Overcoming Fears and Biases in Clinical Supervision

This episode was pre recorded as part of a live continuing education webinar on demand. CEUs are still available for this presentation through all CEUs. Register@Allce.com Counselortoolbox you I'd like to welcome everybody today's presentation and it's the last one in our sixth session series on supervision. How's that for a bunch of S's for you? Anyhow, today we're going to be talking about providing feedback, addressing anxiety and overcoming biases. We're going to review different types of supervisory interventions or different ways we can provide feedback and reasons we would identify types of biases and ways to overcome them, and different types of anxieties, especially those anxieties that our supervisees may have and how we can address them in supervision. So feedback or intervention or whatever you want to call it can be triaged into three levels. Immediate intervention, it's something you need to step in and do something about, you know, right now. If it's a live session, it may be even worth knocking on the door and interrupting the session. If it's a not live session, it's something you stop the supervisee and go, wait a minute, wait a minute, we need to talk a little bit about this. And that typically ends up being something that revolves around making a mandatory report or something. In my experience, those are some of the only times that I've had to do an immediate intervention where, you know, I wanted to make sure that the supervisee recognized that they needed to make a report and make sure that it was done. A non immediate intervention is one where you see that the supervisee has gone a little off track or maybe done something that was slightly unethical or wasn't in the best interest of the client in some way, shape or form. So it's something, it's not a suggestion, you know, maybe next time you might try. It's a don't do that again. But it's a non immediate intervention. Whatever happened is not likely to cause harm to the client, but it's something that the supervisee needs to do henceforth and forevermore. And a lot of times non immediate interventions come up when it surrounds paperwork more so than what happens in supervision or I've been lucky, my supervisees have been very good from practicum all the way up through licensure. And the third level of supervision can be categorized as suggestions. Those are the things that we throw out that went really well. Might I suggest next time or you know, can you think of other ways you might address this with a different population or that went really well with this particular client. What would you do if it happened to be an adolescent? And then brainstorming and making suggestions for how that might go. Other suggestions you can throw out there because we do have more experience under our belt, you know, different ways they may be able to save time, to become more effective and efficient at doing their paperwork and handling their progress notes and things like that, or how to more effectively develop that initial rapport in order to build therapeutic alliance. So suggestions are things that we do a lot. Immediate interventions, you're going to do them occasionally, that's probably 1% of what we do. And then the non immediate interventions. In most cases, that's going to be less than 20% of what you do with your supervisee. Because most of the time they're on the right track. Feedback and intervention are designed to enhance counselor competencies such as, and here we go again. Personal characteristics, their self, awareness of who they are, what they bring to the counseling situation, how they impact the dynamics of what's going on in the room. You know, we're assuming that they are competent human beings, but we're enhancing their competencies in terms of their awareness and their ability to use function with their personal characteristics. And that can also include how they decorate their office and you know, how they carry themselves, how they handle themselves. One of my former employees, great clinician, but he was very much kind of laid back, very, you know, I call it loosey goosey. You know, he was a not one that tended to run by structure and time limits and things like that, where I, on the other hand, tend to be very somewhat rigid. So we had very different personal characteristics. And the way we ran our therapeutic therapy sessions were often very different. You know, I can loosen up when I need to, but I don't think I can ever get quite as loose as he could. And he can be a little bit more structured. But structure was something that he struggled with personally. So when we came in contact with clients who preferred a particular type of structure in session, or responded best to a certain type of structure in session, we had to be aware of our own tendencies and how to adjust those. So this is what we're talking about with personal characteristics. They're philosophical foundations. When we're enhancing these and providing feedback, we're going to be asking the supervisee with each client, what do you think is causing this? What do you think is triggering this? What interventions might you use and how does that fit with your philosophical approach? And generally, if they're coming up with the interventions they see how things fit. They're just not throwing the kitchen sink at it. But we want to make sure that they're making those connections between their philosophy of mental health and the interventions that they're using and how they're trying to help the client change communications, verbal and nonverbal. We're going to really focus on that. I know when I did my initial practicum and I was having to transcribe my sessions, which was painful, and it was even more painful when I realized how many times I used audible pauses like and okay, hence what we were talking about. So recognizing what their verbal characteristics are, audible pauses that they may use, things that they may do that have a positive or negative effect on the client. And nonverbal communications, especially when we're talking about cultural awareness, what should your. Your nonverbals reflect if you're working with someone from a culture other than yours? What are we talking about? With the appropriateness of continued direct eye contact? What are we talking about in terms of space, for example, counseling skills. Obviously, this is where most of us tend to hit more in terms of providing feedback and interventions with our supervisees. We tend to not look as much at the other stuff. So counseling skills, I'm not going to belabor adjunctive or administrative activity. That's kind of everything in the kitchen sink. So this includes scheduling being on time, how you present yourself, how you complete your paperwork, completing progress notes, making sure that they are done in a way that are appropriate and