Evaluation in counseling supervision

¶ … Counseling Supervision

Worthington & Tan (2002) stated that to maintain the integrity of the supervisory relationship and protect their supervisors from vicarious liability, trainees have an obligation to disclose all relevant and important case material. For example, the APA principles state that "psychologists are honest, fair, and respectful...[and]...do not make statements that are false, misleading, or deceptive" (APA, 1992, p. 1599), which could apply to intentional nondisclosure as well as false statements (i.e., acts of omission as well as acts of commission). Under conditions in which a trainee knowingly withholds important case material from a supervisor, the trainee could be considered to be violating the principle of integrity through her or his dishonesty (Fly et al., 1997).

Gundrun (1991) stated that supervision means that trainees are confronted with old patterns of relating to authority figures. In the trainees' unconscious minds, supervisors play the roles of parents, teachers, or other authority figures. Especially in the early supervisory process, supervisors may be identified with parental figures. We may assume that the supervisory situation is evocative of the supervisees' relationship with authority figures, independent of the role supervisors may play in reality. For example, supervisors can act more as teachers of psychotherapy with a patient-centered approach, giving didactic comments about the patients and recommendations on technique or in a more supervisee-oriented approach, they can focus on the supervisees' experiences with their patients and supervisors, by exploring attitudes rather than teach techniques. A third approach supervisors could use would be two combining or alternating the patient-centered and supervisee-oriented approaches according to the demands of the situation.

Milne & Oliver (2000) had their own take on what it is to be a supervisor as well as what it entails they believed that, clinical supervision is defined as: 'An intervention that is provided by a senior member of a profession to a junior member or members of that profession. This relationship is evaluative, extends over time and has the simultaneous purposes of enhancing the professional functioning of the junior member(s), monitoring the quality of professional services offered to the clients she, he or they see(s) and serving as a gatekeeper for those who are to enter the particular profession. In turn, flexible methods of supervision are those styles, roles, foci, formats and techniques that improve efficiency.

Style' refers to the supervisors characteristic manner (e.g. experiential or didactic); 'roles' to such functions as consultant or colleague; 'foci' to the factors or processes that receive primary attention during supervision (e.g. professional or organizational issues); 'format' to the supervisory arrangement (e.g. 1:1 or group); and 'techniques' to the specific interventions used by supervisors (such as offering support or feedback). It is possible for there to be flexibility in relation to all of these variables, but for there to be efficiency there needs to be a greater output (i.e. better supervisee functioning) for the same input (i.e. supervisor time), or the same output for less input. The following review of the literature adopts these definitions but concentrates on flexible formats, because of the current professional interest in this aspect of supervision. It is acknowledged, however, that flexibility may usefully be introduced in relation to all of the above methods, as well as through other routes (e.g. enhanced competence and alternative arrangements for clinical experience placements). Some of the options for enhancing efficiency in these areas are noted in the discussion (Milne & Oliver, 2000).

One question that Gundrun (1991) looked at is why the supervisory situation is such a good forum for revelation about relationship patterns with regard to authority figures. What are the specifics of the supervision? One characteristic of supervision is that it is a helping process. The very position of needing help places supervisees in a subordinate, dependent position, for-which the parent-child relationship serves as the universal prototype.

A second characteristic of the supervisory situation is related to the specific demands this situation poses on supervisees. In order to get help supervisees are requested to reveal to their supervisors their doubtful understanding of the patients' dynamics, their technical errors, and own emotional responses. Exposure of self in supervision is an absolute requirement for progress to occur, as the self is used as an instrument in the psychotherapeutic process. Therefore, the learning process in supervision inevitably fosters concern with self-esteem regulation. The vulnerability that supervisees may feel in exposing their selves can activate conflicts around trust and mistrust in relation to authority figures (Gundrun, 1991).

Gundrun (1991) stated that the third characteristic of the supervisory situation is more connected with how learning takes place. The supervisees' readiness to learn and accept new models requires an act of disloyalty or infidelity to previous identification models, such as parents and teachers and perhaps old theories. Thus, to be able to integrate new knowledge, supervisees have to give up some measures of autonomy in accepting the authority of the supervisor.

A fourth way to characterize the supervisory situation is to focus on the dual role supervisors actually have to play. They are not only teachers who should promote learning, but also evaluators. Trainees know that their skills and psychological functioning are being judged, but they do not know against which standards. This is likely to create insecurity. Supervisees risk the possibility of criticism, shame, or perhaps rejection because of their admitted inadequacy. Again, it is felt that it is not only the therapeutic work, but also the whole self, which is being judged.

If supervisees in the supervisory process reveal old patterns of relating to authority figures, we may ask how this will be expressed more concretely. Most logically, the whole supervisory process will be invested with strong emotional reactions on the part of the supervisees. Being dependent, being exposed, and being judged are processes that will not go unnoticed by supervisees. Being dependent may evoke feelings of helplessness or protest against this dependency. Being exposed and judged may evoke feelings of shame, fear, insecurity, or anger. It is common that trainees idealize their supervisors as benevolent, omnipotent mentors. When, however, supervisors fail to give supervisees what they crave, the supervisors are seen as harsh and critical withdrawers. The feelings of admiration are replaced by anger, rage or devaluation (Gundrun, 1991).

Although supervisors certainly become the target of the supervisees' mixed feelings toward authority, these feelings are seldom manifestly and directly expressed. Rather, they are felt as "something is in the air." They may also be experienced more diffusely, as, for example, in terms of anxiety.

