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Preparing for Supervision

Academic and clinical instruction are the foundations of training for professional counselors. In order to develop professional competence, students need to step outside of the classroom and practice their skills in laboratory or clinical settings. Fieldwork experiences (e.g., practicum, internship) provide opportunities for development through experiential learning. Because counselor development and competence is not simply related to experience, but is related to supervised practice, supervision is a vital aspect of fieldwork experiences. In addition, because development as a professional counselor does not end with a degree, working effectively with supervisors is a key element in professional growth and development throughout one’s career.

As a student, it is natural for you to rely on your supervisor to facilitate the supervision process and choose interventions to aid in your growth and development as a counselor. It is important to understand that YOU also contribute to a successful supervision experience. This module is designed to facilitate your learning to work productively with a supervisor and to use supervision effectively. Supervision time is valuable. Being prepared for, and intentional throughout, supervision increases the likelihood of a rewarding learning experience.

In This Module

Definition and Components of Supervision

A variety of definitions for clinical supervision exist. Differences typically reflect aspects of the author’s discipline and training focus. Bernard and Goodyear (1998) offer this definition that has come to be accepted within the counseling profession:

Supervision is an intervention that is provided by a senior member of a profession to a junior member or members of that same profession. This relationship is evaluative, extends over time, and has the simultaneous purposes of enhancing the professional functioning of the junior member(s), monitoring the quality of professional services offered to the clients she, he, or they see(s), and serving as a gatekeeper of those who are to enter the particular profession.

Within the definition, there is mention of several components of supervision:

Supervision is an intervention

There are unique competencies and skills involved in supervision that allow the supervisor to help the supervisee. Models of supervision exist that provide a framework for the process. In addition, supervisors incorporate various modes and interventions to facilitate supervisee development.

Awareness of these models, modes, and interventions will help the supervisee understand the underlying processes of supervision and therefore, be a more active participant in the supervision process. A dialogue can develop between supervisor and supervisee as a means to share personal styles and preferences for frameworks and interventions to be used in supervision.

Supervision is provided by a senior member of a profession

A clinical supervisor is more advanced, at least in some important ways, than the supervisee. During fieldwork experiences, supervisors typically include a course instructor and an individual clinical supervisor. Depending on the level of the fieldwork experience and the program, the clinical instructor may be the course instructor or other professor from the training program, a doctoral student from the training program, and/or a professional counselor affiliated with the site at which the student is engaged in the fieldwork experience.

It is important that the supervisee understand the roles and expectations of each supervisor.

Supervision is a relationship that extends over time

The process of supervision occurs within the relationship established between the supervisor and supervisee. It is important to keep in mind that both the supervisor and supervisee contribute to the relationship and have responsibilities within the process. As assumption of supervision is that it will last long enough for some developmental progress of the supervisee. Supervision is differentiated from brief interactions (such as workshops), and consultation that, by definition, is time and session limited, although all of these interactions share common goals (e.g., training in a skill, clarification of process, regaining objectivity). The fact that supervision is ongoing allows for the relationship to grow and develop. The importance of the supervisory relationship has received much attention in supervision literature.

While not the sole determinate of the quality of supervision, the quality of the relationship between the supervisor and supervisee can add or detract from the experience. It is important that the “relationship” aspect of supervision not be overlooked or neglected.

The supervisor evaluates, monitors, and serves as a gatekeeper

In addition to enhancing the professional functioning of counselors, supervisors have an ethical and legal responsibility to monitor the quality of care that is being delivered to the supervisee’s clients. In order to enhance the professional functioning of the supervisee and assure quality of care, the supervisor constantly monitors and provides feedback regarding supervisee performance. This formative evaluation forms the basis of the work done in supervision. The supervisor also serves as a gatekeeper for those who want to enter the counseling profession. The supervisor is charged to evaluate the counselor based on work done with current clients, and to assess potential for working with future clients. As part of this role, supervisors formally evaluate supervisees. These summative evaluations occur after there has been enough supervision to expect a certain degree of competence. For example, during fieldwork experiences, summative evaluations typically occur at the midpoint and end of semesters.

Evaluation is a crucial aspect of the supervision process, and one that is often the source of discomfort for both the supervisor and supervisee.

Models of Supervision

Theories and models serve to help us make sense of and organize information. Operating within a model grounds our practice and helps practitioners with intentionality and consistency. Supervisors should outline their model of supervision, discuss how decisions regarding the focus of supervision are generally determined, discuss their expectations of the supervisee, and how the process will be evaluated for effectiveness. Often this information is included in a Professional Disclosure Statement that is presented to the supervisee.