will ensure reimbursement. And reimbursement is an issue. Helping supervisees become aware of why it's important to write notes in a particular way, of all the requirements from your accrediting bodies, whether it be Jaco or car, for your state regulations, different funding sources that will help them understand. Just like we want to help clients understand why we're asking them to do something, we want to help supervisees understand why we're asking them to do this reassessment every 30 days, why we're asking them to make sure that they update the treatment plan every single week, which, by the way, is a requirement of most insurance companies for intensive outpatient type treatment. So if you provide that, be aware. Anyhow, I know a lot of supervisees and supervisors and even programs who aren't aware of the requirements of their funding sources. And that can really result in huge paybacks, which can result in layoffs and downsizing and ethical behaviors. Again, this is an area as a supervisor, we often tend to get kind of lax in because our supervisees don't often experience ethical conflicts that come to the level of having to talk about them. They encounter a client trying to give them a gift, or running into a client in public, or those sorts of things. They encounter making a mandatory report. That's not uncommon. But there are a lot of other ethical behaviors, like the fact that we're required not only non malfeasance, above all, do no harm, but beneficence ethically. We are required to do things in the best interest, do things to enhance, do things to advocate for our clients. So where does that come from? How do we do that? So I typically go over the ethical principles with my supervisees and we talk about one each month. And I say each month because I have my supervisees for anywhere from six months to two years, depending on what level they're at. And this is just something we go over one session during part of one session, one week each month. So it doesn't overwhelm supervision. But I'll throw out ethical scenarios for them periodically. Or when we're doing a supervision session over a client, if something comes up that, you know, it could have gone a different way and become an ethical dilemma, I might say, well, how would you handle that particular situation if it had gone this particular way? And we'll talk about those different things. So it's up to us to really drive home the fact that ethics need to be something that we're thinking about on a continual basis. Periodically, I will have my supervisees also go into the meeting minutes from our licensure board and review the ethical complaints that were ruled on. And most of the time, not always, but most of the time, the ethical complaints that are still coming up happen to be on dual relationships and practicing outside the bounds of competence. So we explore those again and how to make sure that you're not going down that road. Five types of supervisory intervention Facilitative brings about discussion through non directive questions like what might the next step be? You're going through a scenario with a client and you're watching a tape and you pause it and you say, all right, tell me kind of where you think we're at right now and what do you think the next step might be? Or maybe you're not even reviewing a tape on this client. And I do this with each client that we review. I say, okay, what are your goals for next week? What are you hoping the outcomes will be? If we're talking about a particular intervention that was used and maybe it didn't go so well, I might ask what are Some other interventions you could have used in that instance, or even if it did go well, I would have said, if it would have flopped, what were your backups? Because it's always good to have backups. And when we're talking about making diagnostic impressions and creating that integrated summary, or even looking at a particular behavior, like maybe the client is being resistant, well, what does that mean? What explanations exist to help us understand why this behavior is somehow beneficial to the client? What's rewarding it, what's maintaining it? What's the benefit of it? What's the function of this behavior? So I want to know what other explanations exist besides just the most simple one? We do this with diagnosis, too. If you've been in my other classes on diagnosis and differential diagnosis, we look at what medical things could be causing it, what situational things could be causing it, et cetera. So I want clinicians to really broaden their mind, and I don't want to tell them, did you think about this, this, or this? I want them to get there. So I want them Socratically, if you will. I want to ask those questions to elicit that sort of information at the beginning of supervision. I do some training on the multiple causes for differential diagnosis, and I do some training on some of these things and give them some handouts to look at so they can think about when they're looking at a particular behavior, what other explanations might exist. So I've given them this history, and hopefully they're pulling on it now. If you haven't done the prep work ahead of time and done some training with them, and you start asking these questions, you may need to be a little bit more directive with what you're doing. You ask for other explanations. They may come up with. I don't know. So you may need to probe a little bit more confrontive supervisory interventions, address specific actions or behaviors and require the counselor to answer a question about it, such as, why did you choose to pursue that avenue with the client? When I was in my initial practicum, I would bring tapes in for my supervisor to review, and he would listen to them. And, you know, after a while, he stopped them. And he's like, why did you go down that road with that particular client? And because the client wanted to go down that road, he's like, no, no, no, no, no, no, no. You're all over the map. You're letting the client just lead you all over the place, and you're not getting anywhere. Every time it starts to get a little uncomfortable, you go somewhere else. So you need to choose and have a little bit more direction. I'm like, oh, okay. But he wanted to know what my thought was. He wanted to know what my reasoning was. And sometimes a clinician will choose to do something and you may want to stop them just to find out what their rationale was. What was your intent when you asked the client this question? Were you hoping? What kind of response were you hoping for? Where were you hoping it would lead you? Other types of confrontive questions can be much more administrative, like what is your timeline for preparing for the audit on January 25th? Or you've got this client that has major depressive disorder. What are the three interventions that you think are going to work best with them? So they have to