Manual Clinical Supervision: Legal, Ethical, and Risk Management Issues

Specific supervisor competencies and the qualities and characteristics of effective supervisors will be reviewed. Legal, Ethical, and Risk Management Issues is a must for any mental health and social service professional with staff reporting to them. Paperback , pages. To see what your friends thought of this book, please sign up.

To ask other readers questions about Clinical Supervision , please sign up. Lists with This Book. This book is not yet featured on Listopia. Tmkral rated it liked it Jul 08, Bernard rated it it was ok Jan 05, Keisha rated it it was amazing Jan 06, Peggy Olson rated it liked it Jul 28, Paula Jursa rated it really liked it Mar 30, Midyet rated it it was amazing Jul 07, Isabel Sanchez-cummings rated it it was amazing Dec 27, It is based on a scenario where a supervisor oversees one to five counselors. This plan is based on several principles:. With the formula diagramed below, each counselor receives a minimum of 1 hour of group clinical supervision per week.

Each week you will have 1 hour of observation, 1 hour of individual supervision with one of your supervisees, and 1 hour of group supervision with five supervisees. Each week, one counselor will be observed in an actual counseling session, followed by an individual supervision session with you. If the session is videotaped, the supervisee can be asked to cue the tape to the segment of the session he or she wishes to discuss with you.

Afterwards, the observed counselor presents this session in group clinical supervision. Over the course of months, with vacation, holiday, and sick time, it should average out to approximately 1 hour of supervision per counselor per week. Figure 7 shows this schedule. When you are working with a counselor who needs special attention or who is functioning under specific requirements for training or credentialing, 1 additional hour per week can be allocated for this counselor, increasing the total hours for clinical supervision to 4, still a manageable amount of time.

Correct documentation and recordkeeping are essential aspects of supervision. Mechanisms must be in place to demonstrate the accountability of your role. See Tools 10—12 in Part 2, chapter 2. These systems should document:. Supervisory documents and notes are open to management, administration, and human resources HR personnel for performance appraisal and merit pay increases and are admissible in court proceedings.

It is imperative to maintain accurate and complete notes on the supervision. However, as discussed above, documentation procedures for formative versus summative evaluation of staff may vary. Typically, HR accesses summative evaluations, and supervisory notes are maintained as formative evaluations. From a legal perspective, the supervisor needs to be specific about what was agreed on and a timeframe for following up.

As discussed earlier, your first tasks in clinical supervision are to establish a behavioral contract, get to know your supervisees, and outline the requirements of supervision. You might request that the counselor give some thought to what he or she would like to accomplish in supervision, what skills to work on, and which core functions used in the addiction counselor certification process he or she feels most comfortable performing. It is important to determine the knowledge and skills, learning style, and conceptual skills of your supervisees, along with their suitability for the work setting, motivation, self-awareness, and ability to function autonomously.

A basic IDP for each supervisee should emerge from the initial supervision sessions. You and your supervisee need to assess the learning environment of supervision by determining:. A number of methods and techniques are available for clinical supervision, regardless of the modality used. Methods include as discussed previously case consultation, written activities such as verbatims and process recordings, audio and videotaping, and live observation. Techniques include modeling, skill demonstrations, and role playing.

Figure 8 outlines some of the methods and techniques of supervision, as well as the advantages and disadvantages of each method. The context in which supervision is provided affects how it is carried out. A critical issue is how to manage your supervisory workload and make a reasonable effort to supervise. The contextual issues that shape the techniques and methods of supervision include:. As noted above, clinical and administrative supervision overlap in the real world. Most clinical supervisors also have administrative responsibilities, including team building, time management, addressing agency policies and procedures, recordkeeping, human resources management hiring, firing, disciplining , performance appraisal, meeting management, oversight of accreditation, maintenance of legal and ethical standards, compliance with State and Federal regulations, communications, overseeing staff cultural competence issues, quality control and improvement, budgetary and financial issues, problem solving, and documentation.

Keeping up with these duties is not an easy task! This TIP addresses two of the most frequently voiced concerns of supervisors: One of the most important administrative tasks of a supervisor is that of documentation and recordkeeping, especially of clinical supervision sessions. Unquestionably, documentation is a crucial risk-management tool. Supervisory documentation can help promote the growth and professional development of the counselor Munson, However, adequate documentation is not a high priority in some organizations.