Supervisees should take the opportunity to discuss their general preferences for receiving feedback, their methods of learning, their expectations of support and critical feedback, and question what to do if they perceive that something is not going effectively in supervision. This discussion, at the beginning and throughout the course of the relationship, may aid in facilitating a positive relationship that leads to counselor development. Training in theory and models of supervision increases supervisor knowledge, and provides guidance for how to direct student learning, as well as how to understand the supervisee experience and development.

In general there are four types of clinical supervision models:

  1. Psychotherapy-based models
  2. Developmental models
  3. Social-Role models
  4. Eclectic or Integrationist models/Supervisor’s Model in Practice

While it is acknowledged that there are models of supervision that are based on theories of psychotherapy, Bernard and Goodyear (1998) state that an indicator that supervision is coming into its own is that there is an increase in models that were developed independent of psychotherapy. Therefore, this section will focus on the developmental and social role models of supervision.

Developmental Approaches to Supervision

Developmental models of supervision have dominated supervision thinking and research since the 1980s. Developmental conceptions of supervision are based on two basic assumptions:

  1. In the process of moving toward competence supervisees move through a series of stages that are qualitatively different from one another.
  2. Each supervisee stage requires a qualitatively different supervision environment if optimal supervisee satisfaction and growth are to occur (Chagon and Russell (1995).

Three influential models reflecting the developmental perspective are presented (see Bernard & Goodyear, 1998).

Littrell, Lee-Borden, & Lorenz Model (1979)

This model attempts to match supervisor behavior to the developmental needs of the supervisee. Briefly summarized, there are four stages to this model:

  1. Characterized by relationship building, goal setting, and contracting.
  2. The supervisor vacillates between the role of counselor and teacher as the trainee is faced with affective issues and skill deficits.
  3. The supervisor adopts a more collegial role of consultant as the trainee gains confidence and expertise.
  4. The supervisor’s role becomes “distant” and he or she serves as a consultant. At this stage the supervisee takes responsibility for his or her learning and development as a counselor.

The Stoltenberg and Delworth Model (1987)

Stoltenberg and Delworth revised the earlier contribution of Stoltenberg (1981) and included aspects of the Loganbill, Hardy, and Delworth model (1982). Stoltenberg and Delworth described three developmental levels of the supervisee and eight dimensions:

  1. intervention skills
  2. assessment techniques
  3. interpersonal differences
  4. client conceptualization
  5. individual differences
  6. theoretical orientation
  7. treatment goals and plans
  8. professional ethics

The three structures proposed to trace the progress of trainees through the levels on each dimension are:

  1. the trainee’s awareness of self and others
  2. motivation toward the developmental process
  3. the amount of dependency or autonomy displayed by the trainee

The Skovholt and Ronnestad Model (1992)

This model, one of few that is grounded in research, went beyond focus on trainee development and recognized that therapist development continues throughout the lifespan. A brief description of the stages follows.

  1. Competence: Persons at this stage, although possibly having some experience with clients, are untrained. They may stay at this level for many years. The central task at this stage is to use what one already knows; the conceptual system is based upon “common sense.”
  2. Transition to Professional Training (First year of graduate school): The central task at this level is for the trainee to assimilate information from a number of sources and apply this information to practice. The conceptual system is driven by the urgency to learn conceptual ideas and techniques.
  3. Imitation of Experts (Middle years of graduate school): The trainee’s central task is to imitate experts at the practical level, while maintaining openness to a diversity of ideas and positions; the trainee is developing a conceptual map of some sort, though typically, it is not complex.
  4. Conditional Autonomy (Internship): Trainees have the central task of functioning as professionals; they have begun to develop a refined mastery of conceptual ideas and techniques.
  5. Exploration (Graduation—2-5 years): There is a move to explore beyond what is known. There will be rejecting of some previously held ideas and models.
  6. Integration (lasts 2-5 years): Professionals work toward developing authenticity. Their conceptual system has become individualized, thus enabling them to act in natural and productive ways. They are most likely integrative or eclectic in their approach to working with clients.
  7. Individuation (lasts 10-30 years): Its central task is a highly individualized and personalized conceptual system. There is a move toward an even deeper authenticity.
  8. Integrity (lasts 1-10 years): The task is to become oneself and prepare for retirement. At this point, the conceptual system is highly individualized and integrated.

Conclusion

Bernard and Goodyear (1998) recognize that “a developmental approach to supervision is intuitively appealing, for most of us believe we have [or will] become better with experience and training” (p. 26). It is also important to keep in mind that most empirical investigations of developmental modes report “partial” or “some” support. See Worthington (1987) and Stoltenberg, McNeill, and Crethar (1994) for reviews of developmental models of supervision.

Social Role Supervision Models

As differentiated from the premise of the developmental models, social role models focus on the roles in which the supervisor engages, and the focus of supervision. Two models will be presented.

