Models of Supervision

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Models of Supervision
Kerry Smith
University of Hull, Department of Clinical
Psychology
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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)

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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)

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What is Supervision?

• Supervision is a formal relationship in which
  the supervisors task includes imparting expert
  knowledge, making judgements of the trainees
  performance, and acting as a gatekeeper to the
  profession
• Holloway, 1997

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What is Supervision ?

• Supervision provides a container that holds the
  helping relationship within the therapeutic
  triad
• Hawkins and Shohet, 1989

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Experiential Learning Cycle Kolb (1984)
Experience
Active experimentation
Reflection
Abstract Conceptualisation
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Learning StylesRiding and Cheema (1991)
Wholistic
Verbaliser
Imager
Analytic
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Models of Supervision

• Developmental Model Stoltenberg and
  Delworth(1987)
• Functions Model Kadushin(1976) Proctor (1987)
• Key Issues Model Gilbert and Clarkson
• Training ModelsHolloway (1995)-A Systems
  Approach
• Process Models Hawkins and Shohet
• Therapy specific Models

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Developmental modelStoltenberg Delworth
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Integrated Developmental Model -Stoltenberg and
Delworth
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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.

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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

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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
• MechanismsObservation, skills training, role
  play

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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

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Implications for Supervision/ Training across
levels

• Level Three
• Most structure provided by the trainee, more
  focus on personal /professional integration
  (dont assume this level for all)
• Interventions Facilitative, Confrontive
  occasionally, conceptual from personal
  orientation, process, re blocks
• Mechanisms Peer/ Group supervision

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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

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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

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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 therapists own reactions
  and the wider service relationship into
  conceptualisation and intervention later in
  development.

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Functions of supervision- Kadushin (1976)

• Educative
• Supportive
• Managerial

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Functions modelProctor(1987)

• Normative-maintenance of professional standards
  and managerial issues
• Restorative- support and stress reduction
• Formative- skills and knowledge development

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Key IssuesGilbert and Clarkson

• Reduction of harm
• Ethics/professional practice
• Skills /techniques
• Conceptual framework
• Transference/Countertransference
• Developmental
• Personal issues
• Treatment/ Goals
• Assessment

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Training models A Systems ApproachHolloway
(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

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Holloway (1995)

• Tasks Therapy skill, conceptualisation,
  professional role, emotional awareness, self
  evaluation
• Functions monitoring/evaluating,
  advising/instructing, modelling, consulting,
  supporting/ sharing

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Task

• Think about
• What do you consider is the main task of
  supervision?
• What function would you use?

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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

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Process Matrix
Supervision
Therapist
Client
Hawkins and Shohet
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Supervision Process Six Modes of
SupervisionHawkins and Shohet, 1989

• 1)Reflection on the content of Therapy
• 2)Exploration of interventions by therapist
• 3)Exploration of therapy process/ relationship

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Modes of supervisionHawkins and Shohet, 1989

• 4) Focus on therapists counter-transference
• 5) Focus on here and now process as a mirror of
  the there and then process
• 6) Focus on supervisors counter-transference

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The Model within its wider context

• Mode One client plus clients wider social
  context
• Mode Six- A Fantasy relation ship between client
  and supervisor
• Mode SevenThe general organisational, social and
  political context in which the work is taking
  place

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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

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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

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Hawkins and Shohet

• Modes in detail

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Mode one The client

• Aim Help the therapist enhance their feel for
  the person.
• Techniques Focus on image of client, extract new
  information

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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

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Mode threeClient/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

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Mode fourThe Therapist

• Aim To explore what is being pulled from
  therapist?
• Techniques Who does the client remind you of?
  Whats going on inside you?

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Mode five Therapist/Supervisor interaction

• AimTo model reflective behaviour
• Techniques Reflect feeling back, share feelings,
  See-it-feel it -name it.

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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

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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