Counseling Today, Cover Stories

A steadying hand

By Laurie Meyers November 1, 2014

Receiving supervision is an experience common to all counselors. Some view it as little more than an experience to be endured — another box to be ticked off the list in pursuit of a counseling degree or counselor licensure. Perhaps that’s because securing the proper supervision can be a frustrating, time-consuming and expensive proposition, especially at the beginning of a counseling career when Bird landing on an outstretched handthe paychecks are low and the burden of student loan debt is heavy.

Many other counselors, however, possess a different perspective, believing that all the “gains” achieved through supervision are worth the potential “pains” that accompany the process. Professionals who study and provide counselor supervision contend that the supervisory experience is critical to a counselor’s development. Many of these professionals also think that supervision is something counselors should seek throughout their careers — not just at the beginning of a career — from senior colleagues and peers.

Counseling Today recently spoke with several counselors about what makes a supervisory relationship work, as well as some of the challenges inherent in supervision.

A reflection of the counselor-client relationship

In a recent small study, American Counseling Association members M. Kristina DePue and Glenn Lambie found that effective supervision is more about the relationship itself than the particular methods or strategies used during supervision (studies have found, of course, that the same holds true with the counseling process). Lambie and DePue examined satisfaction ratings by supervisees and supervisors and found that high satisfaction ratings correlated with greater competency levels during the practicum process.

As with the counselor-client relationship, the supervisor-supervisee relationship should include trust and acceptance, says DePue, an assistant professor of counselor education at the University of Florida. As a constructivist, she believes the supervision process is (or should be) a holding environment — one of support, challenge and continuity.

“I know that might sound odd to many people,” DePue says, “but when we think about it, counseling serves the purpose of providing a safe space for growth and change. In reality, supervision does the same thing. Therefore, we should expect to see very similar patterns in these relationships.”

In fact, DePue thinks that in order to provide understanding and effective supervision, those who supervise must keep the therapeutic relationship in mind.

“Students aren’t that dissimilar [from] our clients,” she points out. “They are attracted to this profession for various reasons, but oftentimes they come to training with a history of wounds that need healing. Supervisors should know what to expect from trainees at a particular developmental stage. For example, if we are working with practicum students, skill acquisition and self-awareness may be drastically less than [it is in] a person in their first year of licensure. It is important to consistently think about the individual student and what they need at this point in the trajectory of their career. Always be mindful that students are developing skills and developing personally. We can help or harm their development, and I think having realistic expectations is a huge part of not being too critical or harsh on students.”

Lambie, a professor of counselor education and chair of the Department of Child, Family and Community Sciences at the University of Central Florida, agrees about the importance of maintaining an environment in which supervisees are able to be themselves and feel comfortable trying different things.

Referring to his supervision of students, Lambie says, “We don’t want it to be just sink or swim. When you’re new you need feedback, and we want to provide you with that feedback.”

Lambie’s advice to other supervisors is to remain mindful throughout the process. “Be purposeful in trying to develop a strong supervisory bond. Don’t just take it for granted,” he urges. “It’s important for a supervisor to model what he or she wants to support in his or her supervisees. If I want you to be more empathetic but I’m yelling at you, I don’t think that’s going to be a good experience.”

Critical support

During their professional journeys, many counselors experience critical incidents — specific moments or cases that cause them to question the path they’re on. Oftentimes, these critical incidents can be positive, serving as turning points that deepen a counselor’s sense of professional identity, says Ruthann Smith Anderson, an ACA member and past president of the Ohio Mental Health Counselors Association. However, when a supervisee experiences a critical incident, the encounter can be overwhelming. Supervisors need to recognize when supervisees have had a critical incident so they can help guide the supervisee through it.

“There are moments when counselors-in-training come up against something they don’t expect in terms of who they are in counseling and what counseling is. It can cause them to question themselves, their qualifications and capabilities,” says Anderson, a licensed professional clinical counselor supervisor (LPCC-S) and an assistant professor of counseling and human development at Walsh University in North Canton, Ohio.

Critical incidents among supervisees often involve questioning professional identity, difficulty with the complexity of real-life cases and even struggling with the supervision process itself, Anderson says. In some cases, supervisees are dealing with a sense of disappointment because they are not as professionally competent as they assumed, she adds.

