Goals of Clinical Supervision for Addiction Counselor Interns

GOALS OF COUNSELING SUPERVISION LadyAnn Graham-Gilreath Capella University COUN 5004 Kathy Blaydes INTRODUCTION This paper examines the purpose and goals of supervision during academic and intern training from the perspective of the profession in pursuit, addiction counseling on the masters academic level. This will include a brief definition of supervision in the substance abuse field, will evaluate two current models, will delve into descriptive benefits of supervision, and explain the ethics behind it all. Looking at several definitions in existence proposed by several reputable sources, as stipulated by Dixon, (NIDA 2015), according to (Bernard and Goodyear, 1998) it is proposed this all around definition: “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.” According to SAMHSA.org in their Treatment Improvement Protocol, series 52, they introduce two addiction-counseling definitions: “Supervision is a disciplined, tutorial process wherein principles are transformed into practical skills, with four overlapping foci: administrative, evaluative, clinical, and supportive” (Powell & Brodsky, 2004), cited by (TIP 52, 2009). “Supervision is “a social influence process that occurs over time, in which the supervisor participates with supervisees to ensure quality of 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 too ethical and diversity issues in all aspects of the process. Such supervision is key to both quality improvement and the successful implementation of consensus- and evidence-based practices” (TIP 52, 2009). Supervisors and supervisees during the academic and interning portion of their training come together in a therapeutic alliance seeking a comprehensive developmental framework that will incorporate blueprint models of the supervision process. The created working connection between supervisor and supervisee must establish the climate control of the alliance, the set expectancies of goals, and utilize the brilliant supervisor’s impact from expertise to achieve desired outcomes by both (Bordin, 1983) Matching a supervisor with a supervisee is almost as difficult as matching a donor and recipient. Students and interns approaching their licensing internship will be undertaking supervision for an official state accepted number of hours in which the goals of supervision may be clearly outlined. The best approach to this is to match the competency of the supervisor in one area of expertise with the student seeking that same area as a profession, i.e. addiction counseling. The favored goals of the supervisee are to master set specific skills, i.e. O.A.R.S in Motivational Interviewing, expand the comprehension of one’s clients, grasp the enormous detail of the supervision process; administration, colleagues’ advice in teamwork, consider all legal issues, and above all hold ethical standards of the highest quality in all practicing areas. For the student/intern who is about to embark on the change putting all the academic and researched intellectual information by transforming this valued knowledge into usable skills with a measure of expertise, one must possess a model or supervisor to emulate, seek advice, and become close in bonding with a genuine regard for each other’s abilities (Bordin, 1983). Basic goals of supervision focus on the assurance of delivery of high quality interventions and treatment plans, create a positive work environment, develop clinical staff and administrative skills, become familiar with organizations and their policies, learn accountability and proper documentation, self-evaluation and reflecting skills, maintaining absolute ethical standards, become acutely aware of client’s rights, draw on past cases from supervisor, and if possible avoid anxiety issues from distress. The therapeutic work with clients parallels the therapeutic relationship with supervisor (Dixon, 2015). The purpose of supervision is to align the supervisee’s abilities for the best interventions and delivery of treatment with respect to their clients, employment agency, and overall organizations of professional status in keeping with its function of mission. According to East Carolina University’s approach to supervision, they consider four theoretical frameworks for supervision: Psychodynamic Theoretical Framework, Behavioral Theoretical Framework, Cognitive Theoretical Framework, and Developmental Theoretical Framework, (ECU, 2015). 