come up with a specific answer to a specific question. Conceptual feedback contributes new information and a different way of visualizing the case, such as, you know, you're working with Sally, she's a 27 year old female with a 7 month old child and she presents with symptoms of depression. So if the clinician goes in and starts treating the depression and starts trying to immediately address the cognitions and stuff, that might work. But we want to figure out what's causing Sally's depression, what are the roots of this depression and is it. She's just got major depressive disorder that's episodic, which may be true, but there also may be other stuff that's contributing. Is she dealing with grief? Maybe it was an unplanned pregnancy or she had this baby and now she's like, oh, this is not what I expected at all. Maybe she's got some postpartum depression going on more than just the baby blues. Maybe there's hormone changes. With a seven month old child. When you quit nursing, you go through a whole other set of hormone changes, just like you did after you give birth. So for some women, they have a resurgence of depression at that point in time, or is she presenting as depressed? Is she having lack of energy and fatigue and difficulty concentrating and all that stuff we would normally say is depression because she hasn't slept in three months because the baby's colicky and now is starting to teeth. I don't remember when teething starts. So we want to look at all the different things that might be contributing because our interventions are going to differ. I mean, if she is experiencing this depression because she's exhausted, cognition and cognitive behavioral stuff is going to help. But we also need to help her recognize that she needs more sleep or more quality sleep and figure out how to start doing that. So conceptual is where you're taking your vast amounts of information and going, I hear where you're coming from. What if we added this extra piece here or these extra few pieces to consider, to shuffle around? How would that change the picture? Prescriptive feedback directs the counselor to respond in a particular manner the next time a certain set of circumstances occurs. So that can be an ethical issue. If a client tries to give you a present that's, you know, an extravagant gift, let's role play how you will respond in the future in order to make sure that you're responding ethically and maintaining. Agencies I've worked for have always had a very strict rule about not accepting gifts from clients. And so we needed to role play how to make that happen. Other ways you can use prescriptive. Maybe you notice that the supervisee struggles when a client is blaming his wife for things, and he's just constantly blaming his wife, and you can't seem to get him to change direction from that or see his part in it. So you might prescribe, if you will. So the next time John starts blaming his wife for everything, how about if you try doing this? Or the next time a client calls at the last minute to cancel? Because the supervisee is like, you know, I've got 15 clients, but nine of them canceled this week, and all of them were at the last minute. So we're not going to get. I wasn't able to put anybody else in the slot, so I don't have enough billable hours. Okay, well, prescriptively, next time this happens, what are you going to do? You need to remind them that there's a fee for not coming and talk about the reasons that they're canceling at the last minute if they're habitually doing it. Catalytic feedback moves the process along by asking provocative or what if questions. What if the client were to gather baseline data for a week? Catalytic is, you know, kind of a what I put or what I think about in terms of, oh, what's his name? Columbo type questioning. Sometimes it's a little bit more on the facilitative method where. Help me understand a little bit more about what's going on here. I'm confused. But it can also be what if. What if the client were to gather baseline data for a week? You know, in your mind, you're thinking it's going to help the client figure out how often this is really happening and start to see progress. You know, if you believe in gathering baseline data, which obviously I do, but you want the supervisee to be able to come up with that. So you're presenting something and you're saying, well, what if that. What if this were to happen? What if you use the empty chair technique to help the client process the issues that she's having with her father? Well, the supervisee may say, you know what, that's not going to fly. Or I've tried that already. Or there can be a lot of different responses, but the supervisee may also say, hey, that's an interesting idea. And then you can talk about what might happen in the session. What if you were. If the client were to try some type of intervention for one week? What if she were to try the quarter flip, which you flip a quarter in the morning. If it lands on heads, you have got to act like you are happy, like you have reached your destination. If it lands on tails, you can be your normal self. And then you write a journal at the end of each day to see if there was any difference in your interactions when you were or how your day went when you were actually forcing yourself to carry yourself high, smile at people, hold your head up, yada yada. What if you held the client on point for this topic? So maybe they're talking about the abuse they had as a child and they start to get to a point where they might hit and have an aha moment, and then they just change directions or they refuse to go any further. Usually it's changing directions. So what would happen if you hear what the client's saying and they say, but I want to go back to this other thing for a second, and you held the client on point for that topic for the whole session? Or what would happen if you helped the client reconceptualize the problem? Sometimes clients see the problem as emanating from one particular thing. You know, this incident is what has caused all my misery and continues to cause all my misery. What if you help them to see that, yes, that incident was the trigger that started a cascade effect. However, let's look at some of the things that are happening now that you might be able to change in order to address that. So, you know, helping them start to see that they may be maintaining their own misery in some ways. In later practice, the what if the catalytic stuff is often the feedback you get from colleagues when you ask for suggestions. If you go in and go, I'm really hitting the wall with this client. This is what's going on. What would you do? They may give prescriptive suggestions, or they may say, more often than not, they say well, you know, I haven't worked with this client, you know, as much as you have, but what if you tried doing this? What ifs are also great feedback