“One of the things that supervisors have to do is provide a safe environment,” Anderson says. “Supervisees frequently feel insecure and full of self-doubt, and they need to feel that they can come to the supervisor and express that. You [the supervisor] have to find a way to give feedback that is clear, concrete and immediate, and you want it to be sandwiched with feedback about what the supervisee has done well. Supervisors need to remember how vulnerable supervisees are and to help normalize it — tell them that these reactions are common. In talking with students, they have consistently said that if they don’t feel safe [in the supervisory relationship], they won’t bring up their doubts.”

Providing consistent feedback requires close supervision. In Anderson’s program, all supervisee sessions are taped so that the supervisor can later review the session with the supervisee. Supervisors also watch some sessions live from another office.

Going over the session tapes with supervisees helps Anderson track their professional development and provide guidance in areas in which they need more help. For example, perhaps the supervisee didn’t stop to note that what the client was saying didn’t match his or her affect — maybe the person was smiling or laughing while talking about something sad. Anderson can jump to that spot in the session tape and ask what the supervisee was thinking at that moment and what the supervisee might say now. If the supervisee still doesn’t recognize the problem, Anderson will explain it and ask why the supervisee thinks he or she missed it. The supervisee can then bring the issue up with the client in the next session and also will have learned to watch for similar reactions with other clients.

Working with and teaching supervisees, not just telling them what they did wrong, is part of successful and supportive supervision, Anderson says. “When [providing] supervision, hopefully you are doing supervision on several levels — developing skills, deepening the ability to hypothesize or conceptualize, and exploring who the supervisee is as an individual and how that influences [his or her] work,” she explains.

When supervising closely on all three of those levels, Anderson says, supervisors are likely to catch a supervisee’s critical incidents and any other issues that need to be addressed.

Protecting against client suicide

Among the most difficult circumstances any counselor will face is a client’s death by suicide. Now imagine confronting that reality in the supervision process. Although it is not a common occurrence, it can and does happen, says Daniel Weigel, a licensed professional counselor (LPC) and ACA member. To protect supervisees, clients and themselves, supervisors must observe caseloads closely, teach supervisees how to assess for clients who may be suicidal and build a strong supervisory relationship that encourages novice counselors to ask for help anytime they are working with a client who is potentially suicidal.

Such clients aren’t likely to come in to counseling and announce that they’re feeling suicidal. Instead, counselors must be on the alert for subtle signs, including behavioral or verbal clues that novice counselors and counseling students might overlook, says Weigel, a counseling professor and the practicum and internship coordinator for the counseling programs at Southeastern Oklahoma State University. As an example, he mentions clients who avoid using a future orientation in conversation, such as discussing plans for the weekend or talking about what they’ll do after graduation, or who speak almost exclusively in the past tense.

Because not all clients will have been diagnosed previously, supervisors also need to teach their supervisees to recognize signs of disorders such as depressive disorders, bipolar disorders, substance abuse and schizophrenia that commonly accompany suicide attempts, Weigel says. Other signs supervisees should be taught to probe for are a previous history of suicide attempts (which Weigel identifies as perhaps the best predictor of future attempts); isolation from social supports such as family members, a partner, friends or a religious community; abuse of alcohol or drugs; and addictive behaviors such as gambling, among many other potential signs.

“Counselors-in-training require education in recognizing these clues and trusting their instincts to ask the necessary questions if such situations arise with a client,” Weigel says. Supervisors can help supervisees by observing or shadowing actual suicide assessments (if clients give their permission). As supervisees become more experienced, they can also learn by co-participating with supervisors or taking the lead (under live supervision) in conducting suicide assessments and interventions.

Providing close and collaborative supervision is likely the only way for a supervisor to accurately determine whether the supervisee’s client is at risk for suicide, Weigel says. “To rely solely on information presented by a supervisee verbally or in written form, as opposed to the raw data presented in recorded sessions, live supervision or co-counseling supervision strategies, is unlikely to reveal the subtle clues of client suicide risk,” he says.

Weigel acknowledges that much of the supervision being provided in the field is not live, in part because many supervisors don’t have the time necessary to see their own clients and observe live counseling sessions conducted by their supervisees. In addition, many supervision sites don’t have the capability to tape sessions for later review. So Weigel stresses the importance of developing a strong supervisory relationship, particularly if supervision must be based solely on verbal or written reports from the supervisee. Otherwise, supervisees may be tempted to hold back and present only that information they think will “please” the supervisor. According to Weigel, this is very common behavior.

