Certified Clinical Supervisor exam -D.J Powell

What are 3 basic rules that can guide supervisors in assessing the skill level of counselors?

A supervisor should not assume a developmental level based on the counselors experience and training A supervisor should not assess counselors simply on the basis of initial impressions. An objective measurement should be used. A supervisor should not determine developmental levels on the basis of 1 or 2 domains. They should be proficient in all domains

Relationship descriptive dimension

Facilitative (egalitarian, insight oriented) <—-> Hierarchical (the supervisor is the expert, at the top)

6 major organizational stakeholders

Owners, employees, customers, vendors, competitors, community.

Consultant role of supervisor

Provide alternative case conceptualizations, oversight of work to achieve mutually agreed upon goals, and professional gatekeeping for the organization and discipline.

Networked, team based structure

A structure of organizational management that is based on the big picture instead of linear thinking; flattened with decentralized functions, based on outcomes. Core competencies. All employees interact with customers and are encouraged to do this; functional relationships instead of department silos

What are the 4 key elements of the addiction model?

1. Addicts can change their beliefs, attitudes, and behavior despite level of initial motivation 2. Addiction is a primary, multifaceted disease (affecting the physical, psychological, social, and spiritual dimensions) 3. Both long term and short term goals are specified. Abstinence alone does not constitute a successful outcome 4. The principles of AA and NA are fundamentals to recovery

Define the Minnesota model of treatment

A model of recovery that is a comprehensive, multi professional, abstinence-oriented approach to addictions treatment that looks at it as a disease with the promise of recovery, not cure using 4 key elements.

Level 2 supervisor characteristics Bonus: what counselor do they work best with? What needs to happen in order for level 2 supervisor and level 2 supervisee to work well together?

Displays confusion/conflict issues Sees supervision/counseling as more complex, multidimensional Has fluctuating motivation, esp when supervisory functions are not rewarded Focuses on supervisee Loses objectivity —sometimes as a result of focusing on other factors in administration and counselors. May avoid interacting with counselors Blames supervisee for supervisor problems Works best with level 1 counselors, ok with level 2 There's needs to be a culture of honesty where both are open about their vulnerabilities and need for growth

Level 3 supervisor characteristics

Functions autonomously Displays self and supervisee awareness —doesn't blame the counselor. Is able to give an honest self appraisal Differentiates boundaries/roles Able to supervise at all times Prefers to work with certain level of counselor— tends to develop their own preference

Describe Insight Oriented Counseling and Supervision, outlining specific characteristics of the client, counselor, and supervisor

Counseling is a process of experimentation, discovery, cognitive and emotional exploration, and interpretation The client: responsibility for change rests on them, who initiate action The counselor: task is supportive, interpretive, and educational Supervision: focuses on the verbal content of therapy, a process of unfolding, uncovering, interpretation, discovery, focusing on interaction, dynamics, (counter)transference, and biases. Skills acquisition is 2nd. Responsibility rests on supervisee. Personality change is a goal of supervision and counseling.

Management abilities

Get work done thru staff; make effective use or resources; get results in goals and objectives; control thru command; identify, analyze, and solve problems; adapt to change; organize work as needed; intervene to bring positive results; see all aspects of operations

Information gathering descriptive dimension

Indirect (method is obtaining info) <—-> Direct (observation)

Descriptive dimensions (common factors)

Influential Symbolic Structural Replicative Counselor in treatment - promote recovery process; if it interferes refer them to tx Information gathering Jurisdictional Relationship Strategy

Level 3 counselor characteristics

Has deeper client understanding Understands limits, not disabled by doubt Is consistently motivated over time —>as opposed to just when successes happen Is forging own therapeutic style—>has a basic framework that she has eclecticly built upon Displays increasing autonomy Is stable in 6 factors that influence counselors to enter the field Intimacy Power Financial concerns Personal growth Intellectual abilities Altruism Is nondefensive Displays appropriate use of self Is able to switch tracks Pigeonholes clients less often Accepts supervisor of different orientation Can move smoothly from assessment to conceptualization to intervention Displays broad ethical perspectives

What is the purpose of the sud clinical pathway?

Improve screening/assessment, interventions, and outcomes for SUD Behavioral Health Consultant (BHC) should provide additional assessment of factors that worsen or perpetuate SUD Initiate evidence based interventions Provide ongoing assessment of intervention effect

What are the 8 domains of the integrated developmental model?

Intervention skills Assessment techniques Interpersonal assessment Client conceptualization Individual differences Theoretical orientation Treatment goals and plans Professional ethics

What is the 3rd step in building an SBIRT pathway

Review evidence for ideas about how to improve outcomes for the target group Ex: clinical, cost, patient/prover satisfaction Create a table that summarizes strategies. Can be done informally.

Symbolic descriptive dimension

Latent (underlying, unconscious psychodynamic) <——> Manifest (over, manifest cbt)

What strategies are useful for level 3 counselors?

Level 3 supervisor —>if not, they may seek supervision elsewhere Use a client centered approach Be a supportive colleague, reality tester, sharer of experiences Use wisdom as a guide —>as opposed to structure or flexibility Stimulate and challenge the counselor Use catalytic interventions Use self disclosure when helpful —elicit self discovery, self directed.

Describe the philosophical foundation of the blended model of clinical supervision

People have the ability to bring about change with assistance People don't always know what's best for them, they may be blinded by their resistance The key to growth is to blend insight and behavioral change at the right amounts and times Change is constant and inevitable Concentrate on what is changeable It is not necessary To know a great deal abt the problem to resolve it There are many correct ways to view the world

Which model do these descriptive dimensions reflect?

Structural model—theory is learned deductively; skills are learned inductively. Focusing on aspects of the missing or flawed patterns of the internal ecosystem, allowing the family to be its own healer. Supervisor models and there is lots of live observation.

What neurotransmitters are involved in the development of SUD?

Serotonin, noradrenaline, acetaldehyde, the family of brain chemicals called tetrahydroisoquinolines (TIQs)

How does the blended model treat the counselor in treatment DD?

The AODA blended model does not view therapy as an essential ingredient in the counselor's supervision and holds it to be inappropriate for the supervisor to provide such therapy. However, since many professionals in the field come from either a recovery background or analogous life experiences (such as living in a family dominated by addictive behaviors), it is important that they engage or have engaged in whatever program of personal recovery is needed to ensure that those issues do not intrude into clinical practice (related). Relapse prevention is not addressed in supervision, they are referred out for issues like this (unrelated)

Psychodynamic definition of supervision

The development of a relationship between 2 people that deals with transference displacement; emotional and personality conflicts/characteristics. An isomorphic process. Deals with who else is figuratively in the room as well as overt and covert interactions (what is really going on)

Describe the SUD centered approach to family dynamics

The first step is to stop the drinking: then the family dynamics can be addressed. Stopping the drink- ing entails cutting through the denial of all parties, not placing or accepting blame, accepting the problem in their lives, seeking out help from others, surrendering to the obsessions that drive the family (as the recovering alcoholic surrenders to her inability to control her drinking), and having family members individually learn to accept responsibility for themselves.

Servant leadership

The leader is at the foundation of the enterprise, supporting, not directing the teams that design and implement the tasks.

Ground rules for Strategic supervision

The supervisor will intervene reluctantly and only when essential, preferring phone-ins to bug-in-the-ear. • The supervisor will offer only one concise, brief idea at a time instead of a series of suggestions. • If more involved recommendations are necessary, the super- visee will be called out of the room to talk with the supervisor. • The supervisor and supervisee will discuss the strategy for the case prior to the counseling session to reduce the number of interventions during the session. • All suggestions are only suggestions. The therapist has the responsibility to guide the session as he deems appropriate. However, if a supervisor tells a counselor he must do some- thing, that is to be considered a directive. Since the super- visor has clinical responsibility for the client, she must always retain the authority to direct a session should she think it necessary. • Group training, using observation from behind the mirror, will be used when possible because it is the most efficient way to train therapists.