The Discrimination Model (Bernard, 1979)

The discrimination model attends to three separate foci for supervision:

  1. Intervention Skills: What the trainee is doing in the session that is observable by the supervisor (interventions, skills, techniques, etc.)
  2. Conceptualization Skills: How the trainee understands what is occurring in the session, identifies patters, or chooses interventions—all covert processes
  3. Personalization Skills: How the trainee interfaces with a personal style with therapy at the same time he or she attempts to keep therapy uncontaminated by personal issues and countertransference responses
  4. **It is noted that others have suggested a fourth category as a focus of supervision but is not in Bernard’s original model.**
    Professional Behaviors: How the trainee “acts” and attends to professional issues such as ethics, dress, paperwork, etc.

Once a supervisor has made a judgment about the trainee’s abilities within each focus area, a role is chosen to accomplish the supervision goals. Within the supervision process (or session), three roles may be assumed by the supervisor:

  1. Teacher: Supervisor takes responsibility for determining what is necessary for the supervisee to learn. Evaluative comments are also part of this role.
  2. Counselor: Supervisor addresses the interpersonal or intrapersonal reality of the supervisee. In this way, the supervisee reflects on the meaning of an event for him- or herself.
  3. Consultant: Supervisor allows the supervisee to share the responsibility for learning. Supervisor becomes a resource for the supervisee but encourages the supervisee to trust his or her won thoughts, insights, and feelings about the work with the client.

Example: The supervisor and supervisee are discussing a client who is presenting for career counseling. The client has repeatedly expressed fear of the interview process, which the supervisee has heard, but he is unsure of how to help. The supervisor decided to focus on a lack of intervention skills.

  • Supervisor to Supervisee (teacher role): I would like you to try a role play with the client reflecting a job interview.
  • Supervisor to Supervisee (counselor role): John, we have discussed the idea and process of role plays before. You seem very hesitant to introduce a role play in session. Will you talk with me about that?
  • Supervisor to Supervisee (consultant role): You’ve stated your view of the client’s concern and I agree, what ideas do you have for how to proceed?

The Hawkins and Shohet Model (1989)

The supervisor’s role is to offer support and reassurance, but also to contain any overwhelming affective responses that a supervisee might have. There are six foci that are addressed in this model.

  1. Reflection on the content of the therapy session (therapist narrative)
  2. Exploration of the strategies and interventions used by the therapist (therapist activity)
  3. Exploration of the therapy process and relationship (therapy process)
  4. Focus on the therapist’s countertransferance (supervisee’s state)
  5. Focus on here-and-now process as a mirror or parallel of the there-and-then (supervision process). What has been discussed by others as parallel processes.
  6. Focus on the supervisor’s countertransference (supervisor experience)

Eclectic or Integrationist Models and the Supervisor’s own model in practice

In truth, it is likely that most supervisors behave as integrationists or eclectics. Indeed, supervisors who operate within the social role models also attend to the developmental levels of the supervisee. Norcross and Halgin (1997) suggested that supervisors should attend to the “cardinal principles of integrative supervision.” Among these principles are to:

  • conduct a needs assessment;
  • consider the therapy approach (method of supervision should parallel the content of supervision);
  • blend supervision methods;
  • operate from a coherent framework;
  • customize supervision to the individual student;
  • match supervision to trainee variables;
  • consider the developmental level of the trainee, and the trainee’s personal idiom;
  • assess the trainee’s therapeutic skills;
  • address with trainees their “relationships of choice”;
  • construct explicit contracts;
  • and evaluate the outcomes.

Because most supervisors develop their own, unique, integrationist perspective, it is important that the supervisor and supervisee engage in a discussion about the processes and model of supervision that will be used.

Modes and Interventions of Supervision

Modes of Supervision Delivery

There are four modes of supervision delivery.

  1. Individual: As the name implies, individual supervision is conducted on a one-on-one basis between the supervisor and supervisee. Typically, the supervisee is prepared to discuss counseling sessions that occurred. Discussion centers on the sessions as a context for supervisee learning and development.
  2. Dyadic: Dyadic supervision is generally conducted in the same way as individual supervision, but the supervisor works with two supervisees at the same time.
  3. Group: In group supervision, a designated supervisor works with a group of counselors. The unique aspect of group supervision is that members are not only influenced by the supervisor, but they also are influenced by (and influence) the others in the group. Interventions are incorporated to capitalize on, and account for, this interrelatedness. Practicum and Internship experiences in training typically incorporate group supervision as their “classroom” experience.
  4. Live: Live supervision occurs as the supervisee is acting as counselor. Supervisors interact with the supervisee “in the moment” and therefore directly affect the counseling process.

Supervision Interventions

There are a variety of supervision interventions that can be incorporated into the supervision process. Borders and Leddick (1987) listed six reasons for choosing different supervision methods: “the supervisee’s learning goals, the supervisee’s experience level and developmental issues, the supervisee’s learning style, the supervisor’s goals for the supervisee, the supervisor’s theoretical orientation, and the supervisor’s own learning goals for the supervisory experience” (p. 28).