Weigel advises supervisors to screen clients carefully before pairing them up with a counseling student or novice counselor to determine if they are an appropriate match. He also directly discusses the possibility of client suicide with his supervisees.

“Allowing supervisees who are not carefully oriented and trained in suicide assessment to see clients is a very dangerous position in which to place everyone. The first step in handling a potential crisis between a supervisee and his or her client is to educate [the supervisee] on the process before clients are ever seen,” says Weigel. He explains that preparation involves carefully reviewing the signs of suicide risk with supervisees, while also encouraging them to tune in to their own feelings and trust their instincts.

“Many novice counselors feel like impostors or feel unprepared to see clients,” he says. “Part of the role of the supervisor is to help supervisees feel empowered to trust the skills they have learned and the instincts they carry. This is especially true regarding skills related to crisis intervention.”

At Southeastern Oklahoma State, if a supervisee at the practicum or internship level suspects a client may be suicidal, he or she must bring the supervisor in immediately. Supervisors should establish a procedure for this circumstance ahead of time because suicidal clients should never be left alone, even for a moment, Weigel emphasizes. Once the supervisor is called in, he or she will typically take over the suicide assessment and ideally give the counselor-in-training the opportunity to observe the assessment and intervention in real time, he says.

Preparing supervisees for the possibility of client suicide is an incredibly difficult part of supervision, Weigel says. “[It] can, quite frankly, become overwhelming at times. Any client with whom we work is at risk of death by suicide, just as any supervisee’s clients might be at risk of the same. For me, the scariest part of clinical supervision is the fact that one of my supervisee’s clients might die by suicide, and I may never have had a chance to meet with that client.”

Multicultural competence

The United States has long been a nation of many cultures, and its population continues to grow more diverse. Yet most counseling programs offer only one course specifically devoted to multiculturalism, notes ACA member Kevin Feisthamel, director of counseling, health and disability services at Hiram College in Ohio. He doesn’t believe that’s enough.

“We need to become aware of our biases and become competent,” asserts Feisthamel, an LPCC-S and national certified counselor. “As supervisors, we need to be up to date on the latest [multicultural] research. [But] we get complacent or get so busy that we don’t have time. We forget that we have an ethical mandate [to teach multicultural skills].”

Being multiculturally competent as a counselor doesn’t automatically make you multiculturally competent as a supervisor, says Paula Britton, an ACA member and professional clinical counselor supervisor who runs a multicultural workshop for supervisors in Ohio. “In many states, you don’t need any additional multicultural training to become a supervisor,” she notes. When supervisors aren’t multiculturally competent, they are really doing their supervisees a disservice, contends Britton, who believes that supervision is the best place to learn multicultural competence.

Multicultural awareness in supervision doesn’t just concern clients; it may also be an issue within the supervisory relationship itself, says Britton, a professor of clinical mental health counseling at John Carroll University. “People who come from oppressed cultures often have trouble with trusting people in power, and supervisors are people in power,” she points out.

If a supervisor doesn’t take the time to understand a supervisee’s personal cultural background, the supervisor may make assumptions that further impede trust being established in the supervisory relationship, Britton says. And if a supervisee doesn’t trust the supervisor, he or she will be less likely to ask questions or bring up concerns, which can have a negative effect on the counselor’s professional development and, ultimately, the quality of care provided to clients.

Britton offers the example of a white supervisor with a supervisee who is African American. The supervisor might make the assumption that the supervisee comes from a low-income background. “Then the supervisee feels misunderstood but doesn’t want to say anything because [he or she is] being evaluated,” Britton says.

The best way for supervisors to start building a relationship of trust is to genuinely get to know their supervisees by asking about their culture. “I see a lot of supervisors who are worried that they will offend someone, so they just don’t say anything [about cultural differences],” Britton says. “We know from literature that that is the worst thing you can do. The more questions you ask, the better. The supervisor can [also] say [something like], ‘I’m aware that I’m white and you are Latino. I want to be sensitive, but if I say something insensitive, let me know.’”

