Designing and running supervisor training courses: Best practice recommendationsDr. Aisling McMahon

EFPA, Brussels25th May, 2018

Introductions: What does supervision mean to me as a psychologist?

words

images

metaphors

Plan of day & expectations

－Brief overview of supervision definitions & research

－Workgroups: Content & methods of supervisor training

－Recommendations for best practice in training

－Outline of a supervisor training course

－Main areas of training course content－Overview / Exercises / Discussion / Sharing experience

－Evaluation of training

－Review

－Check-in about expectations/needs

Definitions of supervision

－“Clinical supervision is the signature pedagogy of the mental health professions (Bernard & Goodyear, 2014, p.2)

－“Supervision is an intervention provided by a more senior member of a profession to a more junior colleague or colleagues who typically (but not always) are members of that same profession. This relationship is evaluative and hierarchical, extends over time, and has the simultaneous purposes of enhancing the professional functioning of the more junior person(s), monitoring the quality of professional services offered to the clients, she, he, or they see, and serving as a gatekeeper for the particular profession the supervisee seeks to enter” (Bernard & Goodyear, 2014, p.9)

－“Supervision is a joint endeavour in which a practitioner with the help of a supervisor, attends to their clients, themselves as part of their client-practitioner relationships and the wider systemic context, and by doing so improves the quality of their work, transforms their client relationships, continuously develops themselves, their practice and the wider profession” (Hawkins & Shohet, 2012, p.60)

Functions of supervision

－Supervision seen to provide 3 key functions:

－a restorative, supportive function for supervisee, protecting

against stress & burnout

－a qualitative function in its monitoring/review of ethical,

professional & anti-discriminatory practice

－a developmental function, where professionals can continue

to learn in a complex field of practice

(Proctor, 1988)

BPS Clinical & Counselling Divisions & most Irish & UK

counselling & psychotherapy organisations regard

supervision as a core ethical, professional practice & require

all members to receive regular career-long supervision

Efficacy of supervision

－100 year history of supervision practice but growth in research only

in last 30 years (Watkins, 2011)

－Supervisees report positive benefits: increased self-awareness,

treatment knowledge, skill acquisition & utilisation, self-efficacy,

professional identity development & strengthening of supervisee–

client relationships (Research reviews: Watkins, 2011; Wheeler &

Richards, 2007)

－Some evidence emerging that supervision results in improved

competency (e.g., Mannix et al., 2008) & improved client outcomes

(Bambling et al., 2006; Bradshaw et al., 2007; Callahan et al., 2009;

Milne et al., 2008) but this is mixed (Rousmaniere et al., 2016)

－Given its triadic nature, involving supervisor, supervisee & client, &

impact that extends through time, it is difficult to evaluate

Recent attention to training

－“As with any multidimensional interpersonal task, supervisors require solid

foundational training in order to fulfil their role with competence, confidence and

credibility (Page & Wosket, 2015)

－“It is no longer assumed that competence as a supervisor is accomplished through

osmosis” (Falender & Shafranske, 2012)

－Without training & standards, supervisors can be caught in a ‘‘tyranny of niceness’’

(Fleming et al., 2007) or ‘‘passive to the point of destruction [or] judgemental,

authoritarian, and demanding to the point of sadism’’ (Hoffman, 1994)

－Policy directives/guidelines from many mental health professional bodies for

supervisor training (e.g., APA, BPS, BACP, PSI)

－Supervisors mostly attend supervision workshops (64-84%, Milne et al., 2011) but

limited numbers have formal supervision training (16%, McMahon & Errity, 2015)

－Recent international interdisciplinary consensus on supervision competencies

(Falender et al., 2004; Milne et al., 2009; Olds & Hawkins, 2014; Watkins, 2013)

Impact of supervision training

－Trained supervisors have been rated by observers as less

authoritarian, encouraging supervisees to take an active role

(Barrow & Domingo,1997)

－Supervisees had higher rates of trust/rapport with trained

supervisors & placed higher value on supervision (White &

Winstanley, 2010) & trained supervisors judged as less frequently

providing harmful or inadequate supervision (Ellis et al., 2013)

－Supervisors report multiple benefits from training, incl. greater

awareness, confidence & skill in contracting, use of models, giving

feedback, managing boundaries & systemic/organisational issues

(Ooijen & Spencer, 2017) & greater emphasis on supervisee

learning (Younge & Campbell, 2013)

－Limited studies, more research needed

Work groups

What content do we need to include in supervisor training?

What methods/formats of learning should we use in supervisor training?