What is the difference between the systems approach and structural approach?

The systemic approach to family therapy looks at the effect of a presenting symptom (such as alcohol abuse) on the family system, structural family therapy comes at the problem from the opposite direction, looking first for structural problems in the family system that interfere with clear flow of information and decision making.

Strategy descriptive dimension

Theory <—-> Technique

Jurisdictional descriptive dimension

Therapist (is responsible for client. Either way supervisor has vicarious liability) <—-> Supervisor (is responsible for client, directly.)

Describe the replicative DD as it relates to the blended model

This model acknowledges the parallelism (parallel) and isomorphic process in which counselors behave in supervision in a manner consistent with clients in therapy; however the supervisor only addresses unconscious and psychodynamic factors as they interfere with clinical functioning due to the danger of role conflicts and dual relationships Although this model acknowledges the existence of parallel processes, it chooses for pragmatic and ethics reasons to treat these as discreet entities outside the supervisory process (discreet)

These descriptive dimensions match the strategic model. Explain why

This model is highly skills based, not discounting theory but putting skills before theory, since the purpose of therapy and supervision is meaningful change, not simply learning more about oneself. This model theorizes that other models tend to encourage supervisees to be too egocentric, when the goal should be to learn skills designed to encourage change that fit the conceptualization.

What strategies are useful for level 2 counselors?

Understand the counselor is less technique oriented—> no longer relying on cookie cutter interventions and sees it takes a while 4 skill development Realize the Counselor is ready for confrontation and needs to learn alternatives Be prepared for challenges to supervisor competence —> similar to how teens are with their parents Focus on transference Develop conductive supervision—> as opposed to more directive, didactic based Encourage independence Realize the counselor knows s/t is wrong but lacks the skills to fix it Provide blend of clients—>not just very difficult or easy Recognize need for convincing rationale Distinguish btw supervision and therapy —>burnout symptoms can occur as motivation wanes, they realize their limitations, and fluctuate btw autonomy and dependence

How is the influential DD treated in the blended model? What is an example of when you might start on the opposite end of the spectrum early?

Whether the supervisor start on the cognitive (skills) end of the spectrum or the affective end largely depends on the individual stage of development, needs, cognitive abilities, and contextual variables. Level 1s with limited formal training may look for cookbook answers. It is important to instill basic helping skills and the basics of the 12 core functions. As they progress, you will use more theoretical issues and deal with affective (counter transferential) concerns. However, depending On their needs, you may need to deal with this sooner. Ex: a counselor in recovery who shows personal preoccupations that interfere with treatment. Requires a skillful supervisor to know with side to address with who and at what time.

What are characteristics of effective challenges when it comes to providing feedback in supervision?

(a) are tentative, such as 'Could it be that.. .; (b) include expressions of care and respect; (c) are tied to rein- forcement for steps which have already been successfully accom- plished; (d) are specific and concrete behaviors and are controlling variables, rather than therapist traits"

Brief Intervention process

-Advise Maximum Drinking Limits —7 drinks women; 14 drinks male Assess using Readiness Ruler: engage and illicit change talk Advise and Assist Follow up: Continue Support

What are the two main stages of evaluation? Bonus: how should the evaluation leave the supervisee feeling?

1) Goal setting 2) feedback —clear, timely, constructive Should leave them feeling positively motivated for growth rather than obstruct improved performance by reducing energy and limiting risk taking

Recommendations for Videotape Supervsion

1. Clear goals must be set to determine why when and how VTS will be conducted. —>directed and focused segments and discussion. A 1 hr tape can last for hours. 2. Recorded interactive processes must be contextualized. The counselor should describe what's happening/the context 1st to prevent them from just agreeing with supervisor 3. Tape segments should be selected bc they provide teaching moments, not pretexts for scoring critical points. —>focus on constructive teaching! Not pointing out errors. 4. Supervisor should provide gradual feedback. Not a litany of judgments.

How should the supervisor manage their workload under the following conditions: 1. Responsible for 1-5 counselors 2. For 6-10 counselors 3. 11-15 counselors 4. 16+ counselors

1. Do up to 5 hours of individual sup each week, 1.5 hrs small group supervision or some combo. Depending on if under 3 or over 3. Sup also observe min of 1.5 hrs week 2. It is recommended that the sup hold 2 small group supervisions per week with 4-6 counselors in each grp. Total of 3 hrs group each week with 5-8 hrs of observation and prep time. 3. Concentrate on small group supervision with individual supervision for special needs counselors and entry level staff. Level 3 counselors could also conduct small group sessions 4. This is rarely possible and leads to high levels of personal stress and deviation from professional standards. Designating a senior counselor is usually necessary

What is included in the individual development plan?

1. Expectations for supervision: the model of therapy to be taught; number of clients; number of sessions and duration; techniques and interventions; fees/billing; admin details; type and frequency of eval 2. The counselors experience and readiness for the position 3. Procedure to be used to observe the counselor in practice: method of observation, how and when it will be discussed. 4. Procedures to be used to determine the counselors reasoning, conceptualization, and decision making skills 5. Procedures to be used to evaluate the counselor: includes the number, frequency, and type of assessment, And who will make them. What will be the outcome of evals 6. Procedures to be used to intervene to help the counselor achieve goals of supervision and IdP.

1. Facilitative. Using client-centered models, a supervisor facili- tates discussion by asking nondirective questions, such as, "How do you feel about that comment?" "What did you see happen- ing at that moment?" "Tell me more about that response." "How did you feel about the way the session went?" Facilitative responses move the discussion along without providing direc- tion or confrontation. They are nonthreatening and probably represent the most common type of supervisory response. specific action or behavior on the part of the counselor and 2. Confrontive. Confrontive responses by the supervisor address a

1. Facilitative. Using client-centered models, a supervisor facilitates discussion by asking nondirective questions, such as, "How do you feel about that comment?" "What did you see happen- ing at that moment?" "Tell me more about that response." "How did you feel about the way the session went?" Facilitative responses move the discussion along without providing direc- tion or confrontation. They are nonthreatening and probably represent the most common type of supervisory response. 2. Confrontive. Confrontive responses by the supervisor address a require the counselor to answer a question about it-for ex ample, "I saw this going on in the session. Did you notice it: not, what got in your way?" Another example is, "Why did you say that? It did not seem to work, I know you are aware of group dynamics, so why did you make that response?" Confrontive responses can be given in a supportive and helpful manner or can put the counselor on the defensive. 3. Conceptual. A conceptual response contributes new information and a different way of visualizing the case-for example, "There seems to be some transference going on in this session. Let's talk about how transference affects the session." In group counseling, a conceptual response might sound like this: "If you recall from Yalom, this group appears to be at an early stage of development. Let's review early-stage issues and how you can get past this impasse." Conceptual responses are edu- cational and instructional. 4. Prescriptive. Prescriptive responses, heard most frequently in skills-oriented models of supervision, direct (or strongly encourage) the counselor to respond in a particular manner the next time a certain set of circumstances occurs. A supervi- sor who is responding prescriptively might say, "The next time the client says this, I want you to respond in this manner, to say that..." Prescriptive responses are most often associated with bug-in-the-ear and phone-in supervision, with the supervisor using the immediacy of the medium to redirect the counseling session. 5. Catalytic. A catalytic response moves the process along by ask- ing provocative or what-if questions-for example, "Do you think this session might have gone differently if you had said you this?" "If made this one change in your procedure, what do you think might happen?" "What if you got up and changed chairs?" With a catalytic response, the supervisor pro- vokes the counselor to take a different perspective or adopt a te different paradigm. Whereas prescriptive responses might be most helpful for level 1 counselors, level 3 counselors can benefit greatly from catalytic remarks, which promote self- exploration, conceptualization, and more inclusive integra- tion of methods.