interventions, whatever you want to call them, for ethical issues. You know, when a client comes in and says they want to give you a hug, you know, is that ethical? What if a client came in and did this? How would you handle it? Feedback is a supervisor's response to the data presented, and lack of data leads to ineffective feedback. So if we're not getting the full picture of what's going on with the clients, we can't provide effective feedback to help clinicians be more effective in session. Hence the reason we want to get good observational data. Feedback is designed to help us, the supervisors, understand or kind of get inside the head of the supervisee so we can sort of anticipate their next move and bring about a positive change in the professional life of the counselor, helping them move toward becoming the type of counselor they want to be. Not necessarily making them embrace our style, but helping them implement the techniques and skills and tools that they find useful. That kind of flow with their theoretical and philosophical approach. Feedback needs to be supportive, challenging and pragmatic. Those supervisors that just supervisee comes in, you listen to everything, nod, uh huh. Well, sounds like it was a good week. I'll see you next week. That's not helpful. It's not. It is supportive, but it's not challenging. And it's also not very pragmatic. It's not helping the supervisee delve deeper into what other techniques could I use. Why did this technique that I used work? You know, it worked great, but why did it work? Let's see if the supervisee can actually articulate that you want to present feedback more in terms of it was a good session and I liked how you did blank, blank and blank. So you're identifying specific things that the supervisee can seize in on and go, okay, I'm going to do that again. You might also add a, I'm wondering what would happen or what you need to do in order to help get this client to come in more regularly or something. And then maybe also add a. If I had to give one suggestion or area to work on, it would be, you're not always going to have suggestions or areas to work on that you want to throw in there. And I try not to do that at every session because I don't want the supervisee to feel like I'm always going to give them, you know, you didn't do this right I might though, at the end add, all of this went really well. Continue to work on reading the book on DBT skills and next week we'll talk about different ways you can use DBT and start using those skills in session or something. So I really want to take part of their individual development plan and use that in their feedback. At the end of, at the end of a supervision session, effective feedback is elicited rather than imposed. I don't always want to be standing there lecturing at them. Supervisees should be seeking us out, asking for feedback, asking, what do you think about? Hopefully they don't think they know everything because if they do, we're in a bad place. Because, you know, we've been in the field for, you know, 5, 10, 20 years and hopefully we all recognize that we don't know everything either. So supervisees often come out and they're like, I have all this book learning, I have so much more knowledge than Jim on the street. Well, that's true, but there's so much more to learn. So I want supervisees to maintain their excitement and always be seeking feedback, not just from me, but from books, from resources, from other professionals. They need to learn how to continue to build their skills. Effective feedback is timely. You don't want to just say, oh, I'll get to it, you know, and then forget to mention in this supervision session and two or three more supervision sessions go by. Then you're like, oh yeah, you know, last month, you know, you had this case that's not effective. You want to modify the behavior, put the modification in as close to the behavior as it happens. Effective feedback is communicated clearly, directly and with regard to specific issues. Going back to that statement that we talked about on the last slide, you don't want to say, you know, it was a good session. You want to be specific and say, I really liked how you did these three things. And if you have issues, instead of saying that was a really bad session, point out, you know, this particular thing didn't go really well because, and you know, talk about how to do it more effectively the next time. Give them something tangible to work on if they have to work on something. Effective feedback is also constructive and descriptive rather than critical and judgmental. And part of that is just how it's presented. But we also want to keep our value laden words in check as much as possible. So for example, you could say when the client revealed his concern about his anger issues and you responded by saying, well, you know, once we get your anxiety under control, your anger is probably not going to be a problem at all. He seemed to kind of shut down. I'm wondering what you intended to communicate and what your rationale was for saying that. Not just going, you know, when the client brought up his anger issues, your response was totally inappropriate. Okay, how was it inappropriate? You know, maybe the supervisee had a rationale for what they were trying to get at, and I can't see how that would work in this situation, but it could. But we want to make sure we identify specifically which interventions or which behaviors we thought were ineffective and talk with the supervisee about what to do differently or why they did them, or both. Effective feedback is directed towards changeable behavior. Not everything is changeable. For example, I am never going to be somebody who can just sit here and talk like this. I talk with my hands, I talk big, I make gestures. I can be more reserved. But, you know, part of it is just kind of how I am. Other behaviors, like my, you know, the pitch of my voice is not changeable. I can't change that. So if you've got a counselor who has a different pitch, they can't do that. They can adjust maybe how they. How loudly they talk to somebody. I don't hear low tones very well. So if somebody has a really low voice and they're talking in a really low tone, I can't hear them. So we might want to say you need to need to adjust your volume. Or you can say, when clients do this, then you should respond with this. So sort of an if then statement, but it's directed towards something that is changeable, not something that just exists. Feedback is not used as a disciplinary weapon. You know, if you make this mistake three more times, then I'm going to discharge you from supervision with me. Now, occasionally there are circumstances that come up where you're providing feedback because something was royally unethical and inappropriate. I'm hoping that never happens, but it could. Where you might have to say, you know, if you show