See reviews of conceptual and empirical publications regarding supervision in several counseling disciplines in Shulman and Safyer, In recent years, signs of growing interest in and appreciation for the importance of clinical supervision for substance abuse counselors have appeared. This TIP is one example.
The most prominent definitions of clinical supervision have many common elements, although their emphases may be somewhat different. A social influence process that occurs over time, in which the supervisor participates with supervisees to ensure quality clinical care. Effective supervisors observe, mentor, coach, evaluate, inspire, and create an atmosphere that promotes self-motivation, learning, and professional development.
They build teams, create cohesion, resolve conflict, and shape agency culture, while attending to ethical and diversity issues in all aspects of the process.
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Such supervision is key to both quality improvement and the successful implementation of consensus- and evidence-based practices CSAT, , p. Clinical supervision is a disciplined, tutorial process wherein principles are transformed into practical skills, with four overlapping foci: Supervision is an intervention that is provided by a senior member of a profession to a more junior member or members of that same profession. Clinical supervision is an interpersonal tutorial relationship centered on the goals of skill development and professional growth via learning and practicing.
Through observation, evaluation, and feedback, supervision enables the counselor to acquire the competence needed to deliver effective patient care while fulfilling professional responsibilities. Supervision is a process whereby a counselor with less experience learns how to better provide services with the guidance of a counselor with more experience and skill. In fact, a clear boundary must exist between supervision and counseling. Clinical supervision for substance abuse counselors differs from supervision for other healthcare providers in several important ways.
This places those acting as supervisors as well as the agency at considerable legal risk. According to Eby et al. One-on-one discussions are the primary model of interaction between supervisors and counselors 90 percent reported , with group clinical supervision second 60 percent. Other forms of interaction include email 56 percent , written messages 41 percent , and telephone 52 percent. The primary modes of supervision include:.
Salaries remain a significant issue for counselors and clinical supervisors. There is no significant difference in salaries by licensure or certification Eby et al. Generally, counselors are only moderately satisfied with the overall quality of their supervisory relationship. Clinical supervisors are somewhat more satisfied than are counselors. Supervisors and counselors report feeling lukewarm as to whether the supervisory relationship is meeting their specific needs.
Generally, counselors and supervisors report perceived role overload, emotional exhaustion, and stress at work. It is important to point out that any significant level of burnout and exhaustion may have a detrimental effect on client care, job turnover, and employee satisfaction Eby et al.
These data are at variance with other studies. Caution should be exercised, however, when comparing data compiled in , given the significant changes that have occurred in the substance abuse treatment field in recent years. There are unique barriers to implementing clinical supervision programs and to improving the overall quality such programs where they exist. In a survey of substance abuse counselors, 30 percent reported that they did not receive supervision Culbreth, The situation has doubtless changed since this study was completed, as indicated by the Eby et al. Of those receiving supervision, respondents preferred weekly supervision sessions but had no preference for the gender of the supervisor Culbreth, Other studies indicate that supervisees prefer same-sex supervisors Alderfer, Culbreth and CSAT indicate that slightly more than half of the supervisors were male.
Although the group as a whole had no preference for whether the supervisor was in recovery, counselors without graduate-level training preferred supervisors in recovery over nonrecovering supervisors, according to Culbreth It is important to ask whether clinical supervision for substance abuse counselors is effective in improving their counseling skills. Although some studies approach this question for other groups of clinicians, Eby is the only one who has explored it with substance abuse counselors. However, again a note of caution: Perhaps this result might be attributed to generally higher rates of compensation in for-profit organizations.
Arguably, an even more important question is the degree to which quality clinical supervision translates into improved clinical skills and client outcomes. A second question is whether supervision is reflected in better client outcomes. It appears that there is no empirical evidence on this question regarding supervision for substance abuse counselors. Freitas reviewed ten studies of psychotherapy supervision and concluded that the research was generally of poor quality. Psychometric information for the measures used was lacking in most.
No statistical controls were in place for Type I and Type II errors, 1 and clients were not randomly assigned to therapists. Freitas points out that even defining and measuring client outcomes is fraught with difficulty. When the supervisor—supervisee relationship is added, it is not surprising that the effects of supervision are obscured. However, anecdotal evidence and common sense both lead one to believe that clinical supervision is of value and that some elements of client outcome may be attributable to it.