How should threats of violence be followed up on?

1. Follow any applicable state or federal laws. 2. When counselor has direct knowledge of potential harm to an individual, group, or property, the counselor under super- visory guidance must determine: (a) the client's propensity (desire plus ability) to perpetrate violence; (b) the client's in- tention to perpetrate violence; and (c) whether a specific vic- tim has been identified. 3. When a credible threat of violence exists according to the above criteria, the counselor under supervisory guidance must, as appropriate: (a) seek a commitment from the client not to act violently; (b) take action to eliminate the threat; (c) inform the police and the identified victim. 4. It is the supervisor's responsibility to ensure that the counselor understands the concept of the duty to warn and that specified actions are taken. Federally mandated reporting is exempt from the requirement of confidentiality. Such limits on con- fidentiality should be made clear to the client as part of ob- taining informed consent to treatment. Furthermore, it is sometimes possible to involve the client in the process of warn- ing the prospective victim or the police, thereby strengthening both the therapeutic alliance and the client's sense of respon- sibility (Wulsin, Bursztajn, and Gutheil 1983).

What steps should be followed in treating ethnicity as a factor in supervision?

1. Recognize, be aware, and sensitive to ethnic differences. 2. Explore cultural variations as they relate to supervision. —> ethnicity shapes belief systems abt what constitutes mental illness. Acting in neurotic symptoms vs. acting out In behavior vs. somatic symptoms 3. Look at ways ethnicity determines help seeking behaviors —> level of trust, openness, attitude

Role playing vs. Role modeling vs. Demonstration

1. The acting out of parts in an unrehearsed drama. Is an alt to observing a counseling session. Info and instructions can be overt or covert, intentionally withholding some info from some participants. Is ideal for skills practice using real world scenarios. Fear, anxiety, boundaries, and hostility should be monitored. Should be clear and closely resembling a real scenario; debrief after. 2. Learning by watching an expert perform the task to be learned. Can be more passive. Relys on an active discussion before (what to look for) and after findings with follow up opportunities to practice the skill. 3. A presentation by an expert that displays and explains a procedure, followed by opportunities to discuss and practice the skills. Is the teaching method of choice for new skills and procedures that are observable. Should be a hands on procedure that combines explain actions with hands on practice in a safe environment and immediate feedback from an expert.

Describe the steps involved in anxiety management as it applies to evaluation in supervision.

1. The supervisor identifies the supervisee's anxious behaviors such as rationalization, discussing tangential issues, showing anger and aggression, judgmental behavior, blaming state- arements, or using anxiety as a defense. 2. The supervisee recognizes the cognitive pattern and explores the needs it expresses, such as performance demands and the need for approval: "I need to be a good counselor. If I'm not perfect, I'm a failure." Or, "I need my supervisor's approval for what I do." 3. The supervisor challenges the irrational beliefs with questions such as, "How bad will it really be if I don't get what I want?" or, "Where is the evidence that you must always be competent here-that you cannot fail at times?" 4. The supervisor and supervisee construct rational and logical thoughts related to the anxiety or anger. They do this with statements such as: "Yes, you want to be a skilled clinician, but will need help from others. It is okay to ask for that at times you help. It is not a weakness." 5. The supervisee agrees to take a behavioral risk and try out the supervisor's logical arguments. The supervisee may say some- thing like this: "I want to get this task accomplished in coun- seling, and this is what I'll do to get there, even if it feels a little unfamiliar or uncomfortable."try

What 3 things should supervision goals include? How should they be established?

A clearly stated, attainable, specific, measurable, and observable outcome Specific action steps to bring about the outcome Specific procedures to evaluate the outcome Should be written and mutually agreed upon—>demonstrate a shared vision

Clinical Supervision

A disciplined, tutorial process wherein principles are transformed into practical skills with 4 overlapping focus: administrative, evaluative, clinical, supportive

Supervision sociograms

A map of interactions within a group session btw group members, including counselor. Provides a graphic portrayal of the communication flow and group dynamics.

Command-control structure

A structure of organizational management based on heirarchies, pyramid structure; top down communication where the goal is to satisfy management and climb to the top instead of improve organizational goals and outcomes. Please the boss, not the customer

Boundary profiling

A supervision technique used to assist the counselor when they have persistent frustration. When was this less of a problem. On a scale 1-10, rate yr level of incompetence...how will you know when you are more competent?

BARS

A system that uses behaviorally anchored rating scales for performance appraisal in clear measurable terms. Specifies the level and standard of performance in objective, impersonal manner Supervisors need to design bars for counseling skills. —> put a specific # to clinical skill/behavior ex: you will make 4 + reinforcements in the next individual session.

Saliency

A technique in supervision where the supervisor asks what is the most important thing you need to know...what issues are important to the supervisee? Helps to create trust. A good second step.

Solution focused supervision

A technique that incorporates effective questions designed to break thru counseling dilemmas. The supervisee has the inner capacity to change/find own solutions with guidance from the supervisor. The solution itself is the best answer to the problem. Not the why.

What are the 4 overlapping foci of clinical supervision

Administrative, evaluative, clinical, supportive.

Influential descriptive dimension

Affective (feelings) <——-> Cognitive (thoughts)

Describe contemplative supervision. How is it different from traditional supervision?

An aspect of the mew blended model of clinical supervision that integrates spiritual aspects of change based on data on how and why people change, what people want in therapy and supervision, and what truly is important in treating the client. It reduces supervisor need to be expert, to have all the answers, empowers counselors to find their own answers; is a committment to healing by enhancing the isomorphic relationship btw counselor and supervisor and btw therapist and client. Models a healthy therapeutic alliance and promotes looking at the larger picture and not just oneself. Traditional supervision focuses on the efficiency of functioning, how one should live; this approach looks at a dynamic process, what one wants to see occur in therapy and supervision. Integrates mind, body, and spirit.

CRAFFT

An efficient and effective health screening tool designed to identify substance use, substance-related riding/driving risk, and substance use disorder among youth ages 12-21. is the most well-studied adolescent substance use screener available and has been shown to be valid for adolescents from diverse socioeconomic and racial/ethnic backgrounds. It is recommended by the American Academy of Pediatrics' Bright Futures Guidelines for preventive care screenings and well-visits, the Center for Medicaid and CHIP Services' Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program, and the National Institute of Alcohol Abuse and Alcoholism (NIAAA) Youth Screening Guide.

Evaluative supervision

Asses counselor skills, clarify performance standards, negotiate objectives for learning, use appropriate sanctions for job performance impairment and skill deficits

Describe how to assess a counselors suitability for the specific work setting.

Assess the counselor general ability to meet the specific requirements of the work setting. Is this person a good match for the milieu? To determine this, list a range of problems the counselor may encounter, the types of cases that occur most frequently, and specific skills needed. Ask them to present on a broad range of cases, not just the easy ones.

Describe the teacher role

Assist in the development of knowledge and skills by identifying learning needs, determining strengths, promoting self-awareness, and transmitting knowledge for practical use and professional growth.

What are the 3 basic structures of the integrated developmental model?

