Clinical supervision is a social process in which supervisors work together with their supervisees to promote clinical care. Good supervisors observe, counsel, train, assess, inspire, and create a surrounding that enhances self-motivation, knowledge, and professional development. Competency based clinical supervision is a process of supervision that describes the competencies needed for good practice. It is a standard approach employed by psychological health professionals when providing supervision in educational, training, and medical fields. It thus acts as a guide in both medical and supervisory competencies and is accountable for current legislative initiatives that require training during supervision (Chapin 208).
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Clinical supervision is vital for the establishment of professional competence in mental professionals. Research shows that “clinical supervision is the most critical facet of the psychotherapy training endeavor” (Falender and Shafranske 17). Supervisees see clinical supervision as an essential component of training since it enhances their therapeutic responsiveness and increases their capacity to work with their own emotions and reactions.
While the establishment of therapeutic competence is one of the objectives of clinical supervision, it should be recognized that the major objective is to enhance the quality of the therapeutic procedure for the sake of the client. The idea of clinical supervision is that it alters some features of the therapist, which results in proficient delivery of psychiatric therapy and subsequently, good outcomes for the patient.
The dual objectives of supervision, establishment of therapeutic competence and enhancement of the quality of therapeutic procedure, can be achieved in many distinct ways and “there are probably as many approaches to supervision as there are supervisors” (Falender and Shafranske 7).
Supervision is vital in the medical training of psychological health professionals. In competency based clinical supervision, tools which assist the supervisors in implementing collaborative practices in a competency-based context are required. Competency based clinical supervision is intended to help medical supervisors who are new in the medical field enhance their skills.
It is also designed to assist clinical administrators who are interested in creating a new method of clinical supervision or advancing an already existing one. This type of supervision is necessary and vital in improving customer care and leads to professional improvement of the staff. This paper will discuss Competency Based Clinical Supervision with specific focus on the role played by Chemical Dependency counselors, social workers and licensed professional counselors in curbing drug addiction issues.
Through clinical supervision, mental professionals are provided with a private, safe, and encouraging environment, which enables them to reflect on therapeutic practices. This helps improve the quality of services offered to patients as the clinical professionals adhere to a framework of supervision.
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Competency Based Clinical supervision is carried out by experienced Chemical Dependency counselors, social workers or licensed professional counselors. These help unconventional practitioners to develop a clinical identity and to acquire the knowledge and talents required for effective practices. The supervisor acts as a guarantor in the protection of patients and other clients against shoddy practices and undesirable results.
Clinical supervision in addiction counseling is different from other types of supervision in the medical field. It deals with advising individuals on the dangers of substance abuse. Many drug addiction supervisors and counselors were once drug addicts and it is reported that 38% of them counsel during their recovery stages.
Supervisors in the nation are entitled to certain qualifications and licensing though those lacking these qualifications are considered great in counseling drug addicts due to the life experiences. Counselors recovering from disorders arising from substance use need to be monitored due to issues arising from relapse. Research has shown that there is a significant difference between recovering and non-recovering counselors. Non-recovering counselors exhibit low levels of job satisfaction, organizational disloyalty, and reduced turnover intentions (Marsh and Sandra 75).
What Makes for Good Supervision?
Good supervision is a dynamic practice for the supervisor and the supervisee. Because of the practical nature of clinical supervision and the need to establish a trustworthy and open working environment, there is need for attention when it comes to the setting of clinical supervision. For clinical supervision to be successful, supervisors need to be weary of the task’s limits in understanding the client. They have to assist the patient to become ‘the best therapist that they are capable of becoming’ (Myers and Don 662). The supervisees need to be honest and obedient to the supervisor. They should assess their suggestions without becoming overly defensive.
Since clinical supervision is complicated, there is need for considerable attention from both the supervisee and the supervisor. Another requirement for effective clinical supervision is that it should be consistent and dependable. There is need for clear boundaries to allow for the exploration of complicated issues. For instance, clinical supervisors who are at the beginning of their remedial career are required to be reliable in terms of how frequent and for how long they meet with their supervisees.