View in own window. Research on these issues is extremely complex, which has doubtless prevented many from undertaking it. Efficacy studies are now accepted as the standard of evidence-based practices, but clinical supervision does not easily lend itself to this type of study. For the most part, it is not prescriptive, standardized, or manualized. Differences among supervisors are enormous. It makes intuitive sense that supervisors and counselors progress through what could be described as stages as they become more expert in their fields.
It is perhaps the best known approach of several developmental models, which assume that a counselor matures and becomes more self-confident and skilled over time. Level 1 counselors are new to the field, highly motivated, and highly anxious. Supervision for these people should include direct observation, skills training, and support. According to Stoltenberg, McNeill, and Delworth , a counselor with 1—5 years of experience in the field might be expected to be in Level 1. In supervision, they need support, empathy, and constructive feedback but are ready to begin processing personal issues, such as self-awareness and defensiveness.
At Level 3, counselors are fairly autonomous and have gained professional identity. They typically have been in the field for more than 10 years and have a high level of insight into their functioning. In their review, Falender and Shafranske a conclude that while developmental models are appealing, there is no empirical support for them. However, it makes sense to conclude that individuals can learn to become better supervisors and that in the process, they become increasingly confident and less dependent on more experienced supervisors. To reiterate the above statement, Watkins , among others, has proposed that supervisors similarly progress through stages as they become more competent, autonomous, identified with their role as supervisors, and self-aware.
Psychotherapy-based or philosophically based models provide an excellent opportunity for supervisors to model the behaviors they wish to teach. The roles used most frequently by theorists are teacher, counselor, and consultant. They also include monitor, evaluator, therapist, facilitator, and administrator. However, the Discrimination Model is especially valuable to supervisors to differentiate what role they are adopting at a particular time in supervision, and with individual supervisees.
The model has a number of essential elements:. Individual supervision is, historically, the typical modality of supervision most clinicians receive. It provides the supervisor the opportunity to develop a closer relationship with the supervisee and to tailor the process to the unique needs of that person.
Several formats are possible in individual supervision. Co-facilitation, where the supervisor sits in on the individual or group session led by the supervisee, allows the supervisor to share the experience of the group. For substance abuse counselors, postsession debriefing is most common. The supervisee brings a case or a problem that arose during a session to the supervisory session for discussion. The advantages of individual supervision are that confidentiality can be better preserved, counselors may feel more safe and comfortable in a one-on-one experience, individual needs can be better addressed, and greater depth and honesty may be established.
The disadvantages of individual supervision are that it is time consuming and therefore expensive, particularly if a supervisor has several supervisees. It also increases opportunities for miscommunication among staff, and does not provide counselors with opportunities to learn from each other. Distance supervision individual and group , by telephone or email has also been used. A current, and largely unmonitored and regulated system is cyber supervision, where the supervisor observes a counseling session through the Internet.
A number of States have cyber supervision programs in place.
Clinical Supervision in Alcohol and Drug Abuse Counseling: Principles, Models, Methods
Key issues about this medium remain to be addressed: Group, dyadic, and triadic supervision, in which two or more supervisees meet with a supervisor, is widely used with substance abuse counselors. The advantages of group supervision are similar to those of group therapy.
The primary advantage is that it saves time and money; more counselors can receive supervision with less time spent. The group can provide feedback to supervisees from a variety of perspectives and the team can learn from each other. On the other hand, individual supervisees may not get what they need in a group, and shame and embarrassment can result from self-disclosure to peers. Supervisors have to be attuned to group process and dynamics. Competitive, challenging behavior can occur between peers. Research has generally supported the effectiveness of group supervision e.
In tracking a six-person group, interviews by Christiansen and Kline indicate that group processes operate in this modality. Over time, group members came to recognize the anxiety as a helpful motivator to their learning. Trust increased, and feedback was perceived as less evaluative and more informative. Several surveys show a limited preference among supervisees for individual supervision.