Autonomy —dependence on authority, ability to make independent decisions, degree of supervision required, self confidence Self and other awareness Motivation

The 4 As of supervision

Available: open, receptive, trusting, nonthreatening Accessible: easy to approach and speak freely with Able: having real knowledge and skills to transmit Affable: pleasant, friendly, reassuring

What is the 2nd step in building an SBIRT pathway? Describe

Building a pathway team (ex for teen: pediatric np, sw, adolescent peer recovery coach Should be cross functional with different departments involved. Members should be good at multitasking

What is the best way to conduct a competency assessment? Why?

By observing the counselor in action direct. They are subjective but behaviors can still be classified and measurable. More objective criteria like time spent with clients and outcomes tend to have limited value since they don't consider contextual factors.

Describe the common features of the new work environment

Camaraderie (laughter in the halls, parties); deemphasis on politics (mutual respect and shared goals instead), growth values (truth, risk taking, authentic communication, connectedness, employee empowerment); family and community (healthy, shared table time, eating together)

CRAFFT Questionnaire: what does it stand for? How do you use it?

Car, Relax, Alone, Forget, Family/Friends, Trouble A self questionnaire designed to be used with teens

Define Clinical Pathways

Care delivery plans that ensure close working relationships between the counselor/SW and other members of the team in providing care for a target population

What is the following scenario an example of? A supervisor and supervisee may determine, for example, that the supervisee needs to improve on his intake skills, specifically assessment and diagnosis. The goals set for the next year will be for the counselor to increase his knowledge and se of DSM-IV, to be familiar with its diagnostic axes, and to meet a professional stan- dard of accuracy in assessments and client conceptualizations, as determined by the supervisor. The supervisor will measure the attainment of these goals by observing a series of intakes done by the supervisee and reviewing the diagnoses and rationales. To aid the counselor in reaching the goals, the supervisor will provide reading material and didactic presentations on DSM-IV for staff, will allow the counselor to observe the supervisor doing intakes, and will give the counselor feedback on particular clinical cases. If necessary, the supervisor will require the counselor to conduct a variety of intakes on various DSM-IV diagnostic categories and axes.

Clearly stated goals; specific action planning, and specific evaluation mechanisms

What are the 3 basic tenets of the skills model?

Counselors must learn the appropriate skills and extinguish inappropriate behavior Supervision assists counselors in developing and assimilating specific skills Counselor knowledge and skills should be formulated in behavioral terms

What is the first step in building a pathway?

Decide which population to focus on. Typically a population is selected bc current problems in providing care exists. Ex. Difficulty accessing services.

The Journey DD

Deepening <—> Developing Is supervision a process of going downward and inward for reflection and introspection (deepening) or developing upward and outward (developing) in professional development?

Clinical Supervision

Developing counselor knowledge and skills, identifying learning issues and problems, determining counselor strengths and weaknesses, promote self awareness and professional/personal growth, transmit knowledge for practical use. Teacher, mentor, trainer, professional role model

What can the supervisor do at the beginning of the final counselor eval to quell anxiety?

Do ongoing feedback; quarterly reviews help to make it a little formality. Say, I don't like to do it but every so often I need to step outside of my normal role and do admin tasks.

Describe how to assess the learning style of a counselor.

Does he learning by doing or watching? (Active vs. Vicarious). External locus of control (relys on feedback and guidance) or internal locus of control (process info and draw conclusions inductively?

What tasks are essential to Clinical supervision in the beginning sessions?

Establishing a working relationship Assessing the counselors clinical knowledge and skills, prior experience, and training needs Agreeing to a behavioral contract, setting The ground rules for supervisory sessions. Introducing the counselor to issues like confidentiality, dual relationships, informed consent, and administrative requirements Setting learning goals for the supervision in the form of a supervision training plan

Assessment; how is it different from screening

Etiology Quantitative/Qualitative Diagnosis

The individuals strengths, supportive elements in their environment, stage of readiness for change, faith and persistence, chance events such as a job change, the presence of an underlying personality disorder, length of time addiction has persisted, clients sense of faith, personal responsibility, and persistence, high remission disorders like depression, anxiety, phobias, OCD may also be included. These all are examples of what?

Extra therapeutic factors, which account for 40% of change that occurs in treatment.

What are placebo effects? How can the therapist use this and contribute to this?

Factors such as hope and expectancy, which account for 15% of the change in therapy. Hope is a common factor in all change, it is a positive expectancy. Expectancy research has shown that clients model their therapist pattern of thinking and sense when the therapist stop believing they can succeed. One of the easiet and most effective things a therapist can do is encourage clients with words like I know you can do this, you have done it before, and keep it up. Therapists can contribute by empathetic communication, clear expectations, and empowerment. The stronger the alliance, the more powerful the effect.

What are key results areas?

Goals with measurable outcomes that determine if supervision is successful.

Discuss group supervision. What are the 4 goals of group supervision?

Group side should be a max of 4-6 members to allow for regular case presentation (every other month for each counselor). Larger groups should have a more didactic style but smaller groups should be experiential. 1. Skills development 2. Personal growth and integration 3. Mastery 4. Evaluation

Supportive supervision

Hand-holding, cheerleading, coaching, morale building, burnout prevention, and encouragement of personal growth

Describe how to assess for Knowledge and Skills of Counselor. What tools might be useful?

How prepared are they to perform specific tasks. Is he skillful in interacting with clients? Able to articulate a theoretical model? Use the Barrett-Lennard Relationship Inventory; and evaluation form.

Describe how to assess the conceptualization skills of a counselor. What instruments might be useful?

How well are they able to conceptualize, formulate a hypothesis me treatment plan with specific clinical interventions. The most effective way to assess this is to have the counselor present cases . Some instruments include the Oetting-Michael's Anchored Rating for therapists; Intentions list; clinical assessment questionaire, and written tx planning simulation

Summarize what should be included on the agenda for the first supervisory session Hint: 4 steps

I. Introduction of supervisor and supervisee (s) A. Supervisee's description of personal counseling experi- ence and background 1. Types of experience 2. Settings worked 3. Influences of these experiences on current counseling philosophy and orientation 4. Motivations for becoming a counselor and for under- taking the training/employment B. Supervisor's reciprocal description of background 1. Relating the supervisor's experiences to those of the supervisee 2. Demonstrating the supervisor's qualifications for being a supervisor II. Presentation of specific requirements of supervision A. Meeting time and place (duration, frequency) B. Observation procedures and requirements, including those pertaining to taping 1. Releases required 2. Number of tapes required 3. Tape review procedures 4. Variety of tapes (different clients, phases of care) 5. Write-ups expected (format) 6. Cofacilitation procedures 7. One-way mirror procedures 8. Process notes, verbatims 9. Confidentiality restrictions C. Evaluation procedures 1. Acknowledgment of supervisee anxiety and fears about observation and evaluation 2. Presentation of evaluation criteria and methodology 3. Feedback from supervisee regarding evaluation 4. Agreement on type and frequency of evaluation 5. Site visits by field supervisors, if relevant D. Individual development plan (IDP) III. Anticipated structure and process of supervision A. Teaching mode to be employed B. Supervisory process issues C. Boundaries of supervision versus therapy D. Clarification of any other supervisory relationships E. Group supervision issues, if applicable F. Resources available, reading assignments, homework G. Supervisee's and supervisor's expectations, desired out- comes H. Plans for next session, first quarter of training/supervision 1. Time/scheduling 2. Arrangements for taping, observation, write-ups 3. Time management, scheduling, cancellation proce- dures, administrative tasks, job requirements, filings, confidentiality of information I. Ethical, legal, and professional requirements IV. Behavioral contracting A. Establishment of a behavioral contract between super- visor and supervisee B. Criteria for evaluation of outcomes of behavioral contract and outcome measurements C. Rewards and reinforcements for fulfillment of behavioral contract D. Sanctions for noncompliance with behavioral contract E. Criteria for supervisee progress, including skills and knowledge gain, behavioral changes, expectations of level of change, developmental expectations F. Obstacles to progress: lack of time, fear of success, fear of failure, performance anxiety, resource limitations G. Progress review

How is supervision time determined?