Counselors need to educate themselves, but that doesn’t mean they have to be experts on every culture, either with their supervisees or with their clients, Britton says. Rather, she explains, they simply need to speak up and acknowledge when there are holes in their cultural understanding.

“Say to your supervisee, ‘I don’t know a lot about this culture. Let’s explore it more,’” she urges. By doing that, a supervisor shows the supervisee that learning is a career-long process and that even veteran counselors don’t have all the answers, she says.

Feisthamel sits down with his interns whenever they will be working with a client from another culture and asks them how knowledgeable or comfortable they feel about that particular culture. “They [the supervisee] might say, ‘Well, I’m not too familiar with the culture in India,’ and I’ll say, ‘OK, what are your questions? Let’s look at the research and find out what’s working for Indian people.’”

Feisthamel also encourages his supervisees to ask questions. “I think sometimes students don’t ask questions because they’re afraid to be wrong,” he says. The supervisor needs to make sure that the supervisee feels comfortable enough to ask questions — even if they seem stupid, asserts Feisthamel.

Britton agrees. “The best thing you can do as a supervisor with any supervisee is make them feel safe instead of making them feel like they have to pretend.”

Helping counselors-in-training and the community

Counseling students at Indiana State University receive assistance with internship placement, but the program staff there also wanted students to get more experience under live supervision. So the staff lobbied to reopen a community mental health clinic, associated with the university since the 1970s, that had recently fallen by the wayside.

“We have an underserved community,” says Catherine Tucker, director of the clinical mental health counseling program at Indiana State. “We also have a highly service-oriented program.”

The clinic is staffed by three of the department’s counselor educators, as well as outside clinicians and the students themselves. Students begin work there during their practicum and stay on during the summer between practicum and internship. Although they are placed outside the clinic for internship, they still put in hours at the clinic.

But the clinic isn’t just convenient for the community and students; it’s essential to the supervisory process, says Tucker, a member of ACA. Instead of reviewing tapes from supervised sessions off campus, as the program used to do, all supervision at the clinic is live. Each consultation room has a camera with a live feed that is monitored by staff and other students in a main control room. The camera also records all sessions so that students can review them later. In addition to being observed from the control room, students come out halfway through their counseling sessions for a brief consultation on what is going well, what isn’t and what they might try next.

“It is so much better [than before] because they [the supervisees] can go back in and, if they missed something, they can ask questions,” Tucker says. “Or if they need to change techniques, they can do it then. If they are just bringing in a tape or discussing it [afterward], it’s too late. They can make a change the next week, but the opportunity for immediate change [and learning] is gone. I think all the skills develop more rapidly when you have the chance to go back and correct in real time.”

How do supervisees react to being watched by multiple observers? “They’re very self-conscious at the beginning,” Tucker acknowledges. “It’s strange [for them] to think that they’re being taped and watched.”

But the faculty reassures supervisees that the purpose of the observation is not to catalog all their faults. “We see this as a developmental process,” Tucker explains. “Other students also observe. If you don’t have another client, you are expected to watch another session. At first [the supervisees’ reaction is] kind of deer in the headlights. We talk a lot about that in practicum and let them know that it’s normal to be strung out and anxious the first few times.”

“Starting out, we want to make sure basic skills are solid and that they can do an interview,” Tucker continues. “As time goes on, we want to make sure they are solid on diagnosis and that they can pull in their [chosen] technique. We also want them to know that they are in a developmental role. Growth happens over the length of a career, not just in one process. We don’t expect perfection, but we always expect to see progress.”

The supervisees and the program also benefit from the participation of counselors from outside the university. These counselors not only provide an outside perspective but also help students gain an understanding of the nuts and bolts of private practice, such as billing practices and issues (the clinic charges a nominal fee and doesn’t bill), and all the documentation that practitioners need to keep. “They [the outside practitioners] also have access to outside referral services that we don’t have,” Tucker adds.

The clinic serves individual adults, children, families and couples. The faculty uses this variety to push supervisees out of their comfort zones.

“If they say that children make them nervous, we’ll stick them with a 4-year-old,” says Tucker, noting that several of her supervisees initially voiced feeling uncomfortable counseling children, only to later decide that they wanted to become play therapists.

But the main point of the clinic is to give the students experience counseling a wide variety of clients. “They need to become generalists, because in the beginning [of a counseling career], you need to be able to handle whatever comes through the door,” she says.