1) Psychodynamic Theoretical Framework encompasses supervision as s therapeutic exchange on relational dynamics between all parties concerned. Within this approach, the foundations explore the parallel attributes between counseling and supervision conflicts and are acted out in each. Change and learning are experienced via internalization. There is primary importance placed on interpersonal dynamics. Demonstration of verbal and non-verbal communications is empirically observed. Within observation, there is ample opportunity to examine cover behaviors, sensory abilities, and cognitive routines. Will focus on dynamic awareness, contingencies, power of change, and therapeutic usage of dynamics (ECU, 2015) 2) Behavioral Theoretical Framework envision that competency of learned skills requires tailored supervision. Its primary purpose is to implement skills and discard behaviors that are not efficient, effective, or appropriate. Focus on the teaching applications throughout supervision process. Strategies for this include analysis of delivery assessment skills, goal and treatment planning ability, how to implement evidence-based practicing, review self-assessment ideals, reflect on peer supervision and observations, modeling, engage in role playing, acquire self-management abilities, and work on the behavior discrepancies (ECU, 2015). 3) Cognitive Theoretical Framework is grounded in the cognitive conceptualization of one’s working reality and environment. This is somewhat flexible is style. Concentration is on self-awareness of cognitive process of applications. Foremost is the acquisition of competent cognitive therapy techniques, goal planning, and strategies with the ability to recognize and modify misconceptions in daily activities. Work to control cognitive ability in the development of counseling skills with both personal issues and clinical issues. This usually calls for a one-hour weekly session and biweekly group sessions. Therapy is drawn from the cognitive-behavioral therapy model, (CBT), (ECU, 2015). 4) The Development Theoretical Framework proposes “developmental change takes place over time gradually in cognitive, complexity, differentiation, and integration”. Supports that skills will progress as levels of complexity increase both in understanding and application. That supervision in this capacity will enhance the positive nature of this framework as it grows. There is a slow transformation of identity from academic student/intern to professional counselor. Level 1 supervisee will be apprehensive, lack confidence, illustrates confusion, exhibit discomfort, and will be highly dependent on the supervisor and authority. Level 2 will be in sync with client but struggle to retain objectivity, show great performance with empathic skills, have bouts of indecision where motivation is needed, may still be overwhelmed by the process as a whole. Level 3 will demonstrate remarkably skilled improvement and begin autonomic decision- making, possess dynamics, is highly motivated and show independence with large amounts of responsibility (ECU, 2015). The two models under evaluation will be Discrimination Model and Stoltenberg’s Developmental Model: Using the “Discrimination Model” for novice supervisees is appropriate, the supervisor will assist with process skills, followed by conceptualization skills, and reflecting personalization skills, (Capella, 2015). In this capacity, they will act more like a professor to the novice supervisee. First, the processing/intervention skills will examine and observe the supervisee’s interactions, then critique them showing issues where the supervisee may have focused better, or may have left out. Second, with the conceptualizing skills, this will be to examine and test the supervisee’s ability to assess correctly greater issues of importance and prioritize them, focus on immediate attentions for next session, i.e. self harm or violence intention, (Capella University, 2015, p. 1). Third, will be to help develop the supervisee’s own personal set of values and teach self-examination using the clients the supervisee currently has to re-evaluate ability not to impose any personal values on a client in judgment or persuasion or prejudice, in cultural, religious, racial, sexual preference, or gender attributes the supervisee may harbor deep down, or that may be in question. This will ultimately make understanding one’s self to better grasp and challenge the correction if any misgivings about any one particular client or group as a whole and curtail to the specific needs of the client (Capella, 2015). In “Stoltenberg’s Development Model” is as stipulated earlier a ritual advancement through increasing difficult identifiable transitional stages. The emphasis is on the supervisee in performance, or “doing things the right way” (APA, 2011, blog). In this model, there are four-subdivision stages known as the dependent stage, dependent-autonomous stage, conditional dependency stage, and integrated. In the dependent stage the apprehensions and anxiety are predominant, direction is necessary, open the exploration