Clinical Supervision

The purpose of supervision in mental health counseling is to enrich the clinician’s attitudes, knowledge and skills in order to competently provide quality care resulting in improved clinical outcomes.

In the context of evidence-based mental health practices, clinical supervision is a useful tool in disseminating evidence-based practices and ensuring the fidelity and effectiveness of a treatment program.

Three Components of Supervision

  • Educational/Clinical – the supervisor teaches therapeutic skills and helps the clinician develop self-awareness in order to better the therapeutic interactions with clients.
  • Administrative – objectives of the agency/organization’s policy and public accountability are transformed into tasks to be accomplished by the clinician.
  • Supportive – the supervisor guides the clinician in finding ways to decrease job related stress in order to improve job performance.

The Goals of Supervision

  1. Promoting supervisee growth and development through teaching.
  2. Protecting the welfare of the client.
  3. Monitoring supervisee performance and gatekeeping for the profession.
  4. Empowering the supervisee to self-supervise and carry out the above goals as an independent professional.

The Roles of a Supervisor

  1. Teacher.
  2. Mentor.
  3. Consultant.
  4. Career counseling.
  5. Sounding board.
  6. Advisor.
  7. Administrator.
  8. Evaluator.
  9. Recorder and documenter.
  10. Empowerer.

Qualities of a Good Supervisor

  1. Warm and supportive.
  2. Provides useful feedback and constructive criticism.
  3. Experience and effectiveness as a mental health clinician.
  4. Possesses good clinical insight.
  5. Empathic – ability to be present with a supervisee.
  6. Adheres to ethical practices.
  7. Ability to support and challenge.
  8. Multicultural awareness.
  9. Training as a supervisor.
  10. Ability to manage multiple tasks, relationships and levels.
  11. Available and approachable.

References:

Fall, M. & Sutton Jr, J. M. (2004). Clinical Supervision: A Handbook for Practitioners. Boston, MA: Pearson Education, Inc.

Haynes, R., Corey, G., & Moulton, P. (2003). Clinical Supervision in the Helping Professions: A Practical Guide. Pacific Grove, CA: Brooks/Cole Thompson

Models of Clinical Supervision

There are a number of models or theoretical frameworks that supervisors may utilize in supervision. The models are applicable to both individual and group supervision. The models used in supervision allow clinicians to see the theories demonstrated and apply them to practical sessions with clients. Many supervisors use a combination of the models in practice to develop their own personal supervision style. 

  • Developmental models meet the clinician where they are at in their professional development. Supervision is tailored to meet the professional needs of novice to advanced clinicians. In general, this may be broken down into three stages representing the independence of the supervisee, from least to most, as they develop through practice and supervision.
    • Integrative Developmental Model (IDM) – the IDM model is one of the most popular developmental models. This model was developed by Stoltenberg, McNeill and Delworth in 1998 and has a backing of ten years of research. The model is based on three levels of the supervisee’s development: novice (entry-level), intermediate (process-issues) and advanced (independence or a consulting relationship). The model works well with recent graduates.
    • An expanded developmental model - introduced by Skovholdt and Ronnestad in 1992, it focused on eight stages of clinician development. These eight stages include: competence, transition to professional training, imitation of experts, conditional autonomy, exploration, integration, individuation and integrity.
    • Supervision based on Attachment Theory - infant neurobiology attachment patterns continue into adulthood and play out in numerous relationships including that of supervisor and supervisee. Supervisors can learn about their supervisee’s attachment patterns through their interaction in supervision and tailor supervision to such an attachment pattern. In general, secure attachment outcomes between supervisor and supervisee are useful and important in clinical work.
  • Psychotherapy-based models utilize psychotherapy theory to apply similar techniques used with clients in the supervision setting. In these models, there is a great deal of focus on the client-clinician and clinician-supervisor relationships and interactions.
    • Psychodynamic Model – the focus in this model is on the client-clinician interactions and its effect on the outcomes of sessions. Supervisors focus on concepts such as transference and parallel processing during supervision.
    • Person Centered Model – the focus in this model is on the supervisee–supervisor relationship in which the supervisor is not seen as any more of an expert than the supervisee. The goal of supervision is to work on developing a warm, welcoming environment where the supervisee is able to bring their concerns to the table and engage in a collaborative process with the supervisor.
    • Cognitive-Behavioral Model – similar to that of using CBT with clients, supervisors work with clinicians to learn how their own cognitions affect their skills in session with clients and work to change cognitions to improve session outcomes with clients.
    • Family Therapy Model – this model of supervision is mostly used with clinicians who work with families. The idea behind the model is for the supervisor to work with the clinician through their own family of origin history and learned behavior in order to recognize how those affect their work with clients.
    • Feminist Model – similar to the other psychotherapy models, the feminist model stresses the collaborative relationship between supervisor and clinician following the principles of the model for feminist therapy. The goal for use of the model is to empower the clinician, recognize the power balance and discuss multiple perspectives in order to enhance the supervisee’s abilities. When using the feminist model, it is recommended that the supervisor state that this model of supervision will be used. This act models for the supervisee the clear and open communication expected from all parties.
  • Integrative models engage a variety of concepts, theories and strategies in supervision that reflect the integrative approach the clinicians are practicing. There are two approaches to integrating theories. The first is technical eclecticism, where ideas are borrowed from different schools of thoughts to create the integrated approach. The second is theoretical integration that aims to fuse theories into a more comprehensive theory.
    • Discrimination Model – supervision is tailored to the individual training needs of each clinician based upon their intervention skills, conceptualization skills and personalization skills. Each skill is reviewed separately and the supervisor determines whether their role is of teacher, counselor/coach or consultant.
    • Systems Approach to Supervision (SAS) – the SAS model provides a framework for supervisors to use in supervision that does not subscribe to any particular model. The SAS model provides specific goals of supervision, seven dimensions for the basis of supervision and the three stages of supervision in order to guide supervision education and practice.
    • Solution-Oriented Model – this model is based on family and narrative therapy and incorporates solution-focused techniques. The goal of this model is to allow the clinician to feel that they are the expert and thereby empowering them to come to their own solutions for practice.

