perspective

15. Focus and Role Interactions
• Supervisors tend to use Teaching role with Novice
Supervisees
– Evolve toward Consulting role as Supervisee becomes
experienced
• Supervisors tend to focus on intervention and
conceptualization skills with Novice Supervisees
– Evolve toward Personalization issues as Supervisee
becomes experienced

16. Framework for Supervisory Styles
• Supervisors Goals tend to be:
– High on Support; Low on Direction
• Supervisees Want Supervisors to be:
– High on Support AND Direction
HIGH SUPPORT LOW SUPPORT
HIGH DIRECTION Supportive Teacher Directive or Expert Teacher
LOW DIRECTION Counselor Consultant

17. A Final Thought…
• Common Factors Model
– There are factors in supervision that are common to
those in counseling, teaching, and ALL relationships
– Lampropoulos (2003) proposed:
The Relationship Support/Relief from Tension etc.
Instillation of Hope Self-Exploration, awareness
Rationale/Ritual Exposure & Confrontation
Acquisition & Testing of New Learning
Mastery of New Knowledge

18. One More Final Thought…
• Supervision, like Therapy is a Conversation
• “Conversation” implies Conversion
– Conversion of Mind
– Conversion of Affect
– Conversion of Behavior
– Conversion of Heart
– Conversion of Soul