door, and feelings of self-evaluation become acute. In the dependent-autonomous stage the first signs of differentiating from supervisor path, will begin to initiate new behaviors, may become over confident of overwhelmed, motivation may vary in strength, needs to appear competent and inwardly fears. Conditional dependency stage check with supervisor in higher degrees of difficulty, demonstrates strong clinical skills, establishes the unique personal style, uses supervisor as a peer or colleague. At the integrated stage the supervisee is competent enough of independent practice, is understanding and knowledgeable of limitation levels, implements the process of counseling as a professional becomes a team player in agency is comfortable seeking peer advice. (CMHC, 2008) Benefits of supervision encompass first, one of the crucial requirements by law for addiction professional counselors, that they obtain licensure after an intense, rigorous education process followed by a supervision program. This is most important to the client’s point of view to know and trust that they are in the trusting hands of competence. Letting them know that you have gone through intensive supervision training gives positive reassurance they might desperately need to hear and feel. This automatically turns into a professional session in the eyes of the client. A second benefit is the promotion of developed counseling competencies; this includes: 1) processing/intervention skills, 2) assessment techniques, 3) interpersonal assessment, 4) conceptualization ability, 5) differential multicultural acceptance and compliance, 6) theoretical therapy and themes orientation, 7) assessment and treatment goal planning, 8) implantation of sound ethical practice, and 9) the therapeutic alliance between supervisor and supervisee. A third benefit is to collectively promote always the welfare of your client in a positive regard with the highest ethical standards. During the professional years, continuous development will be necessary as technology changes and newfound scientific data keep arising. This is one reason that continual education is required for addiction counselors and the supervision ensures that these benefits will secure for greater increased care of clients, mature competencies, and highly professionalized skills (ACA, 2013, blog) Critical issues of ethical supervision entail applying these: Balance The rights of the clients The rights and responsibilities of the supervisees The responsibility of supervisors to supervisees and supervisee’s clients Competence Competence of supervisors Competence of supervisee Multiple roles and relationships Role conflicts Avoid dual relationships Modeling ethical practice Supervisors have the responsibility of keeping information obtained in supervisory relationship confidential. Explain limitations and parameters of confidentiality Do not share personal information shared in supervisory sessions Maintain confidentiality of supervisee’s clients Explain what will be shared with faculty and evaluation Ethical Decision-Making Model: Supervisor must teach: The Ethical Decision-Making Model 1. Identify the problem 2. Apply the ACA Code of Ethics 3. Determine the nature and dimensions of the dilemma 4. Generate potential courses of action 5. Consider the potential consequences of all options 6. Choose a course of action 7. Evaluate selected course of action 8. Implement the course of action Make sure to check for incompetence of supervisor: Engages in exploitive or harmful dual relationships Sexual contact with supervisees Misuse of power Extreme burnout Makes poor decisions due to inexperience Creates a negative experience for supervisee Takes on more than one role with supervisee needing to clarify boundaries Watch out for “boundary crossings” and “boundary violations.” According to Syracuse University, (CHRS), (2015), in their lecture on ethical issues, “the first and most important clinical and ethical challenge of supervision is the supervisor must be competent enough to clarify and assist both the best interest of the client and the supervisee simultaneously.” Stipulated in the ACA Code of Ethics, (2015), (ACA, F.1.a, p. 12), explains that the supervisor’s obligation is to monitor the services given by the new trainee or supervisee. This entails both the client’s welfare and the full development growth of the supervisee in a professional capacity and understand fully they must at all times be very aware of the Code of Ethics in performing their duties on topics such as vicarious liability, Duty to Warn, confidentiality, and self-regulated personal values. In the case of online supervision, (ACA, F.2.b, p.13) outlines that with use of technology, the supervisor must be competent in their usage skills in order to