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Many clinical supervision models identify 3 stages of supervisee development: Beginning, Middle, and Advanced. Motivational Interviewing (MI) skills are easily adaptable to these 3 stages of supervisee development and can help to provide direction for the clinical supervisor in the supervisory sessions. 

Using MI skills in clinical supervision offers an opportunity to role model a theoretical modality during the supervisory session. If both the supervisor and supervisee are familiar with MI skills then it also allows for a common language to be shared, building an alliance while increasing the confidence of the supervisee.

In the Beginning Stage of Supervisee Development the supervisee is:

  • Gaining basic clinical skills
  • Wanting to appear confident and an expert
  • Self-focused
  • Often feeling inadequate or identifying with imposter syndrome

Motivational Interviewing emphasizes building a relationship of empathy, curiosity, and collaboration which is at the foundation of all clinical work, including clinical supervision. Supporting a supervisee as they are beginning their clinical practice requires careful attention to their vulnerability while they present their cases and documentation for feedback and review. The skill of Engagement is the 1st of the 4 Processes of Motivational Interviewing and is a useful tool in the supervisory relationship.

The Middle Stage of Supervisee Development is often distinguished by:

  • Increased exploration in clinical modalities
  • Increased internalized confidence 
  • Ability to recognize their own impact in the relationship with client
  • Willingness to admit mistakes and experiment with their own style

During this Middle Stage of Supervisee Development the supervisor is able to role model all 4 Processes of Motivational Interviewing which are Engagement, Focusing, Evoking, and Planning. An astute clinical supervisor will ask the supervisee for their solution; elicit their view; explore; and expand on the thoughts and ideas of the supervisee. Reviewing the use of these skills with the supervisee opens the door for practice, discussion, and feedback

Movement into the  Advanced Stage of Supervisees Development is characterized by:

  • High skill acquisition and mastery in one or more clinical modalities
  • High confidence in various clinical roles
  • Comfortability with the complex nature of the clinical relationship
  • High autonomy and understanding of when to ask for help

The 4 core Motivational Interviewing skills, or OARS, are Open questions, Affirming, Reflecting, and Summarizing. These skills, though applicable throughout all the supervisee stages of development, are particularly useful in the Advanced Stage. Keeping clinical supervision effective as clinicians become more skilled is a challenge for many supervisors. Listening for the nuanced feelings and values of the supervisees in addition to the issues they might avoid is a complex reflection skill.

The spirit of partnership, evocation, acceptance, and compassion are fundamental to Motivational Interviewing. All of these are essential in developing an open and safe environment in supervision with the goal of the supervisee growing and evolving into a skilled clinician. Each of the skills in Motivational Interviewing are applicable when providing clinical supervision since both put the focus on change as a result of collaboration. Coupled with other supervision models, it affords the supervisor another tool in their supervisory toolbox.

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Resource:

Miller, W.R.  & Rollnick, S. (2013) Motivational Interviewing: Helping people to change (3rd Edition). Guilford Press.

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We welcome guest columnist, Dayna Guido.  Dayno is presenting a live webinar with Hillary Bolter on March 10, 2023, "Using Motivational Interviewing Skills in Supervision". You can find details about this course here.

About Dayna Guido:

Dayna Guido, MSW, LCSW, ACSW has over 40 years of experience as clinical social worker, clinical supervisor, and trainer. She is the author of Creative Ways to Learn Ethics: An Experiential Training Manual for Helping Professionals and The Parental Tool Box: For Parents and Clinicians. 

 Dayna taught for 23 years in graduate programs and is in private practice in Asheville, NC specializing in providing clinical supervision and ethical consults. She currently leads virtual supervision groups for fully licensed clinicians and supervision groups for supervisors.

 Using expressive arts in therapy, supervision, and training is one of the ways Dayna keeps her own skills evolving and fresh. Recently she developed The Ethical Courage Decision Making Model and is now expanding the idea of Intuitive Mindfulness and how it can be used in clinical settings.

The COVID-19 pandemic has been in place since March of 2020, almost three years. The majority of clinical social workers, and other mental health clinicians, have been providing mental health services virtually during this time.  The initial switch from seeing patients in-person to seeing them virtually was a difficult one for many clinicians, even one that violated the way that some Codes of Ethics say that psychotherapy should be practiced.  

The question of whether psychotherapy should be conducted through videoconferencing or audio-only platforms has shifted to whether it is safe to return to the office to provide the ever-increasing need for mental health treatment (from 20% to 50% of the country).  About 30-40% of clinicians have decided to maintain their practices virtually and have given up their offices.  For clinicians who have been debating whether they want to return to the office and/or are anxious to do so, there are several factors to consider, as follows:

There are many factors that contribute to the success of a telehealth encounter, as there are many factors that contribute to the success of an in-person encounter. Ideally technology should not represent a barrier or challenge to conducting a successful telehealth visit, especially in terms of establishing a feeling of rapport between patient and provider. Technology is just the means to accomplish an end – providing effective and efficient healthcare to patients. The expectation that it is the same as in-person is misplaced as the expectation really is that it should be equivalent. It cannot be denied that the use of technology as a means of communication fundamentally changes the nature of an encounter. This change however should not be regarded as negative – there are actually some people who communicate better virtually than in person and vice versa. The differences between in-person and virtual encounters need to be acknowledged and participants need to be aware of these differences and learn how to adjust their actions and communication styles to accommodate the differences.