up, you know, to supervision again and you're under the influence, or if you go into session like that again, where you're under the influence, or you seem like you haven't slept in days, then we're gonna have to take some corrective action. So sometimes it comes up, but we don't want to regularly use it to discipline and, like, you're keeping a score chart like, well, you had five inappropriate interventions this week. I just don't know what I'm gonna do with you or rank your supervisees. Please don't ever rank your Supervisees from least problematic to most problematic each week. You know, that would be horrible. Constructive feedback is presented with positive feedback and or recognition of work well done. So I always try. I don't necessarily sandwich it, but I may start out with constructive feedback and say so you know, you had some struggles this week. We talked about these three changes that you're going to make. However, you also did have these other good points and I want to try to end on a positive note if at all possible. I don't want them walking out of there feeling like, oh, I just got my butt handed to me. Methods of providing feedback trunk or break down information into manageable bites. Not a litany of done me wrongs. So make a list of all the things that you want to go over and cover one at a time. So if you did a supervision session or you watched three tapes of the supervisee gave you and there are things that you want to go over, make a list such as maybe starting out with okay rapport and therapeutic alliance issues we need to go over. Let's talk about this a little bit and here's how I saw it. In these three tapes I reviewed adherence and relevance of their interventions to the treatment plan. Again, based on what I saw in these three videos, you were either on point, you know, hopefully, or you seem to get a little bit off track here with this particular client. Talk about different interventions used. If you see ones that went really well, you may comment on that and go that was awesome. If you see some hiccups you can also comment on that. But you want to identify the specific interventions. If you reviewed tapes, it's helpful to have the tape queued up to those sessions or sections and be able to show the supervisee exactly what you're talking about. Then finally go over any ethical issues that could have come up or that did come up that you saw in the taping. Provide non threatening but thought provoking and challenging questions and share your own experiences in concrete terms. You know, I will share with supervisees, especially you know, prac1 students about my first experience going into a super into a counseling session with a client. I was scared to death and how it went and all that stuff. For the first time I tried to use the miracle question and it didn't go well. So I didn't know that. I didn't really know how to use it as effectively as I should have. I wish my supervisor would have done more role playing with me in order for me to know how competent I was with some of these interventions before I tried Them in group or with a client. But, you know, no harm, no foul. I never tried anything that was too, you know, off the charts. Providing support and encouragement. You know, we want to make sure that our feedback has a significant amount of positive stuff to it and encouragement. If a session goes really bad or a client drops out, or, you know, heaven forbid a client attempts suicide, we're going to want to review what's going on. You'll do a root cause analysis with the supervisee, see what may have precipitated it, what could have been done to prevent it or intervene earlier. And you know, you're going to talk about those sorts of things, but also providing encouragement because it's going to happen to most of us at some point in our career and talking about the issues surrounding, related to suicide and suicide attempts to help the supervisee figure out kind of how they feel about it and help them understand the legal ramifications, what they do and don't want to do. And you know, pull your agency attorney in there if you need to, or risk manager and suggest alternatives when you're providing feedback. If you see a supervisee is doing one thing and they do it really well, but that's the only intervention they know. When a client starts to do a particular behavior, you might encourage them to go online and learn two or three different interventions that you could use, for example, to teach mindfulness. So they have a little bit few more tools in their toolbox. It's like having a, a set of drill bits. You know, each drill bit is a slightly different size and you need different drill bits for different tasks. They're still drill bits. It's still the same sort of thing that you're doing, but they're going to be used for different, under different circumstances. Effective challenges are tentative. We weren't there. You know, maybe the supervisee had a very legitimate reason for doing what they did. So I don't want to start coming at them authoritatively or right off because I want to know what was your thought process? How did you get to this point? You can ask what would have happened if, you know, if you're suggesting an intervention, what would have happened if you had stopped the client right there and asked them to practice taking their deep breaths and used a mindfulness exercise to help them get regrounded or whatever the case may be. So I'm going to propose that it's something that watching it without any other background information except for what I have been given by the supervisee, I might have tried it. However, the supervisee will be able to go, that could have been. That might have been useful, or it would have flopped. You can also say something as, I'm curious why you chose this intervention, and maybe you would have chosen the same exact one. You know, it's. But you want to know what their thought processes are. You want to know their rationale. Help me understand what you were hearing when you responded this way. So all of those are just trying to get into the mind of our supervisees. They're not necessarily criticisms, but they're helping us understand the supervisee better. And I repeat that repeatedly to my supervisees. Just because I ask you why you chose a particular intervention or what you were thinking when you said this, I'm not necessarily being critical. I may have done the exact same thing, But I'm curious as to the process that got you there. That way, they don't feel like they're always going, oh, did I do something wrong? No, you didn't do something wrong. I just want to get inside your head a little more. Effective. Challenges need to be phrased with the tone of care and respect, especially if they are going to end up in some sort of constructive feedback if it's something that you didn't think went really well. But either way, you