Attention should be given to the anticipations of both partakers, that is, the supervisor and the supervisee. Clarity is a necessity in clinical supervision, especially in cases where group supervision is involved. In such circumstances, the supervisor should allocate time for each person in the group. The supervisor should always establish a good setting for the supervisory procedure. He should create an environment that encourages free communication between him and the supervisee. Drug addicts should feel free when relating with the supervisor.
Once the above requirements are in place, then, both the supervisor and the supervisee should now adhere to the basic tasks of supervision, which include having an account of what has taken place and reflecting on what has transpired between the supervisor and the supervisee. The supervisee should inform his supervisor what happened during his counseling session with the patient.
Addressing Personal Factors in Supervision
Clinical supervisors draw on both individual and professional sources when carrying out mental treatments. The morals the supervisors derive from these sources “become so intertwined that it is virtually impossible to differentiate among them.” (Falender and Shafranske 242).It is, therefore, important for clinical supervisors to understand all the influences from beliefs and culturally entrenched values to unsettled differences.
The major aim of competency based clinical supervision is to help the supervisee to become aware that the process of psychiatric therapy is value-laden and that personal values and ideas about human beings are incorporated in the theories and procedures that guide the remedial procedure. The practice of supervision is subject to individual influence and the supervisors must be aware of the ways of life, values, and characteristics that unavoidably influence their practice.
Regardless of its theoretical perspective, clinical supervision entails human commitment and understanding. Personal interactions act a basis for interpersonal competencies in clinical supervision and influence the supervisor’s ability to facilitate the supervisory process. Through addressing personal factors in clinical supervision, the supervisee appreciates the connection of individual and professional factors, internalizes the attitudes of the supervisor, and comes up with tactics that effectively makes the patient an ally in the clinical supervision process. In clinical supervision, clinical supervisors and supervisees should strain the normative and pervasive contributions of individual factors.
In clinical supervision, supervisees are supposed to examine their clinical activities and since this involves personal contacts, it may encourage anxiety and shame. Supervisee shame, which is the “the globalised sense of not being enough” may be enhanced in supervision, especially due to the fact that there is some level of hierarchy when it comes to the relationship between the clinical supervisor and the supervisee (Thomas 1700). Supervisee shame may make the supervisee to reveal what takes place in therapy and the supervisory union may split up to a point where the activities leading to accomplishment of the supervision objectives cannot be performed.
The supervisor can stop supervisee nervousness and shame by using a sympathetic supervisory style, which praises the supervisees when they exhibit proper behaviors in the supervisory session. Supervisors can also stop supervisee’s shame by focusing on the experience of the supervisee in terms of the supervisory relationship in a sympathetic and supportive manner (Falender & Shafranske177).
Building Technical Competence
Technical competence is a central issue in clinical supervision both in establishing the psychology curricula and in setting standards for practice. The approaches involved in building technical competence include input and output models. The input model focuses on the academic curricula required to produce a proficient psychologist while the output model outlines the activities that make a competent psychologist able to work independently. Competence in clinical supervision is vital to both models and ensures that both occur (Falender and Shafranske 206).
Building technical competence also involves the developmental model and the supervision specific model. In the developmental model, clinical supervision entails the supervisee consulting from supervisors who are more experienced in clinical supervision. This enables him to draw on their knowledge and skills.
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The model concentrates on the educative functions of clinical supervision and clarifies the distinct steps that mental professionals should go through in their professional growth. The supervision specific model helps build technical competence by concentrating on the functions and responsibilities of clinical supervision. The model evaluates the administrative functions of the clinical supervisor as well as the ethical issues involved. It establishes a good learning relationship between the supervisor and the supervisee by identifying their strengths and weaknesses (Thomas 1700).
Alliance in Therapeutic and Supervisory Relationships
Therapeutic alliance is vital in psychotherapy and is considered highly significant in supervisory relationships. Six supervisory elements demonstrate alliance in supervisory relationships. These include style, use of power by the supervisor, self-disclosure, attachment style, evaluation practices and good ethical behavior (Falender and Shafranske 200). Research shows that the value of the relationship between the psychotherapist and the patient has a great impact on the outcomes of supervision. Accordingly, many modern psychotherapists focus on the counseling power of the supervisory relationship. Research shows that;
Factors common to different psychotherapies, such as whether or not the therapist has established a positive working alliance with the client/patient, account for much more of the variance in outcomes than specific techniques or modalities (Isaac and Mitchell 21).