In general supervision should occur 1 hour for every 20 hours of clinical work (direct client contact) the counselor does. 20 hours per week for ft staff is generally a good estimate.

Coach role of aupervisor

In this supportive role, supervisors provide morale building, assess strengths and needs, suggest varying clinical approaches, model, cheerlead, and prevent burnout.

The Internalization DD

Integration of wisdom <—> Compartmentalizations of external philosophies

Describe the principles of contemplative supervision

It defines health as when the mind is present in the heart, when mind, body, and spirit are integrated, when an individual is at peace with his mind, Body, and spirit, even if one of the elements is in pain or suffering Does not seek to offer answers. Is ok with silence, saying i don't know, or I could be wrong. Creates a safe space for intuitive connection Presence, compassion, and love Contemplative listening and hearing without an agenda, without a compulsion to help, by abandoning ones desire to be wise, comforting, and knowledgeable. Mindful in the present moment. Open to meta messages Teaches self disclosure. Take a moment to remember ones humanity before the session Nonjudgmental, authentic presence. The supervisor roots wisdom in al ways of knowing: observation, logical inference, behavioral learning, and intuition. Growth is paradoxical. Sometimes less is more Learn how to manage and value emotions Supervisors need to explore their own spiritual journey.

What does an accurate and thorough counselor assessment include? KLCSM

Knowledge and skills: how prepared are they to perform specific tasks. Is he skillful in interacting with clients? Able to articulate a theoretical model? Use the Barrett-Lennard Relationship Inventory; and evaluation form. Learning Style: Does he learning by doing or watching? (Active vs. Vicarious). External locus of control (relys on feedback and guidance) or internal locus of control (process info and draw conclusions inductively? Conceptual skills: How well are they able to conceptualize, formulate a hypothesis me treatment plan with specific clinical interventions. The most effective way to assess this is to have the counselor present cases. Some instruments include the Oetting-Michael's Anchored Rating for therapists; Intentions list; clinical assessment questionaire, and written tx planning simulation Suitability for work setting: Assess the counselor general ability to meet the specific requirements of the work setting. Is this person a good match for the milieu? To determine this, list a range of problems the counselor may encounter, the types of cases that occur most frequently, and specific skills needed. Ask them to present on a broad range of cases, not just the easy ones. Motivation: To what extent is the counselor driven by values (ex: helping others) and to what extent by needs (ex: healing personal wounds). Burn out risk? Positive or negative reinforcers. There are a number of tools to assess this: the environment scale, r and d counselor development questionnaire, w and r supervision questionnaire, and supervisor perception form. This phase, the contracting period, lasts for 2-3 sessions.

Match the instrument with the skill it is designed to measure: Knowledge and skills Learning style Conceptualization skills Suitability for environment Motivation Barrett-Lennard Relationship Inventory; evaluation form, Intentions list; clinical assessment questionaire, the environment scale, r and d counselor development questionnaire, Oetting-Michael's Anchored Rating for therapists, w and r supervision questionnaire, and supervisor perception form, written tx planning simulation

Knowledge and skills—> Barrett-Lennard Relationship Inventory; and evaluation form Learning style: external vs internal locus of control. No specific evals mentioned Conceptual skills—> Oetting-Michael's Anchored Rating for therapists; Intentions list; clinical assessment questionaire, and written tx planning simulation Suitability for work setting—>list range of problems, types of cases, and specific skills needed. No specific tools. Motivation—>environment scale, r and d counselor development questionnaire, w and r supervision questionnaire, and supervisor perception form.

The listening DD

Listening with the heart <—> Listening with the head

Describe technique factors. Why are they important?

One of the big 4 factors that effect change in therapy. It accounts for 15% of therapeutic change. All tend to have similar outcomes. They are important in history taking; maintaining confidentiality, adhering to legal and ethical standards, accurate patient placement etc.... It is needed to learn this, master it, and then transcend it. It also needs to be matched to the clients stage of change.

What are effective questions?

Open ended, asking what and how instead of trying to pin down why answers. Gives the supervisee credit for answering (correctly or incorrectly). Helps the supervisee feel valued and empowered. May help to get a broader range of responses that can be used in counseling.

Replicative descriptive dimension

Parallel (psychodynamic, counselor replicates the patient problem in supervision<—-> Descreet: independently unrelated (skills oriented, events are not parallel to underlying dynamics)

What areas should be covered in a thorough counselor competency evaluation?

Personal characteristics —> how they bring themselves into the session Philosophical foundations —> client eval, dx, theory, explanation etc Communications—> OARS Counseling skills —> how they deal with issues using counseling skills. Adjunctive activity —> case notes, staffing, appointments Ethical standards

Phases of counselor impairment

Phase 1: over working compulsively. Staying late, expressing feelings of loyalty while beginning to criticize management decisions Phase 2: there is a change in work behavior and attitude (intervene now! In the early phases). Relations start to be strained. May denigrate AA and the counseling program Phase 3: Crisis begins. Progressive deterioration in job performance. Difficulty recalling and judgement issues. Isolation and morale issues. Phase 4: General immobilization. Tardiness may begin. Phase 5: confusion and overreaction. Complaints more frequent Phase 6: signs of depression, apathy, cynicism, laziness, lack of cooperation. Physical appearance may decline Phase 7: discipline and termination. Happens usually as a result of poor supervision.

Administrative supervision

Planning, organizing, coordinating and delegating tasks, selecting and assisting staff, determining clinical and administrative privileges

What sources of info are available when determining counselor level of development?

Previous assessments by former supervisors; can be used as a baseline for future assessments. Should be taken with a grain of salt assessments/measurements by current supervisor; counselor assessments; client ratings, work samples

What major ethical areas should supervisors be concerned with?

Professional credibility: have enough training; don't operate outside scope of practice Evaluation: should be ongoing; consistent; in writing and give them a chance to respond fair objective. . Respect: them as a person, separate clinician. Honor differences. Informed consent: knowledge level, let them know if it is a trainee Confidentiality

The Questioning DD

Questions <—> Answers Does the supervisor pose questions or answers?

What is the 3 acid test as it applies to ethics?

Questions to ask yourself when faced with an ethical Dilemma: 1. Is it legal? Will I be violating civil law or company policy? 2. Is it balanced? Is it fair to all concerned on the short term and long term? Does it promote a win-win? 3. How will I feel about it myself? Does it make me feel proud? Would I feel good if my family knew about it?

Structural descriptive dimension

Reactive (clt centered, fluid, flexible) <—-> Proactive (structured, planned, curriculum); spontaneous or planned.

How should the supervisor respond to allegations of impropriety of a supervisee?

Recognize ignorance is not an acceptable excuse. Confront the supervisee; document recommendations made and actions taken; place a critical incident report; question the client; and monitor cases. Have supervisees review and sign the code of ethics.

Which of the big four factors that affect change does the following represent: The single most significant issues in therapy outcome, accounting for 30 percent of the change. Acceptance, mutual affirmation, and encouragement of risk tak- ing, caring, empathy, warmth, and interventions. Key, though, is whether the client feels the therapist's compassion, caring, warmth, accurate empathy, congruence, positive regard, genuineness, and acceptance. A basic rule is that people change when they are moving toward you, not away from you. And most important, it is not the therapist's perception of the relationship that brings about change; it is what the client feels about the quality of the therapeutic relationship.

