Supervision Essentials for a Systems Approach to Supervision [1 ed.] 1433822075, 9781433822070

Table of contents :
Contents
Foreword to the Clinical Supervision Essentials Series
Acknowledgments
Introduction
Chapter 1
Essential Dimensions of Systems Approach to Supervision
Chapter 2
Case Illustration of Process in Supervision
Chapter 3
Handling Common Supervisory Issues
Chapter 4
Applying the SAS Model to Teaching Supervision
Chapter 5
Future Directions and Conclusion
Suggested Readings
References
Index
About the Author

Citation preview

Supervision Essentials for

a Systems Approach to Supervision

Clinical Supervision Essentials Series Supervision Essentials for Psychodynamic Psychotherapies Joan E. Sarnat Supervision Essentials for the Integrative Developmental Model Brian W. McNeill and Cal D. Stoltenberg Supervision Essentials for the Feminist Psychotherapy Model of Supervision Laura S. Brown Supervision Essentials for a Systems Approach to Supervision Elizabeth L. Holloway

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Clinical Supervision Essentials HANNA LEVENSON and ARPANA G. INMAN, Series Editors

Supervision Essentials for

a Systems Approach to Supervision

Elizabeth L. Holloway

American Psychological Association • Washington, DC

Copyright © 2016 by the American Psychological Association. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, including, but not limited to, the process of scanning and digitization, or stored in a database or retrieval system, without the prior written permission of the publisher. Published by American Psychological Association 750 First Street, NE Washington, DC 20002 www.apa.org

To order APA Order Department P.O. Box 92984 Washington, DC 20090-2984 Tel: (800) 374-2721; Direct: (202) 336-5510 Fax: (202) 336-5502; TDD/TTY: (202) 336-6123 Online: www.apa.org/pubs/books E-mail: [email protected]

In the U.K., Europe, Africa, and the Middle East, copies may be ordered from American Psychological Association 3 Henrietta Street Covent Garden, London WC2E 8LU England Typeset in Minion by Circle Graphics, Inc., Columbia, MD Printer: Maple Press, York, PA Cover Designer: Mercury Publishing Services, Inc., Rockville, MD The opinions and statements published are the responsibility of the authors, and such opinions and statements do not necessarily represent the policies of the American Psychological Association. Library of Congress Cataloging-in-Publication Data Names: Holloway, Elizabeth, 1950- author. Title: Supervision essentials for a systems approach to supervision / Elizabeth L. Holloway. Description: Washington, DC : American Psychological Association, [2016] | Series: Clinical supervision essentials series | Includes bibliographical references and index. Identifiers: LCCN 2015042131 | ISBN 9781433822070 | ISBN 1433822075 Subjects: LCSH: Psychotherapists — Supervision of. | Counselors — Supervision of. Classification: LCC RC459.H653 2016 | DDC 616.89/14092—dc23 LC record available at http://lccn.loc.gov/2015042131 British Library Cataloguing-in-Publication Data A CIP record is available from the British Library. Printed in the United States of America First Edition http://dx.doi.org/10.1037/14942-000

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Contents

Foreword to the Clinical Supervision Essentials Series Acknowledgments

vii xiii

Introduction 3 Chapter 1. Essential Dimensions of Systems Approach to Supervision

13

Chapter 2.  Case Illustration of Process in Supervision

33

Chapter 3.  Handling Common Supervisory Issues

55

Chapter 4.  Applying the SAS Model to Teaching Supervision

81

Chapter 5.  Future Directions and Conclusion

103

Suggested Readings

107

References 109 Index 121 About the Author

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Foreword to the Clinical Supervision Essentials Series

W

e are both clinical supervisors. We teach courses on supervision of students who are in training to become therapists. We give workshops on supervision and consult with supervisors about their supervision practices. We write and do research on the topic. To say we eat and breathe supervision might be a little exaggerated, but only slightly. We are fully invested in the field and in helping supervisors provide the most informed and helpful guidance to those learning the profession. We also are committed to helping supervisees/consultees/trainees become better collaborators in the supervisory endeavor by understanding their responsibilities in the supervisory process. What is supervision? Supervision is critical to the practice of therapy. As stated by Edward Watkins1 in the Handbook of Psychotherapy Super­ vision, “Without the enterprise of psychotherapy supervision, . . . the practice of psychotherapy would become highly suspect and would or should cease to exist” (p. 603). Supervision has been defined as 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 77 is evaluative and hierarchical, 77 extends over time, and

1

Watkins, C. E., Jr. (Ed.) (1997). Handbook of psychotherapy supervision. New York, NY: Wiley.

vii

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77 has the simultaneous purposes of enhancing the professional function-

ing of the more junior person(s); monitoring the quality of professional services offered to the clients that she, he, or they see; and serving as a gatekeeper for the particular profession the supervisee seeks to enter. (p. 9)2

It is now widely acknowledged in the literature that supervision is a “distinct activity” in its own right.3 One cannot assume that being an excellent therapist generalizes to being an outstanding supervisor. Nor can one imagine that good supervisors can just be “instructed” in how to supervise through purely academic, didactic means. So how does one become a good supervisor? Supervision is now recognized as a core competency domain for psychologists4,5 and other mental health professionals. Guidelines have been created to facilitate the provision of competent supervision across professional groups and internationally (e.g., American Psychological Association,6 American Association of Marriage and Family Therapy,7 British Psychological Society,8,9 Canadian Psychological Association10).

2

Bernard, J. M., & Goodyear, R. K. (2014). Fundamentals of clinical supervision (5th ed.). Boston, MA: Pearson.

3

Bernard, J. M., & Goodyear, R. K. (2014). Fundamentals of clinical supervision (5th ed.). Boston, MA: Pearson.

4

Fouad, N., Grus, C. L., Hatcher, R. L., Kaslow, N. J., Hutchings, P. S., Madson, M. B., et al. (2009). Competency benchmarks: A model for understanding and measuring competence in professional psychology across training levels. Training and Education in Professional Psychology, 3 (4 Suppl.), S5–S26. http://dx.doi.org/10.1037/a0015832

5

Kaslow, N. J., Rubin, N. J., Bebeau, M. J., Leigh, I. W., Lichtenberg, J. W., Nelson, P. D., et al. (2007). Guiding principles and recommendations for the assessment of competence. Professional Psychology: Research and Practice, 38, 441–51. http://dx.doi.org/10.1037/0735-7028.38.5.441

6

American Psychological Association. (2014). Guidelines for clinical supervision in health service psychology. Retrieved from http://www.apa.org/about/policy/guidelines-supervision.pdf

7

American Association of Marriage and Family Therapy. (2007). AAMFT approved supervisor designa­ tion standards and responsibilities handbook. Retrieved from http://www.aamft.org/imis15/Documents/ Approved_Supervisor_handbook.pdf

8

British Psychological Society. (2003). Policy guidelines on supervision in the practice of clinical psychology. Retrieved from http://www.conatus.co.uk/assets/uploaded/downloads/policy_and_guidelines_on_ supervision.pdf

9

British Psychological Society. (2010). Professional supervision: Guidelines for practice for educational psychol­ ogists. Retrieved from http://www.ucl.ac.uk/educational-psychology/resources/DECP%20Supervision%20 report%20Nov%202010.pdf Canadian Psychological Association. (2009). Ethical guidelines for supervision in psychology: Teach­ ing, research, practice and administration. Retrieved from http://www.cpa.ca/docs/File/Ethics/ EthicalGuidelinesSupervisionPsychologyMar2012.pdf

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The Guidelines for Clinical Supervision in Health Service Psychology11 are built on several assumptions, specifically that supervision 77 77 77 77 77 77

77 77 77 77 77 77 77 77 77 77

requires formal education and training; prioritizes the care of the client/patient and the protection of the public; focuses on the acquisition of competence by and the professional development of the supervisee; requires supervisor competence in the foundational and functional competency domains being supervised; is anchored in the current evidence base related to supervision and the competencies being supervised; occurs within a respectful and collaborative supervisory relationship that includes facilitative and evaluative components and is established, maintained, and repaired as necessary; entails responsibilities on the part of the supervisor and supervisee; intentionally infuses and integrates the dimensions of diversity in all aspects of professional practice; is influenced by both professional and personal factors, including values, attitudes, beliefs, and interpersonal biases; is conducted in adherence to ethical and legal standards; uses a developmental and strength-based approach; requires reflective practice and self-assessment by the supervisor and supervisee; incorporates bidirectional feedback between the supervisor and supervisee; includes evaluation of the acquisition of expected competencies by the supervisee; serves a gatekeeping function for the profession; and is distinct from consultation, personal psychotherapy, and mentoring.

The importance of supervision can be attested to by the increase in state laws and regulations that certify supervisors and the required multiple super­v isory practica and internships that graduate students in all professional programs must complete. Furthermore, research has American Psychological Association. (2014). Guidelines for clinical supervision in health service psychology. Retrieved from http://www.apa.org/about/policy/guidelines-supervision.pdf

11

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confirmed12 the high prevalence of supervisory responsibilities among practitioners—specifically that between 85% and 90% of all therapists eventually become clinical supervisors within the first 15 years of practice. So now we see the critical importance of good supervision and its high prevalence. We also have guidelines for its competent practice and an impressive list of objectives. But is this enough to become a good supervisor? Not quite. One of the best ways to learn is from highly regarded supervisors—the experts in the field—those who have the procedural knowledge13 to know what to do, when, and why. Which leads us to our motivation for creating this series. As we looked around for materials that would help us supervise, teach, and research clinical supervision, we were struck by the lack of a coordinated effort to pre­ sent the essential models of supervision in both a didactic and experiential form through the lens of expert supervisors. What seemed to be needed was a forum where the experts in the field—those with the knowledge and the practice—present the basics of their approaches in a readable, accessible, concise fashion and demonstrate what they do in a real supervisory session. The need, in essence, was for a showcase of best practices. This series, then, is an attempt to do just that. We considered the major approaches to supervisory practice—those that are based on theoretical orientation and those that are meta-theoretical. We surveyed psychologists, teachers, clinical supervisors, and researchers domestically and inter­ nationally working in the area of supervision. We asked them to identify specific models to include and who they would consider to be experts in this area. We also asked this community of colleagues to identify key issues that typically need to be addressed in supervision sessions. Through this consensus building, we came up with a dream team of 11 supervision experts who not only have developed a working model of supervision but also have been in the trenches as clinical supervisors for years.

Rønnestad, M. H., Orlinsky, D. E., Parks, B. K., & Davis, J. D. (1997). Supervisors of psychotherapy: Mapping experience level and supervisory confidence. European Psychologist, 2, 191–201.

12

Schön, D.  A. (1987). Educating the reflective practitioner: Toward a new design for teaching and learning in the professions. San Francisco, CA: Jossey-Bass.

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We asked each expert to write a concise book elucidating her or his approach to supervision. This included highlighting the essential dimensions/key principles, methods/techniques, and structure/process involved, the research evidence for the model, and how common supervisory issues are handled. Furthermore, we asked each author to elucidate the supervisory process by devoting a chapter describing a supervisory session in detail, including transcripts of real sessions, so that the readers could see how the model comes to life in the reality of the supervisory encounter. In addition to these books, each expert filmed an actual supervisory session with a supervisee so that her or his approach could be demonstrated in practice. APA Books has produced these videos as a series and they are available as DVDs (http://www.apa.org/pubs/videos). Each of these books and videos can be used together or independently, as part of the series or alone, for the reader aspiring to learn how to supervise, for supervisors wishing to deepen their knowledge, for trainees wanting to be better supervisees, for teachers of courses on supervision, and for researchers investigating this pedagogical process.

ABOUT THIS BOOK In this book, Supervision Essentials for a Systems Approach to Supervision, Elizabeth Holloway works from a social role–relational cultural perspective that incorporates multiple contextual influences on the supervisory process. From looking at personal and professional characteristics of the triad to their interpersonal relations, she expands the model to consider the systemic and organizational contexts in which clients, supervisees, and supervisors function. She aligns each of these facets to the competencybased training in professional psychology. With the relationship at the core, the supervisor in this model takes on different functions (i.e., evaluator, advisor, role model, consultant, counselor) and asks critical questions of self, trainee, relationship, and contract as a way to inform the learning tasks needed by the supervisee (i.e., counseling skills, case conceptualization, professional role and ethics, emotional awareness, and self-evaluation). In this way, the model acts like xi

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a sophisticated compass. With the use of the case method, the supervisor knows where he or she is at any given moment and what else needs to be considered to keep supervision on course. This is a rich and complex model, but Dr. Holloway’s numerous in depth examples and clear writing style make it extremely accessible. Regardless of your theoretical approach, the interactive, collaborative, and dynamic systems approach model offers a common language and a visual roadmap to help supervisors and educators figure out the critical factors that need to be considered to improve the supervisory process and solve therapeutic/supervisory dilemmas. We thank you for your interest and hope the books in this series enhance your work in a stimulating and relevant way. Hanna Levenson and Arpana G. Inman

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Acknowledgments

M

y first thanks must go to Hanna Levenson, Arpana G. Inman, and the American Psychological Association publishing team for creating the Clinical Supervision Essentials series. The effort involved in designing a book series that includes live supervision film is significant, and I am deeply grateful for the approach and professionalism of everyone involved in this project. For my part in the film series, I was honored to work with Linh Lee, a young professional, who demonstrates in the pages of this book her candid presence and insightful understanding of clinical practice and supervision. My appreciation is extended also to the supervisee who remains anonymous herein, but whom I remember vividly for her courage and determination. In leafing through this book, the reader will discover many figures that depict the systems approach to supervision. Through the years I have revised the visual form of the model, and for this latest rendition my thanks go to graphic artist Adam Grossi for his creative, clean, and contemporary interpretation of my work. Finally, I would like to acknowledge the wisdom and knowledge of those trainers, supervisees, and supervisors who have spent many hours sharing with me the challenges and joys of their practice. In many ways, the book is the culmination of those fruitful conversations during the last 35 years.

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Supervision Essentials for

a Systems Approach to Supervision

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Introduction

S

upervision is an instructional method that is handheld, parsimoniously constructed in the moment, accountable in the long term, and remarkably intense as an interpersonal construction. When I was a graduate student, my practice of supervision fueled my motivation to ask questions about this method of teaching. What was really going on in the conversation of supervision? What incidents in supervision were critical to a person learning to be a therapist? I spent the first 10 years of my work engaged in research that involved recording, transcribing, and analyzing the talk of supervision. Empirical findings from these studies were interesting, informative, and dispelled some assumptions held about the supervision process. For example, findings revealed that supervision with a novice trainee is largely a teacher–student relationship in role, attitude, and behavior. Specifically, these interactions were characterized by supervisors offering their opinions and suggestions and supervisees asking questions of clarification or extending and agreeing with supervisors’ ideas. http://dx.doi.org/10.1037/14942-001 Supervision Essentials for a Systems Approach to Supervision by E. L. Holloway Copyright © 2016 by the American Psychological Association. All rights reserved.

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However, these approaches to studying the discourse of supervision, although significant, omitted a large part of my experience as a supervisor. For example, how did I think about supervision in the moment, as I designed training approaches, or reacted to particularly intense interactions with supervisees? The empirical methods I was using were not uncovering the questions that emerged out of my experience. So I sought a way to uncover the talk of supervision. What are the perceptions and attitudes that supervisors have about their role and actions? What do supervisees need at different junctures of their training? How do they name what they need? These types of questions initiated my quest to understand supervisors’ and supervisees’ reflections on their experience of supervisory process. Again I was interviewing, recording, and analyzing discourse but using a qualitative method—grounded theory, a constructivist qualitative method of textual analysis—to uncover emergent understandings of the phenomena as remembered and articulated by the participants themselves. This research gave me the opportunity to explore the tacit knowledge or practice wisdom of supervisors and supervisees. In combining my earlier research in discourse analysis and later efforts in grounded theory, I began to shape a fuller understanding of supervisory process and practice and the development of the systems approach to supervision (SAS). Equally significant in the formation of the SAS model have been the many educators and trainers in Europe and Asia I have met while teaching the model. I remember in my initial workshops in Britain in the early 1990s when Terri Spy looked at me during the first tea break and asked, “Well, is it done?” I knew immediately what the “it” was—a book on supervision. It wasn’t until 2 years later that I was able finally to exclaim in response, “Yes, Terry, IT is done” (Holloway, 1995). However, it is not at all done, for as I and other SAS trainers continue to be involved in supervision practice, the model has transformed itself to fit different contexts of supervision and act as a guide in mentoring and coaching across the professions. The SAS model describes the supervision process as consisting of seven dimensions, or systems, that interact with one another in both obvious and subtle ways. These systems include the supervisor, the supervisee, the learning tasks of supervision, the functions of the supervisor, the client, 4

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INTRODUCTION

the organization, and finally the supervisory relationship. Each of these dimensions is considered in depth in subsequent chapters. In the remainder of this introduction, I recount the history and development of the SAS model and discuss the role of theory before briefly summarizing the chapters in this book.

CROSSING BOUNDARIES In creating the SAS model, I wanted to design a conceptualization of teach­ ing and practice in supervision that would be relevant in supervisory contexts outside of the United States. Although counseling psychology programs in the United States dominated the research and training of supervision in the latter part of the 20th century, theory and research in supervision has proliferated during the last 15 years in Australia, New Zealand, and the European Union. Pointedly, the first conference devoted specifically to supervisory issues across professions occurred in 1991 in London and was named the British Association of Supervision Practice and Research. It was followed in 1992 by the International Conference of Supervision, held in Hanover, Germany, at the INITA institute of training. In England and Europe, supervision became a field of study taught not only in clinical areas but also across many other professions. For example, in Switzerland supervision certification is available through freestanding training institutes of study that align curriculum with government requirements. Professionals from different areas of practice, including social work, psychology, education, medicine, and business, may participate in a 1- to 2-year courses to gain supervision certification. The Association of National Organizations for Supervision in Europe was formed in 1997 to provide an exchange of views on training initiatives, research, and theories related to supervision as a practice of process-oriented consulting. Many European countries, such as the United Kingdom, require career-long supervision of clinical practice, so the models of supervision have an emphasis on the supporting (restorative), coaching, and consulting roles of supervision. In contrast, supervisory models in the United States are designed for therapists in training, from practicum through 5

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postresidency clinical placements, and thus must include a gatekeeping, evaluative function. The development of the SAS model was greatly influenced during the many workshops that I was privileged to offer in the United Kingdom and European training institutes and universities from 1988 through 2006. In particular, pioneering scholars of supervision theory and practice in these countries—Michael Carroll, Maria Gilbert, Brigid Protor, and Julie Hewson of England; Willem Lammers of Switzerland; Mathias Sells of Germany; and Karin Van Beekum of the Netherlands—were instrumental in expanding the model to include diverse professional settings. Thus, the SAS model embraced influences from the United States and the European Union and developed into a model that might be applied to supervisees-in-training or be consultative supervision for advanced counselors.

PURPOSE OF THE SAS MODEL The purpose of the SAS model (Holloway, 1995) is to guide supervision teaching and practice by providing a framework based on empirical, conceptual, and practice knowledge. The factors that consistently have been identified as salient to the process and outcome of supervision (Bernard & Goodyear, 2014; Holloway & Neufeldt, 1995; Russell, Crimmings, & Lent, 1984) have been used to build a dynamic model that can assist in systematic assessment of (a) the supervisee’s learning needs, and (b) the supervisor’s teaching interventions in diverse contexts. The model can be used as a frame of reference for an individual practitioner to think through a dilemma, for case consultation of supervision, or for training in supervision. It provides a strategy for systematically using a case method approach that encompasses the presentation of client and supervisee histories, accompanied at times with examples of the supervision interaction and followed with a conceptualization of the supervision situation and suggestions for interventions. It is an effort to understand supervision by offering a common language that is relevant to supervisors and educators across different theoretical points of view. The model is meant to raise questions about what each of us does as a supervisor rather than to tell a supervisor what to think and what to do. 6

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The SAS framework provides four components of support for educators and practitioners to uncover their own thinking, attitudes, decision making, and behaviors: (a) a descriptive base, (b) guidelines stating common goals and objectives, (c) a way to discover meaning as it relates to participants and the profession, and (d) a systematic mode of inquiry to determine objectives and strategies for interaction during supervision.