It has been theorized that therapeutic relationship is made up of three parts, which include the working union, counter transference and the actual relationship. The working union is referred to as the association between the patient and the psychotherapist. It is composed of tasks, objectives, and bond. Objectives refer to what the patient expects to achieve from the supervision based on his areas of interest. Tasks refer to what the supervisee is supposed to do to help the patient achieve his objectives while the bond refers to the ability of the supervision to bring the patient closer to his objectives. Therapeutic relationship is a good predictor of the outcomes clinical supervision.
When the relationship between the supervisor and the supervisee is good, and the clinical supervisor offers high levels of compassion, warmth, recognition, validation, and authenticity, the supervisee’s capacity to learn such skills and to apply them in advising clients is improved. Supervisory relationship influences the outcome of clinical supervision. For instance, the presence of destructions in the supervisory relationship makes the supervisees to be dissatisfied and this may adversely affect the outcomes of the process. It is therefore vital for supervisors to constantly keep an eye on the supervisory relationship, and address issues arising from the relationship.
Building Diversity Competence in Supervision
Psychologists have recognized the importance of training learners to serve patients from diverse groups. The diverse groups are characterized by race, ethnicity, sex, and physical abilities. Research in clinical supervision has however shown that many training programs do not offer courses that deal with diverse populations. There is therefore need for more efforts in building diversity competence to promote the provision of better services (Falender and Shafranske 206).
While building diversity competence in supervision, psychotherapists should offer services, train and carry out research with persons and only in regions within the limits of their proficiency based on their academic achievements and professional experience. Clinical supervision should put into consideration diverse factors such as age, sex, gender identity, traditions, race, nationality, religious conviction, sexual orientation, verbal communication, and socio- economic position. Clinical supervisors need to be competent by treating diverse supervisees independently without accounting for differences environmental niches and identities.
According to Falender and Shafranske
It has been determined that we have not adequately defined competencies necessary for service provision, nor have we been mindful of the cultural or diversity aspects of personhood—involvement of the person who is the client in all of that individual’s complexity” (Falender and Shafranske 120).
Ethical and Legal Perspectives and Risk Management
Psychologists face ethical and legal predicaments during the supervision process. The relationship between the patient and the physician is ethical. Clinical supervisors and supervisees should define and sustain moral, professional, individual, and social associations.
Physicians should cure and take good care of their patients while at the same time working hard to maintain their self-esteem. A Psychologists ethical behavior towards his clients strengthens the relationship between the patient and the physician as well as the relationship between the patient and the community. The physician should always ensure that the patient is well informed about his condition, proposed treatment, other treatment options, and the involved risks. The main ethical principle in clinical supervision is the psychologist recognition that the client has the power to accept or reject treatment (Falender and Shafranske 120).
Research shows that many clinical professionals are not aware of the risks, both ethical and legal, that accompany clinical supervision. Research shows that “An increased attention has recently been paid to supervisor liability and malpractice. Pivotal to the concern is the principle of respondent superior or vicarious liability. One who occupies a position of authority or direct control over another (such as a supervisor and supervisee) can be held legally liable for the damages of another suffered as a result of the negligence of the subordinate” (Falender and Shafranske 27).
The clinical supervisor should be able to defend his supervisory activities even in circumstances where his supervisee is wrong. This is because he is responsible for the supervisee actions when it comes to the treatment of patients. The ethical codes for practitioners in mental health talk of the moral issues involved in clinical supervision. According to the NASW, social workers in the field of clinical supervision should have the required knowledge and talents to supervise effectively, and should supervise only in their fields of knowledge and proficiency. The social workers should set clear, suitable, and culturally acceptable boundaries. They should avoid multiple associations involving risks that are harmful to the supervisee such as manipulation. They should assess the performance of the supervisee in a just and respectful manner.
The primary responsibility of a clinical supervisor is to keep an eye on the services offered by other supervisors and supervisees. He should make sure that patients are aware of the experiences of the supervisees who offer services to them. He should incorporate the policy of informed consent into supervision. As a professional, he has the power to terminate supervisory associations with prior notice. It is recommended that professionals in clinical supervision adhere to the ethical guidelines by frequently reviewing the codes.