We've invited Terrance Williams, founder of Meta Wellness. His company provides virtual reality platforms for mental health professionals to host their Telehealth sessions in virtual reality. Terrance has been a pivotal pioneer in bringing Telehealth into the next stage of technology: Virtual Reality.

Meta Wellness specializes in creating virtual reality spaces for behavioral health clinicians and their clients in the metaverse. Terrance was inspired by the virtual reality space a couple of years ago. He wanted to make a valuable impact in the telehealth space by creating virtual reality platforms that were fun, challenging, and different. Terrance prides himself on making clients feel less shamed and judged in sessions within the creative digital spaces. He shared that a mental health therapist just recently thanked him for saving clients' lives by developing this innovative and interactive platform.

Like all behavioral health professionals, social workers are making increased use of technology to deliver services to clients, communicate with clients, gather information about clients, and educate students and practitioners. The advent of technology—including Internet, text (SMS), email, video, social media and networking, cloud storage, and other forms of digital communication and software—has introduced novel and unprecedented ethical and risk management challenges. These dramatic changes in the ways that social workers use technology have led to major efforts to develop new standards in the profession. These efforts have occurred in three distinct, albeit related, domains: (1) practice standards, (2) regulatory and licensing standards, and (3) code of ethics standards. It is essential that today's social workers be thoroughly familiar with these significant developments to ensure that their practice complies with prevailing standards.

Since the COVID-19 pandemic, many educational systems have adapted their service  delivery model to serve the needs of students. The impact of COVID-19 continues to disrupt traditional forms of education, and many schools and universities have turned to virtual learning to continue providing education to students. While virtual learning can offer flexibility and convenience, it can also bring its own challenges that can negatively impact students' mental health. Providing psychological support to students in a virtual context is essential to ensure their well-being and academic success.

This article highlights the advancement and necessity of an Empowerment approach for supporting help-seekers. Empowerment Psychology has its roots in community psychology, multicultural, and social work theories. The early emphasis on empowerment is associated with building up disenfranchised communities and supporting individuals through a sociopolitical lens (Rappaport, 1981). Zimmerman and Warschausky (1998) argued that the empowerment construct has inherent variance according to one's access to resources, but must include intrapersonal, interactional, and behavioral components. Various empowerment models express these components (Bakari, 2022; Cattaneo & Chapman, 2010; Masin-Moyer, Kim, Engstrom & Solomon, 2022).

What characteristics make a phenomenal supervisor? What about a not-so-great one? It has been an amazing few years of holding space for the community’s stories of mental health and clinical supervision, including the need for something different, something modern, and something more. For many mental health professionals, we’ve had a challenging experience of feeling unsupported or unheard by a clinical supervisor. It’s an experience that feels ever more significant when we recognize that supervisors shape us as new clinicians in the field.

It Started Out Personal

Poor supervision is how my journey started. I left graduate school with an experience of supervision that felt confusing and concerning because of an absence of boundaries. Fortunately, Christina (now my co-author and co-founder) was my next supervisor in agency work and she showed me what it was like to receive compassionate support and empowered leadership, which resulted in me meeting my full potential as a young clinician. Several years into the field, I was promoted into a supervisor role and was determined to do something different for my supervisees.

A Modern Approach to Supervision

Christina started as my supervisor and is co-founder of Supervsionary, LLC, our co-owned business focused on trainings and tools for providing quality clinical supervision. Christina and I both recognize our responsibility to the next generation of clinicians through our roles as mental health leaders and clinical supervisors. Having both worked in community mental health and actively participated in the professional development of dozens of green therapists, our awareness of supervision needs was intensified when we discovered that the most current well-known model of clinical supervision was developed in 2005. So much has changed since then! In response to our own work with supervisees, The Empowerment Model of Clinical Supervision was defined in 2018 and in 2019 the book was released, thus introducing The Empowerment Model of Clinical Supervision to the greater mental health community.

What is The Empowerment Model?

What does it take to show up as an effective supervisor that can empower and support others? A brief exploration of redefined roles within the supervisor and supervisee relationship is a valuable place to start. The Empowerment Model names and defines roles of:

  • Self
  • Leader
  • Researcher
  • Teacher
  • Consultant
  • Colleague

You’ll notice that the role of counselor from previous models is intentionally omitted for several reasons, including efforts to respect boundaries and avoid dual roles in the supervisory relationship.

How is this Model Different?