THEORETICAL FOUNDATIONS Theoretical models of supervisory practice in professional psychology have proliferated during the last 70 years, beginning with long-term psycho­ analysis of the budding psychoanalytic therapist. By the 1960s, early models of supervision were viewed as a teaching activity distinct from psychotherapy but often were aligned with a theoretical approach to counseling. Thus, supervision models typically were named for their counseling theory counterparts—rational emotive supervision, client-centered supervision, social learning, and working alliance (Goodyear, Bradley, & Bartlett, 1983) (also see some books in this series, e.g., Sarnat, 2016). These models were built on the assumption that the method of teaching a specific approach to practice must mirror the counseling approach being taught. Despite the prominence of these counseling-based approaches, by the early 1980s there were murmurings from a minority of scholars in counseling psychology that the practice of supervision must be considered as a praxis involving competencies and skills distinct from counseling (Holloway, 1984; Kagan & Kagan, 1990; Loganbill, Hardy, & Delworth, 1982; Stoltenberg & Delworth, 1987). Holloway and colleagues (Holloway, 1992; Holloway, Freund, Gardner, Nelson, & Walker, 1989; Holloway & Poulin, 1995; Holloway & Wolleat, 1981), Stoltenberg and associates (Stoltenberg, McNeill, & Crethar, 1994; Stoltenberg, McNeill, & Delworth, 1998), and Friedlander, Ladany, and associates (Ladany & Friedlander, 1995; Ladany & Lehrman-Waterman, 1999) published a persuasive body of research in the 1980s and 1990s that corroborated this contention. It is from this second generation of counseling models that the SAS emerged as a part of the social role movement in supervision. 7

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Social role theories are based on the supervisor choosing from several potential roles relevant to the domain of teaching. The most frequently recognized roles—teacher, counselor, and consultant—were first named as relevant to supervision practice in Janine Bernard’s (1979) discrimi­ nation model; however, the roles of evaluator, lecturer, and role model also have been used to describe supervisor behaviors and attitudes, as first named by Alan Hess (1980). Typically, role theories of supervision outline the expectancies and behaviors that are considered part of the supervisory relationship and, specifically, part of the overarching role of the supervisor. Numerous studies during the last 50 years have examined the relevance of social role theory to the conceptualization of supervisory practice (Bernard, 1979; Byrne & Sias, 2010; Ellis & Dell, 1986; Ellis, Dell, & Good, 1988; Gysbers & Johnston, 1965; Hart & Nance, 2003; Luke, Ellis, & Bernard, 2011; Stenack & Dye, 1982). From Gysbers and Johnston’s 1965 study that asked supervisors and supervisees to respond to the Supervisor Role Analysis Form (SRAF) to more recent studies of supervisory style by Byrne and Sias (2010), aligning supervisors’ functions and actions with subroles has been proved both empirically and pragmatically. In alliance with the social role tradition of psychotherapy supervision research, the SAS model includes five supervisor subroles—evaluator, advisor, role model, consultant, and counselor. The SAS model is distinguished as a social role approach to super­ vision; however, in the practice of supervision, the model is grounded in a relational approach to teaching the highly complex skills of therapeu­ tic practice. Supervision is an intense and demanding relationship that requires both participants to be fully engaged while navigating within the boundaries of their respective roles. The SAS relationship is theoretically grounded in concepts of symbolic interactionism (Blumer, 1969), social role theory (Blumer & Morrione, 2004), and relational-cultural theory (Jordan & Walker, 2004). As such, it honors the principles of these theo­ ries while integrating them into a pragmatic heuristic with the intent of guiding practice. Symbolic interactionism is made up of three interdependent con­ structs: the self, the world (as represented by others), and social action. 8

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INTRODUCTION

The self creates meaning through social interaction with the world as represented by other humans and events. Critical to creating a “sense of self ” is the dynamic interplay between the “I” as reflector of action and the “me” as the object of self-reflection (Mead, 1934). Bowers (1988), in describing the fundamental principles of symbolic interactionism in contrast to other ontological positions stated, The I is the active, interactive, dynamic, interpreting component of the self. . . . Rather than simply taking on a role by internalizing external expectations, the self is the accumulation of all previously experienced social interaction as interpreted and synthesized by the I. (p. 38)

The elevation of a reflective, dynamic, and interactive self with others and through social engagement is the essence of the learning alliance in supervision. Although guided by the expectations of externally defined social roles, supervisors interpret and express these uniquely. In addition, the supervisor encourages the trainee to actively reflect on and synthesize the interactions that emerge in the counseling and supervisory relationship as they are relevant to the role of the counselor. Thus, the relationship becomes the central vehicle to experience and understand social processes within the complex systems of organizational work, client needs, and supervisory actions. The nature of the supervisory relationship is guided by the importance of connected relationship in enhancing the human condition and the experience of learning. This understanding of relationship as both a healing and learning environment is grounded in the work of relationalcultural theory (Jordan, 1997; Miller, 1976; Miller & Stiver, 1997) and “connected knowing,” as introduced during this same time period (Belenky et al., 1997). Miller and Stiver (1997), working in a clinical context, emphasized the importance of “growth in connection” and “healthy growth-fostering relationships.” Their work conceptualized the significance of “power with,” rather than “power-over,” mutuality, and cultural presence in relationship. They posited that when people are connected in relationship authentically, there are five essential qualities that enhance growth: zest, action, knowledge, 9

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worth, and desire for more connection. These relational-cultural theory concepts of growth-enhancing relationships and the significance of cultural understanding are central to the SAS perspective of building a relational environment that will allow the supervisee to learn and develop as a professional (Schwartz & Holloway, 2012, 2014). Also reflected in the conceptualization of the SAS relationship is Belenky and colleagues (1997) emphasis on the importance of connection rather than separation in human learning and that educators as partners in learning can “encourage students to evolve their own patterns of work based on the problems they are pursuing” (p. 229). This approach to collaborative problem solving is foundational to the case method teaching, which is integral to supervision practice. The generation of these qualities in relationship creates a learning alliance that can hold emotional intensity, conflict, and differences in cultural values and experiences. These qualities are precisely those needed in maintaining bonds of trust and the interpersonal sensitivity necessary in a relationship in which the student and teacher are learning and modeling the professional role of therapist. Supervision is an intellectually challenging experience for both participants, and one might ask how emotionally enhancing relationships contribute to heightened learning of complex roles. Fredrickson and Losada (2005) devoted their research to the creation of intellectual communities of human relationships. Particularly relevant to supervisory practice are the relationships among good feelings (i.e., positive emotions, moods, and sentiments) and widened scope of attention, broadened behavioral repertoires, increased intuition, and creativity. These are all critical attributes in creating, engaging, and understanding the complex emotional fabric of therapeutic relationships. In the teaching of psychotherapeutic practice, of specific import is Fredrickson’s suggestion that a positive feeling state will promote increased intellectual functioning. However, positive emotional states are not the only possible avenue for learning and connection, for issues of disagreement and conflict emerge in any healthy relationship (Miller & Stiver, 1997). For the creation and facilitation of the supervisory relationship to be in accord with the theoretical principles of relational-cultural theory and connected knowing, 10

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the supervisor must consider the client and the counseling relationship as well as the emotional conditions of the supervisor and the supervisory relationship. In SAS supervision, a strong base of mutual connection in the relationship provides an opportunity for positive professional growth, reflection, knowledge, skills, and resiliency through the judicious use of relational roles. Recent developments in policy formation around competency-based training in professional psychology also have influenced this revision of the SAS model. The profession as a whole has promoted the competency movement through professional conferences that have resulted in a series of papers that identify supervision competencies and methods for the education and training of these competencies and their assessment (e.g., Falender et al., 2004). In this movement, Falender and Shafranske (2004, 2006) and Pilling and Roth (as cited in Fuertes, Spokane, & Holloway, 2012) have been prominent scholars in the development of models for competency-based supervision. Supervision as a primary teaching method in practice is implicated in the competency movement, not only as a functional competency but also as a primary or secondary method of teaching the foundational competencies. For example, in the United States, six essential practice elements have been identified (Fouad et al., 2009) within the functional competency of supervision: expectations and roles, processes and procedures, skills development, awareness of the factors affecting quality, participation process, and ethical and legal issues. Thus, the articulation of best practices for assessment of each of the benchmarks becomes a critical component of the supervisor’s education (Kaslow et al., 2009). In the 21st century, it is time to revisit SAS in light of the current thinking on competencies in supervision.

ORGANIZATION OF THIS BOOK This book is intended for educators and practitioners of supervision practice. Chapter 1 begins with a description of the seven dimensions of the SAS model, including visual aids to depict the intersection of each of these dimensions in practice. Chapter 2 presents an analysis of SAS process in 11

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practice, in this case via a supervision session I conducted as a part of the American Psychological Association’s Systems Approach to Psychotherapy Supervision DVD.1 Selected portions of the sessions have been chosen to illustrate critical moments in the supervision work. In addition, material from my retrospective reflections on the session, as guided by series host Arpana Inman (also available on the DVD), has been included to help convey my underlying decision-making process as related to the SAS model. Chapter 3 is an in-depth case study of my work with a counselor in training and the meaning that I make of my engagement and intervention with her across our relationship. I have used a particularly poignant session to illustrate the manner in which the SAS model can be used to guide the choice and timing of interventions based on relationship qualities and skill development. Chapter 4 applies the SAS approach to the teaching of supervision and illustrates the discussion with exercises and case analyses. Throughout Chapters 2, 3, and 4, I have made an effort to bring to the forefront common supervisory dilemmas that emerge in the context of supervision of clinical practice and the supervision of supervisors in training. Chapter 5 offers future directions for supervision research and practice and concludes with suggested readings for the student of supervision.2

For more information, please visit http://www.apa.org/pubs/videos/. Portions of this chapter first appeared in The International Handbook of Clinical Supervision (pp. 598–621), by C. Watkins Jr. and D. L. Milne (Eds.), 2014, West Sussex, England: Wiley Blackwell. Copyright 2014 by Wiley Blackwell. Reprinted with permission.

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he systems approach to supervision (SAS) model was designed to provide a visual road map for supervisors to intentionally and strategically consider the numerous factors that could impinge on their teaching and learning. Further, it is an effort to understand supervision by offering a common language that is relevant to supervisors and educators of different theoretical perspectives and a visual representation of concepts that depicts their relationship to each other. In testament to the model’s accessibility and heuristic appeal, SAS has been translated into four languages (Chinese, German, Hebrew, and Portuguese) and has been taught to trainers on four continents. Figure 1.1 presents the full model and the properties that describe each of the seven dimensions encompassed by the model. In this chapter, the dimensions of supervision and the empirical evidence that supports their inclusion in the model are presented. There are seven dimensions or factors in the SAS model, including the core dimension—the relationship. Each dimension was created from a

http://dx.doi.org/10.1037/14942-002 Supervision Essentials for a Systems Approach to Supervision by E. L. Holloway Copyright © 2016 by the American Psychological Association. All rights reserved.

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Figure 1.1 Seven dimensions of the systems approach to supervision. From The International Handbook of Clinical Supervision (p. 603), by C. Watkins Jr. and D. L. Milne (Eds.), 2014, West Sussex, England: Wiley Blackwell. Copyright 2014 by Wiley Blackwell. Adapted with permission.

comprehensive review and conceptual clustering of the empirical, conceptual, and practice bases of knowledge in the field. In Figure 1.1, six dimensions are represented around the periphery of the circle; they point to the core dimension—the supervisory relationship. The two middle dimensions and foremost to the creation of the relationship are the supervisor and the supervisee. At the bottom of the figure are the learning tasks of the supervisee and the supervisor’s strategies for teaching. At the top of the figure are the two contextual factors—client and institution—that influence the relationship as well as the process that unfolds in implementing strategies and tasks for teaching and learning. The components of the model are part of a dynamic process in which they interrelate and mutually influence one another. Whether trainer, consultant, or supervisor, reflection on these conceptual dimensions can guide questions that will lead to an integrated understanding of the relationship’s potential to promote individual relational learning and professional expertise. Although the SAS model is classified as a social role model, it is evident from the figure that the context of the system in which supervision takes shape is critical to the model. The model suggests that the supervisor’s decision making and actions are always consciously or tacitly 14

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related to the system in which they are embedded. Other authors have taken a systems model approach to supervision and although each model has unique elements, all consider the context, the components within a system, and their dynamic interplay in which all components are interdependent and react to influence and change of the other components (e.g., Burck, 2010; Burck & Daniel, 2010; Burnham, 2010; Schilling, 2005).

THE RELATIONSHIP OF SUPERVISION The relationship of supervision is central to the learning alliance created between the supervisor and supervisee. The relationship creates the holding environment for the supervisee’s reflection on and growth as a developing professional. Ideally, supervision is a growth-enhancing relationship adhering to the principles of positive psychology and relationalcultural theory. Not only does this create a condition for learning, but it also models relational and interpersonal qualities that are a necessary quality of a therapeutic relationship. Supervisees have the opportunity to learn by experiencing and reflecting on their interpersonal behavior and emotional reactions to being in a fully engaged learning environment. This is an important goal of supervision because learning to be a therapist requires self and other awareness as well as responsibility for one’s interpersonal behaviors and actions. Forrest and colleagues wrote extensively on interpersonal competence in the profession (Elman, Forrest, Vacha-Haase, & Gizara, 1999; Forrest, 2008, 2010; Forrest, Miller, & Elman, 2008; Johnson, Barnett, Elman, Forrest, & Kaslow, 2012) and supported the significance of emotional reflection within the context of relationship. Importantly, interpersonal awareness and skill are now included in the competency benchmarks for counseling psychologists (Kaslow et al., 2009). Supervision plays a critical role in recognizing and developing this competency area that has the potential to expand a person’s whole understanding of self as engaged with the various social contexts presented by the client. This self-learning is embedded in relational structures that demand a knowing awareness of the processing, adjusting, repairing, and maintaining of relationship. The interstitial space of the relationship is a place where self and other knowledge is mutually imparted and negotiated; it is 15

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a place of risk and opportunity. Relationships with these characteristics of relational-cultural theory can greatly contribute to a student’s embracing the role complexity and skills of the psychotherapist. In the SAS model, there are three essential elements that guide the understanding of the formation and quality of the relationship: (a) the interpersonal structure of the relationship as described by the power and engagement across the five subroles of supervision, (b) the developmental phase of relationship, and (c) the learning contract of supervision. These are conceptual constructs that have been defined from empirical findings in supervision (see review by Inman & Ladany, 2008; Inman et al., 2014). The use of these three organizing constructs to describe critical influences of the relationship provides a language for differentiating relational factors of influence (see Figure 1.2).

Interpersonal Structure of Relationship Power and involvement are helpful constructs in understanding the structure of the supervisory relationship. These two constructs have been used in social and personality psychology to understand the transactions and implicit rules that govern formal and informal relationships. Follett (1941) introduced power with, a concept that was pluralistic and dynamic, representing an everevolving process of human interaction. Follett’s alternative conception of power is based on the relationship of involvement and mutual influence similar to the more current constructs of mutuality found in relational-cultural theory research. Involvement may also be referred to as intimacy that includes attachments, the degree to which each person uses the other as a source of selfconfirmation (Miller, 1976). This basis of power is consistent with the ideals of psychotherapy and supervision, in which the intent is not to control but to empower individuals to exercise choice and self-determination. This power with positioning in the relationship is in opposition to the supervisor’s responsibility for imparting expert knowledge, making judgments of trainees’ performance, and acting as a gatekeeper to the profession in clinical supervision of therapists in training. All of these responsibilities add to the complexity of creating an enhanced learning environment that promotes the supervisee’s empowerment as a professional. These 16

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Mission and values Organizational structure Performance management system Culture and climate Professional standards & ethics

Client characteristics Diagnosis & goals Psychosocial history Social support Counseling relationship

Counseling experience Theoretical orientation Learning goals & style Cultural values Interpersonal style

Professional experience Professional role Theoretical orientation Cultural worldview Interpersonal style Monitoring/evaluating Instructing/advising Modeling Consulting/exploring Supporting/sharing

Counseling skills Case conceptualization Professional role & ethics Emotional awareness Self-evaluation

Figure 1.2 Systems approach to supervision (SAS) dimensions and factors of influence. From The International Handbook of Clinical Supervision (p. 603), by C. Watkins Jr. and D. L. Milne (Eds.), 2014, West Sussex, England: Wiley Blackwell. Copyright 2014 by Wiley Blackwell. Adapted with permission.

evaluative and “expert” aspects of the role can create a hierarchical relational structure that depends on power over. On the other hand, the creation of a learning alliance that encourages transparency, vulnerability, and trust requires a power with orientation in the relationship. The existence of both power over and power with relational attributes has caused considerable consternation for clinical supervisors because of the tension resulting from having to monitor the trainee’s competency to ensure client safety while supporting trainee growth. The shifts of power and engagement in the relationship are described in the social role models through a number of supervisor subroles that are activated dependent on the immediate supervisory process, the trainee’s learning 17

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needs, and the client’s welfare. As supervisors, we hold the relational tension among the often-conflicting roles of monitor, advisor, role model, consultant, and mentor, requiring us to use a delicate but firm hand in guiding the supervisee through the intellectual and emotional demands of therapeutic work. The seemingly conflicting responsibility for evaluation and a developmental focus on the trainee has been debated frequently in the literature (e.g., Baltimore, 1998; Burns & Holloway, 1990; Frawley-O’Dea, 1998; Itzhaky & Itzhaky, 1996). Empirically, the impact of power and involvement on the process of supervision has been studied by researchers using different models of power to understand how power is perceived by super­visees. Three preferred methods have been used in supervision research to describe the power of the supervisor: French and Raven’s (1960) sociological typology (see also Robyak, Goodyear, & Prange, 1987); Strong, Hills, and Nelson’s (1988) circumplex model; and Penman’s (1980) communication matrix (see also Holloway, Freund, Gardner, Nelson, & Walker, 1989). In general, studies have confirmed the shifting use of power dependent on the supervisor’s exercise of different functional roles in the relationship. For example, the supervisor is responsible for evaluation of the trainee and gatekeeping to the profession. In this role, the supervisor’s power over is perceived by the trainee, whereas when collaborating and consulting with the trainee, power with is more influential in the engagement. These empirical findings have influenced the choice and arrangement of the subroles or functions of supervision, which I discuss in Chapter 3. Phase of Relationship Mueller and Kell’s (1972) conceptualization of the developing, maturing, and terminating phases of the supervisory relationship (see Table 1.1) is a useful heuristic to the evolving phases. As the supervisory relationship develops, the participants, using more personally relevant, interpersonal, psychological, and differentiated information in an effort to reduce interpersonal uncertainty, will attempt to predict each other’s behavior. Relationship crises might entail periods of a lack of mutuality as new information is incorporated and the relationship is redefined. If mutuality or a shared 18

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Table 1.1 Phases of the Supervisory Relationship Developing phase

Mature phase

Terminating phase

Clarifying relationship

Increasing individualized attention

Understanding connections among theory, research, and practice with specific clients

Establishing contract

Increasing social bonding and influence potential

Consolidating knowledge in evidence-based practice

Supportive process

Developing skills of case conceptualization

Decreasing need for direction from supervisor

Developing competencies

Increasing self-confidence and self-efficacy

Increasing reflection on professional role

Developing treatment plans

Confronting personal issues as they relate to professional performance

Ending relationship experience and skills

definition of the relationship cannot be attained, the relationship usually is terminated (Morton, Alexander, & Altman, 1976, p. 105). In a grounded theory study, professional counselors with 5 to 20 years of experience identified mutuality as a core dimension when asked what made for good supervision (Holloway, 1998). Other studies have examined the changing patterns of communication across time in the supervision relationship (see review of discourse analysis in Holloway & Poulin, 1995). Wedeking and Scott (1976) found that supervisor messages changed from the beginning to the final stages of the relationship. In addition, the association of relationship phase with supervisory behaviors has been investigated in case study designs that used microanalytic techniques (Garb, 1989; Martin, Goodyear, & Newton, 1987; Strozier, Kivlighan, & Thoreson, 1993) to point out that supervisees decreased the proportional use of deferential messages across the span of the supervisory relationship. The facilitative conditions of genuineness, empathy, and unconditional positive regard that are so important in building the therapeutic relationship are equally important in building the supervisory relationship, particularly at the beginning. Like clients, therapists in training need 19

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to feel safe, supported, and trusting of their environment before they can feel comfortable enough to take risks and engage in self-reflection, practice new behaviors, and actively seek feedback. Advanced supervisees, having a blueprint for the relationship of supervision from previous experiences, are able to truncate the discomfort of uncertainty and the need for reassurance by relying on known general expectancies for supervisory roles. Thus, they can move more quickly to establish specific expectancies for an interpersonal relationship. In contrast, beginning level trainees are perhaps still learning their own role expectations and those of their supervisor and thus are not as quick to enter into the interpersonal supervisory relationship. No matter what level of experience a trainee might have, it seems there is a natural relationship stage in which participants need to become familiar with the role expectations set by the supervisor and the supervisory context (Rabinowitz, Heppner, & Roehlke, 1986). This initial stage of building familiarity serves to reduce ambiguity and uncertainty in the relationship and emphasizes the need for a clear contract for the work of supervision. The Contract of Supervision Each supervisor and supervisee will have idiosyncratic expectations of roles and function in supervision. As in any working relationship, the clarity of these expectations directly affects the relationship and the establishment of specific learning goals. The supervisor has a responsibility to ensure that the supervisee is clearly informed of the evaluative structure of the relationship, the expectancies and goals for supervision, the criteria for evaluation, and the limits of confidentiality in supervision. Inskipp and Proctor (1989), among others (Hewson, 1999; Schilling, Jacobsen, & Nielsen, 2010), identified the supervisory contract as critical to establishing a way of being together in the supervisory relationship. Not only do the supervisor and supervisee need to negotiate specific tasks, but they also need to define the process parameters of the relationship. By acting openly and purposefully, the supervisor increases the probability that both participants will behave congruently with established expectations and a strong supervisory alliance can be formed to enhance supervisory outcomes (Inman et al., 2014). 20

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The negotiation of norms, rules, and commitments at the beginning of any relationship can reduce anxiety and move the involvement to a level of trust that will promote the degree of vulnerability needed for the task to be accomplished. In addition, the supervisor must be alerted to the changing character of the relationship and thereafter initiate discussion on renewed goals and relational expectations. Not only will the trainee’s learning needs change as experience increases or clients progress, but his or her increasing skill and interpersonal confidence also will influence issues of relational control. Research studies have corroborated that trainees, particularly beginning trainees, can greatly benefit from making role expectations clear and detailing competency-based expectations at various intermediary stages of evaluation (Friedlander, Keller, Peca-Baker, & Olk, 1986; Holloway, 1998; Ladany, Brittan-Powell, & Pannu, 1997; Ladany & Friedlander, 1995; Muse-Burke, Ladany, & Deck, 2001; Olk & Friedlander, 1992).