Documentation is no longer an option for supervisors. It is a critical link between work performance and service delivery. You have a legal and ethical requirement to evaluate and document counselor performance. A complete record is a useful and necessary part of supervision. Records of supervision sessions should include:. Several authors have proposed a standardized format for documentation of supervision, including Falvey b , Glenn and Serovich , and Williams By some estimates, people waste about two hours every day doing tasks that are not of high priority.

In your busy job, you may find yourself at the end of the week with unfinished tasks or matters that have not been tended to. Stop performing some tasks often training or supervision or take work home and work longer days. In the long run, neither of these choices is healthy or effective for your organization. Yet, being successful does not make you manage your time well. Managing your time well makes you successful. Ask yourself these questions about your priorities:. It is wise to develop systems for managing time-wasters such as endless meetings held without notes or minutes, playing telephone or email tag, junk mail, and so on.

Effective supervisors find their times in the day when they are most productive. Time management is essential if you are to set time aside and dedicate it to supervisory tasks. Additionally, Part 3 of this document provides a literature review and bibliographies available online only at http: The following are examples of online classroom training programs in clinical supervision in the substance abuse field:. For information about tools to measure counselor competencies and supervisor self-assessment tools, along with samples, see the following:.

Turn recording back on. National Center for Biotechnology Information , U. Information You Need to Know. Introduction Clinical supervision is emerging as the crucible in which counselors acquire knowledge and skills for the substance abuse treatment profession, providing a bridge between the classroom and the clinic.

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The perspective of this TIP is informed by the following definitions of supervision: 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. Rationale For hundreds of years, many professions have relied on more senior colleagues to guide less experienced professionals in their crafts. As a supervisor to the client, counselor, and organization, the significance of your position is apparent in the following statements: Organizations have an obligation to ensure quality care and quality improvement of all personnel.

Clinical supervision is how counselors in the field learn. In concert with classroom education, clinical skills are acquired through practice, observation, feedback, and implementation of the recommendations derived from clinical supervision.

Clinical Supervision: Legal, Ethical, and Risk Management Issues by George B. Haarman.
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Bernard and Goodyear incorporate the supervisory consulting role of case consultation and review, monitoring performance, counseling the counselor regarding job performance, and assessing counselors. In this role, supervisors also provide alternative case conceptualizations, oversight of counselor work to achieve mutually agreed upon goals, and professional gatekeeping for the organization and discipline e.

In this supportive role, supervisors provide morale building, assess strengths and needs, suggest varying clinical approaches, model, cheerlead, and prevent burnout. For entry-level counselors, the supportive function is critical. The central principles identified by the Consensus Panel are: Clinical supervision is an essential part of all clinical programs.

Clinical supervision is a central organizing activity that integrates the program mission, goals, and treatment philosophy with clinical theory and evidence-based practices EBPs. The primary reasons for clinical supervision are to ensure 1 quality client care, and 2 clinical staff continue professional development in a systematic and planned manner. In substance abuse treatment, clinical supervision is the primary means of determining the quality of care provided.

Clinical supervision enhances staff retention and morale. Staff turnover and workforce development are major concerns in the substance abuse treatment field. Every clinician, regardless of level of skill and experience, needs and has a right to clinical supervision. In addition, supervisors need and have a right to supervision of their supervision. Supervision needs to be tailored to the knowledge base, skills, experience, and assignment of each counselor.

All staff need supervision, but the frequency and intensity of the oversight and training will depend on the role, skill level, and competence of the individual. The benefits that come with years of experience are enhanced by quality clinical supervision. Clinical supervision needs the full support of agency administrators. Just as treatment programs want clients to be in an atmosphere of growth and openness to new ideas, counselors should be in an environment where learning and professional development and opportunities are valued and provided for all staff.

The supervisory relationship is the crucible in which ethical practice is developed and reinforced. The supervisor needs to model sound ethical and legal practice in the supervisory relationship. This is where issues of ethical practice arise and can be addressed. This is where ethical practice is translated from a concept to a set of behaviors.