References:

Bennett, S. & Deal, K. H. (2009). Beginnings and Endings in Social Work Supervision: The Interaction between Attachment and Developmental Processes. Journal of Teaching in Social Work, 29(1), 101-107.

Haynes, R., Corey, G., & Moulton, P. (2003). Clinical Supervision in the Helping Professions: A Practical Guide. Pacific Grove, CA: Brooks/Cole Thompson

Tips for Entering a New Mental Health Clinical Supervision Relationship

The initial meeting sets the tone for the supervisory relationship. Here are some tips and suggestions to prepare for the first supervision meeting.

  • Be prepared with questions to ask and be prepared to answer some questions.
  • Come prepared with information about your educational background and experience. It may be helpful to have a copy of a resume or CV.
  • Be prepared to discuss your theoretical orientation, populations you’ve worked with, your strengths and weaknesses, your goals for professional growth and skill development, any special interest you have  and your hopes for supervision.
    • Be mindful of how these ideas are communicated during the discussion.
  • Come familiar with the policies and procedures of how the agency deals with crisis and other emergencies. If you are unaware, this will be something you want to bring up and discuss.
  • Be prepared to talk about future supervision and the availability of your supervision.
  • Be prepared with an agenda of topics and items you think are important to touch on during supervision. This is helpful for each supervision meeting.

During the supervision session:

  • Be an active participant, be proactive.
  • Take initiative appropriately.
  • Monitor yourself and your reactions throughout the discussion.
  • Remain flexible.
  • Ask for what you need, do not make demands.
  • Take responsibility for learning and growth in supervision.
  • Self-assessment and reflection are the best tools for improving as a mental health clinician, learning as a supervisee and problem solving relationships with clients and supervisors.
  • Avoid blaming and focus on planning and problem solving.
  • Ask yourself what you can learn from your supervisor and do not focus on what your supervisor is not currently providing. Remember, you can ask for what you need.

Reference: Pearson, Q. M. (2004). Getting the Most Out of Clinical Supervision: Strategies for Mental Health Counseling Students. Journal of Mental Health Counseling, 26(4), 361-373.

Information for Specific Professions

  • OMH Guidelines - Under section 4.21 of this document is information regarding OMH’s standard of care for clinical supervision.
  • Social Workers - Basic practice guidelines for using and providing supervision.
  • Mental Health Counselors - Basic information about supervision for Mental Health Practitioners including: Creative Arts Therapists, Marriage and Family Therapists, Mental Health Counselors and Psychoanalysts. This information also comes from the New York State Education Department.
  • OASAS CASACs - CASAC scopes of practice including requirements for clinical supervisors. OASAS also provides additional information on administrative and clinical supervision definitions and minimum requirements.  
  •  Psychologists - Basic practice guidelines for providing supervision. 

Clinical Supervision Podcasts

Episode 5 - Dr. Lawrence Shulman: Models of Supervision: Parallel Processes and Honest Relationships

What is supervision? Peter Sobota, Clinical Assistant Professor at the UB School of Social Work, speaks with Dr. Lawrence Shulman, Professor and Dean Emeritus of the UB School of Social Work, about the nature of supervision in direct practice and administration. During their conversation they touch upon issues of power, authority, trust and role clarity, to name a few.

Episode 9 - Professor Hilary Weaver: Culturally Competent Supervision

This episode features Professor Hilary Weaver speaking at the Fourth International Interdisciplinary Conference on Clinical Supervision, convened in Buffalo, NY, spring 2008. Dr. Weaver discusses diversity issues in the context of supervision, highlighting the Transactional Model of Identity and the critical role supervisors have in promoting, modeling and developing cultural competence within human service organizations.

Episode 12 - Dr. Cal Stoltenberg: Evidence-Based Clinical Supervision (part 1 of 2)

This is the first of a two part podcast by Dr. Cal Stoltenberg about the art/science of clinical supervision. In this episode, Dr. Stoltenberg addresses the difference between supervision and clinical work with clients. He cautions against becoming too focused on distinct competencies, and recognizes the need to implement quality training. In addition, Stoltenberg notes that there are different models of supervision, and that individual characteristics and culture must be factored into the clinical supervision relationship.

Episode 14 - Dr. Cal Stoltenberg: Evidence-Based Clinical Supervision (part 2 of 2)

This is the second of two episodes in which Dr. Stoltenberg talks about the art/science of clinical supervision. In Part 2, Dr. Stoltenberg tackles the question, "How do we evaluate what's occurring in supervision and how is it affecting work with clients?" Stoltenberg suggests that supervision should be concerned with tracking what clinicians are implementing with clients, how are they implementing it and how effectively it is working.

Episode 137 - Eda Kauffman: Clinical Supervision: Integrating a Trauma-Informed Lens

In this episode, Eda Kauffman explains how she came to incorporating a trauma-informed lens into her work as a clinical supervisor. She describes how trauma-informed clinical supervision is different from traditional supervision. She also explores its use in social work field education.