THE SUPERVISOR AND SUPERVISEE The supervisory relationship is formed uniquely by the persons who come together to create a learning experience. Each relationship is uniquely conceived and unfolds as both parties increase familiarity with the other. Nonetheless, there are generally accepted role expectancies of super­ visor and supervisee. These role expectations have come from a variety of sources, such as professional guidelines, competencies of performance, theoretical conceptualizations, and empirical findings. The SAS model has categorized the professional and personal factors that are relevant to the process of supervision as found in the empirical and conceptual literature. Figure 1.2 presents the five relevant areas or factors for the supervisor and for the supervisee. The empirical evidence for the supervisor and supervisee factors are discussed here. Supervisor Factors The supervisor brings to the supervisory relationship an independent way of viewing human behavior, interpersonal relations, and social 21

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institutions, all of which are largely influenced by cultural socialization. Supervisors’ views and experiences are described by five factors— professional experience, professional role, theoretical orientation to therapy, cultural worldview, interpersonal style. These factors have been included based on the empirical literature (see Figure 1.2). Because cultural perspectives are relevant to the conceptualization of professionalism and mental health, the SAS model considers cultural values to be embedded in the supervisor’s attitudes and actions. Cultural characteristics, which include gender, ethnicity, race, sexual orientation, religious beliefs, and personal values, strongly influence an individual’s social and moral judgments. Such nuances of the supervisory relationship are sometimes subtle, but they are always critical aspects of the supervisory work. The potential for mutuality and emotional awareness in the supervisory relationship provides a unique opportunity for teaching and learning the salience of culturally congruent treatment (Bernard & Goodyear, 2014; Burkard, Knox, Hess, & Schultz, 2009; Constantine, Warren, & Miville, 2005; Ladany, Friedlander, & Nelson, 2005). The SAS model is meant to encourage supervisors to recognize the importance of cultural factors in supervision and draw attention to how these issues interact with each of the other contextual factors. For example, Are cultural differences acknowledged as salient in client treatment? Does the organization include cultural sensitivity as a part of professional development? Other supervisor factors in the model—experience level, theoretical orientation, and interpersonal style—have been related to trainee satisfaction with supervision (Bernard & Goodyear, 2014; Holloway, 1992; Inman et al., 2014). Empirically, it has been shown that the amount of experience a supervisor has in counseling and supervision seems related to the judgments the supervisor will make regarding selfdisclosure, trainee performance, and choice of instructional approach to supervision (Stoltenberg, McNeill, & Crethar, 1994). Supervisor experience also has been examined in relation to supervisor use of facilitative behaviors, planning of supervisory sessions, and judgments of trainee performance (Marikis, Russell, & Dell, 1985; Stone, 1980; Sundland & Feinberg, 1972; Worthington, 1984a, 1984b). Such 22

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studies suggest that experience in supervision frees supervisors from making global personality judgments of the trainee, allowing them to focus on the situational characteristics that might be influencing the trainee’s performance. The influence of the supervisor’s theoretical orientation on supervisory behavior has been the subject of several studies (Beutler & McNabb, 1981; Goodyear, Abadie, & Efros, 1984; Goodyear & Robyak, 1982; Guest & Beutler, 1988; Sundland & Feinberg, 1972). Holloway et al. (1989) studied the Goodyear (1982) videotape series and concluded theoretical orientation of the supervisor was related to perceived differences in supervisory behavior and actual differences in supervisory discourse. Goldberg (1985) maintained that the supervisor’s personality or character style and theoretical orientation are the most influential factors in supervisors’ behavior. Studies relating supervisor theoretical orientation and supervisor methods strongly support Goldberg’s claim (Carroll, 1994; Putney, Worthington, & McCullough, 1992). Interpersonal style as perceived by the trainee has been operationalized in the research literature by several instruments, such as the supervisory working alliance (SWAI; Patton & Kivlighan, 1997), the Supervisory Relationship Questionnaire (SRQ; Palomo, Beinart, & Cooper, 2010), the Supervision Questionnaire–Revised (SQ-R; Worthington & Roehlke, 1979), and the Supervisory Styles Inventory (SSI; Friedlander & Ward, 1984). These instruments have been used extensively to understand the connection in quality of relationship, such as supervisor communication, task orientation, trust, interpersonal sensitivity, facilitative conditions, evaluative process, perceptions of conflict resolution, self-reflection, skills attainment, and personal growth (see reviews by Ellis, Ladany, Krengel, & Schult, 1996; Ladany, Ellis, & Friedlander, 1999; Muse-Burke et al., 2001).

Supervisee Factors In SAS, characteristics of the supervisee, identified in the empirical literature, have been grouped into five supervisee factors: experience in counseling, theoretical orientation in counseling, learning goals and style, cultural worldview, and interpersonal style (see Figure 1.2). 23

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Trainee experience level has been a frequently studied factor in super­ vision research. Experience level of the trainee has been related to perceived supervisory needs and satisfaction with supervision (Johnston & Milne, 2012; O’Donoghue, 2012; Stoltenberg et al., 1994). The predominant finding that distinguishes the expressed needs of beginning-level trainees from those of intern-level trainees centers on different relationship characteristics (Heppner & Roehlke, 1984; Miars et al., 1983; Wiley & Ray, 1986; Worthington, 1984a, 1984b). For example, beginning-level trainees appear to require more support, encouragement, and structure in supervision, whereas interns demonstrate increasing independence from the supervisor (Hill, Charles, & Reed, 1981; McNeill, Stoltenberg, & Pierce, 1985; Reising & Daniels, 1983; Wiley & Ray, 1986; Worthington, 1984a; Worthington & Stern, 1985) and more interest in exploring higher-level skills and personal issues affecting counseling (Heppner & Roehlke, 1984; Hill et al., 1981; McNeill et al., 1985; Stoltenberg et al., 1994; Worthington & Stern, 1985). Tracey, Ellickson, and Sherry (1989) designed an analog study to examine the relationship between supervisory structure and trainee learning. Their findings partially support previous work that indicated that, as trainees progress through levels of experience, their need for supervisory structure diminishes (McNeill et al., 1985; McNeill & Stoltenberg, 2016; Reising & Daniels, 1983; Stoltenberg et al., 1994; Wiley & Ray, 1986). However, the need for supervisory structure is moderated by personality variables of the trainees (in this study as measured by psychological reactance) and the situational determinants of the supervisory focus (crisis versus noncrisis client). Ward, Friedlander, Schoen, and Klein (1985) examined the influence of different self-presentational styles (in the SAS model, this is referred to as interpersonal style) on supervisors’ judgments of counselor competence. This was an analog study in which the investigators created stimulus conditions in which trainees took a defensive or counterdefensive interpersonal style. Supervisors evaluated the defensive trainee as more self-confident and the counterdefensive trainee as more socially skilled. When the client was reported to have improved, trainees were judged to be altogether more competent, self-confident, expert, and attractive than when the client worsened, 24

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regardless of trainee style. From this study it appeared that in judging trainees’ professional skills, supervisors were influenced more by client progress than by trainees’ presentation style. Competency models in counseling psychology, including supervision, have delineated the importance of multicultural sensitivity and skill in therapeutic contexts. In the SAS model, cultural values, such as ethnicity, race, sexual orientation, and religious beliefs, are seen as salient to trainees’ attitudes and actions toward their clients and supervisors. Research in this supervision area is relatively limited (Constantine, Fuertes, Roysircar, & Kindaichi, 2008; Inman et al., 2014; Ladany, Brittan-Powell, et al., 1997; Ladany, Inman, et al., 1997), but there has been significantly more research on the relation of cultural variables to counseling relationship and counselor effectiveness (Fuertes, Spokane, & Holloway, 2012).

CONTEXTUAL DIMENSIONS OF SUPERVISION Contextual factors of supervision are conditions that are related empirically and practically to the supervisor and supervisee’s choice of task and function and the formation of the relationship. Whereas task and function can be inferred from the process of communication, contextual factors are sometimes not obvious to the observer or apparent to the participants. Based on their tacit knowledge and experience, supervisors and trainees make decisions about their engagement and topic of conversation. In teaching supervision, the properties of the contextual factors are guideposts for supervisors to consider in a reflective process that uncovers the motivations and intent of their actions in supervision. Factors that might influence information processing and decision making have been studied by asking supervisors or trainees to reflect on their own or the other’s actions (Holloway, 2000; Neufeldt, Karno, & Nelson, 1996; Skovholt & Rønnestad, 1992). The contextual dimensions in the SAS model are the client and the institution or organization in which the trainee is delivering service (see Figure 1.1). Each of these contextual dimensions is described by five factors based on conceptual and empirical literature and discussed next (see Figure 1.2). 25

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Client Factors The characteristics of clients and the issues they bring to the therapeutic context are central to the teaching and learning of supervision. The dynamics that unfold in the therapeutic relationship often are reenacted in the supervisory relationship. Thus, the importance of employing the client material as a springboard to designing appropriate teaching objectives and strategies cannot be underestimated. In SAS there are five client factors: client characteristics (social, psychological, and biological), clientidentified problem and diagnosis, client history, client social and familial context, and the counseling relationship (see Figure 1.2). Supervisors routinely screen clients for beginning level trainees to ensure that they are assigned only cases that are appropriate to their level of competence and supervisors’ areas of expertise. Competency guidelines created in the last decade delineate the progression of skills acquisition for counseling psychologists from practicum to internship for counseling psychology. Thus, supervisors need to align the matching of client needs to the training level of the trainee. Research on client attributes, as related to the process and outcome of psychotherapy, are relevant to supervisor decision making. For example, the literature on matching client gender or ethnic identity with that of therapists suggests that, although there appears to be a preference for ethnically similar counselors, this is not consistently evident in the empirical literature (Coleman, Wampold, & Casali, 1995; Miville et al., 2009; Ober, Granello, & Henfield, 2009). It behooves the supervisor to recognize that variables, such as social desirability, socioeconomic status, attitudes, or values, may play an important role in the counselor’s potential effectiveness. Therapeutic ineffectiveness may be falsely attributed to the lack of similarity between client and therapist on general qualities when a more in-depth analysis might reveal more implicit characteristics of the client or counselor to be inhibiting progress. The evaluation of therapist effectiveness ultimately rests with the client’s progress, symptom reduction, and relational bonding. Supervisors frequently have relied on trainees’ reports of client change and audiotaped or videotaped recordings of trainees’ counseling sessions. 26

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The advent of evidence-based therapy has raised again the question, What supervisory strategies and processes affect therapist effectiveness and client change? There has been considerable debate over the years on the efficacy of supervision on client outcomes (Bambling & King, 2000; Ellis & Ladany, 1997; Holloway & Neufeldt, 1995; Stein & Lambert, 1995; Wampold & Holloway, 1997; Watkins, 2011). Research on the efficacy of supervision in relation to client change has begun in earnest in the last decade with the rise of evidence-based therapy (EBT) in psychotherapy. However, linking the impact on supervision to client outcomes has been challenging, given the considerable volume of findings that have revealed therapists and supervisors are more generous in their assessment of client improvement and underestimate clients’ deterioration when compared with client reports (Worthen & Lambert, 2007). In an effort to provide clients’ perception of improvement, Lambert and associates have developed a client feedback approach that systematically sends client feedback to the therapist after each therapeutic session (Hawkins, Lambert, Vermeersch, Slade, & Tuttle, 2004; Lambert, Harmon, Slade, Whipple, & Hawkins, 2005; Lambert & Hawkins, 2001; Lambert et al., 2002; Whipple et al., 2003). When a client was not making progress, training therapists were at a loss as to how to rectify the course of therapy; this led to the investigation of supervisors’ receptivity to using client data in supervision. In the early stages of this program of research, supervisors were not overly positive about the use of client outcome data, which is not surprising, given the history and studies that demonstrate clinicians prefer to rely on their intuitive clinical knowledge. However, as the utility of the client progress data became more persuasive, clinicians used the information to focus supervisory discussions. The evidence that client progress and outcome trajectory data can significantly affect client improvement by influencing the therapist’s intervention strategies is a strong argument in favor of supervisors using such client outcome information to guide their supervisory strategies. As Worthen and Lambert (2007) conclude, We believe the use of (client monitoring) feedback (system) . . . will significantly assist our mandate as supervisors to monitor client welfare and through supervision, enhance client outcomes. 27

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Thus, outcome oriented supervision can help facilitate the two primary aims of supervision, enhanced practice and improved client outcomes. (p. 53)

Organizational Factors Supervision, whether a part of a training program or continuing professional development, takes place in the context of institutional organizations, such as in-house departmental clinics, university counseling centers, hospitals, or community mental health or other service settings. The role of supervision with respect to the service demands of the organization is an important consideration in establishing goals and functions of super­ vision (Carroll & Holloway, 1999; Holloway & Roehlke, 1987; Proctor, 1997). Moreover, the service demands of an organization often influence which goals are prioritized and how supervision is arranged, yet the influence of organizational variables on supervision has rarely been investigated or discussed in the professional literature, as evidenced in its omission in comprehensive reviews of the literature (Inman et al., 2014). Institutional characteristics were first defined in SAS as organizational clientele, organizational structure and climate, and professional ethics and standards. However, the SAS model has been adapted to multidisciplinary and organizational systems. In these environments, the supervisor needs to attend to a more detailed knowledge of the organization’s characteristics; as such, the SAS model includes five factors for consideration: organizational mission and values, organizational structure, performance management system, culture and climate, and professional standards and ethics (see Figure 1.2). All of these factors potentially may influence the supervisory latitude and restrictions on client selection, therapeutic modality, supervisory contract, and trainee evaluation.

THE SUPERVISORY PROCESS DIMENSIONS The process of supervision in the SAS models is structurally comprised of the teaching tasks of supervision and the supervisor’s functions. The SAS model’s teaching tasks have been grouped into five broad 28

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supervisee competencies: counseling skills; case conceptualization; professional role, including ethical practice; intrapersonal and interpersonal awareness; and self-evaluation (see Figure 1.2). Although these competency areas were created by a conceptual analysis of the empirical literature two decades ago (Holloway, 1992, 1995), they have been confirmed by subsequent research in this area (see Inman & Ladany, 2008) and align with the competencies defined in the benchmarks and toolkits of competency-based learning: expectations and roles, processes and procedures, skills development, awareness of the factors affecting quality, participation process, and ethical and legal issues (Falender et al., 2004). Supervisor functions are “the kind of action or activity proper to a person, thing or institution” (Webster’s Encyclopedic Unabridged Dictionary of the English Language, 1989, p. 574). Since the advent of social role models of supervision (Carroll, 1996a, 1996b; Ellis & Dell, 1986; Ellis, Dell, & Good, 1988; Hess, 1980), role labels have been useful in providing a common language for supervisors to describe their teaching strategies (Bernard & Goodyear, 2014). In the SAS model, there are five subroles of supervision that have been named with active verbs to emphasize the dynamic, interweaving shifts inherent in these activities. Thus, the supervisor might use the functions of monitoring/evaluating, instructing/advising, modeling, consulting/exploring, and supporting/ sharing (see Figure 1.2). The strategies aligned with these roles have been studied by researchers using discourse analysis and classification of supervisor verbal behaviors. A summary of these findings can be found in Holloway and Poulin (1995). Each supervisor function can be characterized by behaviors typical of its respective social role and, as discussed earlier, in the structure of the relationship by the form of relational power governing the role. The supervisor’s awareness of relational power is critical in her or his choice of which subrole to use to achieve particular teaching goals. Supervisor tasks and functions are the combination of the super­ visor and supervisee working together on a particular learning task that in turn creates a process of interaction. Figure 1.3 illustrates the process by 29

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Counseling skills Case conceptualization Professional role & ethics Emotional awareness Self-evaluation

Figure 1.3 The process of supervision: functions and tasks.

imaging the wheel of supervisory functions on the outside circle turning to choose a specific teaching task at a particular point in time. The choice of different functions or strategies aligned with subroles may be influenced not only by the trainee’s learning needs at the moment but also by the other contextual factors described in the model. For example, if a neophyte trainee is just beginning with a new client, the supervisor may choose to use an advising function around case conceptualization. On the other hand, an experienced counselor experiencing resistance from a client may warrant a consulting approach by the supervisor. The use of the task function matching to describe supervisory process has been explored by DeCato (2002) in the supervision of psychological testing, Arnon and Hellman (2004) with school counseling supervisors, and Xi-Qing (2004) in the observation of clinical supervision in China. Unfortunately, there is no simple rule for determining which strategy might work best with a given supervisory situation. There is no precise matching of strategy to learning task; however, there is a certain likelihood of coupling strategies and tasks, such as professional ethics and monitoring rather than perhaps emotional awareness and monitoring. However, 30

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SAS emphasizes the number of factors that might be taken into consideration when determining a way to move forward with a supervisee. The emergence of an interactional process from functions and tasks being chosen is enhanced by the supervisor’s awareness of the full SAS road map—contextual factors and relational conditions. For example, when considering how to approach a beginning level counselor who is grappling with an emotional response to the client, the supervisor may begin by supporting the counselor’s awareness of emotion in his or her role as counselor while guiding him or her to a deeper understanding of how it is affecting the relationship with the client. On the other hand, an advanced supervisee may quite ably describe his or her emotional reaction to the client and the role it is playing in fully engaging in the relationship. In this instance, the supervisor may use a more consulting role to collaborate with the supervisee in uncovering a deeper emotional and conceptual understanding of the relational qualities and client characteristics that trigger his or her emotional reaction and how such understanding can lead to more productive therapeutic approaches with the client.1

Portions of this chapter first appeared in The International Handbook of Clinical Supervision (pp. 598–621), by C. Watkins Jr. and D. L. Milne (Eds.), 2014, West Sussex, England: Wiley Blackwell. Copyright 2014 by Wiley Blackwell. Reprinted with permission.

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supervisor’s ability to create a learning environment is essential to a supervisee’s willingness to disclose challenges in the client’s treatment and progress. In this chapter, I describe some specific strategies and challenges that emerged in a recent demonstration of the systems approach to supervision (SAS) approach I taped for a companion DVD to this book, A Systems Approach to Psychotherapy Supervision. These strategies and challenges are discussed from the SAS perspective using SAS graphics to illustrate the dominant themes of what emerged in the process. The context of this session is important in understanding the quality of the supervisory relationship, and in particular, a discussion of the contract, phase, and structure of the relationship will assist the reader in interpreting the ensuing processes. Linh is working in a university counseling center and completing her last practicum before beginning her predoctoral internship. She has studied

http://dx.doi.org/10.1037/14942-003 Supervision Essentials for a Systems Approach to Supervision by E. L. Holloway Copyright © 2016 by the American Psychological Association. All rights reserved.

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my model of supervision and practiced supervision with master’s degree level counselors. Linh was interested in filming this series with me, and I am grateful for her full engagement in the process. Our contract was to schedule five sessions that would focus on Linh’s challenging clients. In preparation for the fifth session that is discussed here, Linh and I had four previous supervisory sessions relevant to her current work with two clients, one of whom is discussed in this chapter and the companion DVD. All written permissions were obtained from her practicum site and the clients to be discussed in supervision. The client’s name and nonessential details of the case have been changed to protect the anonymity of the client. I like to begin work with a mutual sharing of the elements of the SAS supervisor and supervisee dimensions that are recognized as influential in the development of the learning alliance. Thus, we began our first session sharing our professional backgrounds, interests, theoretical orientations, and previous engagement in supervisory practice. Although not necessary in supervision, we were pleased that we had in common an interpersonal psychotherapy orientation to counseling. In the developing phase of the relationship, Linh and I carefully reviewed the supervisory contract, the context of her counseling practice, her professional experience, and her goals for supervision before beginning the discussion about Linh’s clients. The focus on our independent professional work and history as well as laying out our goals for our work in supervision allowed us the opportunity to discover each other’s style of thinking, learning, and being in relationship. This initial focus on the supervisory relationship and the supervisor and supervisee as a part of that relationship is essential to building a learning alliance in the SAS approach. Finally, although I believe that there was mutual respect and care in the relationship, because of our short time together, my reputation in supervision, and our generational span, I think that the power structure was less distributed across our roles than may have been possible within a different context. As the fifth session unfolds, it is evident that both the structure and the phase of the relationship are considerations in my choice of strategies and learning tasks. In this chapter, I identify a series of critical issues that emerged in the fifth videotaped session of supervision. I have centered my analysis 34

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and comments on five different areas, which are presented in the same sequence as they unfolded in the supervision session. I have taken the liberty of labeling these interactions to highlight the critical challenge they presented. To illustrate the process transcript excerpts from the supervision session with Linh, my subsequent debriefing with Arpana Inman also has been included (video of which is available in the companion DVD). The discussion is highlighted by five therapeutically challenging events: 77 77 77 77 77

the client’s no show pattern; the counselor’s emotional awareness; triangulation; cultural identification; and theoretical orientation versus organization guidelines.

Each of the identified challenges is illustrated using a visual mapping structure unique to the SAS model. The SAS icon is used to identify the dimensions and factors of the model that are important in analyzing the presented dilemma, the relationship among dimensions, and their systemic effect on therapy and supervision. In addition, the SAS process icon, which names the learning tasks being addressed and supervision strategies being implemented, illustrates the analysis of supervisory approach. In the transcripts, my comments are prefaced with “H” and Linh’s with “L.” I have taken the liberty of removing some of the hesitations and speech starts that are nonessential to understanding the content or character of the message.

CLIENT’S NO SHOW PATTERN OF BEHAVIOR It is not uncommon for clients, who are being seen at a university counseling center, to have had therapists before arriving on campus. This may be problematic for counselors in training because their credibility and level of experience may be questioned. In this case, the client, Annie, has been inconsistent in keeping her appointments but has shown up for crisis walk-in service on several occasions. Thus, she has managed to get immediate help without committing to the ongoing counseling relationship. In this interchange, I first speak to the client’s competitive approach to 35

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staying in control of a relationship, which has been identified previously, and wonder if the client may be setting up a type of competition with Linh by not showing up for appointments with her but accessing other counselors by coming to the center for crisis appointments. Important to the development of power within our relationship, notice in this excerpt that Linh presents an insightful alternative to my hypotheses that explains the client’s inconsistency in the relationship. Holloway: Linh, it seems like we need to follow up on your client, Annie. In previous sessions we’ve talked a lot about her inconsistency, and one of the things I remember leaving you with, and we need to catch up to see if it’s still relevant, is that she may not be coming in consistently, and part of that could be about her competition with you since she has a lot of competition with cousins, etc. I don’t know if that has emerged again or if you’ve given that any thought, but I’m curious. Linh: I think that—I definitely thought about the nature of this—of Annie, who’s very competitive in many different aspects of her life, but another hypothesis that I have about her being inconsistent in therapy is about her sense of loyalty to her former therapist. Holloway: Ah, yes. Linh: So, as you may remember, she mentioned a while back that she had this therapist for like about a year and a half, and she—even after she moved—after she transferred, moved here, so that she had to terminate with her former therapist, she still maintained some phone sessions with her former therapist. Holloway: While she was seeing you? Linh: No. Before she saw me. Until her former therapist really told her that, “Well, you know, you need to find somebody that you can see consistently, rather than just relying on some phone sessions with me.” And she talked very highly of this former therapist. And so, I’m wondering what part of her inconsistency in therapy is a way to show me and to show herself that she’s still loyal to her former therapist, and . . . she doesn’t want to fully commit to this new therapy relationship. 36

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Linh’s willingness to offer an alternative hypothesis to the client’s behavior is an excellent example of how the power of expertise in the relationship is becoming more balanced. From a process standpoint, I had offered an opinion, and she was able to consider it while also engaging me in considering other conditions that would lead to a fuller understanding of the client’s behavior (see Figure 2.1 for SAS analysis). In the next probe, I follow up on her conceptualization of how the current therapeutic relationship may resonate with a general pattern of behavior for the client. Because Linh’s theoretical orientation is aligned with interpersonal psychotherapy, I thought that it would be valuable for her to consider the behavior in light of recurring interpersonal patterns. Holloway: Right. So, in your mind, does that connect to any of the dynamics she’s revealed to you in other kinds of relationships? Either relationships with friends, boyfriends, family? Linh: Um hmm. [Indicates “yes.”] I think that it—I felt like her previous therapy relationship was not fully wrapped up yet, because a few weeks

Figure 2.1 Systems approach to supervision (SAS) analysis of no show behaviors. The bold areas represent the dominant dimensions and elements within them that are the focus of supervision.