Through supervision, clinicians can develop a process of ethical decisionmaking and use this process as they encounter new situations. Clinical supervision is a skill in and of itself that has to be developed. Good counselors tend to be promoted into supervisory positions with the assumption that they have the requisite skills to provide professional clinical supervision.

However, clinical supervisors need a different role orientation toward both program and client goals and a knowledge base to complement a new set of skills. Programs need to increase their capacity to develop good supervisors. Clinical supervision in substance abuse treatment most often requires balancing administrative and clinical supervision tasks.

Sometimes these roles are complementary and sometimes they conflict. Often the supervisor feels caught between the two roles. Administrators need to support the integration and differentiation of the roles to promote the efficacy of the clinical supervisor. Culture and other contextual variables influence the supervision process; supervisors need to continually strive for cultural competence. Supervisors require cultural competence at several levels. Since supervisors are in a position to serve as catalysts for change, they need to develop proficiency in addressing the needs of diverse clients and personnel.

Successful implementation of EBPs requires ongoing supervision. Supervisors ensure that EBPs are successfully integrated into ongoing programmatic activities by training, encouraging, and monitoring counselors. Excellence in clinical supervision should provide greater adherence to the EBP model. Because State funding agencies now often require substance abuse treatment organizations to provide EBPs, supervision becomes even more important.

Supervisors have the responsibility to be gatekeepers for the profession. Supervisors are responsible for maintaining professional standards, recognizing and addressing impairment, and safeguarding the welfare of clients. More than anyone else in an agency, supervisors can observe counselor behavior and respond promptly to potential problems, including counseling some individuals out of the field because they are ill-suited to the profession. Finally, supervisors also fulfill a gatekeeper role in performance evaluation and in providing formal recommendations to training institutions and credentialing bodies.

Although small substance abuse agencies might not have the resources for one-way mirrors or videotaping equipment, other direct observation methods can be employed see the section on methods of observation, pp. Guidelines for New Supervisors Congratulations on your appointment as a supervisor! Suggestions for new supervisors: Seek out this information as soon as possible through the human resources department or other resources within the organization. Ask for a period of 3 months to allow you to learn about your new role. During this period, do not make any changes in policies and procedures but use this time to find your managerial voice and decisionmaking style.

Take time to learn about your supervisees, their career goals, interests, developmental objectives, and perceived strengths. Work to establish a contractual relationship with supervisees, with clear goals and methods of supervision. Learn methods to help staff reduce stress, address competing priorities, resolve staff conflict, and other interpersonal issues in the workplace. Shadow a supervisor you respect who can help you learn the ropes of your new job. Ask for regular, weekly meetings with your administrator for training and instruction.

Problems and Resources As a supervisor, you may encounter a broad array of issues and concerns, ranging from working within a system that does not fully support clinical supervision to working with resistant staff. Working With Staff Who Are Resistant to Supervision Some of your supervisees may have been in the field longer than you have and see no need for supervision. Things a New Supervisor Should Know Eight truths a beginning supervisor should commit to memory are listed below: The reason for supervision is to ensure quality client care.

As stated throughout this TIP, the primary goal of clinical supervision is to protect the welfare of the client and ensure the integrity of clinical services. Supervision is all about the relationship. As in counseling, developing the alliance between the counselor and the supervisor is the key to good supervision. Culture and ethics influence all supervisory interactions. Contextual factors, culture, race, and ethnicity all affect the nature of the supervisory relationship.

Some models of supervision e. Be human and have a sense of humor. As role models, you need to show that everyone makes mistakes and can admit to and learn from these mistakes. Rely first on direct observation of your counselors and give specific feedback. Have and practice a model of counseling and of supervision; have a sense of purpose. Before you can teach a supervisee knowledge and skills, you must first know the philosophical and theoretical foundations on which you, as a supervisor, stand.

Counselors need to know what they are going to learn from you, based on your model of counseling and supervision. Make time to take care of yourself spiritually, emotionally, mentally, and physically. Again, as role models, counselors are watching your behavior. You have a unique position as an advocate for the agency, the counselor, and the client.