Each mode of supervision lends itself to a variety of interventions. Some of the more popular interventions will be presented. A thorough discussion of supervision interventions can be found in Bernard and Goodyear (1998).

Individual and Dyadic Interventions

  • Self-report: Supervisees report on their sessions. It is the most indirect method of supervision in that the supervisor totally relies on the information and experiences as reported by the supervisee. This method is only as good as the observational and conceptual abilities of the supervisee and the insightfulness of the supervisor (Bernard & Goodyear, 1998). It is generally not the method of choice for beginning counselors-in-training, but remains the most commonly used form of “postgraduate” supervision.
  • Process Notes: Supervisees write case notes after interactions with clients and then submit these to the supervisor. The use of case notes can provide a means of controlling the type of information offered in supervision. The supervisor can track the supervisee’s cognitive processes in a way that self-report, or even more active forms of supervision, disallow (Bernard & Goodyear, 1998).
  • Audiotape: Supervisees audio-record sessions (with client or guardian permission). It is important to note that there is typical resistant reaction to taping by supervisees. This reaction typically takes the form of “my client won’t be comfortable”. Although resistance to taping may be real and must be addressed with clients in a sensitive and ethical manner, it is often the trainee that experiences the greatest amount of discomfort. It is important that supervisors and supervisees address the process of introducing audiotaping into client sessions. Generally, the more comfortable the trainee is with taping, the more comfortable the client will be. Audiotapes are incorporated into supervision in a variety of ways. The supervisor should be clear about the supervision process. In some instances, tapes are submitted to the supervisor prior to the scheduled supervision meeting. In other instances, supervisees are responsible for cueing tapes to particular section and then play the tape in the session. Often in training programs, tape scripts and written analysis of the audiotape are submitted in addition to the actual tapes.
  • Videotape: Videotape has become the technology of choice in supervision. Many of the processes used with audiotapes are used with video. Obviously, videotape provides the means for “seeing” the counseling session – including the interaction between client and counselor. While there are many advantages to videotape, there are also cautions. There can be a tendency for trainees to “perform” while being taped. In addition, feedback can become overly critical and negative. Supervisors are encouraged to follow Breunlin, Karrer, McGuire, & Cimmarusti’s (1988) guidelines (as reported in Bernard & Goodyear, 1998, p. 99). Supervision models such as Interpersonal Process Recall (IPR) and the Reflective Process have been suggested as useful with videotape supervision.
  • Live Observation: In live observation, supervisors watch (through a one-way mirror or in the room) the trainee conduct the counseling sessions. There are many advantages to the use of live observation and it is employed when at all possible (often difficult in field experiences). It is important to note, that the supervisor does not typically interfere with the counseling session (exceptions would include crisis situations).

Group Interventions

Supervisors of group supervision must attend to a variety of dynamics. These dynamics include the relationship between each supervisee and the supervisor, the relationships between the group members, and the individual clinical experiences and needs of each supervisee. The supervisor needs to attend to the issues present in “groups” as well as “supervision.” For this reason, group supervision activities tend to focus on didactic presentation, case conferencing, individual development, and group development.

Case presentations are an example of a “typical” group supervision intervention. There are a variety of methods for case conferencing. Bernard and Goodyear (1998) include two models. It is important to discuss group supervision expectations with the supervisor.

Live Supervision

Live supervision is distinct from either individual or group supervision. The paradigmatic shift consists of two components: 1) the distinction between therapy and supervision seems less pronounced than in traditional supervision, and 2) the role of the supervisor is significantly changed to include both coaching and co-therapist dimensions (Bernard & Goodyear, 1998). Obviously there are many logistics and issues to be addressed when using live supervision. It is dependent upon the supervisor to clearly address these issues with trainees and clients.

  • Bug-in-the-ear: Supervisees wear a wireless earphone through which the supervisor can be heard. Therefore, the supervisor can coach the supervisee throughout the session. The benefit is that there is no direct interference with the flow of the therapy session. An obvious disadvantage is that it can be distracting to the supervisee if overused.
  • In Vivo: The supervisor is in the room with the supervisee and client. The supervisor does not engage in direct therapy, but instead the supervisee consults with the supervisor in the presence of the client.
  • The Walk-in: The supervisor enters the room at some deliberate time and interacts with the therapist and the client, and then leaves. Entering does not necessarily mean there is a crisis and can be used to redirect the session and to establish certain dynamics between the supervisor and the client or the therapist and the client.
  • Phone-ins and Consultation Breaks: As the name implies, the supervisor either phones in information, feedback, or instruction to the counselor, or knocks on the door and the supervisee steps out of the room to talk with the supervisor. In these instances, the client is not privy to what is discussed between the therapist and the supervisor.
  • Computer assisted live supervision: Sometimes referred to as “bug-in-the-eye” it has the same principles as bug-in-the-ear, but instead the supervisee gets information from a computer screen.