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ago, she mentioned that, “Well, you know, before I came to see you I could not get an intake early enough, and so I had to have a session when I felt really down; I called my parents, and my parents did not pick up the phone, so I called my former therapist.” And so, I got a sense that the former therapist still is a backup person for her. So, I don’t quite understand the extent of that relationship yet, and I talked to her former therapist, and it really seemed like her former therapist really played right into this motherly role, and that was the work—the former therapist—that the former therapist seemed to be like the mother that [the client] . . . never had. Linh’s response to my probing for her analysis of the dynamic characteristics of the counseling relationship and how it might be a reenactment of her relationship in general is more descriptive than conceptual. At this point, she does conceptualize the case based on her theoretical orientation to the work. The supervisory process diagram is depicted in Figure 2.2,

Figure 2.2 Supervisory process: learning task–case conceptualization and supervisor strategy– consulting and exploring.

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illustrating the use of learning task and supervisory strategy in this excerpt. The consulting/exploring strategy emphasizes a “power with” collaboration on the case conceptualization of the client. As mentioned, because of the inherent hierarchical nature of the relationship and particularly because of the context of this supervision, I wanted to reinforce Linh’s opinions, especially if they were different from mine and consistent with the client’s behavioral patterns. My follow-up was to move the conversation to Linh’s feeling about following a client–therapist relationship that was still present in the client’s emotional life. This excerpt and SAS analysis are presented in the next section.

COUNSELOR’S EMOTIONAL AWARENESS As the work progressed in this session, I began to explore the implications of the lack of continuity in Linh’s relationship with her client and in particular the competitive pattern that the client set up between her and the previous therapist. In an earlier session, we had discussed the role reversal that occurred in the client’s family of origin. She was left “to mother her mother” after immigrating to the United States because of her mother’s severe inability to cope with the transition to a new country, language, and culture without the father present. This familial role during the early period of the client’s life may have contributed to her confusion around appropriate boundaries, attachment, and counterdependence in relationships. Certainly, the client was manifesting similar relational patterns in her therapeutic attachments. Thus, because of the dynamic the client had set up between her previous therapist and Linh, it was important to explore Linh’s emotional experience of “being second” to the previous therapist. Focusing on the counseling relationship becomes a conduit for uncovering Linh’s immediate experience in being with the client and feeling unseen or in “second position.” Figure 2.3 illustrates the shift in focus from the previous example of consulting around the conceptualization of the client’s behavior to the strategy of supporting the counselor while probing for deeper insight into her own feelings about the client and the counseling relationship. 39

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Figure 2.3 Supervisory process: learning task–emotional awareness and supervisory strategy– supporting and sharing.

Holloway: Let’s talk a little bit about how that is for you, sort of being in second position. Linh: I cannot remember what session it was, but the one time in the intake, she mentioned that she had therapy before, and I think maybe a few sessions after that when she mentioned—she kept talking about how much accomplishment that she’s achieved with the former therapist, resulting in her transferring to this university, and my feeling was, “Wow, so it really seemed like you were very consistent with your previous therapist. I wonder what is going on?” And although I’m very glad that her positive experience in therapy definitely brought her back to therapy, hence with me now, I’m also feeling like she is putting me in this scale, in a way, between me and the former therapist, and I feel like this is an invisible competition that she is putting me in. 40

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Holloway: Right. So, she’s recreating this competition between you and the therapist, as she’s experienced with her competition with her peers, in particular her cousin, or whatever, in terms of achievement? Linh: Yeah. Holloway: So, you see that happening? Linh: Um hmm. [Indicates “yes.”] Holloway: Creating the same dynamic that she’s probably comfortable with? But what about you? You’re used to really achieving, doing well, probably many times in first position, and she’s creating this dynamic for you, whether you embrace, or not, she’s presenting it that way? How does that affect your work with her? Linh: I think at a certain time point, I definitely was frustrated in the session and feeling like I don’t know what else I can do to get you to come consistently, to even have you focus on the work, and trying to have a process conversation with her about just her being inconsistent or about the relationship in the room, and feeling like she was not willing to engage in that conversation with me, no matter what type intervention I’m trying to improve, or to gain more understanding of the relationship, and really feeling stuck with her. Holloway: So, what is it like to sit with her and be trying to make a relationship? Linh: I think at the end of every session I had with her, I felt exhausted of trying, and also she’s very talkative, so a lot of times I felt like I’m trying, trying, trying, but I . . . She didn’t really leave much room for me or for my presence, and I am wondering if she even sees me in the room sometime. Linh’s frustration with the inconsistency and being unable to help the client commit to relationship is revealed in the previous interchange. In my own reflection on this powerful interchange is a sense of my emotional awareness of how difficult it must be to feel second in this relationship. I had a great deal of emotional empathy for how Linh, who is a highly regarded 41

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student, may be experiencing the client putting her aside for a previous relationship. This is an impetus for me to focus on how Linh is experiencing the counseling relationship. She has told me that she feels stuck. What’s happening that initiates her sense of impasse with the client? Is it because she doesn’t know the next strategy? Or is it really about her own emotional presence and what it feels like to be put aside? In the final probe, I am asking her to move more deeply into the feeling of being “unseen” and “devalued” in the relationship. The metaphor of being invisible in the relationship becomes an important symbol of probing more deeply into Linh’s own emotional needs for recognition. It becomes a critical part of weathering the storm of the client’s interpersonal pattern of moving toward commitment and then moving away from it. How Linh handles this counseling relationship will be critical for the client in being able to learn healthy patterns of relationship commitment. In the next excerpt, Linh passes over the probe to explore more deeply the experience of being unseen in favor of reporting the client’s most recent use of the crisis center. I continue to probe for her experience and feelings in and about the relationship. Holloway: How is it now around that? Do you feel seen? Do you feel part of this relationship? Linh: That’s a very good question. I think that after her recent crisis—crisis number three—and really having people (I was not at the agency that day) and having other people who were not as gentle with her in the process who really took hard action intervening in the crisis. I think it made her realize something about just engaging with the therapist in the therapeutic relationship. Holloway: Engaging with you? Linh: Um hmm. [Indicates “yes.”] And so, after her—she had a crisis the week before, and so the week after her crisis, we had a very productive conversation about how I just wasn’t able to advocate for her. I wanted to, but I wasn’t able to, because one, I wasn’t there; two, because she didn’t 42

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really see me, so I—if people look at my notes, they can’t really tell what type of work that we’ve done because we didn’t really do anything. Holloway: Yes. It’s almost like she puts you in the position of being second by not being there, almost tied your hands behind your back, and then you were kind of exposed to the agency on that. Linh: Um hmm. [Indicates “yes.”] Holloway: Tell me a little bit more about what happened in this next session when she came back and sort of had some recognition that it might be useful to be seeing you. Did you feel seen? From the SAS perspective, I mention Linh’s reputation in the agency, thus bringing in the organizational context of the SAS model. I felt that Linh was experiencing a sense of embarrassment about not being able to “hold” her client or advocate for her because of the sporadic attendance and perhaps was anticipating that she was seen as “less than” competent by her colleagues.

TRIANGULATION Following these deeper probes into Linh’s emotional response to the client’s inconsistency and lack of commitment to the relationship, the session moves to the added complexity of the client’s pattern of triangulation. Linh describes the triangulation that the client was creating between her and the previous therapist as well as between her and other therapists that the client sees at the agency when she is in crisis. Being triangulated in this way is a common dilemma for the therapist and one that must be handled with sensitivity and transparency. In essence, the client is discovering if the same maladaptive patterns of behavior will work in therapy as they have in her familial and contemporary world. Although Linh initially was disturbed by the client’s behavior and the perception it created of her as a therapist “not being in the know,” after deep reflection, Linh was able to handle the situation with vulnerability and insight. Her response to the client had the potential to break the triangulating pattern (see Figure 2.4). 43

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Figure 2.4 Depiction of triangulation from the systems approach to supervision model.

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Holloway: How did you handle that? Linh: I was honest with her and said that, “No, you did not get me into trouble. However, I definitely felt very concerned about you, and because we haven’t really met that many times and not very consistently, to be honest I wasn’t sure what really went on with you, so I was very concerned, and also it definitely wasn’t a very pleasant experience having to hear about your client from somebody else.” Holloway: How did she respond to that transparency? Because when you did that, you really talked about your relationship, and there was a certain immediacy to that. Linh: To my surprise, she actually took it well. I wasn’t sure if she would even hear me out, but to my surprise she took it very well, and I have the sense that not a lot of people in her life directly talk about the relationship; people just go on about their day and tell her or not tell her, like her dad telling her what to do, and her mom—she has to parent her mom pretty much. And the topic[s] of feelings and relationship [are] very much avoided in her family, so I think that was—it was a very therapeutic moment for her that somebody actually—[was] transparent and brought it up to her and talked directly about the relationship, and [didn’t let] her talk about something else. Holloway: The thing that I’m so impressed with is that in spite of the frustration, in spite of the way that she almost set up a situation to frame you in competition with other therapists she’d end up with in crisis, is that you reached down, and you found a way to engage her and talk about your own vulnerability. It’s pretty vulnerable to say, “It wasn’t very pleasant to be in a situation where I didn’t know what was happening for you.” What allows you to do that? What in you allowed you to be in that moment to really be vulnerable with her? In essence, Linh was enacting a direct, nonmanipulative model for engaging in a relationship. This approach was consistent with her theoretical orientation and the immediate need to use the counseling session to create a corrective experience. In the moment of supervision, I am struck 45

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with the courage and vulnerability that was required for her to engage at this level with the client. Figure 2.4 illustrates the systems perspective of the SAS model most vividly because it is at this point in the supervisory session that it becomes evident that the client’s behavioral patterns are resonating through all her relationships—with the previous therapist, the counseling center, and Linh. There are two distinct repeating patterns that are shown in Figure 2.4. The client is reenacting her familial pattern with her previous therapist and Linh. In the second, she is triangulating Linh with those therapists who saw her during her crisis sessions. Because the client is not showing up for her appointments with Linh and yet showing up for crisis counseling, Linh’s work with the client is being questioned by the other therapists. In Figure 2.4, the crisis therapists are represented in the organizational dimension. Thus, Linh is caught between the relationship with the client and the relationships with other therapists in the agency. A third triangulation is represented in Figure 2.4 with the dotted line, which represents the potential of reenacting the triangulation with the agency in the supervisory relationship. It is a critical point in supervision because the supervisor must break the pattern of triangulation and stop the reoccurrence of the relational pattern being created by the client. The counselor’s emotional awareness of her experience of the counseling relationship is the first step in this process.

CULTURAL IDENTIFICATION Both Linh and the client are of Asian descent and first generation American. There is an opportunity in the relationship to share common experiences and enhance an initial assumption of empathy and understanding of challenges and triumphs from this perspective. Equally important is the recognition of individual differences despite the potential cultural bond. In the next excerpt, I broach with Linh her understanding of the client’s cultural identification and whether or not it has been a topic of conversation in therapy. I wondered if Linh had addressed the cultural identification and assumptions that the client may be projecting on her as an Asian 46

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American therapist. It is noteworthy that Linh has not pursued the topic directly, yet the client makes several generalizations about Asian families with the assumption that Linh has had the same experience. Holloway: I was wondering in terms of identification—where do you see her identification with you given your history, her history, what she might assume is a real cultural connection here? Has there been any discussion of that; has she brought up her cultural identification with you? Linh: Briefly about family history—family recent immigrants—I was the one who brought it up . . . . I made it a point to ask her more about it. Holloway: Did you self-disclose? Linh: No, I did not—in retrospective . . . I cannot remember why [I] did not engage in that conversation at [a] deeper level. I think it could be I ask one question, she talks for half an hour. [I] felt that she did not want to know about me—felt not relevant to talk—but in future very important conversation to have with her [because] several times she made reference to various stereotypical—you know, about how Asian families can be. In future, I may try to find opportunity to bring it back in session, now that we are in a better stage in our relationship. Holloway: Now that she is making these generalizations, making stereotypes to connect, not differentiating her family. Does she say, “All Asian families,” like that, as opposed to you helping her understand how her family was . . . clearly in her case detrimental to her growth—unpacking stereotype . . . that’s just the way it is. . . . How might you broach that without bringing too much into your background unnecessarily. How might you manage your conversation with her? Linh: In future, if similar reference? [I] may want to explore with her— “all Asian families.” Ask her what she meant by what is she trying to tell me—what [are] some of her beliefs, family values, and cultural values? And make it more about her than about me? Linh sees the omission and responds with a comment that was poignant given her experience of being “unseen” in the relationship and “unvalued”: 47

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“I felt that she didn’t want to know about me.” She moves quickly forward to say that the client talked too much and asking one question would just result in a barrage of talk. Yet upon reflection, Linh sees the importance of taking responsibility to discuss the cultural differentiation and commonality, especially with respect to familial patterns and expectations. Figure 2.5 shows how the focus on the supervisee element of cultural values and its relevance to the counseling relationship is the focus in this interchange. The significance of this interaction, its relevance to the SAS model, and my cultural identification as a female, Anglo Canadian who was the only member to immigrate to the United States as an adult, warrants a deeper level of reflection on my presence in this supervisory encounter. For this reason, I have taken the liberty to include a segment from series host Arpana Inman’s interview with Linh and me (also available on the companion DVD) regarding this excerpt of the supervision session. Holloway: There is a lot going on here. As I was watching it once again, I was thinking there was a moment when she talked about—in the beginning—talked about not addressing the issue, and there was a . . . look of

Figure 2.5 Cultural expectations and assumptions. The bold areas represent the dominant dimensions and elements within them that are the focus of supervision. SAS = systems approach to supervision.

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being perplexed and reflection about that, and then Linh said, well I think it was about the fact that I would ask someone and she would just talk so much. As I looked at that, I think I could have pressed her a little and said, “What stopped you?” And I would have a hypothesis about that which may not have been anywhere in the realm of Linh’s experience. But the hypothesis was that here’s a client who’s not joining with you. She’s being inconsistent and she’s still in touch with her previous therapist, so that there would be a reticence to join in that relationship and gain a greater intimacy and self-disclosure. So why did I not do that? I think if I look deeply within me and reflect, I would say that it is something to do with the phase of our relationship. This is a fifth session. There’s a sense of, Should I press this now, this issue of attachment? Or should we move forward to find out how you’re thinking of it? What kind of strategy might you come up with? So instead of pressing my strategy on Linh, it was more important for me at that point to build our relationship by engaging her having—[turning to Linh] having you reflect on it, having you think about when you might do it next. To me that was going to be more effective. So that’s a very important latent level of what was going on here, and I think in the model speaks to the supervisor’s responsibility of self-reflection in the moment, and retrospectively understanding what might have gone on and why they did something. And I think the model can help in that process. Further, as we move along we talk about the use of self-disclosure, appropriate self-disclosure, and again leaving that to you, Linh, to figure out, what is appropriate self-disclosure? How much would be effective therapeutically here? And that’s why I’m very deliberate about saying, “What part of your background? What part of your cultural presence might be addressed which would help the client break down her stereotypes about her own cultural understanding?” Which again is an important part of her development in this particular issue that needs to be addressed with the client. Inman: This is interesting because in some ways you’re speaking to the process of the tentativeness in both of your relationships. Linh with her relationship with her client, where she’s kind of hesitant to talk about it, 49

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and then you’re wondering how much you can kind of push Linh here. But the other piece I think that is something that’s oftentimes discussed among students and also certainly addressed in the literature is the idea of who brings up these conversations in supervision? So it’s a really neat example of the role of the supervisor and how you did that. Holloway: Right. And you’re referencing who brings up the conversation about culture? Inman: Right. Holloway: And I think that there is a responsibility for a supervisor to be attending to that on many different levels. One’s own level of understanding; of course the supervisee’s, as I mentioned earlier; the organization; and, of course, the client. This reflection illustrates the role of the model to both differentiate and integrate understanding of the three primary players in the relationship of supervision—the supervisee, the supervisor, and the client. Each one is critical to understanding the dynamics and emotional resonance that flows across the relationships and how that understanding can be used for therapeutic healing of the client and mutual professional growth for the supervisor and supervisee.

THEORETICAL ORIENTATION VERSUS ORGANIZATIONAL POLICY This last segment is taken from the concluding section of the supervision session. In this excerpt, there is a conflict of values between organizational policy for short-term treatment and Linh’s theoretical orientation. Given the current fiscal demands and the volume of clients coming to university counseling centers, this dilemma is not uncommon. The counselor is weighing best practices for the client’s condition and fiscal management. It is particularly difficult for less-experienced therapists to navigate this conflict of priorities. Linh contemplates how to manage the system and gain permission for additional sessions for the client despite the number 50

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of sessions allowed. She is in a more vulnerable position to advocate for the client because she has done so before for other clients, and she is a practicum student. Linh: Yeah. I definitely thought about if we really count the number of sessions, and then she has two left, if I really try to defend the case, then she has four left. So, I think a part of me . . . I’ve been entertaining the idea of whether or not maybe next I just talk about termination, and see how it goes, but I felt like we finally got somewhere, and she—I guess that I don’t want to recreate this pattern that her family just tells her, “Go do your thing. You, an adult, go do your thing.” So, . . . I’m afraid that if we don’t spend enough time in termination, and really connecting her with future services, and do a very thorough termination, we may recreate that pattern. In this comment, Linh is considering the effect of termination on the client from an interpersonal pattern perspective. This is consistent with her theoretical orientation, and as her supervisor I reinforce and then expand her conceptualization in the next excerpt. In reflecting later upon this moment, I describe to Arpana Inman the intersecting elements of the model that are influencing my awareness of Linh’s dilemma in counseling. Holloway: Well, to me one of the important things that’s happening is my awareness of the short-term therapy contract that Linh is engaged with her [counseling] center. I am an external supervisor and so need to know what are the organization’s expectations, and what has she contracted for? That to me was very connected with how the strategy was going to take place in terms of the consistency with the client: what the client is confronted with, the whole cultural aspect with the client. How deeply will we move this client along if we only have two sessions left? So here’s where we see an example of the organization and the contract with the organization influencing how we need to set goals with the client and what in fact the strategies will be. As I close this session, I bring Linh back to the question of termination and her primary goals in consideration of the client’s needs. 51

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Holloway: Right. And the pattern you’re talking about is her movement toward, and her movement away, so that she’s either moving toward to be mothered, or she’s moving away, and saying, “I’m completely independent.” And then she goes into crisis. And so, she’s in that stage . . . that transition from home into college, where she keeps recreating her need to individuate and stay connected. So, I guess, part of me hears that you’re kind of ambivalent. Part of you would like to get this ended in two sessions, and the other part, you have some real concern about her. So, maybe one way to think that through today is . . . let’s say that you are going to terminate in two sessions. What are the primary goals for her? What do you see from the therapist side . . . how you would like to leave it? What are the goals for the next couple of sessions with her? Linh: I really felt like [the client], for the lack of a better word, seems very scattered in the session; she talks a lot about many different things, and it seems that it is a recreation of her real life, her day-to-day life. It’s very scattered. She jumped from one thing to another, and not feeling centered. And— Holloway: So, she’s scattered? She has very ambivalent attachment to you? Linh: Um hmm. [Indicates “yes.”] Holloway: So, she’s scattered in a sense of how she’s going to attach whatever crisis counselor is there. She’s scattered in her sessions with you, topically, and you’re also saying that same distractibility is present in her relationships, and in her, essentially in her schoolwork, as well? Linh: Um hmm. [Indicates “yes.”] Holloway: So, that’s sort of where you see this pattern throughout? How does that lead you to think about what might be accomplished in the next couple of sessions with her? Linh is having difficulty formulating a termination plan and digresses slightly to the client’s tendency to be scattered in their discussions, thus making focus particularly challenging for both the client and Linh. To avoid recreating an unfocused supervision session, I acknowledge Linh’s concerns about the client being “scattered” and hook it back into the client’s 52

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pattern in relationships as well as other areas of her life. Finally, my last comment redirects the conversation once again to the termination phase strategy (see Figure 2.6). In this dilemma the conflict between the organization’s mission and culture with the counselor’s theoretical orientation and the client’s interpersonal patterns of behaviors culminate and provide an opportunity to illustrate how each of these dimensions of the model will influence the supervisory strategy. My goal at this juncture is to guide Linh to think clearly about what can be accomplished with the client in the few sessions left and, given those goals, what are her next steps. I am asking to focus on the client rather than attempting to change the agency expectation for the client. If Linh were to opt for the latter, there are consequences that would not be beneficial for Linh or the client. First and foremost, the client would see that she can control something larger than herself by manipulating the system and her counselor to have her crisis needs met without committing to a relationship. Second, Linh would be avoiding the difficult task of termination with the client by diverting her attention to asking for more sessions from the agency. Finally, Linh has indicated that the client

Figure 2.6 Conflict between organization priorities and supervisee theoretical orientation. The bold areas represent the dominant dimensions and elements within them that are the focus of supervision. SAS = systems approach to supervision.

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is scattered in many aspects of her life, so it is critical that there be a focus and direction for termination that might provide a small corrective experience for the client. My strategy in this last segment is to model how Linh will need to be focused with the client given the time that remains in their counseling contract. In the reflective interview on the session, Arpana Inman summarizes the intersecting pieces of SAS that are at play in this intervention. Inman: This is a really important piece, I think, of your model: where you speak about the supervisee in context and kind of needing to really look at the intersectionality between supervisee needs and contextual needs and how supervisees’ professional development in this context really is influenced by how they manage some of these intricacies. I don’t know if you want to say anything more about that because I know this is an important piece. Holloway: Yes, well you’ve reminded me of something: that one of the learning tasks is about professional role and how [counselors] not only [are] managing themselves inside of an organization, but how are they managing and engaged in self-management in terms of their staff? And one of the issues also here is in terms of professional growth and being evaluated in the [counseling] center as someone in training. Now the client has Linh in a position where she has to go back and advocate for more sessions, which has happened in the past. So we have this sense of growth as a professional. We have the relationship with the organization, the contract with the organization, and the relationship with the staff, and your own evaluation as a trainee.

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3

Handling Common Supervisory Issues

I

n this chapter, I demonstrate the application of the systems approach to supervision (SAS) model to a case study of supervisory practice that illuminates common supervisory issues. Dilemmas often occur in one of five areas of the supervisory process as the personal vulnerabilities and professional challenges of counselors in training are triggered by the therapeutic relationship. These five areas include conflict of values with supervisee and client, the supervisee’s anxiety around client needs, countertransference of the supervisee in counseling relationship, supervisee resistance in supervisory relationship, and the teach-or-treat dilemma of the supervisor. Because many supervisory dilemmas emerge within the history of a supervisory relationship and interventions are chosen that are specific to the context of the supervision case, I have chosen to present these dilemmas as a single case study. The case presentation

http://dx.doi.org/10.1037/14942-004 Supervision Essentials for a Systems Approach to Supervision by E. L. Holloway Copyright © 2016 by the American Psychological Association. All rights reserved.