Relationship factors, which are the single most significant issues in therapy outcome that account for 30% of change.

What guidelines can supervisors use when following up to therapist errors?

Separate into 3 categories: 1) therapist behaviors that require immediate intervention by the supervisor with the therapist for the welfare of the client 2) those therapist behaviors that require supervisory intervention but have a low probability of doing harm unless repeated or continued over several sessions 3) those therapist behaviors that could use supervisory intervention on a theoretical or technical point but will not lead to any foreseeable harm to the clients

Which model do these descriptive dimensions reflect?

Skills model.

Solutions focused techniques are great to use in supervision with level 1 counselors and with those with little education or training. List some basic solution focused techniques.

Socializing Saliency Boundary profiling Setting goals Externalizing the issue Identifying exceptions to problem perceptions Making sense of exceptions Future orientation Cheerleading Encouraging the change to continue

What categories can the 12 steps be broken down into?

Steps 1-3: Confession Steps 4-11: Reconstruction of self Step 12: Helping others

Desceibe the strategy DD as it relates to the blended model

The AODA blended model provides for the teaching of technique and theory either simultaneously or in alternation, depending on the level of development of the individual supervisee. Initially the supervisor should teach the twelve core functions and the basic helping skills. As the counselor matures, larger doses of theory can be taught, producing these conceptual pegs on which the counselor can hang his techniques. Theory vs. technique.

DAST

The Drug Abuse Screening Test is a 10 item brief screening tool that can be administered by a clinician, paraprofessional, or self-administered. This tool assesses drug use, not including alcohol or tobacco use, in the past twelve months.

GAIN

The Global Appraisal of Individual Needs is a family of evidence-based instruments used to assist clinicians with diagnosis, placement, and treatment planning.

Mentor/Role Model supervisor role

The experienced supervisor mentors and teaches the supervisee through role modeling, facilitates the counselor's overall professional development and sense of professional identity, and trains the next generation of supervisors.

Audit-c vs AUDIT

The first is comprised from the first three questions from AUDIT Disorders developed by the World Health Organization to identify persons whose alcohol consumption has become hazardous or harmful to their health. The 2nd is a 10-item screening questionnaire with 3 questions on the amount and frequency of drinking, 3 questions on alcohol dependence, and 4 on problems caused by alcohol.

Describe the relationship DD as it relates to the blended model

The model tends to be less hierarchical and more facilitative; however, this is contingent upon setting variables, treatment approaches, and client factors. Clients with less recovery experience and counselors with less tx experience —highly structured and more heirarchical. As they gain more experience, the relationship becomes less structured, more consultive (setting changes too) ex residential therapeutic community vs Outpatient.

Describe the task oriented model of supervision

The most well defined and articulated variant of the skills model. Focuses highly on the development of the supervisor but also addresses the counselor and client in detail.

Which model of supervision does this diagram reflect?

The task model

Why and phone ins and bug in ear mot recommended in the blended model?

The tech is usually not available; relatively few have actually been trained and have experience on these techniques

What is a good way to put the counselor at ease in supervision, minimizing power issues and distancing btw supervisor and supervisee?

The use of positive socializing. Find areas of success for each counselor on each session. Ask positive questions like even in a bad session, what were the good moments? Or how have U been successful with this type of client in the past. A good first step

How should peer supervision be done to avoid harmful consequences?

There should be clear, measureable objectives that are clearly defined. This is designed to supplement supervision with a trained supervisor. Should be done with level 3 counselors only who are colleagues and have low defensiveness and no major deficiencies.

What factors contribute to the halo effect on the eval process

This occurs when supervisor judgments are colored by some systematic perceptual bias: Recency: remembering only last week, not 6 months ago Over emphasis: placing too much or too little weight on 1 factor Unforgiveness: holding on to past mistakes Prejudice Favoritism Grouping: putting all employees in some particular designation in a category. Indiscrimination: everyone gets a good rating or no one does. Stereotyping: basing judgements on preconceived notions about race, gender, religion, ethnicity, age, national origin, sexual preference, marital status To minimize this, supervisor should use a standard rating scale for al employees.

What is the 2nd task of clinical supervision? Describe.

This task is to establish a database on the counselor; to gather an accurate assessment of the counselors knowledge and skills.

What is the best way to demonstrate supervisory involvement?

Through consultation and documentation. Documentation should includes dates, times, specific client names, topics discussed. Doesn't need to be longer than a few sentences.

What is the first task in Clinical Supervision? What does this include?

To establish a supervision contract, can be known as a behavioral contract. Can be oral, but written is preferred. Reduces ambiguity on the supervisors role—line authority or coach/cheerleader/consultant? Reduces anxiety for the clinician in that it outlines expectations.

I'm the blended model of supervision, what is the principle task of the supervisor?

To observe the counselors actions, determine their impact on the client, assess the counselors clinical reasoning process, and help the counselor improve treatment delivery. To teach counselors the skill of turning unorganized data into themes and concepts that links assessment, diagnosis, treatment planning, and intervention

Describe how to assess a counselors Motivation. What instruments might be useful?

To what extent is the counselor driven by values (ex: helping others) and to what extent by needs (ex: healing personal wounds). Burn out risk? Positive or negative reinforcers. There are a number of tools to assess this: the environment scale, r and d counselor development questionnaire, w and r supervision questionnaire, and supervisor perception form.

What are common distractions that can undermine the case presentation procedure that supervisors should watch out for?

Too many presentations in too short time Focusing on a specific problem instead of giving a case overview. Anecdotal material that is not conceptualized by the counselor Supervisee dynamics that interfere with free and open discussion of the case Expectations for interventions beyond the capabilities of the counselor.

Top 4 supervisee ethics

Uphold professional standards of practice. Recognize and deal with personal problems that interfere with practice Treat supervisor with respect and dignity Treat info shared in supervision with the highest degree of confidentiality

What are potential sources of contention in goal setting?

When the goals of the supervisee and supervisor differ. Could be related to their stage of development: stage 1: seeking cookbook answers while supervisor wants them to learn how to integrate theory; stage 2: dealing with feelings of inadequacy, realizing their go to techniques don't always work and may seek to abandon techniques while supervisor encourage them to confront confusion and frustration; level 3: may gravitate to unexamined eclecticism while supervisor wants them to be able to formulate an articulable personal counseling model. Divergent philosophical allegiances. Can include licensure, certification, and agency goals.

How does the supervisor incorporate case management into supervision/ within the supervisory relationship?

Within clinical function of supervision as a consultant: solicits supervisee needs; stimulates discussion of clinical problems; encourages -visee to devise strategies and interventions, offers alternative conceptualization and interventions

What is Screening?

• A range of evaluation procedures and techniques to capture indicators of risk • A preliminary assessment that indicates probability that a specific condition is • A single event that informs subsequent diagnosis and treatment Rapid assessment, quantitative index, categorization

What are top reasons for supervisee anxiety?

• Beginner's quandary, or fear of the unknown-of • Spun glass theory of the mind. Level 1 counselors tend to have a "spun glass" concept of people; they think of their clients as delicate objects that one must be very careful about touching for fear they will break. hurt relatively Performance and approval anxiety. "I want to be the perfect coun- selor, the outstanding student. I want the supervisor to think well of me" • Dominance anxiety. This form of anxiety arises when one oneself in a variety of roles with respect ual (s), so that being in a position of power in one respect supervisor versus supervisee) may make it pos- to the same individ- sible to exercise power in other respects as well.