The Supervisory Relationship

One of the purposes of this module is to educate the student about the process of supervision so that it is not “mysterious.” By knowing about the processes, content, and focus of supervision, you can be an active participant in the supervisory relationship. This knowledge can also provide a basis for “knowing yourself” as a supervisee. By engaging in self-exploration, you can become aware of your hopes and expectations regarding supervision. You can also get in touch with your concerns about engaging in this process. It is natural to have mixed emotions. You want feedback and support, but you may also be apprehensive about having your work scrutinized. The supervisor also brings expectations and their own concerns to the relationship.

So, why is this important? The content and processes of supervision are carried out through the supervisory relationship. Indeed, a positive and productive relationship is critical to successful supervision. Bernard and Goodyear (1998) state, “the supervisory relationship is a product of the uniqueness of two individuals, paired with the purposes of meeting for supervision and modified by the demands of the various contexts that are the subject or content of that experience” (p. 34).

Because each supervisory relationship is unique, there is not a recipe for creating the perfect experience. However, knowing your own thoughts and feelings about the process, coupled with an understanding of supervisor expectations, may serve to aid in the development of a positive and productive relationship.

The Supervisee Experience

It is natural to have mixed feelings about the process of supervision. Although you want to learn, you might also have concerns about having your work scrutinized. The prospect of supervision may be both reassuring and anxiety provoking. Think about what characteristics you consider to be ideal in a supervisor. Some traits of “ideal supervisors” include: is available, is knowledgeable, directs the student’s learning, has realistic expectations. What would you add to the list? What hopes and expectations do you have about supervision? What particular concerns or worries do you have about supervision? What do you know about how you tend to respond to critical feedback? The answers to these questions will affect your views of what happens in supervision. It may be helpful to share your thoughts with your supervisor. Establishing good communication with your supervisor forms a solid foundation of your work together.

“The qualities that you bring to the relationship and the manner in which you communicate with and relate to your supervisor are critical to the quality of your relationship and how much you learn from supervision” (Kiser, 2000, p. 86). It is also helpful to know what expectations supervisors bring to the relationship.

The Supervisor Experience

Supervisors have a responsibility to the supervisee AND the clients the supervisee is counseling. The supervisor bears responsibility for facilitating a positive learning experience for the student. Supervisors may look for the following characteristics in supervisees:

  • Accessible to the supervisor through openness to feedback and instruction
  • Eager to learn
  • Inquisitive and energetic
  • Knowledgeable on at least a basic level
  • Realistic about his or her own skills and knowledge
  • Willing to take risks in order to gain new skills and knowledge
  • Appropriately assertive, taking responsibility for his or her own learning and demonstrating initiative
  • A good listener, observer, and communicator (Kiser, 2000)

This list is not exhaustive, but it does give a picture of the “ideal supervisee.” It may be more important and productive to ask your supervisor about his or her expectations. In addition, to questions about qualities and characteristics of the supervisee, it may also be helpful to inquire about supervision style and philosophy. The point is to verbalize expectations so that there can be greater understanding between the supervisor and supervisee.

Facilitating the Relationship

As with any relationship, respect, genuineness, willingness to listen, seeking to understand, and communication are key components. Although most supervisory relationships develop fairly easily, sometimes there can be special challenges to developing positive relationships. Age, gender, cultural, background, theoretical orientation, and cognitive and learning style differences may influence the development of the supervisory relationship. Indeed, supervisors and supervisees “can simply have very different personalities and personal styles, resulting in distance that may take a longer time to bridge the relationship (Kiser, 2000, p. 85). Regardless of the challenges, awareness, communication, patience, and flexibility are key to building a satisfactory relationship. While you do not have sole responsibility for a positive learning experience, you have a powerful role in shaping the supervisory relationship.

Preparing for Supervision

The process of supervision requires work on the part of the supervisee and supervisor. How a person prepares for supervision is primarily dependent on the process and goals that have been agreed upon by the supervisor and supervisee. Both supervisees and supervisors have a responsibility to prepare for supervision sessions. It is expected that the supervisor manages sessions, comes prepared to discuss topics related to goals and information gained between sessions, and has an idea of the interventions that are to be used during the sessions. Supervisees must also do their part. Some ideas for supervisees are described below.

Mental Preparation

Supervision can be an excited and anxiety filled experience. While some focus of supervision is on successes, much time is spent on facilitating growth in the areas of skills, conceptualization, professional behaviors, and personal reactions. It is important that the supervisee enter the supervision session mentally prepared to address these important issues. Any anxiety may be reduced through a moment of personal mediation prior to the session. Supervisees can remind themselves to be open to the supervision experience. Taking a moment to mentally prepare can help supervisees focus, relax, and “be” in the supervision session thereby leading to an intentional growth experience.