As a supervisor, you have a wonderful opportunity to assist in the skill and professional development of your staff, advocating for the best interests of the supervisee, the client, and your organization. Models of Clinical Supervision You may never have thought about your model of supervision. Explicitly addressing diversity of supervisees e. What are your beliefs about how people change in both treatment and clinical supervision? What universal principles apply in supervision and counseling and which are unique to clinical supervision?

What conceptual frameworks of counseling do you use for instance, cognitive—behavioral therapy, Step facilitation, psychodynamic, behavioral? What are the key variables that affect outcomes? Operational and practical, providing specific concepts and practices in clear, useful, and measurable terms. Outcome-oriented to improve counselor competence; make work manageable; create a sense of mastery and growth for the counselor; and address the needs of the organization, the supervisor, the supervisee, and the client. Developmental Stages of Counselors Counselors are at different stages of professional development.

Figure 2 Counselor Developmental Model. Take into account the individual learning styles and personalities of your supervisees and fit the supervisory approach to the developmental stage of each counselor. There is a logical sequence to development, although it is not always predictable or rigid; some counselors may have been in the field for years but remain at an early stage of professional development, whereas others may progress quickly through the stages. Counselors at an advanced developmental level have different learning needs and require different supervisory approaches from those at Level 1; and.

Identify methods for supervisors to assist counselors in developing these competencies. Provide evaluation criteria for supervisors to determine whether their supervisees have met minimal competency standards for effective and relevant practice. Figure 4 Continuum of Cultural Competence. What did you think when the supervisee said his or her culture is X, when yours is Y? What struggles and challenges have you faced working with clients who were from different cultures than your own? Some of the underlying assumptions of incorporating ethical issues into clinical supervision include: Ethical decisionmaking is a continuous, active process.

Ethical standards are not a cookbook. They tell you what to do, not always how. Each situation is unique. Therapy is conducted by fallible beings; people make mistakes—hopefully, minor ones. Sometimes the answers to ethical and legal questions are elusive. Direct Versus Vicarious Liability An important distinction needs to be made between direct and vicarious liability. Dual Relationships and Boundary Issues Dual relationships can occur at two levels: Supervisor Ethics In general, supervisors adhere to the same standards and ethics as substance abuse counselors with regard to dual relationship and other boundary violations.

Uphold the highest professional standards of the field. Conduct themselves in a manner that models and sets an example for agency mission, vision, philosophy, wellness, recovery, and consumer satisfaction. Reinforce zero tolerance for interactions that are not professional, courteous, and compassionate. Treat supervisees, colleagues, peers, and clients with dignity, respect, and honesty. Adhere to the standards and regulations of confidentiality as dictated by the field.

This applies to the supervisory as well as the counseling relationship. Monitoring Performance The goal of supervision is to ensure quality care for the client, which entails monitoring the clinical performance of staff. Behavioral Contracting in Supervision Among the first tasks in supervision is to establish a contract for supervision that outlines realistic accountability for both yourself and your supervisee. Individual Development Plan The IDP is a detailed plan for supervision that includes the goals that you and the counselor wish to address over a certain time period perhaps 3 months.

Evaluation of Counselors Supervision inherently involves evaluation, building on a collaborative relationship between you and the counselor. There has been considerable research on supervisory evaluation, with these findings: Help staff identify what is happening within the organization that might be contributing to their stress and learn how to address the situation in a way that is productive to the client, the counselor, and the organization.

Get training in identifying the signs of primary stress reactions, secondary trauma, compassion fatigue, vicarious traumatization, and burnout. Help staff match up self-care tools to specifically address each of these experiences. Support staff in advocating for organizational change when appropriate and feasible as part of your role as liaison between administration and clinical staff. Assist staff in adopting lifestyle changes to increase their emotional resilience by reconnecting to their world family, friends, sponsors, mentors , spending time alone for self-reflection, and forming habits that re-energize them.

Help them let go of their idealism that they can save the world. If possible in the current work environment, set parameters on their work by helping them adhere to scheduled time off, keep lunch time personal, set reasonable deadlines for work completion, and keep work away from personal time. Teach and support generally positive work habits. Some counselors lack basic organizational, team-work, phone, and time management skills ending sessions on time and scheduling to allow for documentation. The development of these skills helps to reduce the daily wear that erodes well-being and contributes to burnout.