According to the new blended model that incorporates research, what do counselors need to learn in supervision?

• Counselors need training in attuning themselves to the client's feelings, establishing rapport, and demonstrating caring, compassion, and empathy . • Counselors need to find a collaborative instead of a combative metaphor for treatment. Counselors must learn the subtle interpersonal aspects of the therapeutic relationship. • Counselors need to learn how to develop and monitor the therapeutic alliance, how to assess when there are difficulties with that alliance, and how to repair alliance ruptures. The therapeutic alliance is fundamental to the change process. • Counselors must be familiar with social support networks, community services, and family and community resources, in order to marshal and enhance the potential for success. • Counselors must not accept the conventional wisdom that when treatment does not meet the desired outcome it is the client's fault. They must avoid blaming the client's defensive- ness, narcissism, borderline personality disorder, codepen- dency, irrational thinking, or projection and not allege denial or resistance to treatment. Conversely, counselors must understand that if there is any magic in treatment, it is the magic brought by the client and not the counselor. • Counselors need to promote the client's sense of personal control and empowerment. Counselors need to encourage clients to see their own gains, always conveying positive expectations and hope, always expecting clients to get better, always helping clients to find their own solutions. • Counselors need to learn to focus on the future and on the client's ability to overcome the past. Far too often in the addic- tion field, we predict relapse and failure instead of the possi- bility of success. Even when relapse does occur, counselors must maintain the attitude that the client can and will find solutions that work. sessions. Often simply scheduling an appointment begins the training in intervention with clients who need fewer than ten • Given the realities of third-party payment, counselors need training in intervention with clients who need fewer than 10 sessions. Although 20 to 30 percent of clients (those with multifaceted, more intensive problems) need treatment for more than twenty-five sessions, counselors need to be adept at working with short-term as well as and long term clients and knowing the difference between them. • Counselors need to establish the affective qualities essential for counseling before they are taught diagnostics by their supervisors. This is not to say that diagnostics are unimportant but that counselors need to be taught in a way that helps them avoid making premature assessments and quick value judg- ments about clients. • Counselors need to be able to adapt their relationship to dif- ferent clients and their needs. The most important question a counselor can ever ask a client is, "What do you want?" followed by, "How can I help you get there?" • The earlier change happens in treatment, the more likely will be a positive outcome. Counselors need to remember this fact and realize it is not the therapist that makes the client work but the client that makes the therapist work.

Describe the core components of the SBIRT mode

• Screening: Very brief screening that identifies substance related problems —> helps inform staff, pick tools wisely and it takes pressure off supervisor • Brief Intervention: Raises awareness of risks and motivates client toward acknowledgement of problem • Brief Treatment: Cognitive behavioral work with clients who acknowledge risks and are seeking help • Referral: Referral of those with more serious addictions

10 dimensions of effectiveness

Empathy, respect, genuineness, concreteness, confrontation, self disclosure, immediacy, warmth, potency, and self actualization

Counselor in treatment descriptive dimension

Related (may be required for counselor to be in therapy) <—-> Unrelated (not related to skills training)

Describe the jurisdictional liability DD of the blended model

The buck stops with all those that can be sued (counselor, supervisor, and agency) however the supervisor holds the highest degree of responsibility as it is their job to ensure the necessary skills are learned.

What are 3 main purposes of counselor supervision

1- to nurture counselor professional development (and personal development as appropriate) 2- to promote development of specialized skills and competencies to bring about measurable outcomes 3- to raise level of accountability in services and programs

What are the 6 dimensions of the specifix objectives for recovery in 12 step programs?

1. Cognitive objectives mean that abusers must understand how denial and ratio- substance abuse has affected their life, how nalizations contribute to continued drinking or drug use despite negative consequences, and how the negative conse- quences are connected with the alcohol or drug abuse 2. Emotional objectives include the need to acknowledge feelings such as anger, resentment, loneliness, and shame and to under- stand how these emotions can lead to substance use and abue Also, the abuser needs to deal with these emotions in a way d minimizes the risk of relapse. 3. Relationship objectives include understanding that substance abuse affects relationships with people and that significant oth- ers have "enabled" substance abuse by helping one obtain the substance or by minimizing the negative consequences of its use. 4. Behavioral objectives include understanding how substance abuse affects everything one does and that fellowship of AA or other self-help programs provides a resource for changing addictive habits. 5. Social objectives include the need to participate in a self-help program, to form a relationship with a sponsor, to seek meet- ings within the fellowship as the urge to drink or use drugs pre- sents itself, and to reevaluate relationships with enablers and others. 6. Spiritual objectives include the need to experience hope that the addiction can be arrested, to believe and trust in a power greater than oneself, to acknowledge one's own character

What are the 12 standard components of the Minnesota model?

1. Group therapy. 2. Lectures. 3. Multiprofessional staff. 4. Recovering alcoholics or addicts as counselors. 5. Therapeutic milieu. 6. Work assignments. 7. Family counseling. 8. AA attendance. 9. Daily reading groups. 10. Life-history taking (usually by keeping a diary). 11. Twelve-step work. 12. Recreational and physical activity.

Describe the Philosophical foundation of the blended model

1. People have the ability to bring about change in their lives with the assistance of a guide: people come in with a mixture of a desire for change and resistance. Even the supervisee innately has a desire for learning and growth and fear towards it at the same time. The person assisting must blend insight with specific behavioral skills. 2. People do not always know what's best for them for they may be blinded by their resistance to and denial of the issues: the role of the Therapist and supervisor is to amplify the change process to help the person find solutions. Honor integrity and autonomy—a spirit of respect. A supervisor guides the supervisee with a training road map that can be used when the supervisee gets lost. 3. The key to growth is the blend insight and behavioral change in the right amounts at the appropriate time: too much insight —>analysis paralysis. Too much behavioral change/flooded with skills—> skills they cannot possibly apply all at once. Blend insight (affective growth) with behavioral change in a way that is appropriate for the setting, stage of supervisee development, and model of treatment. 4. Change is constant and inevitable: People will change despite the obstacles they face. Therapists and supervisors must look for the window of opportunity. The art of clinical supervision is reinforcing the inevitability of change in a progressive, developmental manner, depending on the stage of growth for the supervisee. 5. In supervision, as in therapy, the guide concentrates on what is changeable. Serenity prayer. 6. It is not necessary to know a great deal about the cause or function of a manifest problem to resolve it. Keep it simple supervisor (KISS). In supervision, The first step is the reach demonstrable skills. 7. There are many correct ways to view the world: effective guides listen to the individual and share hope, strength, and experience. Guide them in discovering new ways of thinking and new solutions

In the Minnesota model, what 4 short term goals facilitate the achievement of long term goals?

1. To help the SUD person recognize the illness and it's implications on their life 2. To help the person admit they need help and concentrate on living a constructive life 3. To help the person identify what behaviors need to be changed to live a constructive life. 4. To help the person translate understanding to action by developing a new lifestyle

Define systems theory as it relates to supervision

A disciplined way of analyzing as precisely as possible, an existing situation by determining the nature of the elementd which combine and make the situation what it is, establishing the interrelationships among elements, synthesizing a new whole to provide means of optimizing system outcomes. The application of systems technology to supervision.

How does the integrated developmental model define supervision?

As an intensive, interpersonally focused, one to one relationship in which one person is designated to facilitate the development of therapeutic competence in the other person.

Give examples of basic helping skills a beginning Counselor may use or that a supervisor might instill in a beginner

Attending, paraphrasing, summarizing, reflecting feelings, probing, confrontation, and self disclosure).