know, we want to be respectful of our supervisees. We were once new counselors and ideally tied to reinforcement. It can be as simple as, you know what, that was an awesome choice. You know, rewarding what they did after they explained their rationale, saying, you know what? I would have done the same exact thing. I think that was, you know, the best thing that you could have done at that point. Supervisees, often, when you say things like that, hold themselves up, they're like, I did good, and that's awesome. We want to see that. So we want to tie it to reinforcement. If they've had a lot of bad stuff going on and, you know, it was a really bad week or a really bad session, you can say something like, I know it felt like a lot went wrong in that session, but you seem to really have a grasp on what to do differently next time. Maybe there really wasn't much good that came out of the session where you could have said, but this went well, this went well, and this went well. Maybe not. Maybe it was a really bad session, and it just, you know, the counselor was off, the client was off. Whatever the case may be, it was not an A game. But if the supervisee is able to go back and look at it and go, this didn't go well, I Should have done this differently. I should have done this differently in the future. I will. That's what we want. You know, they're not going to break their clients most of the time. So we want to reinforce the fact that we all have bad sessions, we all have B days, and that's okay. The key is to looking back and seeing what caused it, what to do differently to prevent it in the future. And that gives them some reinforcement. So they're feeling like they've got that support. And you're also acknowledging that they have the skills, they know what to do. You've got this. Effective challenges are built upon steps which have already been successfully accomplished. The supervisee needs to have learned the technique and practiced it in supervision. And then you can say, you know, how do you feel trying it with clients next week? Instead of going, you know, I think motivational interviewing techniques, you know, use your. The ors and stuff. When you meet with this client the next time, I think that would be really helpful. Because you've been reading about that, right? And the supervisee might be like, sorta. I read a chapter in one book. I don't want them to feel like they're going in and they're half prepared. I want them to feel like they know what tools they're using and how to implement them. So when we ask supervisees to do things, or even doing a comprehensive assessment, for example, before they go in there, make sure they have the skills to be able to do that assessment and create an integrated formulation, integrated summary. Not all supervisees, not all new counselors can do that. So maybe they can do a great assessment, but they get stuck doing that integrated summary. Okay, we'll do the assessment, and then we'll get together and we'll talk through the integrated summary together. And then next time you can do it on your own. But we want to make sure that we're not asking them to do something they're just not prepared for. Our job partly is to teach. And effective challenges are focused on specific, concrete behaviors such as review your tapes for how many times you used an audible pause. Most of us have a particular sound that we use. It can be. It can be, okay, then whatever yours is, pay attention to how often you use it. If you think your supervisee is using it too frequently, then have them review their tapes so they can pay more attention to it. And that doesn't come up a lot. Every once in a while you'll have a supervisee. And every once in a while you'll have a lecturer in college or Whatever that has an audible pause. That's every fourth or fifth word. And you're just wanting to pull your hair out. Countertransference is projecting unresolved personal issues onto a client or supervisee. We know this. So signs a supervisee may be experiencing are signs that we may be experiencing countertransference towards a supervisee. A feeling of loathing, anxiety, or dread at the prospect of seeing them. Unexplained anger or rage at a particular supervisee. Distaste for working with a particular supervisee. Making mistakes in scheduling, or just forgetting your supervision sessions. A lot of these things, if you saw it in a client, you would say, oh, that may be a transference issue. Well, we need to pay attention to this. If we're having countertransference issues with our supervisees or if they're having counter transference with their clients, it happens. And it could be the way the supervisee dresses. It could be, you know, mannerisms that they have. Whatever it is, as long as you're aware of it, you can manage it. Examples of supervisee transference include Supervisees may idealize the supervisor. So, you know, you want to look out for that and make sure you address any transference issues they're having to you. They may have distorted reactions to you based on their reaction to the power dynamics. They may need acceptance or approval from authority figures. So they're constantly trying to please you, and they may have a reaction to you establishing boundaries. If you say, you really need to try to solve this on your own, and we'll talk about it in supervision next week, if they completely melt down, then you want to take a look at that. Now, obviously, it just really depends on the situation how much they really need that immediate feedback. Supervisor countertransference include us needing approval as a knowledgeable and competent supervisor. Us as supervisors having unresolved personal conflicts activated by the supervisory relationship are reactions to individual supervisees, such as dislike or idealizing some supervisees, whether warranted or not, in comparison to others. You know, maybe you have, you know, LPCs, LCSWs, and addictions professionals that you're all supervising, but you happen to be licensed in one of those disciplines, and you favor the supervisees that are also working towards licensure in that discipline. That might be a form of countertransference that you need to be aware of. Sexual or romantic attraction to certain supervisees and cultural countertransference, such as catering to or withdrawing from individuals of a specific cultural background. Being aware of how supervisees affect you. Supervisors need to be aware that Transference reactions may arise even from the way you decorate your office. Not all emotional reactions are countertransference. Sometimes you may be angry at a supervisee, or they may be angry at you because of something one of you did. It may not be a prior issue. Not all countertransference reactions are harmful. They can give you information about how other people may be reacting to your supervisee in session. Or, you know, it can give your