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also addresses the relevancy of the SAS model in relation to the dilemmas that emerged in this supervision. In particular, this story illustrates the significance of relational practice, the qualities of trust, mutuality, and shared learning, as a central quality of supervision interventions that work from the SAS model. Despite the deep connection formed with the supervisee, the role of the supervisor does not encompass counseling the trainee; the SAS is intended for professional growth only. In this case study and particularly the session presented for illustration, it was my intention to help supervisees recognize that their personal material was influencing therapeutic effectiveness, not to provide an arena in which I would help them resolve any historical issues they held. An experience in therapy is often necessary for a counselor to engage in healthy therapeutic relationships, but it must occur outside of the supervisory relationship and be conducted by a therapist other than the supervisor. The functions of counseling and supervision cannot occur in the same context without creating an unethical dual relationship with the supervisee. Although I do not insist that counselors in training receive counseling as a part of their training program, I suggest they take the opportunity to enter counseling. However, in instances in which trainees’ personal problems are intervening with their counselor role and jeopardizing the welfare of the client, I direct them to seek counseling and, when necessary, terminate their clinical work until such issues are resolved. Because I am the supervisor in this case example, the perspective presented of the work is solely mine. Although pseudonyms have been used throughout the discussion, I have been given permission to include the details of the supervisee and client that are pertinent to the supervisory process. The supervisee depicted in this actual account of practice was a beginning-level doctoral student who was engaged in a practicum experience. The case begins with a portrait of the supervisee, Irene, the setting in which the supervision took place, and the strategy used to uncover the dynamic interplay between supervisee and client. I have inserted excerpts from the transcript to illustrate the critical supervisory issues and my actions as a supervisor from an SAS perspective. 56

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THE AGENCY OF THE SUPERVISION PRACTICE An often-forgotten dimension of understanding supervision process is the role of the organization or agency in which the supervision takes place and the role and contract of the supervisor and supervisee with respect to the agency. In this first description, I outline the key features of the organization as guided by the SAS model. Irene is a Caucasian female in her early 40s who during the time of our supervision was in the second year of her doctoral studies in counseling psychology. At the time of this supervision, I was director of the training clinic and administered the agency in conjunction with my appointment on the faculty. I also saw a few clients at the center and individually supervised two or three students on clinical practice and a small group of students in supervision of supervision. I agreed to supervise Irene and suggested that we contract for supervision throughout her academic year. Irene’s practicum experience took place in a training center devoted to providing clinical experience for master’s and doctoral degree students in multiple fields of psychology. All clients seen at the center were screened first by advanced-level doctoral students to ensure their appropriateness for beginning-level counselors. No persons who had major psychiatric disturbances were accepted as clients at the center. All counseling sessions at the center were videotaped or audiotaped and could be observed live through television monitors. It is an important practice, particularly in training centers and with beginning-level trainees or in new supervisory relationships, to make available to the supervisor video or audiotape of the trainee’s counseling sessions. There are significant nuances of presence, nonverbal behaviors, voice intonations, and rhythms of silence and talk that can be understood only through video representation of the session. In this case study, these elements that emerge in the videotape are critical to understanding the trainee’s underlying anxieties about her client’s expressed needs in the relationship. Although videotaping is not always possible, audiotaping is a second option that reveals voice characteristics, rhythms of the session, and turn-taking patterns between the counselor and client. Finally, if these representations of the counselor’s work are not possible, then I ask trainees 57

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to keep a reflective journal that includes significant moments in the session, emotional responses to the client, and points of progress on client goals and the trainees’ goals for the session. These reflections are separate from the expected clinical progress notes completed for the client’s record. Irene and I met every week of the term for 1 hour for three terms. The total number of supervision sessions was 27. The fourth session is presented in this example. The specific intervention presented in the work sample is characteristic of my supervisory style and my commitment to the tenets of relational practice.

SIGNIFICANT SUPERVISEE CHARACTERISTICS In this section, I relate those aspects of the supervisee dimension of the SAS model that are instrumental in understanding the unique qualities relevant to Irene’s learning. Irene has a congenital, visual deficit and is legally blind. She is able to read print with magnifying aids and use public transportation or a bicycle for transportation. She reports her only visual liability in counseling is not being sure that she sees fine nonverbal, facial behaviors. In adulthood, she has been completely self-sufficient and held several professional positions before returning to the university for doctoral studies in counseling psychology. Upon entry into the doctoral program, Irene felt unsure of her counseling skills because her professional work and training had been more oriented to instruction with parents and children. She particularly felt out of step with her doctoral peer group because most had extensive counseling experience after receiving master’s degrees. Although academically she was able to cope with the demands of the program, she reported feeling anxious about her clinical knowledge and performance. During her first year, she saw clients in a training clinic and was supervised by two different individuals during the course of the academic year. She felt that she had learned from these supervisory experiences basic interviewing skills and interventions but felt unchallenged intellectually by her supervisors. Although she had completed clinical requirements for the program, she wanted to continue to develop her counseling skills and asked me to supervise her because of 58

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her knowledge of my reputation as a clinician and her experience with me as her instructor in a seminar on the topic of supervision. Irene described her specific goals in supervision as follows: (a) to give more attention to the affective nature of the counseling relationship, (b) to improve her skill in conceptualizing client problems as they relate to theory, and (c) to understand any deficit she may have in not recognizing nonverbal behaviors. So far, I have covered important elements of the SAS supervisee elements—Irene’s prior professional experience and counseling experience, theoretical orientation to counseling, learning needs and style, and interpersonal style. Familial and cultural positioning and values as well as interpersonal style become more apparent and an area of important influence in the supervisory process.

GENERAL DESCRIPTION OF THE CLIENT This client was a White woman in her late 30s who came to the center reporting depression. She was seen by a master’s level counselor in training for several months at the center before being referred to Irene. The reason for referral was based on the previous counselor’s completion of her practicum requirement and her departure from the center. The client’s primary goals for counseling, as established with the previous counselor during the first session, were: (a) improve self-esteem, (b) cope effectively with bouts of depression, and (c) understand her role in personal relationships. In addition, it was clear from the case notes and referral information that the client had difficulty trusting and establishing a working relationship in counseling.

INITIAL ASSESSMENT OF SUPERVISEE LEARNING TASKS At the first supervisory meeting, which lasted 2 hours, our discussion focused on Irene’s self-perceived supervisory expectations, needs, and goals as well as my role as a supervisor and her theoretical orientation to counseling. This discussion is guided by the supervisee factors in the SAS 59

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a b

Figure 3.1 Critical supervisee factors and chosen teaching tasks. The bold areas represent the dominant dimensions and elements within them that are the focus of supervision. aInitial focus in assessing the supervisee was learning goals and style. bAfter three sessions, the importance of the supervisee’s interpersonal style became evident. SAS = systems approach to supervision.

model (see Figure 3.1). From this initial assessment of Irene’s educational needs with respect to counseling, I determined that she was relatively open to working with me despite that she had experienced some disappointing and punitive supervisory experiences in the past. From Irene’s description of her orientation to counseling and her previous supervisory experiences as well as my observations of her, I concluded that she was more comfortable with a structured, instructional approach to counseling and supervision. Her primary orientation was psychoeducational, and she lacked trust in her ability to handle ambiguous situations and recognize her intuitive knowledge of the counseling situation. Her tendency was to intellectualize rather than deal with her own affect in the interpersonal context of counseling or supervision. Her apparent strengths included her intellectual abilities, excellent organizational skills, maturity, and eagerness to learn from supervision. From my observation of a counseling interview that she had conducted, I ascertained that she had effective communication skills and could establish facilitative conditions in the counseling relationship. Her growth as a 60

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counselor would need to be directed to her acquisition of deeper emotional awareness of her role in the counseling relationship and increased confidence in intervening at an interpersonal level in the counseling relationship. More specifically, her emotional and interpersonal awareness included (a) willingness to trust her intuitive abilities in counseling, (b) acquisition of skills to deal effectively with ambiguous interpersonal contexts, (c) acknowledgment of her need to receive special attention, and (d) recognition and understanding of her anxiety in unstructured situations.

CONTRACT FOR SUPERVISION The procedure for evaluation and the criteria for evaluation were determined in the second supervisory session. It was decided that an individualized oral evaluation would be used after the first 10 weeks that would reflect Irene’s specific goals for supervision. We would then jointly decide on a set of evaluation criteria that reflected (a) counseling tasks relevant to her level of skill acquisition, (b) the educational context of which we both were a part, and (c) her theoretical orientation to counseling. To provide specific feedback, I used criteria established by the university program on two scales: (a) her performance relative to other students at her level of training and (b) her performance relative to a professional with 3 years of postdoctorate clinical experience. I rated her on these criteria at the end of the second term and at the termination of our supervisory relationship. In all cases of evaluation, Irene and I discussed the criteria, their meaning, and my judgment of her performance. In addition, at the end of each term, Irene and I discussed our supervision activities, including any strengths or weaknesses in the process we were using to facilitate her learning, goals for the next term, and her judgment of my performance as a supervisor. She was given the opportunity to continue with our supervision or transfer to another supervisor at the end of each term. The effort in explicitly offering this option is to provide some balance in the power inherent in a training supervisory relationship, in which the supervisor remains the evaluator and the gatekeeper to the student ultimately achieving the credential necessary to join the professional ranks. The 61

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explicit contractual agreement around evaluation is an important part of establishing a relationship of trust and is central to the SAS model and Domain E: Assessment/Evaluation/Feedback of the competency Guidelines for Clinical Supervision in Health Service Psychology (American Psychological Association, 2015).

ADDITIONAL AWARENESS OF SUPERVISEE LEARNING TASKS The specific intervention that I use to illustrate the SAS model occurred in the fourth session of supervision. However, the preceding three sessions played an important role in my assessment of Irene’s interpersonal competency and laid the relational groundwork for the strategy that I used in the fourth session to begin work on this competency area (see Figure 3.1). Irene had not been assigned a client at the center until after our first two supervisory sessions. Two critical clinical issues emerged during these first two supervisory sessions. First, we discussed her work with a client at the center the previous year and this client’s efforts to contact her recently. Irene experienced anxiety related to the client wanting to arrange a social meeting with her. She had avoided contacting the client and was wondering if she was obligated to respond to the call. She was angry that the client was behaving “dependently” after they had terminated and at the same time was concerned that she would not be able to say “no” to the client’s request without devastating her. The second primary topic of discussion was Irene’s preparation for her first session with her newly assigned client. There were several complicating factors in the referral. Irene was anxious about her ability to deal appropriately with the client. Her anxiety took the form of wanting to plan in detail her approach to the first session so that she would be prepared for any contingency. Her underlying fear appeared to be the client’s discovery of her inadequacy as a counselor and subsequent rejection of her. By the third supervisory session, Irene had met with her client for the first time. I viewed the videotaped counseling session of Irene and 62

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her newly assigned client before the supervision session. I discussed with Irene her understanding of what had taken place during the session, her thoughts and feelings about these events, and her plans for the next session. Although she communicated a warm and accepting attitude toward the client and effectively helped her to express her concerns around being seen by a new counselor, Irene reported to me that she recognized the client had great dependency needs and that she (Irene) did not want to get “hooked into taking care of her.” In summary, three critical incidents emerged during the first three supervisory sessions: (a) Irene’s reaction to the contact by the terminated client, (b) Irene’s fear of rejection by the newly assigned client, and (c) Irene’s reported need “not to get hooked” by the client’s dependency. These reactions by Irene led me to hypothesize that a theme of dependency and counterdependency might be operating in Irene’s interpersonal relationships. In each situation, she feared a client might be overly dependent on her and also feared rejecting or being rejected by the client.

SUPERVISORY STRATEGY AND LEARNING TASKS I approached this supervisory session with the working hypothesis that Irene may be emotionally distressed by the client’s dependency needs and that she did not grasp conceptually the issue of working with such dependency needs in a therapeutic manner. My goals for this session were to observe the counseling session and determine if Irene’s dependency pattern was manifested in the counseling interaction. If indeed it was, I was assured that the decision to focus on her emotional awareness of the client’s interpersonal effect on her and the quality of the counseling relationship was warranted. It was then my goal to help Irene explore her affective response to the client’s dependency needs and recognize the impact this response may have on the counseling relationship. The supervisory strategies that I chose to use in this interview reflect the manner in which I conceptualize the goals and process of clinical teaching. In this session, I considered the overarching teaching goal to be related 63

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to Irene’s emotional awareness of her attitudes and affect toward the client and her dynamic impact on the counseling relationship. Specifically, it was important to help Irene understand her values, attitudes, and affect relevant to the client’s dependent behavior. This objective is reflected by my hypothesis that Irene may have an interpersonal pattern around the issues of dependency/counterdependency that was dysfunctional in the counselor role. Because the counseling session I viewed provided an excellent opportunity to observe Irene’s reaction to dependency in the counseling relationship, I chose to pursue this topic as the central focus of our super­ vision. By reviewing the videotaped segment of the counseling interaction in which the client threatens hyperventilation, I was able to help Irene focus on her counseling skills and her emotional response to this incident. This allowed me to keep the focus on her role as a counselor but at the same time help her explore the personal meaning of her response to the client. My focus was her emotional awareness in the counseling relationship and how it might relate to her interpersonal style. The supervision session unfolds across five phases with the following emphasis. Phase 1 led the trainee to examine her affective response to the client’s expression of anxiety by hyperventilating. In an effort, to help the trainee understand her affective reaction to the client’s need for dependency, I briefly asked her to explore her historical relationships with family or friends that might include themes of dependency. Phase 2 included a role-playing exercise to assist Irene in discovering how she might handle the client’s need for dependency. Phase 3 occurred subsequent to the role-playing exercise and included challenging Irene about her own fears of being depended upon and how that played out in the supervisory process. Phase 4 illuminates the trainee’s resistance to exploring her own affective response to the client and the countertransference now evident in the counseling relationship. Phase 5 ends the session with an exploration of her understanding of the counseling relationship and the involvement of her interpersonal patterns of behavior and suggestions for gaining greater self-awareness in her professional role. The supervisory strategies that I used to facilitate the trainee’s understanding of the process in counseling and its relevance to her own 64

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interpersonal patterns is best understood by examining the unfolding sequence of the process. The specific interventions that occurred within each phase are discussed with reference to the SAS model and illustrated with excerpts from the transcript.

PHASE 1: SUPERVISEE’S PERSONAL VALUE CONFLICTS WITH CLIENT’S NEEDS In this excerpt, Irene begins by describing her concern about the client’s hyperventilation in the session and her own fears about handling this physical exhibition of the client’s anxiety. Irene: Well, I’ve gone over the beginning of the tape and really looked at the beginning of the tape. My first question was had I moved too fast with her. I don’t think so. I think what I did was consistent, and I feel okay with the way I handled it. Although, I was really anxious during the time because, I think I said, I don’t know whether she hyperventilates, but she could have and I certainly didn’t want her going into an “anxiety attack.” I didn’t know how to deal with that. And I didn’t want her to feel that was something she could do with me. Although Irene went on to discuss the client’s expression of tears and her sense that she as a counselor had not pushed too hard, I saw it as important to explore her comment by probing, “You said just a moment ago—I didn’t quite catch what you said about you were concerned about dealing with the hyperventilation, and you didn’t want her to think she could do that.” Her response was critical in understanding the fear that she had of the hyperventilation as related to the client’s dependency needs. Irene: And I don’t want to encourage anything that would put her in a position where she had to be dependent on me. And that would be sort of like in a quasimedical situation. One, in my own knowledge, I’m not sure exactly what you do. 65

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My next intervention was an effort to explore the potential that it was primarily the client’s need for dependency that was triggering Irene’s anxiety. Thus, I sought to emphasize a strategy of exploration of her emotional awareness in response to the client. Supervisor: I think that there is something also about her dependency on you which we have talked about that before. That is: her modus operandi is to be overly dependent, childlike, in fact. And we see this need appearing in a type of anxiety that has the effect of demanding to be taken care of. Does this trigger a fear for you that she will be dependent on you? Perhaps fear is too strong a word? Is this fear strictly coming from her behavior? Significantly, Irene’s response is “No, I don’t think so,” thus acknowledging the role her emotional material plays in her response to the client’s dependency needs. She goes further to explain a recent episode that resulted in her not being able to ride her bike, which was her only mode of transportation other than the bus or asking for rides from friends. This experience greatly threatened her sense of independence. In the following interchange I begin to explore her experience with dependency in other interpersonal relationships. Irene: I guess that I can’t take care of myself in the way I want to. And to a certain extent in the way that I’m accustomed to doing. Supervisor: It’s sort of been taken away from you temporarily. I imagine it’s been something that you have worked hard to achieve—especially given your visual deficit—independence. So it’s hard to have any of it taken away, even a small amount taken away. Irene: It is a very central, defining, crucial thing for me. I think because I was very overprotected as a kid. So to be who I am, the way I conceptualize it is that I sort of had to carve it out myself. And so that I switch from the word independent because I don’t think I’m independent on other people, but I am very self-sufficient. Supervisor: Right, and that’s what you want for her. So it is very—so you are very vulnerable to any part of her that might need your intervention, 66

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in which you might say, “Gee, you can’t be self-sufficient.” You don’t want to give her that message in anyway. Irene: Mmmmmmm. Supervisor: You don’t want to overprotect her. Irene: I guess maybe that’s the way I emotionally react to it. I think in the logical sense that I’m perfectly happy with the fact that there is going to be some dependence, and that is probably going to be very helpful and useful, and we’re going to be able to use it productively. Supervisor: That is your head talking. Irene: Yeah. Supervisor: Yeah, I know you can conceptualize it. Irene: Yeah, I can conceptualize it a lot (shared laughter)—the stuff I can’t understand. From an SAS perspective, the influence of Irene’s familial and personal values of independence as contrasted by dependence emerge as a critical influence in her understanding and response to the client’s behaviors. These long-held emotional values play an important role in the supervisory process.

PHASE 2: CONFRONTING SUPERVISEE’S ANXIETY The supervisory relationship invites an opportunity for counselors to discover their own interpersonal needs and styles as relevant to their dynamic work with clients. The supervisor can judiciously draw attention to aspects of the immediate supervisory encounter to illuminate a process that may be significant in the counselor’s relationship with the client. Confronting the immediacy of the supervisory process in a relationship of trust and mutuality is critical to success and minimizing the counselor’s resistance to deeper emotional awareness. I have taken the liberty of including a long excerpt to demonstrate the gradual approach to an immediacy intervention— supporting/sharing strategy that challenges the counselor—and then the 67

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slow descent from the intensity of the interaction. In the final stages of this intervention, the trainee begins to integrate her emotional reaction to my intervention to her fear of the client’s dependency and ultimately to her own terror of being dependent in her life. Irene: I’m feeling really, I don’t know why now, so vulnerable, but I tripped and fell this morning . . . and that just really shook me up, and I don’t understand it. But that whole thing is all one little ball. Supervisor: So—so then you are feeling that even today (overlap) the vulnerability, the fragility. Irene: Yeah. Supervisor: I know it’s something you don’t want to laugh about, even though you were laughing about it, but it’s something that also touches you and is disquieting. Here she is and what she seeks and what she wants is (supervisor leaning forward in chair toward trainee): Take care of me. Take care of me. Take care of me. Irene: And my initial, first reaction is uh—the word is claustrophobic. Like you are taking some of my space. Supervisor: Like when I move forward to you. . . . Irene: (overlap) Yeah, yeah. Supervisor: . . . like this (supervisor moves forward in chair closer to trainee; long pause). Irene: There is no breathing space in there for me. Supervisor: When I do this, it feels that I’m invading your space. Irene: Uh-huh, uh-huh. My reaction to you is I don’t want my space to be invaded. Supervisor: Do you think part of that is the fact that I’m pressing you on this dependency issue right now, and you are feeling vulnerable. Irene: No, unh-unh, I think I’m just wanting to avoid feeling the whole thing . . . . 68

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Supervisor: Can you help? Can you have any more understanding about that? What is it about the pressing forward that seems like it’s invading? Irene: Demand of some sort? A demand for something I don’t have to give . . . whatever that is at this point. Supervisor: Sort of a pressing at you saying, “I need it, I want you to give that to me. I need either . . .” and here I’m not sure of how we’re going to separate this or if there is a separation, but there are two things happening. One is what my role-playing as the client required saying I need something from you. And the other thing is me having pressed into your space right in this moment. Irene: Uh-huh. (Long pause.) Supervisor: I need you to help me understand how you feel, to help me conceptualize this problem you are experiencing with the client. Irene: But that doesn’t seem to be a problem. I feel fairly clear about it. I may not be. I may be nicely tucking them into compartments, but it seems fairly clear. Uh, I think about, if I were not being able to come up with something, if I weren’t being able to understand it or see it from different angles to look at, then I would feel pressed. Supervisor: But, so then, it’s the role playing that’s accentuating it, meaning it’s her. . . . Irene: (overlap) Uh-huh. Supervisor: . . . “Take care of me. Take care of me. Take care of me.” This excerpt represents the culmination of an intense supervisory process that uncovers deep emotional experiences and strongly held values of the counselor. Because these emotions and values could potentially interfere with the client’s therapeutic healing and was an important area for Irene’s professional development, I risked challenging Irene by roleplaying the client dynamic in the context of supervision. 69

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PHASE 3: CHALLENGING COUNSELOR’S COUNTERTRANSFERENCE In this next section, I move from the counselor’s emotional experience from the role-playing in supervision back to the counseling relationship and its relevance to the immediacy of the supervisory relationship. The counselor begins to integrate the emotional response to dependency historically with her current responses to the client, thus working toward the breaking of the countertransference that has emerged in the counseling relationship. In these next interchanges, I move away from the supervisory relationship and connect the emotional experience the trainee is experiencing with the client’s expression of need in the counseling relationship. My purpose is to assist Irene in using her new emotional awareness to conceptualize the client’s dynamics. Supervisor: What do you want to say back to her? Irene: What do I really want to say to her? (laughter) Really say to her? Supervisor: Yes, really. No not with your head. I know your head can think out something really nice to say. Irene: Right. My reaction to that is—uh—something like, “I don’t know what it is or I don’t have it to give (unintelligible). You are asking me for something, I don’t think I have.” And it’s not a knowledge thing, it’s a quality thing. Supervisor: Not feeling like you have it to take care of someone? Irene: Yeah, there’s a difference in the . . . (pause) you take care of people at different degrees and different levels, and I can take care of people very nicely on a certain level, but I think that the demand is at a lot deeper level. Supervisor: Okay, let’s try and understand that. What does she want to pull from you or you perceive she wants to pull from you? What is that level like? (Long pause.) 70

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Irene: I don’t have many clues from my own perception of it and experience of it. Other than it was really frightening, sort of a dark, non-thing. There wasn’t any differentiation . . . . Supervisor: (overlap) Uh-huh. Irene: . . . uh, going again from my own head things, thinking about what it reminded me of, was probably my mother’s and my interaction and the feeling that my mother didn’t have anything to give on the sort of feeling levels or beyond the nurturing level. Then again, I see beyond that taking care of someone in a real adequate way, but a little differently. Supervisor: So then you have spent a lot of time in your life giving to people in terms of taking care of them. Taking care of their academic needs. Taking care of children and their emotional needs to some degree. But there’s something almost primitive about what this woman needs from someone to survive. Something that touches a much deeper level than “Yes, I can help you to become self-sufficient. Yes, I can help you to learn so you can move ahead and reach your potential.” There is something else she asks and touches in you . . . . Irene: I don’t even know a name for it. I just know there is something that she is requesting . . . . Supervisor: (overlap) Uh-huh. Irene: . . . demanding. At this moment Irene comes to an impasse in uncovering her feeling that is triggered by the client’s expressed need for help. I continue to support Irene in uncovering the feelings that emerge in the session, especially when the client appears childlike.

