Philosophy of Supervision

Purpose and Goals for Supervision 

I believe that the purpose of supervising and guiding new therapist trainees is to both protect the public, as well as provide a necessary training experience for guiding less experienced therapists in the development of their clinical skills, professional credibility, and overall self-confidence. The goals that I have for trainees to embrace and demonstrate as they leave the supervision experience include: Enhanced listening skills (ideas about the clients’ process), enhanced processing skills (making sense of the client’s story), enhanced ability to focus on their own experiences related to the client’s stories, and abilities to manage the therapeutic process (Rober, 2010, as cited in Lee & Nelson, 2014, p. 6). Importantly, adopting a working understanding of the AAMFT Core Competencies (2004) is also a goal that I have with my MFT trainees, noting that “the competencies serve as a guide for graduate training and for postgraduate supervision with the aim of mastery of each competency by the time a trainee is ready to be licensed for independent practice” (Lee & Nelson, 2014, p. 21).

Supervisory Roles and Relationships

I believe that the supervisory role “is to facilitate the growth of trainees as professionals” (Lee & Nelson, 2014, p. 5). For example, in my various roles as a supervisor, I am careful to flex with the changing needs of my trainees. I like using a common-factors approach to supervision (which involves a synthesis of current thinking about supervision into three dimensions), because the dimension of “specificity” identifies four supervisory roles - coach, teacher, mentor, and administrator, that resonate deeply with me. Clearly, there are times when I assume more of a coaching role with supervisees - “assisting a supervisee’s direct work with his or her current caseload of clients,” times when I may take on more of a teaching role - “encouraging and facilitating the acquisition of broadly applicable knowledge and information about clinical work,” times when I may assume more of a mentoring role – “focusing on the personal development of each supervisee as a growing professional,” and finally, times when I may adopt more of an administrator role – “focusing on the broad professional, ethical, legal, and other standards that guide the practice of psychotherapy (Morgan & Sprenkle, 2007).

Like in therapy, success in supervision depends upon strong relationships. Although there are many aspects that impact the supervisory relationship, none is more important than the establishment of a trusting environment. Trainees must be able to trust that supervisors will act in their best interest and supervisors must trust that trainees will be honest and forthcoming. Importantly, the isomorphic process of “what happens in the relationship between supervisor and supervisee will be replicated in the relationship between therapist and client” (Haley, 1988;  Frankel & Piercy, 1990, as cited in Kaiser, 1992), is a key feature of the supervisor/supervisee relationship. Even though I give a great deal of attention to developing and maintaining a trusting and warm relationship with my trainees, I also acknowledge the need to build in accountability, personal awareness, and attending to issues of power and authority.

Systems Thinking

In introducing my philosophy of supervision, it is important to note that Von Bertalanffy’s General Systems Theory (1968), is a central unifying feature in both my clinical work and my approach to supervision as well. I believe that the concept of homeostasis, self-regulation that maintains a dynamic state of balance in a system,  can be understood in a functional supervisory relationship as the rule-governing behavior that helps participants increase flexibility and increase the diversity of their interactional repertoire. An example of this is how I strive to constantly monitor the state of the supervisory relationship by providing input and feedback for the supervisee, as well as soliciting input and feedback from trainees. My use of both formal and informal evaluations, frequent process check-ins, and routine observational analysis of our interactions helps to maintain the equilibrium in the supervisory relationship. Additionally, this systemic supervisory intervention is also experienced isomorphically (a parallel process or replication of similar patterns), by extending to the trainee’s clinical work with families as well. It is hoped that the homeostasis being monitored and regulated in the supervisory relationship also occurs in the work the supervisee is doing within their family therapy sessions as they help to manage and re-negotiate rules, boundaries, and governing principles of the family, soliciting input and feedback, etc.

Personal and Professional Experiences that Impact Supervision

As a clinical supervisor, I understand that I bring many personal and professional experiences with me that impact and shape my supervisory relationships. For example, as a career educator with a strong value placed upon educational attainment, I know that I must be careful not to impose these values on trainees. As I have had the benefit of many wonderful supervisors and mentors in my life (both as an educator and as a therapist), I have a strong desire to pass on many of the rich family systems traditions that have been shared with me.

Preferred Supervision Models and Their Connection with the Candidate’s Own Therapy Model                   

I believe that there are “common mechanisms of change, which cut across all effective psychotherapy approaches … which are not specific to any approach, but which are shared by several or all approaches” (Morgan & Sprenkle, 2007). As a therapist, I clearly utilize a strong blend of structural and strategic family systems approaches, Contextual and Bowenian models of therapy, the Experiential Family Therapy models of Whitaker and Satir, and the adult attachment/relational model of Emotional Focused Therapy. A few examples of how I might integrate some of my preferred theoretical models within a common factors approach to supervision could include:  Helping trainees find comfort in assuming a more directive role in therapy by identifying power differentials, boundaries, family alliances, and parentification of children while working within a Structural model; helping to guide early supervision tasks by encouraging trainees to look for concrete family patterns through the use of genograms; and exploring Bowen’s use of individuation and differentiation as a way to acknowledge potential person-of-therapist issues (Aponte & Carlson, 1990).

Contextual Factors

The concept of “cultural humility” (Tervalon & Murray-Garcia, 1998) requires us to be “curious about our clients’ lives, and continually engage ourselves in self-reflection and self-critique so as to reduce inappropriate and unnecessary power imbalances in therapy” (as cited in Nelson & Lee, 2014, p. 12).  I believe it is very important to have open and ongoing dialogues with supervisees around developing our cultural humility, as well as around issues of power and privilege, and the power of influence we have over others as therapists. Remembering the inherent power differential in the supervisory relationship (as well as the therapeutic relationship), I routinely monitor for potential power struggles with my trainees, as micro-aggressions of any kind can be harmful. I am curious about my supervisee’s unique experiences and perspectives as a way to model growth in developing ongoing cultural competency and sensitivity, and routinely use the Hays (2001) ADDRESSING framework to develop cultural humility.