Beyond The Empowerment Model reflecting modern roles within a fluid model as opposed to a traditional stair-step model, our initial research findings also indicated that supervisees who were engaged in The Empowerment Model by their supervisors showed statistically significant improvement in categories of General Supervision, The Administrative Counseling Process, The Clinical Counseling Process, and The Conceptualization Process compared to the control group. 

Why a Second Edition?

Respecting that things continue to change quickly within the mental health field, we felt it was time to add to the book in areas that support the ongoing development of supervisors and their supervisees. The second edition:

  • Recognizes Telesupervision practices as the result of the Pandemic
  • Offers 47 clinical vignettes instead of the original 33, with added content on navigating interpersonal difficulties with supervisees in addition to client critical incidents
  • Provides Author Anecdotes for added illustration of concepts and story
  • Introduces the Ninety Minute Clinical Supervision Framework for ongoing supervision meetings

Where Do I Learn More?

If you are curious about The Empowerment Model and it’s possible application to your own work as a supervisor, leader, or therapist, you’re in luck! We have several options for how you can take a deeper dive into The Empowerment Model and it’s fit for you!

You can:

  1. Join us for a training on The Empowerment Model through TCI on January 20, 2023, with CEs by registering for this course
  2. Purchase the 2nd edition book at Amazon (beginning January 2023)
  3. Select self-paced trainings for continued professional development
  4. Explore free templates and downloads at the website
  5. Watch various role plays of clinical supervision topics on YouTube

It’s time to take your clinical supervision and mental health leadership to the next level. We can’t wait to hear how these supervision materials have enhanced your clinical supervision work within community mental health and private practice!

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We thank our guest columnistKhara Croswaite Brindle, MA, LPC, ACS.  Khara is the co-owner and co-author (with Christina Murphy) of Supervisionary, LLC and The Empowerment Model of Clinical SupervisionPlease join us for the course she presents for TCI, The Empowerment Model of Clinical Supervision: A Modern Model for Private Practice and Community Mental Health

About Khara:

Khara is passionate about giving people aha moments that create goosebumps and catalyze powerful action. She began her career in community mental health and managed a team of 15 green clinicians who served at-risk youth and families. Khara has provided quality individual supervision since 2014 and currently enjoys providing supervision of supervision to support colleagues in developing their leadership style. She is a Licensed Professional Counselor, Approved Clinical Supervisor, and owner of a group private practice in Denver, Colorado. Khara is the co-founder and co-author of The Empowerment Model of Clinical Supervision, which launched in 2019. She has developed a Supervision Empowerment Academy for mental health leaders and provides clinical supervision training opportunities and consultation within the mental health field.

You can read more about Khara by clicking here and here

 

Dr. Jennifer Sweeton, neuroscientist, clinical and forensic psychologist, best-selling author, and expert on trauma, talks with Ray Barrett from Telehealth Certification Institute about neuroscience and telemental health services.  Dr. Sweeton offers her passion and unparalleled insight about how mental health professionals can activate neurological processes with clients using various telmental health platforms. She will both shock and inspire you with her insight about services and the ways that clients can benefit from them.

With the COVID-19 pandemic shocking the world in 2020, many mental health practitioners began to utilize various telemental health services with their clients.  Dr. Sweeton and her research on these topics allow clinicians to gain insight and understanding of the fundamentals of telemental health as it relates to the services that we provide our clients.

As telehealth becomes a more established practice for both clinicians and their clients, the convenience of it opens many doors to both the busy and the disabled. However, as we shift more attention to telehealth practice and develop that as an option to clients, it's important to understand the ways that cyber communication can affect both the relationship and individual. While telehealth appointments offer many advantages to clients and clinicians, understanding the limitations of them, and the nuance of how they affect bonding and trust is key to developing trust and the ability to help your clients. People act differently, depending on their setting, and that is especially true when placed against the semi-anonymity of the internet. 

 

Hyper Personal Effect Theory

Developed by Joseph Walther in 1996, hyper personal effect theory was a theory that came from studying the effects of commuters in mediated conversation, and it a theory that should be kept in mind when dealing with clients via text based exchanges. Walther suggests that visual and verbal cues are key components in developing relationships, and the lack of them in cyber communications can lead to deeper and intimate connections quicker than in other situations. Cyber communications can be a beneficial way of communicating with clients, but the nature of text based communication without the benefit of verbal or visual components is that there is more time to craft an image, tailor it to the perceived wants and desires of the other party, and present that image in the best possible light. Without tonal inflection to read and body language to assess, the only thing to go on is the words on a screen. It is important to keep hyper personal effect theory in mind when communicating with clients, but also when discussing their own relationships--more and more frequently, people are finding friendship and romantic relationships in online spaces, and the immediacy of the relationships found there can become an emotional problem--for clients who spend the majority of their social interactions in online spaces, understanding hyper personal effect theory and what bearing it might have on those developing relationships is an essential piece of their care.

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