PHASE 4: DEALING WITH TRAINEE RESISTANCE In this next excerpt, Irene begins to move away from the symbolic meaning of the hyperventilation to her own fears of the client’s dependency needs. She struggles with her acceptance of her reaction to the client and 71

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is almost unintelligible in her responses to my drawing her back to the moment in the tape where she experienced fear from the client’s sudden hyperventilation. Supervisor: When she starts to hyperventilate, can’t get her breath, it’s almost that brings it forward. At least it did in this session. Irene: Yeah, in quite a progression. I certainly wouldn’t have gone to this, this point, from that point. I would stay at a much more superficial level. Supervisor: In the session? Irene: Yeah, uh, you say that then I start saying, well I’m not sure that connection is that direct. We’ve done it, but it doesn’t click together. I’m not ignoring it. It just doesn’t make an easy transition. It doesn’t—going back to her hyperventilating—to me, I still don’t see it much more . . . uh . . . than a mechanistic type of thing—yeah, that is . . . and not so much clicking in on making a really significant fundamental demand on me. Supervisor: Uh-hum. It’s not the hyperventilation, but somehow as we talked about it and processed it, that side was there when you mentioned it. You decided, “I don’t want to take care of her in that way now because of her dependency.” Irene: Interesting. This could be just totally opposite, but that’s okay. Uh (pause) . . . if that fundamental thing, that I don’t know what it is, that seems like that might be okay to give, but that may not develop dependency, in that sense, I don’t know. I have a hunch that it is (pause) . . . it is something that doesn’t necessarily (pause) that is given someone without strings, without . . . uh . . . without that type of . . . (unintelligible) I don’t know if this makes sense, but my hunch is that it may not actually itself developed her dependency, give a better sense of it. I wish I could. Supervisor: I think you might be onto something. Let me tell you what I understand from what you say. It is that, “I felt that . . . I said that to you, and I felt that as we talked about it, that maybe what I haven’t discovered is the fact that I can give that to someone, and it won’t take away their selfsufficiency. It won’t mean that I’m being overprotective of them. It won’t 72

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mean that I’m taking away my respect of them as a person who can take care of themselves.” After this interchange Irene begins to recover from her confusion and delves more deeply into her reaction to the client and how to formulate counseling responses that will not reinforce the client’s helplessness yet provide support. When I challenge her on how she might be with the client when the “childlike voice emerges,” she becomes confused about where she is in her process. In this next brief passage, she struggles and catches herself as she thinks through what she can offer the client. Importantly, we are now translating her awareness of the counseling relationship dynamic to counseling skills that can alter the pattern to a therapeutic level. Irene: We connect a little differently. There’s more distance, physical than psychological. Uh . . . I’m not as willing to (pause). Certainly what I did on that tape, was I was not willing to (pause) remark upon that childishness. But I know it’s there. I’m (pause) I’m processing more (pause) intellectually, I think, than affectively. In that moment of recognizing her need to move away from her sense of vulnerability in not being able to respond to the client’s needs when expressed in a childlike manner, I ask her to examine more deeply what causes her to push away from that experience with the client. She responds with insight, “It’s a value judgment that is getting in there (long pause). It’s wrong to be a little kid when you are grown up.” As this phase comes to a close, Irene is able to transform her new insight of the source of her reaction to the client’s dependency; it is a deeply held familial and personal value that initiated in her own struggle to be independent as a person with a visual deficit. Without working through these feelings, she will continue to project them on the client and push her away. In the next segment, we see the use of the teaching function on my part and her response. Supervisor: It is worthwhile for us to go back having looked at this part of the tape and ask, “Well what message are you giving her?” Because 73

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usually the strong emotional message does come through in one way or another . . . . Irene: Uh-huh. Supervisor: Start to think about ways that you want to communicate with her, messages that you want to give her and what that’s going to involve for her. You know what I . . . . Irene: Yeah. Supervisor: . . . Do you understand what I mean? Irene: I think what you are saying is that what’s going to get across to her, regardless of how I relate to her is, is that emotional relatedness: whatever it is that I’m projecting. And that, almost after the fact, then we look at what that possibly is. It doesn’t mean that I’m going to be able to obviously relate selectively initially. I don’t think I’m going to be able to detour some of the stuff that I do without some real thought and some practice. Supervisor: I don’t think it’s something that you’re going to be able to use a cover-up on. A “cover-up,” for me, in counseling is . . . I think (laughter) that word demands some explanation. Who knows what I mean by cover-up? But a cover-up in my mind is that there is a very strong emotional response, and the counselor is a little shamefaced about the emotional response they are having. And as a consequence, it’s not looked at, although they have an awareness of it, and they try to cover it up with the head. Intellectual rationalizations, conceptualization with elaborate strategies, and with strong rationale to avoid the emotion. Are you okay with this? Or how are you feeling about it? Irene: I have a certain amount of vulnerability around it, but uh . . . I thought that entertaining the possibility that I could attempt to try to hear her with that stuff in a different way, then I get to be more present rather than distanced. And to see what that does to me. Supervisor: So that you will become more aware of what that emotional response is. So what you are saying to me at this point is that it is kind of murky down there, but that a level of respect that it is different. 74

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Irene: Well, what I’m still amazed at is the fact that it wasn’t until you roleplayed that it came through so strongly and that it is directed to an area that I really don’t know about; it seems that I have no knowledge of this dark area. And I’m scared, shockingly so.

PHASE 5: PLANNING FOR SUPERVISEE’S PERSONAL GROWTH: TEACH OR TREAT? In the final phase of the supervision, I invite Irene to share more of the videotape and focus on those areas where she has made effective interventions with good results from the client. The client seems to be improving in her ability to discuss difficult situations without asking to be rescued, and Irene shows good empathic presence during the client’s tearfulness. The taped segment initiates a more focused discussion of the counseling strategies that she might use when the client breaks down emotionally and ends up confused. Significantly, as we view taped segments that are related to the dependency theme of the client, Irene is able to identify her reaction and how it seems to affect the counseling process. Irene: Yeah, this is making what’s already going on pretty clear. . . . Supervisor: Mmmmm. Irene: The flip side is that she’s a catalyst because she just is, and that’s fine, but I don’t want to impose anything on her. Supervisor: We’ll be careful with that. I understand what you are saying, and that’s why we’re doing this with work: to gain some understanding and be clear about what is happening and what she needs and what you can give to her therapeutically. For you to know “what I can and can’t give, and if I can give it, can I give it therapeutically.” Irene: Now . . . uh . . . if I find—and I’m not prejudging the case—but if I find . . . uh . . . that there isn’t a lot of that child stuff that I can handle comfortably. The option isn’t only for me to look at that stuff for myself, 75

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but there are also some things that I can handle myself and still be able to be with her. What do you think? In these closing remarks by Irene, she is recognizing the importance of doing her own work and concerned that she may not be able to manage to resolve her own feelings. She questions whether she can be with the client effectively. She finally asks for reassurance that she can cope with the situation effectively and learn to give therapeutically to the client. This is an important learning task, for it allows the counselor to see the importance of her or his own emotional material in the work and the necessity of seeking counseling so she or he can separate between self and other. In this instance, I suggested to Irene that she work toward greater awareness in a counseling relationship, purposefully being clear on our boundary and contract to engage in her historical precedence to these feelings only in relation to the client, and that the deeper work required must happen in a counseling relationship.

SUMMARY The rhythm of the session might be depicted as an initial gathering of information on the supervisee’s response to the client’s expressed need for dependency. This path of exploration leads to an intervention that urges Irene to examine the personal meaning of her behavior in the counselor role. Supervision uncovers the historical background of Irene’s fear of dependency and uses this awareness to help Irene understand the countertransference of her interpersonal pattern into the counseling relationship. Although initially Irene is resistant to accepting the role of dependency/ counterdependency in her relationship with the client, she finally recognizes the importance of this in her personal and professional life. The session culminates with Irene and me working collaboratively to develop counseling strategies that will assist her in working therapeutically with the client. Irene begins to make observations and connections to other aspects of her work in the counselor role and with this client. The session ends with my suggestion that the trainee continue to explore her affective response to the client’s dependency and its impact on the therapeutic encounter. 76

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Figure 3.2 Systems approach to supervision analysis of the supervision case. The bold areas represent the dominant dimensions and elements within them that are the focus of supervision.

Throughout the transcript and my commentary, a number of dimensions in the SAS model have become relevant. In Figure 3.2, boldface type highlights the most prominent dimensions and factors of influence in my decision making as a supervisor. Although the figure does not reflect the sequencing of the foci as the session unfolded, it does suggest the complexity of influence that emerges in just one supervision session.

CASE CONCEPTUALIZATION OF SUPERVISION The purpose of the exploration was to help Irene focus on her affective self (one of her initial goals for supervision) and determine if her reaction to this client reflected a deep-seated interpersonal pattern of 77

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behavior or was situation specific to her lack of experience with a client’s anxiety response. It is a challenging task to develop a relationship that encourages openness and trust, does not abdicate the responsibility of professional evaluation, and ultimately empowers the trainee in his or her role as an autonomously functioning professional. In my work with Irene, my interventions were intended to give her the opportunity to pursue the topic of the dependency/counterdependency theme in the counseling relationship. Irene’s need for self-sufficiency and her vulnerability to dependency on others because of her visual challenge were important factors in my approach to this exploration. I wanted to offer her enough space to come up with her own strategies for dealing with the interpersonal problem that was identified in the counseling relationship material. I confronted her early with the possibility that the material might have been more than just her reported inexperience in dealing with hyperventilation. Subsequently, I worked with her resistance to exploring her fear of interpersonal dependence and her personal desire to be highly independent. She revealed that she devalued the client’s need for dependence and had negative images connected with these needs. This appeared to me to be a result of her own projected fears of being dependent, given her history with visual challenges, and her counterdependent response in interpersonal relationships. I did not instruct her to behave in a particular way in the counseling relationship; nor did I direct her to resolve this issue in counseling. My assumption was that she would resist such direct instruction given her counterdependent needs. Rather, I intended to invite her to gain self-awareness of her emotional response and to facilitate her understanding of this response and its meaning in the counseling relationship, the supervisory relationship, and her outside world. At the end of the session, I provided a loosely structured assignment for her to get in touch with these emotional and attitudinal issues. However, I indicated that I was aware that she probably had her own means of taking care of herself in this way. Note her reaction that, indeed, she did have self-derived means to gain awareness. I trusted that if I gave her the responsibility to work on this critical issue and if I had successfully used the supervisory relationship for her discovery of the critical nature of 78

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the dependency/counterdependency, she would pursue it. This trust was based on my recognition of her great sense of responsibility in becoming a counselor, her general need to challenge herself, and the positive learning alliance we had developed. If I were to dictate her handling of the issue, I predicted that she would resist by minimizing its importance in her interpersonal relationships. Another intention in the choice of this strategy was my desire to introduce some ambiguity into her plan for resolution. I did not want her to prematurely resolve the issue, and I knew, given her learning style, that under stress she would gravitate to problem solving and a more structured approach. I suggested that she use meditation to gain awareness of her feelings rather than just what she thought about the issue. This focus is consistent with my confrontation of her responding “from her head.” Another strategy I used to emphasize the emotional response and the immediacy was role-playing the client’s neediness. This brought on an intense response from her of feeling invaded. An additional element to be considered in supervision is the dynamics of the supervisory relationship and how they may reflect the dynamic issues in the counseling relationship. In this instance, I felt it important for me not to overplay her dependency or counterdependency needs in supervision. I did not confront the underlying dependence I felt she was developing with me as a powerful influence in her life. However, this was confronted later in the relationship as an important dynamic as she dealt with the need to establish reciprocity in our relationship and at the same time understand her feelings of possessiveness toward me with regard to other students. Irene continued to work on the issue of the client’s dependence in the counseling relationship throughout the term. This led to her understanding of the role of involvement in the counseling relationship and her willingness to give back to clients emotionally. Irene did seek counseling shortly after this session, confirming the hypothesis that her patterns of dependency and counterdependency were not situationally specific but evident in other intense, significant relationships. She discussed her intent to seek counseling and her desire to change these interpersonal patterns. Her counseling work with the client continued to progress, and 79

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she was able to allow the client to work through issues of dependency with her. She became more self-confident regarding her ability to deal with ambiguous situations, trust her intuitive responses, and recognize her potentiality as a counselor. My evaluation of her work at the termination of our relationship reflected her significant growth in the counselor role, emotional awareness, and self-confidence. The supervisory relationship remained positive and facilitative. It was necessary to work through Irene’s dependence on me as her only source of positive evaluation of her counseling skills. At the time of termination, we were able to mutually agree upon her being transferred to a different supervisor who could help her to continue her growth. I felt that she needed the experience of working with a different individual and still feel valued. She was ready for this change and let go of our relationship in a positive and appropriate fashion without displaying dependency or counterdependency issues. This supervision case is a dramatic example of how deeply held emotional experiences and personal values can affect the character and structure of the supervisee’s personal, counseling, and supervisory relationships, with the dynamic being repeated until the pattern is broken and changed to a more functional and adaptive interpersonal process.

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4

Applying the SAS Model to Teaching Supervision

I

have described the seven components of the systems approach to supervision (SAS) model used in analyzing the supervision process. These include the factors of supervision (task and function); the relationship of supervision, including the supervisor and supervisee; and the contextual factors (organization and client). Although, for purposes of explication, these factors have been talked about in isolation, as has been illustrated in the case example, they are interrelated, often occurring together in the same supervisory session. In this chapter, I discuss the SAS approach to teaching supervision with exercises that help supervisors to learn the elements of the model, their own relevance to the ongoing process of supervision, and their relationship with their supervisees. Throughout my career in counseling psychology teaching programs, I have taught seminars in supervision theory and supervised supervision practicums. The latter entailed doctoral students supervising masters-level

http://dx.doi.org/10.1037/14942-005 Supervision Essentials for a Systems Approach to Supervision by E. L. Holloway Copyright © 2016 by the American Psychological Association. All rights reserved.

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counseling practice. These experiences led me to recognize the inter­ relationship among the three ongoing teaching and therapeutic relation­ ships of counseling, supervision, and supervision of supervision. The SAS model became a vehicle to teach supervision and guide supervisors to expand their understanding of supervision as embedded in a larger sys­ tem and context. In this chapter, I discuss the SAS approach to teaching supervision with exercises that help supervisors to learn the elements of the model, their own relevance to the ongoing process of supervision, their relationships with their supervisees, and the counselors’ relation­ ships with their clients.

SUPERVISOR COMPETENCIES The training of the supervisor invokes the development of competencies, and for this I turn to the Guidelines for Clinical Supervision in Health Service Psychology as promulgated by the American Psychological Association (APA, 2014; http://www.apa.org/about/policy/guidelines-supervision. pdf). In 2015, the APA as a part of the broader movement to determine competency guidelines for professional practice in psychology, published competency criteria for supervisors of professional practice in psychology. The supervisor criteria were described across seven major categories. Each of these competency areas is embraced by the SAS model and is relevant to the training exercises and case analysis of the supervision of super­visors presented in this chapter. Each of these competency areas is presented in Table 4.1 with the corresponding area of training in the SAS model. Although there is not a one-to-one correspondence, it is evident that the model strives to guide supervisors in gaining knowledge and training across a broad domain of practice skills.

TEACHING SUPERVISORS Any discussion of training in supervision includes the multitude of relation­ships that are directly or indirectly part of supervision. Group super­vision of supervisors in training is a common teaching modality. In 82

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Table 4.1 Supervisor Competencies and the SAS Model Domains of competence

SAS model dimension

SAS model elements

Domain A: supervisor competence

Supervisor dimension

Professional experience; positionality in field of practice

Domain B: diversity

Supervisor dimension

Cultural values and worldview; interpersonal style

Domain C: supervisory relationship

Supervisory relationship

Contract; phase of relationship; structure of power

Domain D: professionalism

Supervisor functions

Modeling; instructing

Domain E: assessment/ evaluation/feedback

Supervisor functions

Monitoring and evaluating

Domain F: professional competence problems

Supervisor function

Monitoring and evaluating

Supervisee task

Counseling skills, case conceptualization, emotional awareness, self-evaluation

Domain G: ethics, legal and regulatory considerations

Supervisory tasks

Professional role and ethics

Institutional/organization dimensions

Policies, standards, guidelines, legal considerations

Note. SAS = systems approach to supervision.

group consultation of supervision practice, there is not only the relationship between each supervisor and the trainer but also the relationships among the various supervisor members. In addition, each supervisor may have several trainees, and in turn, each supervisee may have several clients. Not all of these relationships will be discussed explicitly in the group; nor will the supervisor trainer know all of these relationships in detail. However, when supervisor members raise issues in the group, their perspectives will be shaped by their observations and experiences of these various relationships and contexts. Any discussion of the teaching of supervision must involve a discussion of the practice of supervision and the practice of counseling. All three processes—teaching supervision, supervision practice, and counseling practice—are necessarily linked by their concurrence and the supervisors’ and supervisees’ roles in the group consultation and the counseling 83

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relationship, respectively. Because the distinctions among these three contexts of teaching and practicing are easily confused, for the sake of clarity I have named them as follows: 1. The counseling relationship refers to each or all of the counselor trainee’s counselor–client dyads. 2. The supervisory relationship refers to each or all of the supervisor’s supervisor–trainee dyads. 3. The consultative group refers to the group of supervisors who meet with a trainer to discuss and learn about their practice of supervision. By understanding the linkage among these three relational contexts, the tasks and processes of teaching supervision in a group setting may be further illuminated. The group consultation may deal with any of the roles or issues that emerge in these three interrelated contexts. Central to the purpose of the supervision consultation group are questions that relate to the supervisory performance of each member of the group. The super­visors face three central tasks: What should I teach? How should I create a relationship that facilitates the supervisee learning the teaching objectives? Is the welfare of the client in jeopardy? The SAS model is designed to draw the supervisor’s attention to factors that may be influencing significant factors in the counseling or supervisory process that do not enhance the supervisee’s learning. In SAS workshops, the focus begins with supervisors identifying an area of concern, difficulty, or impasse in the relationship. The supervisor’s experience of a shift in the emotional connection in the relationship, the super­visee’s openness to feedback, or the mutuality of the relationship often is an initial sign that there may be some obstacle in learning or relational connection. A deterioration of the quality of the relationship, shifts, and changes that degrade the connection between supervisor and supervisee may transfer inadvertently to the counseling relationship, impeding the client’s progress and treatment. Reference to the model may assist the supervisor in identifying the source or sources of the current dilemma, how these factors interrelate, and how the factors influence the three relational contexts. In the teaching of

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supervision, I encourage supervisors to consider the following questions while reflecting on their work. 1. What factors are influencing the participants’ judgments in guiding the supervision process? 2. What characteristics of the contextual factors have they relied on in their decision making? 3. What characteristics have they not considered but which, upon reflection, seem important in designing a teaching approach in supervision? 4. What kinds of roles do they tend to manifest in supervision, and are these the most beneficial for learning to take place? 5. What tasks of supervision do they focus on with particular trainees? Although each of the contextual factors of SAS will have an influence in the decision making and course that the supervision takes, essentially the consideration of those contextual factors will be filtered and processed by the individuals involved. The defining element of the quality and character of a supervisory relationship is the individuals who come together to engage in the teaching and learning experience. For this reason, I begin the discussion of strategies with a fuller discussion of the supervisor and supervisee, focusing on what they bring to the relationship in the professional context of supervision. The ideal supervisor has been described as a person who exhibits high levels of empathy, understanding, unconditional positive regard, flexibility, concern, attention, investment, curiosity, and openness (Carifio & Hess, 1987). Although such personal qualities are valuable in any relationship, these descriptors focus almost entirely on the intrapersonal and interpersonal characteristics of an individual. All individuals bring to supervision their own interpersonal characteristics, knowledge, abilities, and cultural values. Even so, supervisors express these characteristics uniquely as the foundation on which the supervisory role is built. Supervisors can enhance their own interpersonal style by the manner in which they use their repertoire of interpersonal skills and clinical knowledge to be deliberate, systematic, and relevant in their professional role.

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In Chapter 1, I presented the findings of research that investigated the salience of particular supervisor characteristics and skills. Now I take a more pragmatic approach to enhancing the five elements relevant to the supervisor’s performance: professional experience in counseling and supervision; professional role or roles in the work environment; theoretical orientation to counseling; cultural values, including worldview and familial and personal values; and interpersonal style, including selfpresentation, emotional intelligence, and interpersonal competence (see Figure 4.1). In working with beginning-level supervisors, it is valuable to have them reflect on the attributes and skills that they bring to the relationship. As supervisors become more advanced, this list of attributes and competencies is a good checklist to consider when there may be an impasse in the supervisory relationship. For example, perhaps the supervisor’s interpersonal style is directive and the supervisee, given cultural and familial history, experiences this behavior as overwhelming and demanding. Awareness and recognition of how our attitudes and attributes influence the learning alliance of supervision are critical in reading and flexing to the teaching moment. In teaching supervision, I use this exercise as a beginning to achieving supervisory self-awareness and recognition of the factors that play an important role in a supervisor’s competency.