One consequence of the tensions built into the supervisory process, is that supervisees may try to be selective in what they report. As trainees are eager to be seen in as favorable a light as possible by their supervisors, they may censor process material and carefully select the cases for presentation in a way that they think will support the supervisors' points-of-view. Especially when patients have shown anger overtly during the session and directly to the therapist, the latter tends to omit this from the report to the supervisor. Trainees are prone to avoid discussions about counter transference issues, stemming from the work with the patients, because they fear the power of the supervisor.

Gundrun (1991) conclude by saying that trainees in supervision are confronted with experiences that provoke strong feelings. The therapeutic work with patients does not only evoke powerful feelings, but the supervisory situation itself generates strong emotional reactions in supervisees. In the supervisees' unconscious mind, supervisors will take on the roles of parents, teachers, or any other authority figures. Although supervisors will be the object of the supervisees' mixed feelings toward authority, these feelings are, for different reasons, seldom expressed in a straightforward manner. For example, supervisees know that they are evaluated by the supervisor and want to appear in a favorable light.

Intentional nondisclosure of relevant case material by supervisees (e.g., that described in the first and second vignettes) seems to occur quite frequently (Ladany et al., 1996). According to Ladany and colleagues (1996), 97.2% of supervisees in their sample knowingly withheld information from supervisors. Among the 13 issues identified by Ladany and colleagues, those most likely to increase the risk of liability of supervisors include (a) clinical mistakes, (b) personal problems, - negative reactions to clients, (d) counter transference, and (e) sexual attraction to clients. Although these events do not in and of themselves constitute unethical conduct, nondisclosure of these issues may diminish treatment quality or lead to problems that increase the liability risk of supervisors. Within that context, for example, Hansen, Pound, and Petro (1976) stated that it is a matter of ethics for trainees to acknowledge, recognize, and admit difficulties and problems they are experiencing in their counseling practice. Commonly cited reasons for nondisclosure were that supervisees thought the alliance with the supervisor was not strong enough, or perceived the information as unimportant, too personal, or involving feelings that were too negative. Ladany and colleagues (1996) also reported that 66% of nondisclosures were discussed with someone other than the supervisor, usually a friend or peer in the field. Although supervisors have an obligation to foster an atmosphere in which supervisees feel capable of being forthcoming with important information, we must also be concerned with the possibility that trainees may have predispositions toward nondisclosure, as well as the risk of liability associated with certain types of nondisclosure.

Ellis & Douce (1994) believe that there are eight supervisory themes and issues tend to recur in-group supervisor supervision (i.e., supervisor anxiety, intervention choices, group cohesion, responsibility, parallel process, power struggles, individual differences, and sexual attraction). Given the importance of supervisory issues in counselor supervision (Ellis, 1991), it is reasonable to expect that the eight issues may be important for effective supervisor supervision. In fact, our experience suggests that assessing and confronting these supervisory issues successfully is an integral part of supervisor supervision. Therefore, in the next section we discuss the eight issues and suggest intervention strategies to address them.

The eight supervisory issues seem to cluster into three categories: supervisor issues, group process issues, and counselor-supervisor process issues. Neither the three categories nor the eight issues are mutually exclusive, but tend to be interrelated (Ellis & Douce, 1994).

Ellis & Douce (1994) report that there is a thing called supervisor anxiety. Anxiety experienced by supervisor trainees in their new role as supervisor is a natural reaction (Borders & Leddick, 1987; Dodge, 1982; Hess, 1986). Supervisor anxiety becomes an issue, however, when it inhibits the learning process for the counselor or the supervisor. The supervisor's anxiety may manifest itself in multiple ways that are often characteristic of his or her typical anxiety coping strategy (Mueller & Kell, 1972). The supervisor's anxiety may also become apparent in either supervision context -- counselor supervision or supervisor supervision. For example, during a supervision session in which the new supervisor feels lost or does not know what to do with the counselor, the supervisor may act somewhat scared, quiet and passive, totally cool and competent, or so overconfident that he or she alienates the supervisee

One way to help alleviate supervisor anxiety is to provide specific guidelines for supervisory behavior (Dodge, 1982; Hess, 1986). For instance, Bernard's (1979, 1981) grid of three supervisory roles (teacher, counselor, consultant) crossed with three supervisory functions (process, conceptualization, personalization) provides a convenient set of behavioral anchors to guide supervisors in their new supervisor role.

In addition, early in the training process trainers are encouraged to discuss and validate supervisor anxiety as normal to learning any new skill or role (Borders & Leddick, 1987; Dodge, 1982). The trainer may also want to help the supervisor identify how he or she manifests anxiety in supervisory contexts and learn to manage the anxiety effectively. We have found group supervision to be well suited to these purposes (Borders, 1991; Holloway & Johnston, 1985).

Choice of intervention. As the supervisors advance developmentally in supervisory competence, they tend to grow in their ability to conceptualize counselors individually and in terms of the supervisee's developmental level.This growth seems to be a direct outcome of the supervisors' becoming proficient with the supervision literature and consequently becoming more adept in the ability to focus on the counselor's training needs (Borders, 1989). The supervisor can then select an intervention that will maximize growth for the counselor by providing the proper balance of challenge and support (Blocher, 1983). The constant assessment of what the counselor needs and the act of choosing and tailoring supervisory interventions to the individual counselor and the natural unevenness of his or her growth seem to be essential supervisory skills (Borders, 1989).Initial problems experienced by novice supervisors in choosing the appropriate supervisory intervention seem to encompass at least two intertwined issues: the acquisition and utilization of specific supervisory knowledge and skills (Borders et al., 1991; Borders & Leddick, 1987) and the supervisor's developmental level. Supervisors may over identify with their supervisees and supervise, as they would have liked to have been supervised when they were novice counselors. That is, supervisors may assume that the counselor's experiences with their academic program and with their counseling practicum are the same as their own experiences.