List five people they care about and love. List five accomplishments in their professional life. Gatekeeping Functions In monitoring counselor performance, an important and often difficult supervisory task is managing problem staff or those individuals who should not be counselors. Methods of Observation It is important to observe counselors frequently over an extended period of time. Indirect methods have significant drawbacks, including: A counselor will recall a session as he or she experienced it.

If a counselor experiences a session positively or negatively, the report to the supervisor will reflect that. Simply by observing a counseling session, the dynamics will change. You may change how both the client and counselor act. You get a snapshot of the sessions.

Clinical Supervision and Professional Development of the Substance Abuse Counselor.

You and your supervisee must agree on procedures for observation to determine why, when, and how direct methods of observation will be used. Clients must know all the conditions of their treatment before they consent to counseling. Additionally, clients need to be notified of an upcoming observation by a supervisor before the observation occurs. Observations should be selected for review including a variety of sessions and clients, challenges, and successes because they provide teaching moments.

You should ask the supervisee to select what cases he or she wishes you to observe and explain why those cases were chosen. Direct observation should not be a weapon for criticism but a constructive tool for learning: When observing a session, you gain a wealth of information about the counselor. Use this information wisely, and provide gradual feedback, not a litany of judgments and directives. The client does not want to be taped. Recorded Observation Audiotaped supervision has traditionally been a primary medium for supervisors and remains a vital resource for therapy models such as motivational interviewing.

Several issues related to VTS are unique to the substance abuse field: Many agencies operate on limited budgets and administrators may see the expensive equipment as prohibitive and unnecessary; and. Many substance abuse supervisors have not been trained in the use of videotape equipment or in VTS.

Ethical and Risk Management Issues in Supervision

Clients must sign releases before taping. Most programs have a release form that the client signs on admission see Tool 19 in Part 2, chapter 2. Rationale For hundreds of years, many professions have relied on more senior colleagues to guide less experienced professionals in their crafts. As a supervisor to the client, counselor, and organization, the significance of your position is apparent in the following statements: Organizations have an obligation to ensure quality care and quality improvement of all personnel.

The first aim of clinical supervision is to ensure quality services and to protect the welfare of clients. Supervision is the right of all employees and has a direct impact on workforce development and staff and client retention. You oversee the clinical functions of staff and have a legal and ethical responsibility to ensure quality care to clients, the professional development of counselors, and maintenance of program policies and procedures. Clinical supervision is how counselors in the field learn. In concert with classroom education, clinical skills are acquired through practice, observation, feedback, and implementation of the recommendations derived from clinical supervision.

As shown in Figure 1 , your roles as a clinical supervisor in the context of the supervisory relationship include: Figure 1 Roles of the Clinical Supervisor. Assist in the development of counseling knowledge and skills by identifying learning needs, determining counselor strengths, promoting self-awareness, and transmitting knowledge for practical use and professional growth. Supervisors are teachers, trainers, and professional role models. Bernard and Goodyear incorporate the supervisory consulting role of case consultation and review, monitoring performance, counseling the counselor regarding job performance, and assessing counselors.

In this role, supervisors also provide alternative case conceptualizations, oversight of counselor work to achieve mutually agreed upon goals, and professional gatekeeping for the organization and discipline e. In this supportive role, supervisors provide morale building, assess strengths and needs, suggest varying clinical approaches, model, cheerlead, and prevent burnout. For entry-level counselors, the supportive function is critical. The central principles identified by the Consensus Panel are: Clinical supervision is an essential part of all clinical programs.

The benefits that come with years of experience are enhanced by quality clinical supervision. Clinical supervision needs the full support of agency administrators.

Clinical Supervision Legal Ethical and Risk Management Issues

Just as treatment programs want clients to be in an atmosphere of growth and openness to new ideas, counselors should be in an environment where learning and professional development and opportunities are valued and provided for all staff. The supervisory relationship is the crucible in which ethical practice is developed and reinforced. The supervisor needs to model sound ethical and legal practice in the supervisory relationship. This is where issues of ethical practice arise and can be addressed. This is where ethical practice is translated from a concept to a set of behaviors. Through supervision, clinicians can develop a process of ethical decisionmaking and use this process as they encounter new situations.