  • Written Summaries and Concerns/Questions: Regardless of the particular supervision process, supervisees should come prepared to discuss cases, concerns, and questions. Relying on memory to discuss all that has happened since the last supervision session can end up wasting valuable time. Written summaries are an easy way to organize thoughts. It is also important that supervisees come with their own concerns and questions. Not only will supervision then be tailored to the supervisees experiences, but it also shows commitment on the part of the supervisee. Supervisors do have a responsibility to increase awareness and bring up their own perspectives, but they are likely to become even more invested when the supervisee shows their own investment.
  • Case Notes: Bringing case notes to supervision can help to initiate discussion regarding clients. Supervisees can use case notes to “jog” their memory about particular clients and sessions. Supervisors may appreciate seeing case notes so they can track the conceptualization process of the supervisee.
  • Audio/video tapes: There are a variety of interventions that can be used with audio/videotapes. When audio and/or video tapes are used in the supervision process, it is important that how they will be used is discussed. Regardless of the specific intervention, the supervisee should take some time to review the tapes before turning them over to the supervisor or using them in a supervision session. Of course, if taping is to be used in counseling, consent must be obtained from the client (over 18 years-old) or from a parent/guardian (minors).
  • Tape Scripts: Tape Scripts can be a valuable tool in supervision. Verbatim or partial transcripts of all or part of the session are useful as a way to read what happened in a session. It can be difficult to keep track of all that a person hears on a tape, and a tape script can aid in this process. Specific feedback can be provided and kept within the context of the session. In addition, counselors can go through the tape script, on their own, and identify the intent of responses/interventions, see what happened as a result, and think of alternative responses/intervention.

Evaluation in Supervision

Supervisors have an ethical and legal responsibility to monitor the quality of care that is being delivered to the supervisee’s clients. In order to enhance the professional functioning of the supervisee and assure quality of care, the supervisor constantly monitors and provides feedback regarding supervisee performance.

Evaluation is the “nucleus of clinical supervision” (Bernard & Goodyear, 1998, p. 152). As important as evaluation is to supervision, both supervisors and supervisees may find it stressful. Supervisors are charged to balance an understanding of individual differences in conducting counseling sessions with the notion of competent practice as ascribed by the profession. The supervisor utilizes two general methods of evaluation: formative and summative.

  • Formative Evaluation: Formative evaluation is the process of facilitating professional development through direct feedback. Formative evaluation is part of the foundation of supervision. The supervisor constantly monitors and provides feedback regarding supervisee performance. Choices of supervision interventions, questions asked to facilitate discussion, comments regarding the appropriateness of a supervisee’s case conceptualization, expression of the ineffectiveness of a supervisee’s use of a skill – can all be described as formative evaluation. Because formative evaluation is consistent and tends to focus on process and progress, rather than outcome, it tends to be less stressful and threatening for both the supervisor and supervisee. Hawkins and Shohet (1989) recommend that formative evaluation be:
    • Clear: Supervisor needs to be clear about the message being delivered.
    • Owned: The feedback that supervisors give is their rooted in their own perceptions and is not ultimate truth.
    • Regular: Feedback should be given regularly and in a timely fashion.
    • Balance: A balance of negative and positive feedback should be created over time.
    • Specific: Generalized feedback is difficult to learn from. Positive and negative evaluations should be accompanied by specific examples.
  • Summative Evaluation: Summative evaluation is a more formal expression of the counselor’s skills and abilities. The supervisor must step back, consider all that has been seen and heard, and decide if the counselor’s work with clients and potential for working with future clients “measures up” .When supervision is linked to practicum or internship experiences, summative evaluations typically occur at the mid-point and end of the experience. The summative evaluation process tends to cause more stress for the supervisor and supervisee. By definition, summative evaluation should be the culmination of the evaluation process, if formative evaluation has occurred throughout the process, there should be no real surprises for the supervisee. Rating scales are commonly used as part of summative evaluation (see Evaluation of Counselor Behaviors (LINK). In addition, more specific behavioral feedback may also be provided.

Evaluation Process Considerations

It is acknowledged that evaluation can be an anxiety provoking experience. There are steps that can be taken to facilitate a growth-producing experience.

  1. Supervisees (students), instructors (if part of practicum or internship), and supervisors should discuss grading and evaluation from the outset. The rationale for evaluation, criteria, and methods should be explicit.
  2. Evaluation should focus on the supervisees’ professional work, not personal issues.
  3. The supervisee and supervisor should share the responsibility for evaluation. Supervisors and supervisees could each complete evaluations separately, and then bring them together to compare impressions.
    Students in practicum and internship need to understand that clinical experience is fundamentally different from other academic work.
  4. Grades do take on a different meaning. In clinical work, a lack of knowledge or skill has consequences for clients, the supervisor, and the agency/school, as well as the student. It is important to go beyond “grade mentality” to a learning mentality and work to embrace evaluation as a process of receiving feedback about performance.
  5. Supervisees should communicate with their supervisors about any concerns they may have or ideas for improving supervision.