International, interdisciplinary consensus on supervisor training: Content

－supervisor/supervisee roles, responsibilities & contracting

－difference & diversity in supervision

－establishing & maintaining the supervisory relationship, including awareness of supervisee development

－assessment/evaluation/gatekeeping & feedback in supervision

－knowledge of the profession/specific context of supervisee

－theories, models & modalities of supervision

－supervision interventions/strategies

－ethical/legal/professional issues in supervision

－research about supervision

－self-reflective stance/commitment to lifelong learning

(APA, 2014; BPS, 2010; Olds & Hawkins, 2014; Watkins & Wang, 2014)

Current best practice recommendations on methods of supervisor training

－Include mixture of didactic (concepts, theory, knowledge) & experiential learning (incl. simulated & in vivo practice with supervisees)

－Follow adult teaching & learning principles

－Include assessment of knowledge gain & skill acquisition

－Need for ongoing CPD in supervision & supervision of supervisory practice

(Milne et al., 2011, review & synthesis of best practice)

－teaching (in class/online)

－assigned reading material

－individual/group presentations regarding reading

－discussion of vignettes

－reflective exercises & journaling

－role plays with feedback

－analysis of supervision DVDs

－large & small group discussions

－attendance at supervision of supervision

－time for supervisory practice between training days

－recording & analysis of supervision sessions

－individual learning goals & plans for continued CPD

Outline of a 4-day supervisor training course…Day 1:

－Pre-course self-assessment

－Overview of nature & functions of supervision

－Review of research on supervision

－Exercise: Supervision genogram

－Roles, responsibilities & contracting in supervision: discussion & practice

－Models of supervision – overview, plus skills practice work with Hawkins & Shohet model

Day 2:

－Reflection & discussion of practice

－Overview of Page & Wosket Cyclical model

－Overview of supervisor interventions: Heron’s categories

－Feedback & evaluation in supervision: experience & anxieties

－DVD: analysis in relation to models & interventions

－Real plays, including identification of learning goals & practising feedback

…Outline of a 4-day supervisor training course

Day 3:

－Focus on the supervisory relationship – boundaries, challenges, metacommunication

－Diversity & power in supervision: experiential exercises & discussion

－Adult learning theory & Kolb’s experiential model

－DVD: analysis in relation to models, interventions & experiential process

－Real plays, including identification of learning goals & feedback

Day 4:

－Complexities in supervisory practice – challenges, dialectical tensions: self-assessment & group presentations of reading

－Forms & formats of supervision: Peer, group & organisational supervision

－DVD: group supervision exercise

－Group supervision real plays & feedback

－Post course self-assessment & identification of CPD learning goals in supervision

Pedagogy vs. andragogy

－Shift from focus on the teacher/knowledge transmission to a focus on the learner – start

with adult’s experiences & the context of the learning (Merriam, 2008)

－Knowles et al.’s (2005) adult learning theory: adults learn best when:

－self-directed

－using resources from life experience

－motivated by problem-centred tasks required for their role

－understand utility of the learning

－3 types of professional knowledge (Eraut,1994):

－Propositional – theoretical/ ‘knowing what’

－Process – procedural/ ‘knowing how’

－Personal – ‘lived experience’, often needs reflection & facilitation to become explicit

－Schon (1983) – critique against ‘technical-rationality’ as grounding of professional

knowledge – central value of reflection on, in & for action - becoming aware of implicit

knowledge base & learning through reflection on experience

Experiential learning

Supervision is an

opportunity to enhance

experiential learning

In learning from

experience, we move

from evaluation to

curiosity - safety of the

context affects if we

become evaluative

(judging) or curious

(more exploratory

learning)

Kolb’s (1984) experientiallearning cycle

activity

reflection

learning

application

Starting with personal experience: How were you supervised?

Supervision Genogram

(Aten et al., 2008)

Contracting for the supervisory relationship

－A shared & explicit understanding & agreement on tasks & responsibilities is essential for safe, ethical practice & learning –between supervisor, training organisation & placement agency (Morrissey, 2005)

－Boundary issues: relationship (dual roles), content (personal issues), time, space & confidentiality (limits & recording/reporting; Power, 2007)

－Supervisee ‘bill of rights’ - e.g., right to privacy, to feedback, skilled supervisor (Munson, 2002)

－Need regular reviews of contract & process to minimise unspoken, implicit understandings (“psychological contracts”: Carroll, 2010)

－Boundary issue vignettes in Creaner (2014, p.22-3)

－Reflective questions on boundary & supervision relationship issues in Tribe & Morrissey (2005, p.313)

－Design a contract in class for supervisory real-play exercise

Diversity & power

－Social, gender, religious & cultural inequalities (how we are privileged & oppressed)

are “complex, intersecting & multi-layered” (Patel, 2012)

－Power is embedded in everyday language, discourses & practices (Foucault, 1988)