Clinical supervision is a skill in and of itself that has to be developed. Good counselors tend to be promoted into supervisory positions with the assumption that they have the requisite skills to provide professional clinical supervision. However, clinical supervisors need a different role orientation toward both program and client goals and a knowledge base to complement a new set of skills. Programs need to increase their capacity to develop good supervisors.

Clinical supervision in substance abuse treatment most often requires balancing administrative and clinical supervision tasks. Sometimes these roles are complementary and sometimes they conflict. Often the supervisor feels caught between the two roles. Administrators need to support the integration and differentiation of the roles to promote the efficacy of the clinical supervisor. Culture and other contextual variables influence the supervision process; supervisors need to continually strive for cultural competence.

Supervisors require cultural competence at several levels. Since supervisors are in a position to serve as catalysts for change, they need to develop proficiency in addressing the needs of diverse clients and personnel.

Clinical supervision should involve direct observation methods. Direct observation should be the standard in the field because it is one of the most effective ways of building skills, monitoring counselor performance, and ensuring quality care. Supervisors require training in methods of direct observation, and administrators need to provide resources for implementing direct observation. Although small substance abuse agencies might not have the resources for one-way mirrors or videotaping equipment, other direct observation methods can be employed see the section on methods of observation, pp.

Guidelines for New Supervisors Congratulations on your appointment as a supervisor! Suggestions for new supervisors: Seek out this information as soon as possible through the human resources department or other resources within the organization. Ask for a period of 3 months to allow you to learn about your new role. During this period, do not make any changes in policies and procedures but use this time to find your managerial voice and decisionmaking style.

Working With Staff Who Are Resistant to Supervision Some of your supervisees may have been in the field longer than you have and see no need for supervision. Things a New Supervisor Should Know Eight truths a beginning supervisor should commit to memory are listed below: The reason for supervision is to ensure quality client care. As stated throughout this TIP, the primary goal of clinical supervision is to protect the welfare of the client and ensure the integrity of clinical services. Supervision is all about the relationship.

As in counseling, developing the alliance between the counselor and the supervisor is the key to good supervision. Culture and ethics influence all supervisory interactions. Contextual factors, culture, race, and ethnicity all affect the nature of the supervisory relationship. Some models of supervision e. Be human and have a sense of humor. As role models, you need to show that everyone makes mistakes and can admit to and learn from these mistakes. Rely first on direct observation of your counselors and give specific feedback.

Have and practice a model of counseling and of supervision; have a sense of purpose. Before you can teach a supervisee knowledge and skills, you must first know the philosophical and theoretical foundations on which you, as a supervisor, stand.

Clinical Supervision: Legal, Ethical, and Risk Management Issues

Outcome-oriented to improve counselor competence; make work manageable; create a sense of mastery and growth for the counselor; and address the needs of the organization, the supervisor, the supervisee, and the client. Developmental Stages of Counselors Counselors are at different stages of professional development. Figure 2 Counselor Developmental Model. Take into account the individual learning styles and personalities of your supervisees and fit the supervisory approach to the developmental stage of each counselor.

There is a logical sequence to development, although it is not always predictable or rigid; some counselors may have been in the field for years but remain at an early stage of professional development, whereas others may progress quickly through the stages. Counselors at an advanced developmental level have different learning needs and require different supervisory approaches from those at Level 1; and.

Developmental Stages of Supervisors Just as counselors go through stages of development, so do supervisors. Figure 3 Supervisor Developmental Model. Cultural and Contextual Factors Culture is one of the major contextual factors that influence supervisory interactions. More care should be taken to: Identify the competencies necessary for substance abuse counselors to work with diverse individuals and navigate intercultural communities. Identify methods for supervisors to assist counselors in developing these competencies. Provide evaluation criteria for supervisors to determine whether their supervisees have met minimal competency standards for effective and relevant practice.

Figure 4 Continuum of Cultural Competence. What did you think when the supervisee said his or her culture is X, when yours is Y? What struggles and challenges have you faced working with clients who were from different cultures than your own? Some of the underlying assumptions of incorporating ethical issues into clinical supervision include: Ethical decisionmaking is a continuous, active process.