Evaluation of the Supervisor

In addition to the flow of feedback from supervisor to supervisee, part of on-going evaluation could include feedback from the supervisee to the supervisor. Attention to the process of supervision helps to facilitate a positive growth experience for all involved. In addition to regular feedback, supervisees should have an opportunity to evaluate the supervisor. Although supervisors and supervisees may have different views on what constitutes “good” supervision, feedback provided by supervisees can reveal important information.

Ethical and Legal Issues in Supervision

Perhaps the greatest clinical and ethical challenge of supervision is that the supervisor must attend to the best interests of the client and supervisee simultaneously. There are a number of ethical and legal issues that must be considered by supervisors and their supervisees. The topics of direct and vicarious liability, duty to warn, confidentiality, dual relationships, and informed consent will be discussed.

Direct and Vicarious Liability

If a professional fails to follow acceptable standards of practice and harm to a client results, the professional can be held liable for the harm caused. Direct liability would be charged when the actions of a supervisor were themselves the cause of harm to a supervisee or a client (for instance, if a supervisor suggested (and documented) an intervention that was determined to be the cause of harm). The supervisor does not have to actually carry out the intervention, but if the supervisee follows the suggestion of a supervisor and this results in harm – this is direct liability. Vicarious liability is being held liable for the actions of the supervisee when these were not suggested, or even known, by the supervisor. Therefore, if a supervisory relationship exists, the supervisor can potentially be held liable for any negligent acts of the supervisee. It should be obvious that the supervisor is very invested in the actions of his/her supervisee – and must take the responsibility of supervision very seriously.

Duty to Warn

The duty to warn is as relevant for supervisors as counselors working directly with clients. In fact, in the Tarasoff case (the impetus for the duty to warn standard/law) the supervisor, in addition to the counselor, was implicated in the case. The supervisor has a responsibility to advise the supervisee of conditions under which it is appropriate to warn an intended victim.

The Tarasoff Principle: If the counselor knows or has reason to know of probable harm to another identifiable person or the property of an identifiable person, a warning must be issued if the client’s behavior cannot be controlled.

The “Tarasoff Principle” was established by a court ruling in the Tarasoff v. Regents of University of California case in 1976 (17. Cal. 3d 425 – July 1, 1976. S. F. No. 23042). For more information on the Tarasoff principle see Ethical, Legal, and Professional Issues in Counseling by Remley and Herlihy (2001). For more information on the application of Tarasoff to supervisors see: Fundamentals of Clinical Supervision by Bernard & Goodyear (1998)

Confidentiality

Supervision allows for third-party discussion of therapy situations. It is important to remember that the type and depth of discussion allowed in supervision, is unethical in other situations. Supervisees must keep confidential all client information except of the purposes of supervision. It is sound practice to keep explicit identifying information confidential (for instance, use only first names and reveal few specific demographics). Supervisees also have a right to privacy and it is the supervisor’s responsibility to keep information obtained in supervision confidential except for the exceptions recognized by the profession and law.

Exceptions to privileged communication as reported by Corey, Corey, and Callanan (1993):

  1. When the therapist is appointed by the court
  2. When there is a suicidal risk
  3. When the client initiates a malpractice suit against the therapist (or supervisor)
  4. When a client’s (or supervisee’s) mental health is questioned as part of a civil action
  5. When the client is a child (under age 16) and is a victim of a crime
  6. When information is mandated by the court
  7. When clients need hospitalization for a psychological disorder
  8. When clients express the intent to commit a crime or when they are accurately assessed as being dangerous to others or to themselves

Dual Relationships

Sexual Dual Relationships

  • Sexual Attraction: Sexual attraction is not an uncommon occurrence in supervision relationships. Unfortunately, however, there is little attention to how to openly address and discuss the implications of the attraction – leading to successful resolve of the issue. Because acting on an attraction poses serious ethical dilemmas, addressing the attraction in supervision or through consultation with other professionals is vital.
  • Sexual Harassment: Unlike sexual attraction, sexual harassment is a clear abuse of power by the supervisor and is never acceptable. Sexual harassment can leave the supervisee feeling violated, vulnerable and confused.
  • Consensual (but Hidden) Sexual Relationships: Results of studies indicate that the majority of sexual relationships between supervisor and supervisee fall in this category. Because of the power differential inherent in supervision, it is suggested that no true “consensus” can be freely given by the supervisee. Supervisors have a responsibility to own the “power” that is automatically attributed to them by nature of their role.
  • Intimate Romantic Relationships: There is no distinction in the literature between relationships that occur within supervision, and those that begin there. It is understood that intimate relationship may develop when adults work together in the world of therapy. The important factor is to assure that a relationship that grew out of a supervision relationship poses no ethical compromise for the supervisor or supervisee – and that there are no consequences for the supervisee’s clients.

