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					   Models of Supervision

                  Kerry Smith


University of Hull, Department of Clinical Psychology
          What is Supervision ?

• There is no one model of supervision
• Different therapies develop different models
• Often an assumption that therapy skill =
  supervisory skill (Ricketts and Donohoe 2000)
• Often agreement about what constitutes bad
  supervision but less clarity about the tasks
  needed for good supervision (Magnuson et al
  2000)
        What is Supervision?
• “Clinical supervision is an intensive,
  interpersonally focused relationship in
  which..the supervisor is designated to
  facilitate the development of therapeutic
  competence in the supervisee”

 (Bernard and Goodyear, 1992)
        What is Supervision?
• “Supervision is a formal relationship in
  which the supervisor’s task includes
  imparting expert knowledge, making
  judgements of the trainee’s performance,
  and acting as a gatekeeper to the
  profession”

 Holloway, 1997
        What is Supervision ?
• “Supervision provides a container that holds
  the helping relationship within the
  therapeutic triad”



 Hawkins and Shohet, 1989
        Experiential Learning Cycle
               Kolb (1984)
                        Experience


Active
experimentation                                Reflection




                  Abstract Conceptualisation
             Learning Styles
    Riding and Cheema (1991)

               Wholistic




Verbaliser                 Imager




                Analytic
      Models of Supervision
• Developmental Model: Stoltenberg and
                        Delworth(1987)
• Functions Model: Kadushin(1976) Proctor
  (1987)
• Key Issues Model: Gilbert and Clarkson
• Training Models:Holloway (1995)-A
  Systems Approach
• Process Models: Hawkins and Shohet
• Therapy specific Models
            Developmental model
           Stoltenberg &Delworth
Level 1            Level 2              Level 3           Level 4
Child              Adolescent           Early Adulthood Maturity

Dependent on        Fluctuating         Increased self-   Autonomous
supervisor          autonomy            confidence
Anxious/insecure Fluctuating            Increased insight Personal security
                    confidence
Difficulty in self-                                       Self aware
evaluation
Motivated           May become          Stable motivation Stable motivation
                    disillusioned and
                    blame supervisor
Single focused      Aware of            Sees client in    Addresses
on specifics not complexity of          wider context     personal and
whole               therapy                               professional
                                                          issues in context
    Integrated Developmental Model -Stoltenberg and Delworth
level             Motivation            Autonomy                Self-other
                                                                awareness
1                 High motivation        Dependent on           Limited self-
                  High anxiety          supervisor, need        awareness. Focus
                  Focus on skills       for structure, direct   on self: anxiety
                  acquisition           feedback, minimal       performance
                                        direct                  Difficulty seeing
                                        confrontation           strengthsweakness

2                 Fluctuating.          Dependency-             Focus more on
                  More complexity       autonomy conflict.      client, can
                  shakes confidence.    Specific help           empathise. May
                                        Dependent/evasive       become enmeshed,
                                                                need balance
3                 Stable                Firm belief own         Accepts strengths/
                  Remaining doubts      autonomy                weaknesses
                  not disabling         Sense of when           Can focus on client
                  Total professional    necessary to seek       and process info.
                  identity and how      consultation            Including use of
                  therapist role fits                           own reactions.
      Development of skills and
       knowledge acquisition
• Dreyfus Scale of Competence (1989)
• “Novice” to “Expert”
• Novice: “rigid adherence to taught rules”,
  unable to use discretionary judgement.
• Expert: Able to work with flexibility away
  from rules using a “deep tacit
  understanding” of the theory, relying on
  their own judgement.
                   Task:
• Using this developmental framework
  suggest how supervision should be adapted
  for a first, second and third year trainee.
• Think about how supervision should be
  delivered?
• The main focus of supervision
• The types of cases/interventions provided
• The techniques used in supervision
     Implications for Supervision/
        Training across levels
• Level One:
• Provide structure, manage anxiety,
  supervisor as expert role model, clarity of
  skills and theory.
• Clients: Mild /maintenance problem focus
• Interventions: Facilitative, prescriptive
• Mechanisms:Observation, skills training,
  role play
     Implications for Supervision/
        Training across levels
• Level Two:
• Less structure, encourage more autonomy,
  continue use of modelling bur less diadactic
• Clients: More difficult ,severe presentations
• Interventions: Facilitative, occasionally
  prescriptive, confrontive, hightlight process
• Mechanisms: Observation.less role play,
  process focused
     Implications for Supervision/
        Training across levels
• Level Three:
• Most structure provided by the trainee,
  more focus on personal /professional
  integration (don’t assume this level for all)
• Interventions: Facilitative, Confrontive
  occasionally, conceptual from personal
  orientation, process, re blocks
• Mechanisms: Peer/ Group supervision
          Developmental model
•   Level 1: Self centred
•   Level 2: Client centred
•   Level 3: Process centred
•   Level 4: Process in context centred

