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The Contextual-Functional Model of Clinical Supervision

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Jeff Chang, Ph.D., R.Psych.Athabasca University &Calgary Family Therapy Centrejeffc@athabascau.ca
Fundamentals of Clinical SupervisionOntario Association for Marriage and Family TherapyToronto, ON June 22-23, 2018 (Day 3)
Relational Positions
Skill Development Coach:Demonstrating and giving feedback on supervisee skills (executive skills; Tomm & Wright, 1979):Generic(e.g., attending, questioning, reflecting, summarizing, information-giving, structuring)Model-specific: How to use generic skills in the service of the specific procedures in accord with a theory of counsellingEncouraging self-observation of skills developmentDiscussion question:What are some favorite ways to teach and/or model specific skills?
Vignette
Kelsey is a Master’s student in counselling who has previously worked as a rehabilitation worker, developing behavior management plans for children diagnosed with autism. She had had extensive training in applied behavior analysis. She was pleased to have obtained a practicum in a local clinic that was well known for solution-focused training. Her supervisor, Liz, found that Kelsey’s skill at asking for specific behavioral descriptions and sequences could be easily transferred to the process of shaping her solution-focused questioning skills.
Relational Positions
Catalyst:Tracking patterns of supervisee response to particular client situations (“countertransference”).Raising these patterns with the superviseeSupporting the supervisee to find the correct (for him/her) way to manage the issueThe supervisee’s view will depend on the theory of counselling he/she espouses, and personal beliefs/valuesDiscussion question:How can we nudge at supervisees’ “blind spots” without bashing them over the head?
Relational Positions
Catalyst:Notice recurrent difficulties with clients with particular presenting problems, family interactional patterns, presentation styles, or “personality types.”Monitor longitudinallyReflect on the viability of the supervisory working alliance and consider who direct you should be.Raise your observation directly and tentatively, owning the concern as yours.Assess the supervisee’s response and any effect on the supervisory working alliance.Evaluate whether you want to suggest a task of action or an observational task.Monitor longitudinallyDiscussion question:How can we nudge at supervisees’ “blind spots” without bashing them over the head?
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… At one of their regular supervision sessions, Sandy mentioned to Carol that her work with Amy, who had a similar life circumstance, but had moved her widowed father into a nursing home, was not going well. Sandy admitted she thought Amy had not tried hard enough to keep her father at home. They seemed to be talking in circles. Carol wondered whether the therapeutic impasse was related to Sandy’s personal situation. She gingerly self-disclosed how she felt stuck, or less than objective, occasionally at different points in her life journey, and asked if this might be behind Sandy’s therapeutic impasse with Amy.
Relational Positions
Professional gatekeeper:Entering, formative, and summative evaluationMonitoring and giving feedback to supervisees re: educational program policies and licensing requirementsReporting to educational programs and licensing boardsResolving performance issues, if presentOut-counselling supervisees unsuitable for the profession
Relational Positions
Professional gatekeeper:Discussion question:How do you balance evaluation and development? How do you maintain self-awareness about how to position yourself accordingly?
Relational Positions
Organizational/administrative supervisor:Ensuring compliance with policies and proceduresAddressing performance issues, if presentPolicies are ethical or accountability needs, operationalized.Supporting supervisees with time and workflow managementClinical record-keeping and time management are often the first indications of therapist impairment.Discussion question: How is administrative performance related to clinical competence?
Relational Positions
Personal supporterListening respectfully to events/struggles in supervisees’ personal livesProviding personal support, within the bounds of professional boundariesNOT THERAPY:performance vs. personalDiscussion question:When providing personal support to a supervisee, what indicates to you that you should make a referral for therapy?
Vignette
John, a pre-licensure psychologist in a private practice, was uncharacteristically late getting assessment reports completed. Most of these were parenting assessments done at the request of the local child protective service (CPS), necessitating postponement of court dates. CPS workers were calling John’s clinical supervisor and the owner of the private practice, Dr. Kelly, to complain. When Dr. Kelly asked John about this, he tearfully blurted out that his wife had been having an extramarital affair, which preoccupied him day and night. He felt unable to concentrate on work, and profusely apologized for letting things slip….
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… Dr. Kelly listened carefully and empathically to John. Together, they negotiated a plan to manage the incomplete and late work, and address the concerns of the CPS workers, who were a prime referral source for the practice. They also negotiated a reduction in John’s workload so that he could manage adequately, including John’s request to decline any marital therapy cases from an EAP contract the practice served. Dr. Kelly and John also discussed whether John required a referral to therapy, and what modality (couple or individual). Finally, Dr. Kelly recommended some readings on therapist impairment.

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The Contextual-Functional Model of Clinical Supervision