To avoid ethical problems, the supervisor should have knowledge concerning every patient the supervisee is handling. He should monitor all the activities and verdicts of the supervisee since this can help in averting legal and ethical issues. The supervisor should only work within the area of his proficiency and request for more supervision if need be. Supervision beyond the supervisor’s proficiency leads to negative results and, therefore, saying “no” to issues that the supervisor is not proficient enough is an ethical responsibility.
Evaluation of the Supervisory Process
For clinical supervision to be successful, then a structured approach in assessing and evaluating the supervisee should be adopted. For effective evaluation, the supervisor should converse the evaluation techniques to supervisees and establish written contract, which clearly states the agreements. He should recognize the strong and weak points of the supervisee. Positive feedback criteria should be used during assessments accompanied by multiple counseling skills and methods. Finally, the supervisor should maintain a sequence of work samples for collective evaluation (Falender and Shafranske 36).
Evaluation of the supervisory process is done in a sequence of formal and informal undertakings that lead to an opinion that an “individual is fit to practice a profession autonomously”.
Summative supervisory evaluation entails
how effective or ineffective, how adequate or inadequate, how good or bad, how valuable or invaluable, and how appropriate or inappropriate the trainee is in terms of the perceptions of the individual who makes use of the information provided by the evaluator (Isaac & Mitchell 2).
Clinical supervisors are responsible for collective evaluations of supervisee proficiency. Supervisory evaluation is “the moment of truth when the supervisor steps back, takes stock, and decides how the trainee measures up” (Gilbert and Evans 105). Efficient evaluation requires well-delineated objectives that can be evaluated both qualitatively and quantitatively. The heart of clinical supervision is a continuous influential process, which makes use of feedback and improves trainee talents. Bernard and Goodyear refer to clinical evaluation as “a constant variable in supervision which involves either an overt or covert formative evaluation component (Gilbert and Evans 105).
An organized approach to supervisee evaluation leads to advantageous outcomes. Clinical supervisors should minimize their anxiety as well as that of their supervisees in the supervision process. The implications associated with the evaluation can be changed to suggest a constructive experience from which both the supervisor and the supervisee can mature and learn. Supervisors who express their implemented “supervision theory” should elucidate their evaluation principles as well as their supervision activities. When dealing with clinical supervision, supervisors should adopt multiple evaluation techniques, which lead to the supervisee’s sense of self-respect and accomplishment (Niles 386).
Competencies required for good practice
For clinical supervision to be effective, certain competencies are required. The competency framework for clinical supervision should involve elements such as knowledge in the field of psychotherapy, talents when it comes to relating with the client and finally values.
One of the primary objectives of clinical supervision is the development of certified competence, which entails;
The habitual and judicious use of communication, Knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and community served, (Falender and Shafranske 206).
This requires the achievement of knowledge followed by concentration in performance and results. For clinical supervision to be effective, there is need for supervision competence, which is the result of many constituent competencies that when put together influence the psychotherapists competence in supervision.The clinical supervisor should frequently evaluate his supervisory actions to see whether he is developing professionally. He should learn to consult his colleagues since this helps him to model and teach his supervisees what is required for autonomous clinical supervision practices.
Chemical Dependency counselors, social workers and licensed professional counselors all make use of efficient stress reduction techniques while advising drug addicts. The techniques help in calming the clients’ minds and increase their awareness on the dangers caused by drug abuse. The drug addicts learn effective ways of managing stress and are thus able to manage their personal lives. Addiction counseling is thus the road to a healthy and more industrious life for drug addicts.
It is recommended that clients learn how to deal with society stigma associated with drug abuse and to seek treatment for psychological health and drug abuse disorders. Drug addiction counselors and clinical supervisors should pay more attention to drug addicts whose disorders are medically and psychologically severe. Since the “quality of the clinical supervisory relationship is clearly important to counselors,” (Myers and Don 622), then clinical supervisors should work hard to maintain good relationship with their clients. For clinical supervision to be effective, then the supervisors should adhere to the above-mentioned guidelines.
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