－Need to develop safety & trust, contract about & develop a language to talk about

diversity & power, & develop both supervisor & supervisee reflexivity (Patel, 2012)

－Explicitly addressing power & diversity in supervision is related to greater

supervisee satisfaction (Gatmon et al., 2001; Inman, 2006; Murphy & Wright, 2005)

－Are useful cultural diversity self-assessment tools available on web (e.g.,

https://www.uh.edu/cdi/diversity_education/resources/activities/pdf/diversity%20acti

vities-resource-guide.pdf; https://www.ithaca.edu/hr/docs/didocs/CCSelfAssess.pdf)

－Good cultural sensitivity illustrations in Hawkins & Shohet (2012, ch.8)

Purposeful relational engagement in supervision

－“Learn to speak elephant” –metacommunication in supervision –trying out ‘reflexive processing of moment-to-moment relationship material’ – ‘curative and corrective experience of relational engagement…creation of a space for interactional learning’

－Importance of good supervisory alliance, safety, timing, minding of boundaries

(Calvert et al, 2016, p.5-6)

Supervisor self-feedback exercise

－How comfortable am I in the supervisory role with this supervisee?

－What is the power dynamic like in this relationship?

－How easy is it for me to create a space for thinking for my

supervisee, and for me?

－How easy is it for me to create a space for feeling and intuition for

my supervisee, and for me?

－How flexible am I to engage with the supervisee’s material in

different ways – e.g., Socratic questioning, role play, encouraging

case formulation, giving feedback?

－How often do I bring in my own material or experience, and how is

that going?

－How useful do I think the supervision time is (in terms of benefit to

supervisee and/or their clients)?

…and for the supervisee…

－How comfortable am I in this supervisory relationship?

－What is the power dynamic like in this relationship?

－How easy is it for me to find a space for thinking in this supervisory relationship?

－How easy is it for me to create a space for feeling and intuition in this supervisory relationship?

－How free am I to engage with my work material in different ways – e.g., reflection, role play, developing case formulation, asking for feedback?

－Am I comfortable sharing my difficulties and challenges?

－How useful do I think the supervision time is (in terms of benefit to me and/or my clients)?

Feedback & evaluation

－Practice alone is insufficient to become competent – need intentional, clear &

systematic feedback, related to supervisee’s developmental level & learning

goals (Bernard & Goodyear, 2014)

－Feedback needs to be Clear, Owned, Regular, Balanced & Specific (CORBS:

Hawkins & Shohet, 2012); also dialogical & mutual/two-way

－Need for due process – prior warning of problems & opportunity to

improve/discuss issues arising from evaluation (Carroll, 1996)

－Encourage supervisee self-evaluation - develop self-efficacy & trust in own

judgement (Creaner, 2014)

－“The responsibility to evaluate the trainee is anxiety-provoking for both

members of the supervisory dyad” (Morrissey, 2005)

－Supervisors can be uncertain/withhold feedback & need explicit training in

giving clear, concrete, individualised feedback (Borders et al, 2017)

－In training, explore personal histories of feedback & fears/resistances

Evaluating EuroPsy competencies

－Goal definition

－Assessment

－Development

－Intervention

－Evaluation

－Communication

－Enabling competencies

－Knowledge of competencies & standards

－Means of assessing work (observation, recording, self-report, client/staff feedback, written reports)

－Gatekeeping responsibility & protocols when there is insufficient competence at end of placement/supervision contract

－Other issues, concerns?

Ethical, legal & professional issues

－“Developing ethical awareness and sensitivity is a continuing process

and is at the very core of supervision” (Creaner, 2014, p.70)

－Specific codes of ethical practice for supervisors (see PSI code) -

including respect/confidentiality, competence/integrity, management of

dual relationships, responsibility/clinical accountability

－Discussion of appropriate documentation/record-keeping of supervision

in different contexts

－Legally supervisors have been held accountable for supervisee’s work

in USA but yet to be the case in Europe (Morrissey, 2005)

－Useful to have ethical vignettes for discussion (e.g., Creaner, 2014,

p.22-3)

－Good consideration of supervisory ethical issues in Carroll (1996, ch.8)

Supervision-specific theory & skill: Models of Supervision

－Psychotherapy-based models:

－Liese & Beck’s (1997) CBT model

－Frawley O’Dea & Sarnat’s (2001) Psychodynamic model

－Developmental models:

－Stoltenberg & McNeill’s (2010) Integrated Developmental Model

－Functional/Social role models:

－Holloway’s (1995) Systems model

－Carroll’s (1996) Tasks model

－Page & Wosket’s (2015) Cyclical model

－Hawkins & Shohet’s (2012) Seven-eyed process model

－Evidence-based models:

－Milne et al. (2008) Best Evidence Synthesis model

Focus on 2-3 models & supervisor interventions in training

－Stoltenberg & Delworth’s Integrated Developmental Model

(supervisor responsiveness to supervisee developmental stage)

－Page & Wosket’s Cyclical model (attends to structure,

contracting & transfer of learning)

－Hawkins & Shohet’s Seven-eyed model (attends to process &

relational issues in client & supervisory work)

－Focus on supervisory interventions:

－identifying supervisor interventions, e.g., feedback, role-play,

supporting, challenging (SAGE measure: Reiser & Milne, 2017;

Heron’s, 1989, intervention categories)

－Supervisor facilitation of supervisee learning, e.g., experiencing

reflecting, conceptualising, experimenting (Kolb, 1984)

Integrated Developmental ModelSupervisee development:

Stage 1 – dependency stage – anxious & insecure, highly motivated; can act over/under confident - “Can I make it in this work?” (self-centred)

Stage 2 – dependency-autonomy conflicts – fluctuating between overconfidence/overwhelmed, fluctuating motivation, uneven theoretical understanding - “Can I help this client make it?” (client-centred)

Stage 3 - conditional dependency –increasing self-confidence, insight, more autonomous; can integrate theory, content & process - “How are we relating together?”(process-centred)

Integrated stage 3i – master professional – has personal autonomy, stable motivation, insightful awareness - “How do processes interpenetrate?” (process-in-context-centred)

Supervisor strategy:

－Stage 1 Supervisor provides education, safety, containment, structure, reinforcement of skills, doesn’t undermine what’s unique & exciting about the work for supervisee

－Stage 2 Supervisor balances fostering autonomy with support & structure; develops awareness of countertransference; normalises & offers secure base; shows fallibility

－Stage 3 supervisor offers enquiring framework to facilitate development of self-supervision, emphasises autonomy & growth; focus less on technique & survival strategies; encouraging experimentation & exploration

－Stage 3i supervisor: Supervisory relationship is increasingly collegial. Not about acquiring more knowledge but allowing knowledge to be deepened & integrated into wisdom

Seven-eyed model

Modes of supervision

－Individual, group & peer supervision: Proctor (2008) is the uncontested bible on group supervision; see also chapters in Hawkins & Shohet (2012) & Page & Wosket (2015)

－Proctor & Inskipp DVD is good for group supervision exercises

－Technological advances in supervision: recommend Rousmaniere et al. (2014); also guidance in U.S. Association of State & Provincial Psychology Boards (2015)

Supervisory interventions

1. Prescriptive – influencing/directing, advice, suggestions

2. Informative – imparting knowledge, information

3. Confronting – challenging – truth-telling ‘with love’

4. Cathartic – emotional expression/release

5. Catalytic – encouraging further self-exploration, self-discovery (enabling change in the other)

6. Supportive – validating, affirmative

(Heron, 1989)

Discussion in pairs: Intervention styles

What do you think are

your two weakest and

two strongest

intervention styles?

A weak style may be one

you seldom use or you

feel you don’t use as well

as you’d like

Real-plays

－In trios/fours – supervisor, supervisee, observer(s)

－Observer to note use of Heron’s interventions / supervisory models

Supervisor to identify learning goals in relation to each

role play – what aspects do you want to work on &

develop? Observers to pay extra attention to those

Reflection & discussion

－Reflection on experience of practice sessions－What did I do well in my practice?

－What needed development in my practice?

－Did I observe anything in others’ practice that I’d like to develop more in my own practice?

－Small & large group discussion of arising issues, dilemmas, insights

Supervisory skill: Dialectical tensionsSupervisors must engage in a metaphorical version of the circus art of ‘plate spinning’ : Veilleux et al. (2014)

Self-rating of own supervisory skills

－In small groups discuss reasons for your ratings

－Are there intentional, professional, theoretical and/or practical reasons for your ratings?

－Are there issues of confidence or lack of experience contributing to your ratings?

Evaluation of trainingWhat are the intended outcomes of supervisor training & how should

supervisor skills, knowledge & values be assessed during & following

training?

－Essays (e.g., on supervision models; on personal & professional

philosophy of supervision)

－Supervisor learning log (of supervision hours & supervision of

supervisory work)

－Reflective journal of supervisory development

－Reflective analysis of a recorded & transcribed supervision session

－Report from supervisor of supervision

－Pre- and post-course self-evaluation of knowledge & skills

－Any other methods?

Review & discussion

－What can I take from today back to my own context?

－What are the next steps to further develop supervision training in my context?

Go raibh maith agaibh!aisling.mcmahon@dcu.ie