Preferred Process of Supervision

Both individual and group supervision settings can provide a diversity of benefits for trainees. Individual supervision provides personal attention and nurturing of one trainee at a time, where group supervision provides a collaborative nature that can build confidence and grow peer relationships. For example, although I provide both group and individual supervision, I do prefer one-on-one individual supervision as it gives me time to tailor my work to fit the needs, interests, and issues of a particular trainee. I have also found that one-on-one supervision can also provide the much-needed safety and privacy for less experienced therapists. Lee & Nelson (2014) pointed out that “dyadic supervision maximizes attention on trainees … and focuses solely on the unique training needs of one individual (p. 66).” I offer group supervision to trainees who enjoy the experience of learning and sharing amongst their peers, as well enjoy a financial benefit.

Prior to signing a contract with a potential supervisee, I do offer a free, in person meeting where I provide a written questionnaire, sample contract, sample evaluation tools (including the Nelson & Johnson BSED, 1999), a brief philosophy of my supervision, and a matrix of the various state licensure requirements, in order to help me screen trainees for a good supervision fit. We explore the specifics of my supervision contract and begin to mutually establish appropriate goals and purposes for supervision. I am clear about outlining my preference for gathering direct and indirect feedback about supervisee’s clinical work through the preparation of case notes and case presentations. I expect that trainees will continue to monitor and track their cases and be able to discuss relevant histories, hypotheses, interventions, questions, and concerns. I also ask that trainees get in the practice of asking their clients for permission to audio and video record their therapy sessions, manage confidentiality and tape storage issues, and share their recordings in supervision on a regular basis. Specifically, I am looking for evidence of growth in my supervisee’s listening skills, processing skills, ability to focus on their own experiences related to the client’s stories, and abilities to manage the therapeutic process.

Ethics and Legal Factors

I believe it is critical to routinely manage the supervisory relationship and the supervisee’s clinical work within legal and ethical frameworks. It is my habit to provide supervisees with a copy of the User’s Guide to the 2015 AAMFT Code of Ethics at the beginning of our time together, and explain how we might plan to use an ethical framework in discussing and analyzing future cases. I also offer two ethical decision-making models with trainees that will help them to begin to develop strong ethical approaches of their own (Mowery’s 7 Ps of Ethical Reflection, 2009, and the Kitchener, 1984, and Zygmond & Borherm, 1989, models). I attempt to help trainees define and articulate their own ethical decision-making model, as it is an essential strategy to help provide clarity, consistency, and clear decision making.

Contact me about supervision.

References

AAMFT (2007). Appendix C. The core competencies, draft E. Journal of Marital and Family Therapy, 432-438.

Aponte, H.J., & Carlsen, J.C. (2009). An instrument for the person-of-the-therapist supervision. Journal of Marital and Family Therapy, 35, 395-405.

Caldwell, B., ed. (2015). User’s guide to the 2015 AAMFT Code of Ethics. Alexandria, VA: AAMFT.

Goldenberg, I. & Goldenberg, H. (2004). Family therapy. Pacific Grove, CA: Brooks/Cole.

Hays, P.A. (2001). Addressing cultural complexities in practice: A framework for clinicians and counselors. Washington, D.C. American Psychological Association.

Kaiser, T. (1992). The supervisory relationship: An identification of the primary elements in the relationship and an application of two theories of ethical relationships. Journal of Marital and Family Therapy, Vol. 18, 283-296.

Kitchener, K.S. (1984). Intuition, critical evaluation and ethical principles: The foundation for ethical decision in counseling psychology. Counseling Psychologist, 12(3), 43-55.

Lee, R.E., & Nelson, T.S. (2014). The contemporary relational supervisor. New York, NY: Routledge.

Long, J.K., & Bonomo, J. (2006). Revisiting the sexual orientation matrix for supervision: Working with LGBTQ families. Journal of GLBT Family Studies, 2, 151-166.

Morgan, M.M., & Sprenkle, D.H. (2007). Toward a common factors approach to supervision. Journal of Marital and Family Therapy, 33, 1-17.

Mowery, R.L. (2009, Nov/Dec). Expanding from ethical compliance to ethical empowerment: Supervisors are key (part 2). Family Therapy Magazine, 48-51.

Nelson, T.S., & Johnson, L.N. (1999). The basic skills evaluation device. Journal of Marital and Family Therapy, 25, 15-30.

Nichols, M. & Schwartz, R. (2004). Family therapy: Concepts and methods. Boston: Pearson.

Rigazio-DiGilio, S. (2014). Common themes across systemic integrative supervision models. In T. Todd & C. Storm (Eds.) The complete systemic supervisor: Context, philosophy, and pragmatics (pp. 231-254). West Sussex: 2014.

Storm, C. (2014). Guidelines for selecting and using systemic supervision methods. In T.C. Todd and C.L. Storm (Eds.), The complete systemic supervisor: Context, philosophy, and pragmatics (2nd ed., pp. 357-380). West Suessex: John Wiley & Sons.

Tervalon, M. & Murray-Garcia, J. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9(3), 117-125.

Von Bertalanffy, L. (1968). General systems theory. New York: Braziller.

Zygmond, J.J. & Boorhem, H. (1989). Ethical decision making in family therapy. Family Process, 28, 269-280.