• Developing, maturing, terminating, master
  practitioner
       Developmental models
• Can guide supervisors in assessing needs
• Emphasises aim of development
• Emphasises need for supervision process to
  develop with trainee
• If used too prescriptively may detract from
  individual nature of supervision
• Supervisors developmental process not a
  focus
  Developmental models -common
            factors:
• Focus on change from dependence on
  supervisor/trainer to independence
• Focus on treatment skills early on in learning
  process
• The development of conceptualisation skills later
  on through the learning process
• The development of the ability to incorporate
  understanding of the therapist’s own reactions and
  the wider service relationship into
  conceptualisation and intervention later in
  development.
     Functions of supervision-
        Kadushin (1976)

• Educative

• Supportive

• Managerial
            Functions model
             Proctor(1987)
• Normative-maintenance of professional
  standards and managerial issues

• Restorative- support and stress reduction

• Formative- skills and knowledge
  development
    Key Issues:Gilbert and Clarkson
•   Reduction of harm
•   Ethics/professional practice
•   Skills /techniques
•   Conceptual framework
•   Transference/Countertransference
•   Developmental
•   Personal issues
•   Treatment/ Goals
•   Assessment
Training models: A Systems Approach
Holloway (1995)

• Goals of model: to analyse learning within
  the context of relationship
• Uses a supervision process matrix
• Supervision tasks + functions= process
• Helps to illustrate change in focus and
  different styles of supervision
           Holloway (1995)
• Tasks: Therapy skill, conceptualisation,
  professional role, emotional awareness, self
  evaluation

• Functions: monitoring/evaluating,
  advising/instructing, modelling, consulting,
  supporting/ sharing
                   Task:
• Think about:
• What do you consider is the main task of
  supervision?
• What function would you use?
                   Examples
• A first year trainee talks openly about self
  disclosure that they have used in a clinical session.
  When you hear their tape they sound chatty and
  overly informal. The client is new to the service
  and asks a lot of questions.
• You hear a third year trainee inappropriately
  disclosing personal information to an established
  client. The client is of similar age and background
  to the trainee
              Process Matrix



          Supervision Therapist   Client




Hawkins and Shohet
        Supervision Process :
      Six Modes of Supervision
          Hawkins and Shohet, 1989

1)Reflection on the content of Therapy

2)Exploration of interventions by therapist

3)Exploration of therapy process/ relationship
       Modes of supervision
     Hawkins and Shohet, 1989
4) Focus on therapist’s counter-transference

5) Focus on here and now process as a mirror
  of the there and then process

6) Focus on supervisor’s counter-transference
    The Model within its wider
            context
• Mode One : client plus client’s wider social
  context
• Mode Six- A: Fantasy relation ship between
  client and supervisor
• Mode Seven:The general organisational,
  social and political context in which the
  work is taking place
       Integrating the process

• Good supervision should involve all modes

• Different modes will be emphasised due to :
     Developmental level of trainee
     The nature of work being undertaken
     The style of the supervisee
     The personality of the supervisee
      Therapy Specific Models
• Eg: Cognitive Therapy, Cognitive Analytical
  Therapy, Psychodynamic Therapy
• Structure and processes and techniques in
  supervision parallel those of a therapy session.
• Advantages: Provides modelling of therapy skills
  in supervision. Learning by reflexive practice
        Hawkins and Shohet
• Modes in detail:
        Mode one: The client
• Aim: Help the therapist enhance their feel
  for the person.

• Techniques: Focus on image of client,
  extract new information
            Mode two:
   Client/Therapist intervention
• Aim: Help the therapist to move past stuck
  point

• Techniques: Focus on stuck moment, “What
  would you like to have done”
            Mode three:
    Client/Therapist interaction
• Aim: Recognise roles of both parties in the
  relationship

• Techniques: What would happen if you
  were on a desert island together? Find a
  metaphor for the relationship
     Mode four:The Therapist

• Aim : To explore what is being pulled from
  therapist?

• Techniques: Who does the client remind you
  of? What’s going on inside you?
           Mode five:
 Therapist/Supervisor interaction

• Aim:To model reflective behaviour

• Techniques: Reflect feeling back, share
  feelings, See-it-feel it -name it.
     Mode six: the Supervisor
• Aim: explore what is pulled from the
  supervisor

• Techniques: What is this like for me?
  Boundaries/power differentials shape how
  insight is used
                           References
•   Proctor, B. (1994) Supervision-competence, confidence, accountability. British
    Journal of guidance and counselling, Vol. 22,No3

•   Dreyfus H.L. and Dreyfus S.E. (1986) Mind over Machine: the power of
    Human Intuition and Expertise in the era of the computer. Free Press
•   Stoltenberg C.D. and McNeill B.W. (1997),Supervison from a developmental
    perspective: Research and Practice. inWatkins C.E. (1997) Handbook of
    Psychotherapy Supervision. John Wiley and sons Ltd.
•    Stoltenberg C.D. and Delworth (1987), Supervising Counsellors and
    Therapists, San Fransisco. Jossy -Bass
•   Holloway E. (1997) Structures for the analysis of teaching and
    supervision.inWatkins C.E. (1997) Handbook of Psychotherapy Supervision.
    John Wiley and sons Ltd.
•   Hawkins, and Shohet