Figure 4.1 Supervisor factors of influence. SAS = systems approach to supervision.

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Exercise for Supervisor Self-Awareness Ask supervisors to pair up and engage in a dialogue of reflection on their history and thinking about being a supervisor and being supervised. Have one person take the role of the interviewer and the other person of the interviewee. Have the interviewer guide the supervisor in talking about each of the five elements in the supervisor dimension of the model as applied to being a supervisor (Figure 4.1). At the completion of the dialogue, each participant should write a brief memo (a single page at most). The supervisor might reflect on what he or she learned about himself or herself as a supervisor. The interviewer might reflect on what new things he or she learned about the interviewee, or supervision, or the experience of being the interviewer. Dyads can then switch roles and repeat the exercise. About 30 minutes per interview and memo writing (total 60 minutes) should be allotted for this exercise.

THE SUPERVISEE The supervisor in a new relationship takes the opportunity of the first session to engage in a dialogue of information gathering that might be considered the supervision intake. In this session the supervisor is seeking to understand the details of the supervisee’s professional and learning experiences and needs as well as her personal presence and interpersonal style. The SAS model names five factors that are particularly relevant to understanding the supervisee in his or her professional work and facilitating a learning environment. These five factors are similar to the supervisor factors but emphasize the importance of the supervisee learning style and experience in counseling as well as supervision. They include (a) counseling experience, including the setting, context, and type of supervision received; (b) theoretical orientation to counseling as understood by the trainee at the trainee’s level of experience; (c) learning goals and style to best facilitate providing both support and challenge; (d) cultural values, including worldview and familial and personal values; and (e) interpersonal style, including self-presentation, emotional intelligence, and interpersonal competence (see Figure 4.2). Supervisors can practice gathering information on these 87

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Figure 4.2 Supervisee factors of influence in systems approach to supervision (SAS) model. 

topics while engaging with the supervisee in a manner that begins the establishment of a facilitative supervisory relationship. The second area that is critical to the first meeting (and granted an hour and a half might be required to cover all of the material being outlined) is the nature of the contract for supervision. The expectations for logistics of timing, meeting place, attendance, punctuality, and frequency are determined not only by the supervisor and supervisee but also by licensing and accreditation guidelines and the counsel. Exercise to Focus on Supervisee Ask supervisors to pair up and for one to be in the role of supervisee while the other is the supervisor. You might also want to add an observer role to provide feedback on the interactional process. Have the supervisor engage the supervisee in a discussion of each of the five factors on the SAS supervisee dimension (see Figure 4.2). This exercise is practice for collecting information about the supervisee’s experience and characteristics and using it to plan training interventions. Supervisors might think of using these topics for discussion in their first or second supervisory interview with a new supervisee. This interaction generally takes about 30 minutes with an additional 15 minutes for feedback and discussion of the critical aspects of the interaction and the supervisee’s training needs. 88

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THE CLIENT An important and frequently researched area has been the variety of client attributes in relation to the process and outcome of psychotherapy. Characteristics and variables that have been studied include social class, personality traits, age, gender, intelligence, race, and ethnicity. Some of these characteristics have some real, practical value in determining the appropriateness of short-term versus long-term therapy and premature termination (Garfield, 1994). The relevance of these general client characteristics, rather than specific diagnostic attributes, has not been studied within the context of supervision and/or training. However, in practice, the supervisor frequently considers the client age, ethnicity, gender, and race in determining the appropriateness of the match between counselor and client as well as in problem solving various difficulties that may emerge in the counseling relationship (see Figure 4.3). The literature on matching client gender and/or ethnic minority status with therapists suggests that although there appears to be a preference for ethnically similar counselors, this is not consistently evident in the empirical literature (Coleman, Wampold, & Casali,

Figure 4.3 Client factors of influence. SAS = systems approach to supervision.

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1995). It behooves the supervisor to recognize that variables such as social desirability, attitudes, and values may play an important role in the potential effectiveness of the counselor. Ineffectiveness may be attributed to the lack of similarity between client and therapist rather than in other characteristics of the client and/or counselor that may be inhibiting progress. The counseling relationship is an important basis from which to understand the impact of different treatment strategies as well as the effectiveness of the supervisee in creating a therapeutic relationship (Holloway & Neufeldt, 1995). The reenactment of the relationship dynamics in the supervisory situation is a familiar phenomenon to supervisors and has been named the parallel process (Ekstein & Wallerstein, 1958; Gross Doehrman, 1976). Parallel process occurs when the supervisee in the super­ vision relation­ship unconsciously acts out the central dynamic process of the counseling relation­ship. The supervisee may be experiencing difficulty with the client and feeling powerless to change the situation therapeutically, so he or she takes on interpersonal strategies similar to the client’s form of resistance. If the supervisor does not recognize the dynamic as a part of the counseling situation and the trainee’s feelings of powerlessness, the super­ visor may collude with this reenactment by adopting a role similar to that of the trainee in the counseling relationship. The obvious result is an impasse in supervision. A supervisor who recognizes the parallel process can intervene directly with the supervisee, thus breaking the impasse in supervision while modeling effective interpersonal strategies for the supervisee. Thus, with effective supervisory intervention, the supervisee begins to understand, both experientially and conceptually, the meaning of the client’s behavior and is able to resume a therapeutic approach to the problem.

Exercise for Identifying Parallel Process This exercise is designed to uncover parallel processes in supervision. Parallel process, as described earlier in this book, occurs when the supervisee unconsciously acts out the impasse occurring in the counseling relationship in the supervisory relationship. If supervisors do not recognize and intervene in this dynamic, they may inadvertently replicate a parallel 90

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process in supervision, thus creating a supervisory impasse. The trainer can show a brief videotape of a counseling interaction. The trainer (or informed confederate) takes the role of the supervisee, and a member of the group becomes the supervisor. The supervision interaction is done in front of the group, and the supervisee creates a dilemma that encourages the development of a parallel process in supervision. The demonstration should take about 25 to 30 minutes, after which the group is able to use the SAS model to uncover the parallel process structure. (For an example of a parallel process training situation and the SAS analysis, see Holloway, 1995, and Chapter 2 in this book.)

THE SETTING OF PRACTICE Although Ekstein and Wallerstein (1958) referred to the rhombus of supervision in which the context or agency was involved, current models of supervision often overlook the specific characteristics of the organization or institution in which the supervisee is engaged in practice. The professional standards, human resource policies, and cultural norms, among other attributes, have an impact on the delivery of client services and the type of training and supervision provided. The SAS model identifies five factors that need to be considered by the supervisor when determining the feasibility and appropriateness of certain clinical actions being recommended to the supervisee. These are named in Figure 4.4 as mission and values, organizational structure, performance management system, culture and climate, and professional standards and ethics. In some situations, the supervisor may be external to the organization in which the trainee is engaged in practice. In these situations, the supervisor is responsible for creating a clear contractual agreement with the organization regarding such matters as confidentiality of supervisee and client information, expectations for client load, and provision of supervision. Supervisors are expected to gather information regarding each of the areas in the organizational area in the SAS model. Each of these factors will influence decision making around focus of supervision, expectations for delivery of service, type of client to be assigned, and interstaff relations. 91

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Figure 4.4 Organizational factors of influence. SAS = systems approach to supervision.

Supervisors’ understanding of the functioning and norms of the service agency will help to align the supervisory practice with contractual formal agreements with the service agency, the supervisee, and the supervisor’s obligation to the profession. This exercise is designed to help the super­ visor gain awareness of the multihanded contracts in which the supervision is embedded and how the prevention of triangulation across these con­ tracts is essential to supervisee engagement with the agency and its clients. Exercise for Organization and Contractual Agreements Ask supervisors to form groups of three or four individuals. One volunteer is needed to be interviewed by the group. Volunteer supervisors should be prepared to discuss various aspects of the organizational setting in which they work and have a specific problem situation that is a result of the organization’s structure in relation to supervision. The factors they might consider are on the organizational dimension of Figure 4.4. Members of the group ask questions about the organizational setting to uncover the characteristics that might underlie the dilemma the supervisor faces. This exercise usually takes about 30 minutes and is something like a detective 92

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game as members of the group try to figure out the nature of the problem in the organization in relation to supervision.

TEACHING PROCESS Supervisors may use a number of different strategies to teach, and in the SAS model these strategies are organized around the functions of supervisory roles. The research relevant to these supervisory roles has been discussed earlier in this book. The translation of these functional roles into a process of interaction that effectively creates a learning environment and promotes the supervisory relationship is addressed here. Although there is no precise match in the use of a role with a particular learning task, there are often certain functions and tasks that tend to occur more frequently. For example, advising and modeling functions might be particularly suited for professional role tasks, whereas supporting and sharing may occur more naturally with emotional awareness. Nonetheless, each function might be paired effectively with a particular task dependent on the supervisee’s learning style and needs and the qualities of the supervisory relationship. Note how the choice of how to engage the supervisee using particular functions is influenced not just by learning task but also by the relationship, the characteristics of the supervisee, and the client needs. It is in the process of the interaction of supervision that all factors of the SAS model are instrumental in influence. The goal for the supervisor is to increase the repertoire of strategies that might be invoked within these functions so that they can call on these skills as needed in a particular situation with a supervisee. Each super­visor will have a foundation of interpersonal awareness and competence that will need to be honed and developed to move beyond what is a natural pre­ dilection to the capability to read what is needed in the teaching moment and flex his or her skills to effectively intervene. A first step in the process is to understand the character of each supervisor’s natural style or process of engagement in supervision. In the exercise on process style, you will notice that supervisors will have the opportunity to recognize the typical roles they rely on in engaging the supervisee. The next step in helping super­visors to expand their capability is to encourage their use of other 93

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functions while considering the important influence of trainee learning needs and client welfare. Exercise for Analyzing Process Style In a teaching setting, supervisors in training can actively use the process wheel (see Figure 1.3) to plot their development of skills. Have super­ visors listen to an audiotape or videotape of their supervision interaction. Have them use the matrix to identify functions or tasks or use particular combinations. The completed matrix of 15 to 20 minutes of interaction with a particular supervisor’s style of supervision will give a picture of the supervisee and the process. Specific knowledge about supervisory actions can encourage the supervisor to question or reflect on past behavior. Are the choices of task and function primarily a reflection of the supervisor’s comfort with a particular style of presentation? Are there choices that are more frequently made with a particular supervisee? Or at a particular phase of the supervisory relation­ ship? Do the choices of task and function facilitate the empowerment of the supervisee? Questions can be generated from the simple identification of task and function and can encourage further exploration of factors influencing the supervisor’s actions. Have supervisors consider the factors that have influenced their choice of learning objective and approach to working with the supervisee. Although sometimes these factors are apparent, just as often they may exist only at a latent, rather than manifest, level of the interaction. The contextual factors of supervision are defined and uncovered in supervision interviews and, in some cases, in participants’ comments on their super­ visory behaviors. This exercise will draw awareness to the constant influence of other contextual and supervisee factors in the supervisory process.

SUPERVISION CONSULTATION CASE Through my years of teaching supervision, I have collected stories of supervisors’ struggles to become more effective in teaching the practice of counseling. In this case example, I present a theme that often emerges 94

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with counselors and supervisors in training. Beginning counselors often attempt to bond with the client by using familiar relational strategies that have been successful in forming friendships. Supervisors in training may engage the trainee in an exploration of emotional awareness and insight that broaches the boundary between supervision and therapy. The consultation example is in the context of cosupervision of the two beginning-level supervisors. The presentation of this case includes the supervisors’ impasse with the counselors and critical factors that play a role in the final teaching strategy to break the impasse. Both are experiencing a similar dilemma in their work. The process wheel of SAS is graphically used to show the original task and function and the final teaching strategy (see Figure 4.5). The purpose of the process wheel is to emphasize

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Figure 4.5 Supervisors’ supervision process. Supporting with the learning task of emotional awareness was the strategy that ultimately led to impasse. The strategies needed were modeling professional role to break the parallel process and instructing and advising to teach the skills needed to form a therapeutic alliance.

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the evolutionary change in focus throughout the process of the consultation and demonstrate the way in which the SAS model may be used graphically in supervision consultation. Supervisors’ Impasse Both supervisors arrived frustrated and irritated with their counselor trainees. From their perspectives, the trainees were not engaging in supervision. They were unwilling to talk about their own feelings and thoughts about the counseling relationship and about the supervisory relationship. What was the cause of their supervisees’ resistance? The supervisors were deeply concerned about the supervisees’ futures as counselors because they were unable to engage in the supervisory process. The supervisors were advanced in their clinical skills and experience and were dedicated professionals. They were supervising beginning-level practicum students because of their commitment to training professionals and because of their enjoyment of the supervision process. But today they were definitely unhappy with the supervisory process! The Trainees The supervisors and trainees worked for a small, nonprofit community agency that offered services to low-income individuals. All counseling sessions of trainees were audiotaped for supervision purposes. The trainees were both mature individuals who had entered the counseling profession from other fields. They were eager to learn how to do counseling and were involved in their placement setting. One supervisee was a European American man who had been a teacher for 5 years. The other supervisee was a bicultural, European American and Native American woman who had worked extensively in community action organizations before returning to the university for counselor training. The Supervisors’ Stories The supervisors each had a story of the impasse they were facing in supervision. The impasse is depicted in the SAS process wheel as supervisor 96

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function—supporting/sharing, and learning task—emotional awareness being targeted in the SAS process wheel (see Figure 4.5). Supervisor: Rebecca’s report. My supervisee is having difficulty establishing boundaries with her client, and it seems at times that the two of them are friends chatting on the street. I have explored with the supervisee the difference between friendships and therapy and felt that, although she had an intellectual understanding of this, she wasn’t able to translate this into the practice of her role. The chatting, although somewhat diminished in recent sessions, seems unpredictable, and I don’t think she can recognize the boundaries between the two roles. So that is when I decided to begin a process of emotional exploration with her. I’ve worked really hard at bringing her into her own awareness and felt satisfied with her willingness to selfdisclose about her personal feelings in reference to this client. In fact, I followed this up with two more supervisory sessions in which we probed the meaning of friendships in her culture and the need to feel accepted as a person and professional. I really enjoyed the complexity and connection between the professional boundaries and their connection with the cultural background of the counselor. I began to teach her about the importance of separation and the implications of dual relationships and ethics. She really became very tearful and then shut down. I didn’t really understand what had happened, and then in the last session before today she came in very angry with me for intruding into her personal world and for my lack of sensitivity to cultural background. She insisted that I stick to supervision and teach her the skills of the profession, not try to be her therapist. I was so shocked at the intensity of her reaction and even more shocked that she felt I was mixing up the boundaries. Supervisor: Georgine’s report. I really know what you are going through. My supervisee seems completely incapable of exploring his own emotional response to his client. He’s really trying to befriend his client and is actually giving her feedback on how he sees her as a woman. I think that he is trying to assure her that she is a nice person, someone that he would find attractive. I am so exasperated with 97

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him. He is unable or unwilling to get at what made it so necessary to reach across his professional boundaries like this. I have confronted him several times on this inappropriate behavior with the client. Last time I observed his counseling session with this client, I was totally undone. He seemed to be deliberately seductive with her. In the last supervision session, he told me in no uncertain terms to lay off him about exploring his feelings about the client and that what he really needed was to learn the skills of being a counselor. If he wanted therapy, he’d pay a counselor for it.

The Supervision Consultation Both supervisors sat across from me for their joint consultation hour. Rebecca is a thoughtful, still person. Her quiet intelligence probably is the first impression one would have of her. There is a persistence and tenacity in the way she takes hold of an idea and runs underground with it. She has a keen set of antennae that pick up the nuances of behaviors and their meaning. She looked pretty discouraged today, and in telling her story of supervision, there was the glimmer of anger and resentment. She started her tale at a higher pitch than usual, and I was immediately alerted to the type of intensity she conveyed. Georgine has a great way of being quietly present, delivering searing confrontations with hardly a ripple in her composure and yet with a support and warmth that leave a lingering feeling that you are cared about despite that there are clearly things you need to change. Both supervisors looked at me expectantly, knowing my predilection for complex interpersonal analysis. I could feel their suggestion that I begin an exploration of their feelings in their respective supervision relationships. I felt tugged by the seduction of their intensity and our history of untangling the webs of emotion and behavior in relationship. I knew just as surely that it must be different this time. They needed to be taught rather directly the boundaries of their roles and the meaning of the contract and development of the supervisory relationship, just as surely as their students needed to understand the boundaries of their roles as 98

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counselors. I needed to give to them what their students were asking: that is, to understand experientially the importance of skill acquisition in feeling empowered in a new professional role. As boring and interpersonally irrelevant as it may seem to them in this moment, I must remind them of the purpose of their supervision contract and the level of experience of their trainees. I offered them the possibility that their trainees did just not know how to show warmth and genuineness within the frame of a counseling relationship. This was indeed a parallel process with the counseling and super­ visory relationship that needed to be stopped at the consultative level (see Figure 4.6). We had to engage in a clear and careful analysis of their super­v isory method, so initially we began a process of examining the skills that the trainees lacked and thought about supervisory approaches to teach these skills. We kept the focus on skills that might help facilitate the trainees in learning the role of counselor. I could tell they were dubious and really wanted to divert our attention to their feelings about not being appreciated as supervisors after all their work and attention to these fledgling counselors. I resisted and waited until we had dealt with the skills and teaching methods; then we ventured into talk of relationship, culture, and gender and how these factors were influencing their involvement with their trainees. The supervisors had not misread the difficulty the counselors were having in the development of the counseling relationships, but they had chosen the supporting and sharing function to focus almost exclusively on the trainees’ emotional awareness to address this issue. The trainees engaged at this level of exploration but then felt that they were being seduced into a counseling relationship and being denied the skills that they needed to learn how to help their clients. The supervisors needed to think through each of the factors in the supervisory relationship that may be influencing the impasse. Had they maintained the boundaries of the supervisory relationship as a part of their contractual agreement with trainees? What was the phase of relation­ ship development they were in with these supervisees, and what was the level of experience of the supervisees? Each of these factors, contract 99

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Consultative supervision and parallel process.

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Figure 4.6

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and phase of relationship, were influencing the trainees’ resistance to supervision. The supervisory relationships were relatively new, and deep selfdisclosure might have been experienced as intrusive and unrelated to the counseling work. Although perhaps initially appropriate to explore the trainee’s emotional experience with the client, the supervisors became focused intensely on this area of exploration to the detriment of other areas of potential learning. For example, as beginning-level counselors, they needed skill development in how to create a helping alliance while remaining within the ethical boundaries of the counselor role. The supervisors’ own preference for interpersonal awareness and counseling type interventions in supervision blinded them from acknowledging the need to provide skill training to these supervisees. In summary, supporting/ sharing/challenging strategy with the learning task of emotional awareness led to an impasse. The strategies needed were modeling professional role to break the parallel process and instructing and advising to teach the skills needed to form a therapeutic alliance. The importance of the gender and cultural differences between the supervisors and their supervisees also played a role in their lack of sensitivity to the supervisees’ anger. The supervisors assumed that the trainees’ use of relationship skills was based on some dysfunctional reason for needing to be friends with their clients. Although they were able to engage in a conversation with their supervisees about cultural mores and tradition in professional relationships, in action they were defying those norms in their persistence for self-disclosure and more intimate conversation. The supervisees felt that their behaviors with their clients were being interpreted in a way that maligned their intentions. Eventually the supervisees were able to explain their intentions to their supervisors from a cultural and gender perspective. The super­ visors were able to identify specifically those behaviors of the supervisees that were ineffective in the counseling context, and the supervisees were able to suggest ways they could be with the client that would ameliorate the situation but still feel genuine and culturally and gender congruent. Rebecca finally began a discussion of counseling approaches that were 101

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most effective with her trainee’s own cultural groups and of the differences in relational structure and role that would be expected in cultures other than European American. For both supervisors, understanding the meaning of their initial supervisory focus on personal awareness from a cultural and gender perspective was important in finding a way to relate appropriately to their supervisees.1

Portions of this chapter first appeared in Training Counselling Supervisors: Strategies, Methods, and Techniques (pp. 35–40), by E. L. Holloway and M. Carroll (Eds.), 1999, London, England: Sage. Copyright 1999 by Sage. Reprinted with permission.

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5

Future Directions and Conclusion

T

he field of professional psychology has made great strides in the last decade to establish competencies for psychotherapy and supervision training. Supervision research now needs to address the relevance of these competencies to supervisee performance in the therapeutic role and client outcome. The systems approach to supervision (SAS) model has been built on research that is largely focused on within supervision factors (i.e., those characteristics of supervision, such as supervisor and supervisee attributes, supervisory relationship, and supervisor process, that are related to the supervisee’s satisfaction and performance in the role of counselor). For a full discussion of within supervision factors, see Holloway and GonzalezDoupé (1999). Specifically, these factors of interest have included such variables as relationship qualities, supervisor and trainee characteristics and behavior, and trainee learning needs and satisfaction with supervision.

http://dx.doi.org/10.1037/14942-006 Supervision Essentials for a Systems Approach to Supervision by E. L. Holloway Copyright © 2016 by the American Psychological Association. All rights reserved.

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Fewer studies have examined between supervision and psychotherapy variables that focus on trainee performance in therapy as related to supervision interventions and client outcomes (Fuertes, Spokane, & Holloway, 2012). Almost a decade ago, Wampold and Holloway (1997) laid out a methodological model for supervision research that could include the more distal impact of client outcome. Since that time, little research has tackled this challenging task. As of January 2015 there are accepted standards for competencies in the practice of supervision. As such, it behooves researchers to rigorously investigate the impact of competency-based supervisory practice on trainees’ acquisition of the therapeutic role and their effectiveness with clients. Uncovering the significant relationships among the three-part context of supervisor intervention, trainee/counselor performance, and client improvement needs to be the next step to understanding the impact of competency-based training in supervision and therapist effectiveness. Equally important is the manner in which supervision competency guidelines are used in the training of supervisors. Can these competencies be translated into training modalities? Will models of supervision embrace the competencies and provide an integrated framework for teaching supervision practice? Will there be effective evaluation processes and measures to determine competent practice? Evaluation has largely been localized and unique to characteristics of a particular training program in supervision. Predoctoral supervision education takes place in educational programs and internships that may or may not include supervision of supervision practice or what I have referred to in this book as consultative supervision. Largely, postdoctoral supervisory training in the United States is didactic coursework or workshops attended for credit, often to fulfill licensure or continuing education units requirements with little or no attention to the acquisition of skill as a marker of successful completion of the training. As the profession as a whole embraces the implications for competency guidelines, there will be significant pressure to establish (a) a strong empirical base for the identified competencies as related to therapist performance and client improvement, (b) models of

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supervision that incorporate supervisor competencies, and (c) evaluation criteria that include processes and measures that relate directly to the competency guidelines.