Eighty-one percent ranked individual supervision the most or second most helpful experience, while 45 percent ranked group supervision equally highly. These students preferred individual supervision in terms of their satisfaction, their perception of its effectiveness, and their belief that it better met their needs. Again, the data are sparse, with relatively small sample sizes not specific to the substance abuse field.
Supervisors who use the attractive style are more likely to self-disclose in general and specifically to relate neutral counseling experiences. Those who use the interpersonally sensitive style disclose fewer neutral counseling experiences. The supervisors who saw themselves as more self-disclosing were more likely to use attractive and interpersonally sensitive styles and have a stronger emotional bond in supervision.
Those who used a task-oriented style were likely to have a mutual agreement on the tasks of supervision with their supervisees. Level 1 counselors may likely need more practical information and work on clinical skills task-oriented style. Supervisors under age 50 were less likely than those over 50 to decide on the topics discussed in supervision, less likely to require adherence by supervisees to directives, and more comfortable in self-disclosure.
Certified clinical supervisors were more likely to use the attractive and interpersonally sensitive styles than the task-oriented style. Younger supervisors and those with more education appeared to be more flexible in supervision Reeves et al. Clinical supervision must address gender, racial, ethnic, and cultural concerns. Particularly when the client and counselor or counselor and supervisor are of different cultures, this disparity can have a significant impact on the therapeutic alliance and the effects of treatment Holloway, Supervisors can have a positive effect on their supervisees by providing a climate in which discussion of these issues is encouraged and by modeling appropriate behaviors.
Supervisors have a responsibility to initiate discussions on:. Racial, ethnic, and cultural issues will arise when supervisor and supervisee are of different cultures. Whether the supervisor is responsive to these concerns or not can make a difference in the quality of the supervisory relationship.
One group of researchers defined cultural responsiveness in supervision as:. Using consensual qualitative research, Burkard et al. In events that left negative feelings, supervisors of color avoided discussing cultural concerns with their European American supervisees. Supervisees of color, in contrast, reported that their European American supervisors actively dismissed their cultural concerns. Both groups expressed negative feelings as a result of these events, including anger, frustration, and disappointment Burkard et al.
Clinical supervisors have an obligation to know the relevant State laws that apply to their practice and to ensure that their supervisees also have this knowledge.
Malpractice and liability claims related to clinical supervision include cases involving situations where supervisors failed in their duty to properly supervise counselors and oversee cases. Thorough discussions of legal issues are in most supervision texts Falvey, ; Reamer, , Ethical issues for supervisors, as for counselors, vary.
Dual relationships occur when a supervisor has a second relationship with a supervisee, such as a social, financial, business, or workplace relationship. Boundary violations are a type of dual relationship. They can occur in the structure of the supervisory relationship e. A number of studies of the frequency of sexual misconduct in supervision have been conducted.
Some boundary issues are clear; others are difficult to resolve. The client must give informed consent for the counselor to discuss his or her case with the supervisor. Bernard and Goodyear suggested that informed consent should occur at three levels: For a detailed explanation of these three levels, see Falvey, Supervisor confidentiality is analogous to counselor confidentiality, which must be maintained unless clearly defined circumstances demand disclosure to protect the welfare of the client or the public at large.
Supervisors must know the limits of confidentiality, at both State and Federal levels. The most common were inadequate performance evaluation, breach of confidentiality, and inability to work with alternative perspectives. The existence of these perceived violations was associated with a weaker supervisory relationship and lower satisfaction. Several models for resolving ethical dilemmas are suggested by Falender and Shafranske c.
See also Falvey, Clinical Supervision: Managing Boundary Issues in the Human Services, Supervision contracts or agreements are generally recommended. Training of supervisors has become a significant concern at the State and Federal level, with increasing attention given, especially with the advent of credentialing requirements for certified clinical supervisors.
A number of training models are available. An Internet search will indicate resources in addition to the following:. What makes a good course in supervision? When seeking training in supervision, look for the course that:. Organizational support for supervision is essential to instilling the belief that clinical supervision is key to staff retention and workforce development. Other key organizational issues include how certain organizational models and styles of management influence the process of clinical supervision and how organizational receptivity to supervision affects the outcome and effectiveness of clinical supervision.