Dual Relationships and Boundary Issues Dual relationships can occur at two levels: Supervisor Ethics In general, supervisors adhere to the same standards and ethics as substance abuse counselors with regard to dual relationship and other boundary violations. Uphold the highest professional standards of the field. Conduct themselves in a manner that models and sets an example for agency mission, vision, philosophy, wellness, recovery, and consumer satisfaction.

Reinforce zero tolerance for interactions that are not professional, courteous, and compassionate. Treat supervisees, colleagues, peers, and clients with dignity, respect, and honesty. Adhere to the standards and regulations of confidentiality as dictated by the field. This applies to the supervisory as well as the counseling relationship.

Monitoring Performance The goal of supervision is to ensure quality care for the client, which entails monitoring the clinical performance of staff. Behavioral Contracting in Supervision Among the first tasks in supervision is to establish a contract for supervision that outlines realistic accountability for both yourself and your supervisee.

Individual Development Plan The IDP is a detailed plan for supervision that includes the goals that you and the counselor wish to address over a certain time period perhaps 3 months. Evaluation of Counselors Supervision inherently involves evaluation, building on a collaborative relationship between you and the counselor. There has been considerable research on supervisory evaluation, with these findings: Help staff identify what is happening within the organization that might be contributing to their stress and learn how to address the situation in a way that is productive to the client, the counselor, and the organization.

The development of these skills helps to reduce the daily wear that erodes well-being and contributes to burnout. List five people they care about and love. List five accomplishments in their professional life. Gatekeeping Functions In monitoring counselor performance, an important and often difficult supervisory task is managing problem staff or those individuals who should not be counselors.

Methods of Observation It is important to observe counselors frequently over an extended period of time. Indirect methods have significant drawbacks, including: A counselor will recall a session as he or she experienced it. If a counselor experiences a session positively or negatively, the report to the supervisor will reflect that.

Simply by observing a counseling session, the dynamics will change. You may change how both the client and counselor act. You get a snapshot of the sessions. You and your supervisee must agree on procedures for observation to determine why, when, and how direct methods of observation will be used. Clients must know all the conditions of their treatment before they consent to counseling. Additionally, clients need to be notified of an upcoming observation by a supervisor before the observation occurs.

Observations should be selected for review including a variety of sessions and clients, challenges, and successes because they provide teaching moments. You should ask the supervisee to select what cases he or she wishes you to observe and explain why those cases were chosen. Direct observation should not be a weapon for criticism but a constructive tool for learning: When observing a session, you gain a wealth of information about the counselor. Use this information wisely, and provide gradual feedback, not a litany of judgments and directives. The client does not want to be taped.

Recorded Observation Audiotaped supervision has traditionally been a primary medium for supervisors and remains a vital resource for therapy models such as motivational interviewing. Several issues related to VTS are unique to the substance abuse field: Many agencies operate on limited budgets and administrators may see the expensive equipment as prohibitive and unnecessary; and. Many substance abuse supervisors have not been trained in the use of videotape equipment or in VTS.

Clients must sign releases before taping. Most programs have a release form that the client signs on admission see Tool 19 in Part 2, chapter 2. The supervisee informs the client that videotaping will occur and reminds the client about the signed release form. The release should specify that the taping will be done exclusively for training purposes and will be reviewed only by the counselor, the supervisor, and other supervisees in group supervision. Permission will most likely be granted if the request is made in a sensitive and appropriate manner.

It is critical to note that even if permission is initially given by the client, this permission can be withdrawn. You cannot force compliance. The use and rationale for taping needs to be clearly explained to clients. Tapes can be admissible as evidence in court as part of the clinical record. Since all tapes should be erased after supervision, this must be stated in agency policies. If there are exceptions, those need to be described. Too often, supervisors watch long, uninterrupted segments of tape with little direction or purpose.

To avoid this, you may want to ask your supervisee to cue the tape to the segment he or she wishes to address in supervision, focusing on the goals established in the IDP. Having said this, listening only to segments selected by the counselor can create some of the same disadvantages as self-report: The supervisor may occasionally choose to watch entire sessions. You need to evaluate session flow, pacing, and how counselors begin and end sessions.