provide excellent correct feedback concerning using technology in their practice. Included also in the code of ethics is the standard professional relationship with trainee, (ACA, F.3.a, p.13), which stipulates necessary boundaries and limitations of the relationship. They are not to solve the client’s problems; they are there as a professor to the novice trainee and as a consultant to the more advanced trainee in which they commence granting small measures of autonomy. They help the trainee to progress their personal growth as a counselor with ethical issues well implemented in the supervision. Without the installation of professionalism of ethical standards, the client is put in jeopardy of potential harmfulness with carelessness via a novice counseling that has not reached fully developed proportions. This places the supervisor in danger of misuse of power and could lead to disqualifying the supervisee of their license and state credentials. According to Mulhauser, (2014), supervision is needed to protect the clients and to improve the quality of counselors to provide value to their clients. This will help the risk of serious oversight and evaluations will be competed with greater success. Last, the therapeutic relationship you initiate and develop with your supervisor will serve as an empirical model for your therapeutic relationships with your future clients. Practicing all ethical issues should and will become second nature with proper competent supervision. In conclusion, it is not only valuable to partake in supervision but the law for licensure requires it. This is security for the betterment and welfare of the supervisee clientele, the agency mission compliance, and colleague support when needed. The transition takes place in stages over time and should not be looked at negatively, but with a positive attitude in finding yourself and finding your way throughout the profession of your choice. References American Counseling Association, (ACA), (2011). Clinical Supervision Blog, (Jan 10, 2011). Retrieved August 30, 2015, from http://www.counseling.org/news/blog/aca-blog/2011/01/10/clinical- supervision American Counseling Association, (ACA), (2013). Clinical Supervision Blog, (Jan 10, 2011). Retrieved August 30, 2015, from http://www.counseling.org/news/blog/aca-blog/2013/11/25/for-new- counselors-what-are-the-benefits-of-counseling-supervision- Bordin, E., (1983). Supervision in Counseling: Contemporary models of supervision: a working alliance based on model supervision. The Counseling Psychologist, 11(1), 35-42. Retrieved on August 31, 2015, from http://dx.doi.org/10.1177/0011000083111007 Capella University, (2015). Supervision Scenarios, Retrieved August 25, 2015, from http://media.capella.edu/CourseMedia/COUN5004/SupervisionScenarios/ media.asp Clinical Mental Health Counseling, (CHMC), (2008). Supervision of Mental Health Counseling Interns. Retrieved August 31, 2015, from http://www.powershow.com/view/3e544c- OTJmM/Supervision_of_Mental_Health_Counseling_Interns_powerpoint_ppt_ presentation Continue Education, CE, (2015). Individual and group supervision in counseling, Retrieved August 25, 2015, from http://www.cetuesday.com/individual-an- group-supervision-in-counseling/ Dixon, D., (2015). Clinical supervision: a key to treatment success. National Technology Transfer Center, (SCATTC), National Institute of Drug Abuse (NIDA). Retrieved August 30, 2015, from http://www.attcnetwork.org/explore/priorityareas/wfd/getready/docs/Be acon004.pdf East Carolina University, (2015). Supervision of Counseling students: theory and practice. Retrieved August 31, 2015, from https://www.ecu.edu/cseduc/hace/Counselor/upload/Supervision TheoryPractice.pdf Mulhauser, G. (2014). Counseling and Therapy Supervision, Mental health Library Therapy, Retrieved August 25, 2015, from http://counsellingresource.com/lib/therapy/aboutcouns/supervision/ Pearson, Q. (2004) Getting the most out of clinical supervision: strategies for mental health. Journal of Mental Health Counseling. 26(4), 361-373. Retrieved August 30, 2015, from http://www3.canisius.edu/~farrugia/Supervision91611/Getting%20the%2 0Most%20from%20Supervision.pdf Syracuse University, School of Education, (2015). Ethical and legal issues In supervision, Retrieved August 25, 2015, from http://soe.syr.edu/academic/counseling_and_human_services/modules/Pre paring_for Supervision/ethical_legal_issues_in_supervision.aspx Treatment Improvement Protocol, (TIP 52) (2009). Part 1, Chapter 1, Clinical 2004). supervision and Professional Development of the Substance Abuse Counselor: Information You Need to Know, (TIP Series No 52). Retrieved August 30, 2015, from http://www.ncbi.nlm.nih.gov/books/NBK64848/ PAGE 4 GOALS COUNSELING SUPERVISION Running Head: GOALS COUNSELING SUPERVISION 1