CONCLUDING REMARKS ON THE SAS MODEL The SAS model invites practitioners and educators of supervision to reflect on their actions in supervision, ask difficult questions about the meaning of their work, uncover their own intuitive knowledge, and use a common language to communicate this to others. The model attempts to integrate the research and practice knowledge of supervision and synthesize it in a way that is immediately practical and relevant to the understanding and teaching of supervision. In this book, I have updated the original model of SAS to integrate the recent developments in the identification of supervision competencies, the role of relational practice as a core component of the model, and the application of the model to a live supervision session. The visual representation of the SAS model has been revised from the original work but remains consistent with the primary principles and components of the model. The graphic representation of SAS has been a central identifier and mechanism for teaching the model across several different languages and cultures. The ease with which the complexities of the model could be understood and applied has encouraged me to use graphics liberally in this book. I hope the reader will agree that “a picture is worth a thousand words.” The use of numerous case studies and transcripts in this book, both for the delivery of supervision and the teaching of supervision, was done in an effort to illustrate the versatility of the model for analyzing supervision practice diagnostically, conceptually, and dynamically. To quote the original book on the SAS model (Holloway, 1995): In spite of my effort to capture the SAS model for the printed page, however, the excitement of dialogue, clarification, and demonstration that come from learning in an interactive atmosphere cannot be captured. This might also be said of the nature of supervision.

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The best of supervision will appear in the creative moments of an accomplished supervisor with an engaged student. The belief that supervision does involve artistry as well as skill, however, cannot stop us from striving to establish a method to guide the efforts of supervisors to understand the principles of pedagogy, learn the skill of supervision, and apply creatively these methods with the individual learner. (pp. 180–181)

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Suggested Readings

Abernethy, C., & Cook, K. (2011). Resistance or disconnection? A relationalcultural approach to supervisee anxiety and nondisclosure. Journal of Creativity in Mental Health, 6, 2–14. This article addresses the specific dilemma of resistance and anxiety in supervision from a relational cultural model. It is aligned with the SAS model described in this book. Bernard, J. M., & Goodyear, R. K. (2014). Fundamentals of critical supervision (5th ed.). Boston, MA: Allyn & Bacon. This book establishes the foundation of research and practice in supervision covering all aspects of the literature and models that have guided supervision in the field of the helping professions. Falender, C. A., & Shafranske, E. P. (2004). Clinical supervision: A competencybased approach. Washington, DC: American Psychological Association. The foundation of competency-based supervision is articulated in this clinical supervision model. Fuertes, J. N., Spokane, A., & Holloway, E. L. (2012). The professional competencies in counseling psychology. London, England: Oxford University Press. Competency models across the helping professions is becoming critical to guiding education, training, and practice. This book reviews the different sectors and expertise in the counseling psychology field and establishes the first compiled review of the competency literature in each area. 107

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Hawkins, P., & Shohet, R. (2012). Supervision in the helping professions (4th ed.). London, England: Open University Press. Jordan, J. V. (2004). Relational learning in psychotherapy consultation and supervision. In M. Walker & W. B. Rosen (Eds.), How connections heal: Stories from relational cultural therapy (pp. 22–30). New York, NY: Guilford Press. An often overlooked work on the importance of relational connection in the super­visory relationship. Jordan, J. V. (2010). Relational cultural therapy. Washington, DC: American Psychological Association. Judith Jordan is a founding scholar of the Jean Baker Miller Training. This book describes the importance of relational cultural theory (RCT) in the therapeutic relationship and healing connections. Supervision is a relationship that fosters growth and is aligned with RCT in the SAS model of supervision. Watkins, C. E., Jr. (2011). Does psychotherapy supervision contribute to patient outcomes? Considering thirty years of research. The Clinical Supervisor, 30, 235–256. http://dx.doi.org/10.1080/07325223.2011.619417. This paper is the latest to address the dilemma of capturing client outcome measures as related to supervisory practice. Watkins, C. E., Jr., & Milne, D. L. (2014). Wiley international handbook of clinical supervision. New York, NY: Wiley Press. An important compendium of research in clinical supervision that encompasses the work of researchers and practitioners across the globe. It is a primary resource for all educators of clinical supervision and psychotherapy.

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References

American Psychological Association. (2014). Guidelines for clinical supervision in health service psychology. Retrieved from http://www.apa.org/about/policy/ guidelines-supervision.pdf Arnon, C., & Hellman, S. (2004). On supervision and professional development of school counselors. In R. Erhardt & A. Klingman (Eds.), School counseling in a changing world (pp. 443–464). Tel Aviv, Israel: Ramot. Baltimore, M. L. (1998). Supervision ethics: Counseling the supervisee. The Family Journal, 6, 312–314. http://dx.doi.org/10.1177/1066480798064010 Bambling, M., & King, R. (2000). Supervision and the development of counselor competency. Psychotherapy in Australia, 6, 58–63. Belenky, M. F., Clinchy, B. M., Goldberger, N. R., & Tarule, J. M. (1997). Women’s ways of knowing: The development of self, voice, and mind (10th anniversary ed.). New York, NY: Basic Books. Bernard, J. M. (1979). Supervisor training: A discrimination model. Counselor Education and Supervision, 19, 60–68. http://dx.doi.org/10.1002/ j.1556-6978.1979.tb00906.x Bernard, J. M., & Goodyear, R. K. (2014). Fundamentals of critical supervision (5th ed.). Boston, MA: Allyn & Bacon. Beutler, L. E., & McNabb, C. E. (1981). Self-evaluation for the psychotherapist. In C. E. Walker (Ed.), Clinical practice of psychology (pp. 397–439). New York, NY: Pergamon Press. Blumer, H. (1969). Symbolic interactionism: Perspective and method. Englewood Cliffs, NJ: Prentice-Hall. Blumer, H., & Morrione, T. J. (Eds.). (2004). George Herbert Mead and human conduct. Lanham, MD: Rowman & Littlefield.

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Ward, L. G., Friedlander, M. L., Schoen, L. G., & Klein, J. C. (1985). Strategic selfpresentation. Journal of Counseling Psychology, 32(1), 111–118. http://dx.doi. org/10.1037/0022-0167.32.1.111 Watkins, C. E., Jr. (2011). Does psychotherapy supervision contribute to patient outcomes? Considering thirty years of research. The Clinical Supervisor, 30, 235–256. http://dx.doi.org/10.1080/07325223.2011.619417 Webster’s encyclopedic unabridged dictionary of the English language. (1989). New York, NY: Random House. Wedeking, D. F., & Scott, T. B. (1976). A study of the relationship between supervisor and trainee behaviors in counseling practicum. Counselor Education and Supervision, 15, 259–266. http://dx.doi.org/10.1002/j.1556-6978.1976. tb02003.x Whipple, J. L., Lambert, M. J., Vermeersch, D., Smart, D. W., Nielsen, S. L., & Hawkins, E. J. (2003). Improving the effects of psychotherapy: The use of early identification of treatment and problem-solving strategies in routine practice. Journal of Counseling Psychology, 50, 59–68. http://dx.doi.org/10.1037/ 0022-0167.50.1.59 Wiley, M. O., & Ray, P. B. (1986). Counseling supervision by developmental level. Journal of Counseling Psychology, 33, 439–445. http://dx.doi.org/10.1037/ 0022-0167.33.4.439 Worthen, V. E., & Lambert, M. J. (2007). Outcome oriented supervision: Advantages of adding systematic client tracking to supportive consultations. Counselling & Psychotherapy Research, 7, 48–53. http://dx.doi.org/10.1080/14733140601140873 Worthington, E. L., Jr. (1984a). Empirical investigation of supervision of counselors as they gain experience. Journal of Counseling Psychology, 31, 63–75. http://dx.doi.org/10.1037/0022-0167.31.1.63 Worthington, E. L., Jr. (1984b). Use of trait labels in counseling supervision by experienced and inexperienced supervisors. Professional Psychology: Research and Practice, 15, 457–461. http://dx.doi.org/10.1037/0735-7028.15.3.457 Worthington, E. L., Jr., & Roehlke, H. J. (1979). Effective supervision as perceived by beginning counselors-in-training. Journal of Counseling Psychology, 26, 64–73. http://dx.doi.org/10.1037/0022-0167.26.1.64 Worthington, E. L., Jr., & Stern, A. (1985). The effects of supervisor and supervisee degree level and gender on the supervisory relationship. Journal of Counseling Psychology, 32, 252–262. http://dx.doi.org/10.1037/0022-0167.32.2.252 Xi-Qing, S. (2004). The implication of the Holloway’s SAS model for the clinical supervision in China. Chinese Journal of Clinical Psychology, 12, 92–95.

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Index

Advanced level

Bowers, B., 9 British Association of Supervision Practice and Research, 5

supervisors, 86, 96 trainees, 20, 31 Agencies. See Organizations, institutions and American Psychological Association, xi, 11–12, 82 Anxiety attack, 65 Arnon, C., 30 Association of National Organizations for Supervision in Europe, 5 Awareness emotional, 39–43, 40f interpersonal, 15, 93 self-, 87

Carroll, Michael, 6 Case conceptualization, 77–80 supervisor strategy and, 38f Case examples. See also Irene; Linh countertransference issue in, 70–71 dependency theme in, 62–69, 75, 76–79 depression, 59 dilemmas exemplified in, 55 first session, 34 hyperventilation situation in, 64, 71–72, 78 supervisee portrait in second, 57–58 supervision consultation, 94–102 supervisors’ impasse, 96 of supervisory process, 33–54 trainee resistance issue, 71–75 triangulation in, 43–46, 44f Case method approach, xi–xii, 6 Circumplex model, 18 Client feedback approach, 27–28

Beginning level counselors, 101 supervisors, 86 trainees, 20, 24 Belenky, M. F., 10 Bernard, Janine, 8 Between supervision, concept of, 104 Books, DVDs and, xi, 11–12, 33 Boundaries, in supervisory relationship, 98–99, 100f

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INDEX

Clients. See also Case examples characteristic in relation to outcomes, 89–91 cultural identification with, 46–50, 48f depression case example, 59 description of Irene’s, 59 emotional responses to, 31 factors, 16f, 26–28, 89f friendship with, 97–98, 101 hyperventilating by, 64, 71–72, 78 impasse with, 42, 91 no-show pattern, 35–39, 37f personal values in conflict with needs of, 65–67 screening of, 26 triangulation situation with, 43–46, 44f Communication matrix, 18 Competency -based supervision, 11, 15, 25, 82 core competency domain, viii Competition, 40 Conferences, on supervision, 5 Connection, learning and, 10, 11 Consultative group, 84 Consultative supervision, 98–102, 104 parallel process and, 100f Contextual dimensions, of supervision, 16f, 25–28, 85 relational contexts, 84 Contracts exercise on organizational, 92–93 with Irene, 61–62 multihanded, 92 with organization, 91–92 short-term, 51 supervision, 20–21, 34, 57–58 Counseling relationship, 84 Counselors beginning-level, 101 emotional awareness of, 39–43, 40f ineffectiveness, 90

Counterdefensive interpersonal style, trainee, 24–25 Countertransference, 70–71 Courage, vulnerability and, 45–46 Cover-ups, 74 Crisis counseling, 36, 46 Culture cultural expectations and assumptions, 48f cultural identification with clients, 46–50, 48f cultural variables, 25 relational-cultural theory, 9–10, 16 supervisee cultural values, 48f, 53f supervisor cultural perspectives, 22, 48f supervisory relationship and, 22–23

DeCato, C. M., 30 Defensive interpersonal style, trainee, 24–25 Dependency theme, 62–69, 75, 76–79 Depression, client with, 59 Developing phase, 19t Dilemmas countertransference, 70–71 handling common, 55–80 in supervisory process, 55 trainee resistance, 71–75 DVDs, xi, 11–12, 33 EBT. See Evidence-based therapy Education, pre and postdoctoral supervision, 104 Ekstein, R., 91 Ellickson, J. L., 24 Emotions emotional awareness, 39–43, 40f emotional response to clients, 31 positive emotional states, 10 European Union (EU), 5, 6 Evaluation, 26, 61–62, 104 client feedback approach, 27–28 122

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Index

Impasse, 42, 91

Evidence-based therapy (EBT), 27 Exercises to focus on supervisee, 88 for organization and contractual agreements, 92–93 parallel process identification, 90–91 process style analysis, 94 for supervisor self-awareness, 87 Experience level, professional, 23, 24, 34. See also Advanced level; Beginning level

SAS process wheel and, 95f, 96–97 Ineffectiveness, 90 Inman, Arpana, 35, 48 interview with Linh, 48–50 reflective interview with, 54 Institutions. See Organizations, institutions and Intake, supervision, 87–88 International Conference of Supervision, 5 Interpersonal awareness, 15, 93 Interpersonal style study of supervisor, 23 trainee, 24–25 Interviews with Inman and Linh, 48–50 reflective, 54 Irene (trainee), 55–80 background, 57–58 case setting, 56 case summary for, 76–77 client description, 59 confronting anxiety of, 65, 67–69 contract with, 61–62 countertransference issue, 70–71 critical issues emerging in first sessions of, 62 personal growth phase of, 75–76 personal value conflicts with client needs, 65–67 SAS analysis of case, 77f supervisee characteristics, 58–59 supervisee learning tasks for, 59–61, 62–63 visual deficit of, 58

Facilitative behaviors, in supervisors, 22–23 Factors of influence client, 16f, 26–28, 89f cultural, 22–23 organizational, 28, 92f supervisee, 16f, 23–25, 60f, 87–88, 88f supervisor, 21–23 Fredrickson, B. L., 10 Friedlander, M. L., 24–25 Friendship, with clients, 97–98, 101

Georgine (supervisor), report of, 97–98 Gilbert, Maria, 6 Goldberg, D. A., 23 Gross Doehrman, M. J., 90 Group supervision, 82–83 Guidelines for Clinical Supervision in Health Service Psychology, ix, 82

Handbook of Psychotherapy Supervision (Watkins), vii–viii Hellman, S., 30 Hess, Alan, 8 Hewson, Julie, 6 History, SAS, 5–12 Hyperventilation, 64, 71–72, 78

Journaling, 57–58 Kell, B. L., 18, 19t Klein, J. C., 24–25 123

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INDEX

Lambert, M. J., 27–28 Lammers, Willem, 6 Learning alliance, 9, 10, 15, 17, 34 connection as important to, 10, 11 supervisory structure related to trainee, 24 Learning tasks, 30f case conceptualization and supervisor strategy, 38f emotional awareness, 40f Irene’s, 59–61, 62–63 professional role, 54 Linh (trainee), 33–54 challenging events in, 35 client no-show pattern in, 35–39, 37f cultural identification exemplified in, 46–50 emotional awareness and, 39–43 impasse with client, 42 Inman interview with, 48–50 triangulation and, 43–46, 44f

Parallel process, 90–91, 99, 100f Personal growth phase, 75–76 Personal problems, trainee, 56 Personal values, conflicts over, 65–67 Phases, supervisory relationship, 18–20, 19t, 51–53, 75–76 Positive emotional states, 10 Postdoctoral supervision education, 104 Power, as supervisory relationship construct, 17–18 Power over, 17, 18 Power with, 17, 37f Practice, setting of, 91–93 Predoctoral supervision education, 104 Process wheel, 95–96, 95f Professional experience, 23, 24, 34 Professional role, as learning task, 54 Protor, Brigid, 6 Psychology career in teaching, 81–82 field of professional, 103

Readings, suggested, 107–108 Rebecca (supervisor), 98 report of, 97 Reflective interviews, 54 Relational contexts, 84 Relational-cultural theory, 9–10, 16 Relational practice, 56 Resistance, trainee, 71–75 Rhombus, 91 Role playing, 79 Role theory. See social role theories

Mature phase, in supervisory relationship, 19t Miller, J. B., 9–10 Mueller, W. J., 18, 19t Multihanded contracts, 92 Mutuality, 19, 84

No-show pattern, client, 35–39, 37f Organizations, institutions and

SAS. See Systems approach to

as contextual dimension, 16f, 25 contextual dimension factors, 28 contracts with, 91–92 exercise for contracts with, 92–93 factors of influence, 92f practice setting and, 91–93 role of, 57–58 theoretical orientation vs. policy of, 50–54, 53f

supervision Schoen, L. G., 24–25 Scott, T. B., 19 Screening, client, 26 Self-awareness exercise, for super­ visors, 87 Self-disclosure, 49 Sells, Mathias, 6

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Index

Sense of self, symbolic interactionism and, 9 SFAF. See Supervisor Role Analysis Form Sherry, P., 24 Social role theories, 7–8 power and involvement in, 17 supervisor subroles, 8, 29, 30 Sociological typology, 18 Spy, Terri, 4 SRQ. See Supervisory Relationship Questionnaire Stiver, I. Pl, 9–10 Supervisees. See also Case examples confronting anxiety of, 65, 67–69 cultural values and, 48f, 53f exercise for focusing on, 88 experience level of, 23, 24 factors, 16f, 23–25, 60f, 87–88, 88f learning tasks, 59–61, 62–63 portrait of second case, 57–58 practice setting and, 91–93 Supervision. See also Systems approach to supervision between, 104 within, 103 case conceptualization and, 38f, 77–80 competency-based, 11, 15, 25, 82 connection importance in, 10, 11 consultative, 98–102, 100f, 104 contextual dimensions of, 16f, 25–28, 85 contract, 20–21, 34, 51, 57–58, 61–62, 91–92 as core competency domain, viii critical importance of, ix–x defined, vii–viii DVDs on, xi, 11–12, 33 early models of, 7 first conferences on, 5 group, 82–83 handling common issues in, 55–80

intake, 87–88 learning alliance in, 9 need for forum on, x parallel process and, 100f personal research on, 3–4 research overview and future directions for, 103–105 rhombus of, 91 state laws emphasizing importance of, ix–x between supervision variables, 104 teaching process and, 93–94 Supervision consultation case, 94–102 consultation in, 98–102 supervisors’ impasse, 96 supervisors’ stories, 96–98 trainees, 96 Supervisor Role Analysis Form (SFAF), 8 Supervisors, 97–98. See also Case examples advanced-level, 86, 96 beginning-level, 86 characteristics, 86–87, 86f competencies, 82, 83t cultural perspectives of, 22, 48f facilitative behaviors in, 22–23 factors, 21–23 ideal, 85 impasse, 96 interpersonal style of, 23 learning tasks strategy for, 38f natural style of, 93 percentage of therapists becoming, x self-awareness exercise for, 87 subroles of, 8, 29, 30 supervision process, 95f tasks and functions, 28–31, 30f teaching, 82–87 theoretical orientation of, 23 Supervisory process, 95f agency or organization function in, 57–58

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INDEX

influences from other countries on, 5–6 organizational factors of influence, 92f process wheel, 95–96, 95f purpose of, 6–7 supervisee factors and, 87–88, 88f supervisor competencies and, 82, 83t supervisor tasks and functions, 28–31, 30f support components of, 7 teaching supervision application of, 81–102 teaching tasks in, 28–29, 60f theoretical foundations, 7–11 translation languages for, 13 triangulation depicted in, 44f, 46 updating of, 105 workshops, 84–85

case example of, 33–54 changing structural needs in, 24 dilemma areas in, 55 seven dimensions of, 4–5, 28–31 structure related to trainee learning, 24 systems, 4–5 tasks and functions, 28–31, 30f Supervisory relationship, 84 boundaries of, 98–99, 100f as core dimension, 14, 14f, 15–21 culture and, 22–23 elements of, 16f expectations and, 20–21 interpersonal structure, 16, 17–18 mutuality in, 19, 84 parallel process in, 90–91, 99, 100f phases of, 18–20, 19t, 51–53, 75–76 power and involvement constructs in, 17–18 supervisee factors, 16f, 23–25, 60f, 87–88, 88f supervisor factors in, 21–23 triangulation in, 43–46, 44f, 92 Supervisory Relationship Questionnaire (SRQ), 23 Supervisory working alliance (SWAI), 23 Symbolic interactionism, 8–9 Systems Approach to Psychotherapy Supervision (DVD), 11–12, 33 Systems approach to supervision (SAS) model analysis of Irene’s case, 77f client no-show behavior analysis, 37f as compass, xi–xii components of, 81 concluding remarks on, 105–106 cultural factors and, 22–23 dimensions of, 13–31, 14f essential elements of, 16 formation, 4–5 history and development of, 5–12 impasse in process wheel, 95f, 96–97

Teacher–student relationship, 3 Teaching career in psychology, 81–82 exercise for analyzing process style, 94 process, 93–94 SAS model applied to, 81–102 supervisors, 82–87 tasks, 28–29, 60f Termination phase, 19t, 51–53 Theoretical foundations, SAS, 7–11. See also specific theories Theoretical orientation organizational policy vs., 50–54, 53f of supervisors, 23 Therapists, supervisor percentages for, x Therapy, evidence-based, 27 Tracey, T. J., 24 Trainees. See also Case examples; Supervisees advanced-level, 20, 31 beginning-level, 20, 24 126

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Index

Van Beekum, Karin, 6

defensive and counterdefensive, 24–25 emotional awareness in, 39–43, 40f intern-level, 24 Irene’s case, 55–80, 77f Linh’s case, 33–54, 37f, 44f personal problems and, 56 resistance in, 71–75 in supervision consultation case, 96 supervisory structure related to learning of, 24 Transcripts, 35 Triangulation, 43–46, 44f, 92

Videotaping, 57 Vulnerability, courage and, 45–46

Wallerstein, R. S., 91 Ward, L. G., 24–25 Watkins, Edward, vii–viii Wedeking, T. F., 19 Within supervision, concept of, 103 Workshops, SAS, 84–85 Worthen, V. E., 27–28

Xi-Qing, S., 30

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About the Author

Elizabeth L. Holloway, PhD, professor of psychology in the Graduate School of Leadership and Change at Antioch University, has more than 25 years’ experience as a teacher, researcher, and consultant in relational practice with educators, trainers, organizations, and mental health clients. She is a fellow of the American Psychological Association and diplomate of the American Board of Professional Psychology. She has conducted workshops on her model of clinical supervision and a systems approach to workplace civility throughout the world. She can be reached at eholloway@ antioch.edu or http://www.antioch.edu/phd.

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