supervisees, if they're having a countertransference reaction with a client, they may start to understand how that client's social circle perceives them. The difference between healthy personal or therapeutic responses to clients and unhealthy responses arise from our own unresolved conflicts. So, for example, having compassion for a therapist who's struggling with a client who's relapsed versus anger at the therapist for not doing it right. You know, if you're still struggling because you're angry at yourself that you had a client that relapsed, and you know, you have a supervisee whose client relapses, and then you start to get angry at them, and you're taking all your shoulda, coulda, wouldas and projecting them onto that client. That's your stuff. Supervisors should not assume a developmental level based on the counselor's experience and training. And, you know, be aware of biases towards programs or prior placements. Addictions counselors, for example, don't have to have a master's degree. It doesn't necessarily mean that they are any less good as counselors. I've worked with three phenomenal addictions counselors. They taught me more in the two years that I worked with them than I learned in graduate school about actually counseling and seeing issues and a lot of other stuff like that. So be aware of your biases. Assess counselors on everything, not just initial impressions, and make sure to determine their developmental level based on their performance in all domains, not just one or two. Like can they counsel and can they do paperwork? But make sure they're also ethical and are aware of their cultural influences and all that stuff. Supervisors should use several sources of information to assess counselor development, including assessments by former supervisors, measurements administered by the current supervisor. Going back to those rubrics again, counselor self assessments. I want to see how good you think you are and where you think you need work. Client ratings. We can get a lot of good feedback from the client's perception and looking at work samples, videotapes, observation, and paperwork. So we have all this feedback. We can provide feedback until the cows come home. Now we Are aware of transference and countertransference, which can bias or affect how we provide feedback. So we're checking that. But what other biases affect supervision? The recency bias. And if you're an administrative supervisor, you're also familiar with this, remembering what happened last week, not six months ago. So if you have a supervisee, an employee who has just the last week or two has been sloughing off, not doing their job. Maybe they've got something going on at home that you don't know about or whatever. But the last two weeks is a significant departure. But up until then they were an awesome employee. And it's time for evaluations. What are you going to immediately start thinking of, most likely when you're doing those evaluations, the recent past, not, you know, what has the entire year been like. The same is true if a supervisee has improved a lot over the year. But the first six months were pretty rough. You don't want to necessarily hold them hostage for that, but you do need to look at the entire time span overemphasis on one factor, such as can they develop rapport as opposed to the bigger picture. Their counseling techniques, documentation, ethics. A lot of your counselors are going to be really good at developing rapport and therapeutic alliance. But then moving the client from point A to point B is a lot more difficult. So we want to make sure that we're looking at everything. Unforgivingness leading to an inability to acknowledge improvement. Maybe they made the same mistake four times after you talked about it in supervision. You want to make sure that you're checking your own attitudes and also asking why did they keep making that mistake? You know, how am I not communicating this well? Or what needs to be different? Prejudice based on negative attributions, favoritism, grouping or stereotyping. And that can be again, based on the type of program they come from, how long they've been in the field, what other types of practicums or internship experiences that they've had. Maybe this person's only been a screener and worked in an assessment unit. So you may group all those people together without really giving them a fair shot to show, you know, maybe they have really wicked counseling skills. They just haven't been able to really blossom yet because they've been in that other role, indiscrimination, which is being either too approving or too critical. So try to find middle ground. Always try to present. Present constructive with encouraging feedback. The confirmation bias is favoring supervisees who agree with us. And it's easy if you've got supervisees who are like, yeah, that's an awesome suggestion. Well, the natural inclination is to be a little bit more favorite towards them than somebody who's constantly challenging you, going, I don't think that's the way it should be in group bias, where you overestimate the abilities and value of the immediate group. So you may think that your supervisees have more skills or fewer skills than they really do. So you want to make sure that you're looking at the individuals, not the whole group. Observational selection bias means suddenly noticing things we didn't notice that much before and wrongly assuming the frequency has increased. So maybe you had a client attempt suicide at your facility and so now you're on high alert, looking for all the things that led up to that. So you're seeing it in the Supervisees tapes and everything. And you're like, how are you? How do you keep missing this? Why are you missing this all the time now, when in reality they've been missing it all along, you just didn't see it. So we don't want to assume that they're suddenly getting a lot worse or suddenly missing something just because we didn't notice it that much before. The status quo bias is unwarranted assumption that another choice which is not ours will be inferior or make things worse. So a lot of times supervisees will have this where they're doing what they're doing and they're afraid to try anything new. So they like the status quo. It's methodical, it's going along, and they don't want to upset the apple cart. But we can fall into that same trap. We like things the way we like them, and, you know, maybe trying something a little bit different is scary. So we want to be aware of that. And the bandwagon effect, which is sort of groupthink, just agreeing with a group instead of stepping back. And we can have this as well as if you're doing group soup, other supervisees in the group can have it. And if everybody agrees that, no, there's no problem there, it's a great session, you may miss something that actually could have been a wonderful teaching point. And the false consensus