How is the supervisees level of development a major determinant of supervisory practice?

Bc the supervisor may move at least some distance from the right (rote skills training) to the left (mutual exploration and understanding) as the supervisee develops.

Level 1 supervisor characteristics Bonus: what type of counselors should a level 1 supervisor not supervise? Why?

Displays a mechanistic approach—tends to rely on 1 or 2 techniques Plays a strong expert role—usually with underlying insecurities Depends on own supervisor Is highly motivated Is moderately to highly structured Is invested in trainees adopting ones own model Has trouble with level 2 counselors Shouldn't work with level 2 or 3 counselors. Level 2 counselors naturally challenge their supervisor. With the supervisor already having natural insecurity, this can be threatening and cause them to but heads. "Get along to get along"

What methods are employed in the skills model

Est. A relationship btw supervisor and supervisee to facilitate learning and skill development Supervision begins by asking what one needs to learn to be an effective counselor The next step is to set realistic, measurable, and timely supervision goals that enhance supervisee motivation Modeling and reinforcement are basic tools Skills monitoring is ongoing Role playing and simulation techniques are used Micro training breaks down specific skills into well defined. Measureable categories Other behaviorally based techniques are used What the counselor learns in 1 context is generalized to others

Leadership abilities

Establish trust; serve as team leader; define and set department and organizational goals; inspire staff; communicate enthusiasm and capability; keep up morale; take appropriate risks and be decisive in action; change according to needs; have vision, drive, clear judgment, and maturity; exercise contril

What strategies are useful for common level 1 supervisor issues?

Expose to numerous orientations —>since they tend to overly rely on just 1 Be sensitive to trainee anxiety—>this remains high even as they transition to level 2 Promote autonomy Encourage risk taking—while doing no harm; supervisor must do direct observation, grp presentations and role playing Promote exposure to models Introduce ambiguity—and conflict. Promote the right degree of u certainty to encourage growth Balance support with uncertainty Use role play, application, presentations Help to conceptualize, esp as it relates to treatment planning Address strengths first Do not take too much control Be aware of trainee learning styles Active vs vicarious Locus of control —> external vs internal Conceptual levels —> high vs low Oral vs written

Level 1 counselor characteristics

Focused on basic skills Motivated by anxiety Emulates a role model Categorical thinking - one word descriptors Cookbook answers Highly dependent with a self focus Difficulty conceptualizing Lacks self awareness Does not know what she doesn't know Overuses a model/ tunnel vision Difficultly confronting and self disclosing Anecdotal conceptualization Limited idea of treatment planning Lacks integrated ethics

Level 2 Counseloe characteristics

Focuses more on client—>sometimes overly and may side with the clt against the agency Exhibits greater awareness, frustration, and confusion—> has experienced successes but is getting more difficult cases. Outcomes aren't as easy or straightforward. Is more aware of what they don't know May not look as advanced as other level Shows uncertainty and lingering idealism Loses motivation after difficult clients—> has more skills/tools but doesn't necessarily know which to use, when, and why. Has dependency and autonomy conflicts with supervisor—> negatively independent person who rejects advice and criticism to a dependent hold wanting comfort and protection Less imitative, more self assertive Less inclined to ask for recommendations Better articulates clt classifications, as opposed to 1 word answers Greater cultural awareness Uses more eclectic theory Uses better informed ethics

What 3 core objectives do the 12 step principles reflect?

Growth of spiritual awareness Recognition of choice, personal responsibility Acceptance of peer relationships

What factors contribute to development?

Heredity, environment, learning process, age, critical life periods, continuity or discontinuity of development, and structural considerations

Insight Oriented <——-> Skills Oriented: Match the model to the side of the pendulum (incl. the middle)

Left (psychodynamic, rogerian client centered approach), Right (Behavioral, cognitive, solution focused, Minuchin), Middle (interpersonal process recall, conflict model)

Common examples of Psychopharmacology

MAT: methadone (full agonist), buprenorphine (partial agonist), naltrexone (full antagonist)

Insight Oriented Psychotherapy

Motivational Enhancement Therapy Stages of change (Motivational Interviewing) 12 steps Minnesota model

What bar common methods for observation in psychodynamic supervision? What is the focus?

Nondirective tools, like process notes, verbatim reports, and oral presentations. The focus is on interpersonal and intrapsychic, with the counselor learning to explore the dynamics of counseling through modeling tapes and structured exercises

Describe counselor development from a psychodynamic approach

Phase 1: Childhood—>characterized by supervision as a home base for play and exploration, personal and professional identities are fused during a close bond process involving both questioning whether they can trust and work together. Twinning begins the possibility for further growth Phase 2: Adolescense—>structure building phase where the supervisor functions as an alter ego strengthening supervisee feeling of competence they shared understanding. Supervisor is a non directive guide and motivator for further exploration; new ideas vs safety of home; assimilation and criticism Phase 3: Adulthood—> the supervisee settles into her own professional identity, becoming a colleague of the supervisor and assuming role of supervisor to others. Struggles and expressions of difference take the form of organizational forums, intellectual debates, and political issues

Describe the structural DD as it relates to the blended model

Supervision in this model typically starts as more proactive, with the supervisor or program having concrete behaviors they help them discover (on the counseling end the therapist does this) and specific issues objectives in supervision that cover knowledge and skills necessary for counselors in the first year or 2. As recovery grows (client) and as the counselor development increases. Therapy and supervision become more reactive (spontaneous) reflective of the persons capacity for insight —>more conductive and collegial, self directed.

List the main categories of contextual factors (5)

Supervisor Supervisee Client Setting Training program affiliation

Describe information gathering DD as it relates to the blended model

Supervisor starts with direct observation ( direct) bc there is a need to reach the skills fitting the 12 core functioning and monitor them to see their training needs but switches to more to more indirect observation as the counselor progresses in development and the focus shifts to more symbolic and replicative issues. They become more Insight oriented which brings more indirect info gathering.

Clinical Supervisor roles

Teacher Coach Mentor Consultant All these roles center around the relationship

Describe the symbolic DD in the blended model of supervision

The counselor should be less concerned with historical information and unconscious material (latent) esp. in early developmental stages than with skill acquisition and overt beh and cognitive issues (manifest). The supervisor should not become the counselors counselor (role confusion, boundary violations) but should refer them to the EAP for help with latent issues

Describe skill oriented counseling and supervision as it relates to the client, counselor, and supervisor

The goal is problem resolution, symptom relief, and skill development. Problem oriented and directive in nature. The client: self understanding follows or occurs concurrent with behavioral change. The counselor: initiates action, verbal and nonverbal practices are important The supervisor: little attention is payed to dynamic, intrapsyxhic factors like transference and how the therapist feels abt the client. Directed, predictable, planned by supervisor with routine direct , structured observation.

Supervision abilities

To know responsibilities of staff; communicate these clearly; use the performance appraisal system effectively; write clear job descriptions and quarterly/annual goal and work statements; manage time effectively; delegate responsibilities; promote professional development

According to the blended model of therapy and supervision, what is the first step in supervision? What about in therapy

To teach demonstrable skills, particularly for the new therapist who has limited formal academic background. In therapy it is to accept powerlessness over the problem and surrender to the solutions that inevitably follow

What are the commonalities of developmental models of supervision?

Training is tailored to the supervisees professional and personal development. The centerpiece of all approaches is a self managed, individualized training plan for each counselor.

Explain the experiential didactic approach to supervision

Views supervision as a therapeutic process for shaping the counselors personality and behavior. A more balanced psychodynamic model and accommodates behavioral skills training.