The general consensus about sexual dual relationships is that there is much more potential for harm and negative outcomes, than the potential for good or even acceptable outcomes. Supervisees and supervisors are encouraged to seek discuss these issues and/or seek consultation. The secrecy that typically occurs in the development of dual relationships is an important signal that there is a strong potential for unethical conduct and harm.

Nonsexual Dual Relationships

There is a general consensus that dual relationships between supervisors and supervisees (particularly in counselor education programs) are inevitable. Unlike therapy relationships, persons who work together will share other experiences with each other. In counselor education programs, faculty members may be instructors, supervisors, academic advisors, personal confidants, and mentors.

The potential for negative outcomes, as a result of dual relationships, centers on the power differential between the two parties. Dual relationships may be problematic in that they increase the potential for exploitation and for impairment of the objectivity of both parties, and they can interfere with the professional’s primary obligation for promoting the student’s welfare.

Some authors acknowledge that dual relationships are not tantamount to negative outcomes Indeed, with appropriate attention to the power differentiation, there can be great flexibility in non-sexual dual relationships. While there is the potential for harm, there are also training and personal benefits. These relationships tend to attract more confusion than harm.

Supervisors have a responsibility to openly acknowledge and discuss the management of the multiple relationships that may exist between supervisor and supervisee. Supervisees are encouraged to ask for clarifications regarding any confusion resulting from dual relationships.

Informed Consent

The concept of informed consent is being addressed last, as it has the potential for impacting the ethical/legal issues discussed to this point. Informed consent is the best defense against the difficult and confusing issues that arise in supervision.

Supervisors have an obligation to determine that clients have been informed by the supervisee regarding the parameters of therapy. Clients must not only be aware of therapeutic procedures, but also of supervision procedures. The supervisor assures that clients are informed of the parameters of supervision that may affect them.

In addition, supervisors have a responsibility to inform supervisees about the supervision process, potential for dual relationships, limits of confidentiality, and the conditions of their success or advancement (evaluation criteria and process). Supervisors may use a Professional Disclosure Statement as a to facilitate the informed consent discussion.

Ethical Decision Making

Ethical dilemmas are inevitable in counseling and supervision. To increase your ability to successfully manage dilemmas, consider the following:

  1. Successful management relies on the ability to recognize dilemmas – attend to feelings of confusion, concern, anxiety and fear.
  2. Incorporate experiential learning and case analysis into your work
  3. Include questions regarding potential legal and ethical issues as part of case discussions
  4. Familiarize yourself with ethical and legal codes and cases
  5. Adopt and regularly implement an Ethical Decision Making Model

References and Resources

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  • Bernard, J. M., & Goodyear, R. K. (1998). Fundamentals of clinical supervision (2nded.).Needham Heights, MA: Allyn & Bacon.
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  • Corey, G., Corey, M. S., & Callanan, P. (1993). Issues and ethics in the helping professions (4thed.). Pacific Grove, CA: Brooks/Cole.
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  • Norcross, J. C., & Halgin, R. P. (1997). Integrative approaches to psychotherapy supervision. In J. C. E. Watkins (Ed.), Handbook of psychotherapy supervision. New York: Wiley, 203-222.
  • Remley, Jr., T. P., & Herlihy, B. (2001). Ethical, legal, and professional issues in counseling. Upper Saddle River, NJ: Prentice-Hall.
  • Skovholt, T. M., & Ronnestad, M. H. (1992). The evolving professional self: Stages and themes in therapist and counselor development. Chichester, England: Wiley.
  • Stoltenberg, C. D. (1987) Approaching superivision from a developmental perspective: The counselor complexity model. Journal of Counseling Psychologists, 28, 59-65.
  • Stoltenberg, C. D., & Delworth, U. (1987). Supervising counselors and therapists. San Francisco: Jossey-Bass.
  • Stoltenberg, C. D., McNeill, B. W., & Crethar, H. C. (1994). Changes in supervision as counselors and therapists gain experience: A review. Professional Psychology: Research & Practice, 25, 416-449.
  • Worthington, E. L., Jr. (1987). Changes in supervision as counselors and therapists gain experience: A review. Professional Psychology: Research & Practice, 18, 189-208.
  • Ethical Guidelines for Counseling Supervisors by the Association for Counselor Education and Supervision (ACES)
  • The Approved Clinical Supervisor (ACS) Code of Ethics
  • American Counseling Association (ACA) Code of Ethics – Teaching, Training and Supervision (Section F)