bias, where we believe that supervisees not only think like us, but they agree with us. So we're assuming that what we would do in a session, they will do in a session. And what we suggest they agree with. That doesn't happen all the time. I can tell you that one. So we want to make sure that we are eliciting from the supervisee. What are you thinking? We're trying to figure out and learn their rationale and their approach. Protecting against biases. Use standardized rating scales for all employees or supervisees use those rubrics as much as possible so you can see rapport building. You can see different interventions being used, you can see how different issues are addressed and create behaviorally anchored rating scales. So it's not just a one through five, sometimes, always, never, it's one never or rarely happen. So less than 10% of the time it was happening, sometimes it happened. So 10 to 25% of the time it happened, etc. So you have something that's a little bit more tangible to say. So you can identify where the supervisee should land on that four point Likert scale. Sources of anxiety for supervisees, Beginner's quandary or fear of the unknown. Address this by using role plays co facilitation in order to bridge the gap. When I first started doing groups I co facilitated and then I started doing groups on my own and offered to do live observation. Especially if you can do it through a two way mirror or a circuit closed circuit tv so you're not disrupting the session, but you're there and the supervisee knows you are. Just in case they get stuck. Supervisees need to be aware that clients are not spun glass, they're not delicate objects. So have supervisees list all of the things that the client has survived, you know, to help them see that our clients are really pretty darn resilient. And have the supervisee put themselves in the client's shoes so they can see, you know, if somebody would have said that to me, what would it have done? And I agree, the spun glass theory does seem to fit supervisors as well. We're not going to break our supervisees. They've gone through graduate school, they've gone through oral boards, so they should be good performance and approval anxiety. We want to ensure early and frequent successes and always remember to point out the positive. Remind supervisees that this is a learning process that takes years and hopefully you will never be done learning. So help them remember that there's always going to be feedback you can get and validate their anxiety with self disclosure. Their dominance anxiety can come out as an unwillingness to speak up. Sort of that white coat theory. It's like the boss is talking. Reinforce the notion that the supervisee knows the client better than you do. Point out how much more effective it is if the client asserts his or her rationale needs and wants. So doesn't it make sense that it's more effective if you also assert your rationale, needs and wants. You know, sort of a similar dynamic. And ensure the individual development plan is tailored around the supervisee's stated goals. Kind of like developing an individualized treatment plan. Identify the supervisee's anxious behaviors and defense mechanisms, such as tardiness, overuse of the supervisor, irritability, or just forgetting to talk about a certain client or use an agreed upon intervention. Address those things as reactions to their anxiety and deal with them that way. Look at the function of the behavior and address it. And assist the supervisee in recognizing and exploring the cognitive pattern and the needs that their behaviors are expressing. Do they need control, Approval, Perfection? If they're afraid of perfect, they're not going to be perfect. Is this why they're forgetting this stuff? Challenge irrational beliefs with questions such as every time, every client I have has relapsed, probably not everyone, so let's look for exceptions here. None of my clients like me, so you have the all or nothing talk or I'm a bad therapist because he dropped out. So we're going to challenge that with what other factors might have contributed to your client dropping out. Assist the supervisee in constructing and remembering to use rational and logical thoughts related to the anxiety or anger, such as, you know, if the supervisee says, my client is so resistant, she blocks me at every turn, then we might want to say, okay, well, if she's blocking you, how is she doing that? And what function might that be serving? So encouraging them to really think it through instead of getting frustrated and meeting anger and frustration. And ask the supervisee to write down the name of each client he or she has and state what aspect of each case currently worries him or her. And then we can talk about it and get that out in the open before supervision starts. Feedback can be anxiety provoking for supervisors and supervisees. Try to develop a metaphor for supervision and providing feedback and and remember the intent and spirit is to help the counselor grow. Ensure when you provide feedback, you provide positive as well as constructive feedback. And if supervisees are doing well, make sure to pose hypotheticals to ensure they're able to respond in a variety of situations, not just when things are going great. Types of anxiety to be aware of include the beginner's quandary, spun glass, need for approval, and dominance. Biases include transference, such as prior experiences with students from that particular program, cultural biases or biases based on other individual factors, recency biases, unforgivingness, overemphasis on one factor grouping or stereotyping and indiscrimination. I appreciate you hanging in there with me. Does anybody have any questions? If not, you are good to go and I can see you or I will see you on Tuesday. There's a question that came in how is tardiness supervisee anxiety or defensiveness? Tardiness? Being late is sort of showing that they didn't want to come. For some reason they're avoiding coming. Maybe they're hoping that they won't get called on. Or if they're late then everybody else will have to go and they won't have to present or you'll find something else to do. A lot of times it's an expression of being afraid of evaluation or something is going on in that therapeutic alliance where they're not feeling comfortable around you. Okay everybody, have a fabulous weekend. Stay warm, stay dry, and I'll see you on Tuesday. If you enjoy this podcast, please like and subscribe either in your podcast player or on YouTube. You can attend and participate in our live webinars with Dr. Snipes by subscribing@allce.com Counselor Toolbox this episode has been brought to you in part by allce.com providing 24.7 multimedia continuing education and pre certification training to counselors, therapists and nurses since 2006. Use coupon code counselortoolbox to get a 20% discount off your order this month.