Live Observation With live observation you actually sit in on a counseling session with the supervisee and observe the session first hand. Live observation is effective for the following reasons: It allows you to get a true picture of the counselor in action. It gives you an opportunity to model techniques during an actual session, thus serving as a role model for both the counselor and the client. Should a session become countertherapeutic, you can intervene for the well-being of the client. I got two for the price of one.

It can be intrusive and alter the dynamics of the counseling session. The counselor should always begin with informed consent to remind the client about confidentiality. While sitting outside the group or an individual session between counselor and client may undermine the group process, it is a method selected by some. Sitting outside the group undermines the human connection between you, the counselor, and the client s and makes it more awkward for you to make a comment, if you have not been part of the process until then.

For individual or family sessions, it is also recommended that the supervisor sit beside the counselor to fully observe what is occurring in the counseling session. As preparation, the supervisor and supervisee should briefly discuss the background of the session, the salient issues the supervisee wishes to focus on, and the plans for the session.

The role of the supervisor should be clearly stated and agreed on before the session. You and the counselor may create criteria for observation, so that specific feedback is provided for specific areas of the session. Your comments during the session should be limited to lessen the risk of disrupting the flow or taking control of the session. Intervene only to protect the welfare of the client should something adverse occur in the session or if a moment critical to client welfare arises.

In deciding to intervene or not, consider these questions: What is the probability that the supervisee will make the intervention on his or her own or that my comments will be successful? Will I create an undue dependence on the part of clients or supervisee? Provide feedback to the counselor as soon as possible after the session.

Ideally, the supervisor and supervisee s should meet privately immediately afterward, outlining the key points for discussion and the agenda for the next supervision session, based on the observation. Practical Issues in Clinical Supervision Distinguishing Between Supervision and Therapy In facilitating professional development, one of the critical issues is understanding and differentiating between counseling the counselor and providing supervision.

Figure 6 Differences Between Supervision and Counseling. A feeling of loathing, anxiety, or dread at the prospect of seeing a specific client or supervisee. How is this client affecting you? What feelings does this client bring out in you? What is your behavior toward the client in response to these feelings? What is it about the substance abuse behavior of this client that brings out a response in you? What is happening now in your life, but more particularly between you and the client that might be contributing to these feelings, and how does this affect your counseling?

What strategies and coping skills can assist you in your work with this client? The need for approval and acceptance as a knowledgeable and competent supervisor. Unresolved personal conflicts of the supervisor activated by the supervisory relationship. In a similar vein, aggrandizing and idealizing some supervisees again, whether or not warranted in comparison to other supervisees.

Cultural countertransference, such as catering to or withdrawing from individuals of a specific cultural background in a way that hinders the professional development of the counselor. Balancing Clinical and Administrative Functions In the typical substance abuse treatment agency, the clinical supervisor may also be the administrative supervisor, responsible for overseeing managerial functions of the organization. Tips for juggling these functions include: Be aware of your own biases and values that may be affecting your administrative opinions. Delegate the administrative functions that you need not necessarily perform, such as human resources, financial, or legal functions.

Get input from others to be sure of your objectivity and your perspective. This plan is based on several principles: All counselors, regardless of years of experience or academic training, will receive at least 1 hour of supervision for every 20 to 40 hours of clinical practice. Direct observation is the backbone of a solid clinical supervision model. Group supervision is a viable means of engaging all staff in dialog, sharing ideas, and promoting team cohesion. Figure 7 Sample Clinical Supervision Schedule. Documenting Clinical Supervision Correct documentation and recordkeeping are essential aspects of supervision.

These systems should document: Informal and formal evaluation procedures. Frequency of supervision, issues discussed, and the content and outcome of sessions. Due process rights of supervisees such as the right to confidentiality and privacy, to informed consent. Risk management issues how to handle crises, duty-to-warn situations, breaches of confidentiality. Structuring the Initial Supervision Sessions As discussed earlier, your first tasks in clinical supervision are to establish a behavioral contract, get to know your supervisees, and outline the requirements of supervision.