Although little research has been conducted on these issues, they remain key factors that influence the adoption of clinical supervision within an organization. A Type I error is a false positive or when a difference tests statistically as significant and in fact it is not. A Type II error is a false negative or when a difference tests statistically as not significant and in fact it is. Turn recording back on. National Center for Biotechnology Information , U. Overview of the TIP This Treatment Improvement Protocol TIP is designed to assist clinical supervisors who are either new to this position or wish to improve their skills and administrators interested in establishing a new system of clinical supervision or improving an existing one.
Part 1 is for substance abuse counselors and consists of two chapters: Chapter 1 discusses the basic issues facing clinical supervisors. It provides basic recommendations along with guidelines for new supervisors on practical, legal, and ethical issues, models of supervision, how counselor performance is measured, methods and techniques, administrative supervision, and resources. Chapter 2 presents eight representative vignettes that portray how clinical supervisors might address a variety of situations and challenges.
Chapter 1 provides a rationale for clinical supervision and discusses the major issues for administrators involved in establishing and overseeing a supervision program, including legal, ethical, diversity, and cultural competence issues; the development and implementation of a model for the program; and the provision of support and professional development opportunities for supervisors. Chapter 2 includes tools that can be adapted for use in your supervision program. Review of the literature pertaining to clinical issues discussed in Part 1 of this TIP. Information about the methodology used to perform the literature search see Appendix A.
An annotated bibliography of 19 core sources and a general bibliography. Introduction Most writing on clinical supervision begins by lamenting the dearth of research on the topic. Definitions of Clinical Supervision The most prominent definitions of clinical supervision have many common elements, although their emphases may be somewhat different. Unique Issues in Supervision for Substance Abuse Counselors Clinical supervision for substance abuse counselors differs from supervision for other healthcare providers in several important ways.
Historically, many substance abuse treatment providers were themselves in recovery, with 38 percent of counselors and 30 percent of supervisors self-reported in recovery Eby et al. The field has traditionally supported individuals in long-term recovery with appropriate training as counselors. Counselors without professional preparation are valued for their life experience as well as for the skills they bring to an organization. In a survey, one study compared recovering with nonrecovering counselors.
Nonrecovering counselors say they have significantly lower professional commitment, but believe they have better employment options in other counseling fields. Between 35 and 40 percent of substance abuse counselors and 22 percent of clinical supervisors report a strong intention to leave their current job. High turnover rates contribute to job stress for many clinical supervisors in the substance abuse treatment field.
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Historically, many substance abuse counselors finished their formal education in high school and lack the graduate degrees of others. Traditionally, they may have less supervised practice and less theoretical background.
Overview of the TIP
Substance abuse treatment administrators find it difficult to recruit academically trained staff due to the low salaries offered for these types of positions compared with similar positions in other mental health disciplines CSAT, The nature of substance use disorders themselves makes counseling and clinical supervision unique. Clients also have to deal with the social stigma attached to substance abuse and to seeking treatment for mental health and substance abuse disorders.
Substance abuse counselors are increasingly being asked to treat clients whose illnesses are medically and psychiatrically severe Minkoff, Finally, Eby et al. The primary modes of supervision include: Barriers to Implementing Clinical Supervision. Managers place a low priority on supervision or lack the time and energy to develop a program. Counselors place a low priority on supervision or lack the time to participate in developing a program.
Revised edtion of a text exploring the role of supervisors in substance abuse counseling.
Clinical Supervision and Professional Development of the Substance Abuse Counselor.
The first edition synthesized the various approaches and techniques of clinical supervision. The "blended model" of supervision offered easy-to-follow guidelines on supervisory contracting, observation, case presentation, modeling, feedback, intervention, and evaluation. This revision provides updates on these guidelines and explores new issues. In the wake of the managed care revolution and several new federal and state regulations, supervisors find themselves absorbed in conformity and compliance issues, financial management, various legal issues, and the completion of an endless array of mandated forms.
These, in addition to assuring the clinical knowledge and skill of their counselors, are part of a supervisors new job description. There is a new final chapter on current and future trends in alcohol and drug abuse counseling, and templates for assessment forms, evaluation letters, and development plans. Library Catalogue My Cart.