Tucker believes live supervision is the key to getting counselors-in-training ready for internship and beyond. Therefore, she urges other counselor educators to find a way to incorporate at least a few live supervision sessions into practicum or internships.

“The growth we see is absolutely exponential when compared with the other model [of just reviewing session tapes],” she says. “The thing that really strikes me is that when internships start, they [the counseling students] say they feel really comfortable walking into a meeting and saying, ‘This is my treatment plan, and this is how I’m going to implement it.’ … Seeing the growth firsthand has been really exciting.”

Peer-to-peer supervision

How do you find supervision when you’re in an area with very few providers? And if you’re one of those providers, how do you learn to supervise novice counselors? These are among the challenges that Lauren Paulson, an LPC and ACA member, has faced while working as a clinician and supervisor in a rural area outside of Pittsburgh.

“Many rural environments are lacking a lot of services, and counselors have to work as generalists,” she notes, adding that practitioners in these small, sometimes remote communities often have to fill most or all of the community’s counseling needs. Not only are these practitioners juggling roles and a wide range of counseling issues; they are often doing so without the assistance of colleagues.

“I had this feeling of isolation, and then I became a supervisor and felt even more isolated,” says Paulson, who is also an assistant professor of psychology at Allegheny College in Meadville, Pennsylvania. “I really wasn’t trained to supervise, and rural communities have unique and specific needs.”

For instance, she says, boundary issues are very common. In a small rural community, it’s harder for counselors to draw the line between personal and professional interactions.

“People have multiple roles in the community, and sometimes they may conflict with your role as counselor,” Paulson explains. “You might be sitting on a school committee, and a client’s parent might be working with you.”

Counselors are also more likely to run into clients outside of the office, Paulson notes. “I work out at the local YMCA, and I often see one of my clients in the locker room,” she says.

So on the one hand, Paulson felt like she had little privacy in her role as a counselor. On the other hand, she felt very isolated professionally. “I wanted to connect with others, but it was hard to find [fellow helping professionals] to connect with,” she says.

Those experiences sparked Paulson’s interest in peer-to-peer supervision, which she currently researches. In her research, she has found that other counselors who practice in rural areas mention having the same kinds of challenges — and a desire for community.

Bill Casile acknowledges the difficulty of finding supervision in the comparative isolation of a rural environment, but he says living in an urban environment doesn’t guarantee that counselors-in-training and prelicensed counselors will secure quality supervision either.

“When I talk to graduates, it’s scary the minimal supervision they’re getting,” says Casile, an ACA member and associate professor in the counseling, psychology and special education program at Duquesne University in Pittsburgh. Too often, he says, supervisees working toward their licensure are learning mainly about administrative tasks such as completing paperwork. While these novice counselors are logging hours and getting clinical experience, no one is attending to their skill development, he says.

Casile was initially drawn to the study of supervision because he was dissatisfied with how counselor education programs were performing supervision during the practicum process. He thought the evaluation process was getting in the way of the functional educational purpose of supervision. In other words, supervisors were too busy grading and critiquing to truly teach their students real-life counseling skills.

Casile has long been interested in group supervision and currently teaches a supervision class inTeacher and student which he tries to create a collaborative environment. His work with group supervision and collaboration led him to believe that peer-to-peer supervision might be a useful supplement to counselors’ other supervision experiences.

Casile and Paulson have now teamed up to research peer-to-peer supervision. Their first study involved bringing counselors together just to talk face to face. “It wasn’t hierarchical, just an exchange of information,” Paulson says. The participants thought the experience was helpful, but most had to drive a considerable distance to meet their peers.

So, Paulson and Casile decided to test online peer-to-peer supervision. They recruited area mental health professionals and established an online group through Google Hangouts, a platform that enables online group interaction through audio, video and a chatlike comments box. After the initial meeting to set everything up, the group met twice a month at first and then scaled back to once a month. The group was diverse and included family counselors, school counselors, private practitioners and even a psychologist.

“Initially, Bill and I led the group, but we wanted the group to take over,” Paulson says. “They decided the structure would be that each meeting, one person would present a case [while maintaining client confidentiality], and then we would all discuss it.” The group also reserved time at the end of each session to discuss any concerns its members might have.

Group members also wanted to learn more about supervision itself, Casile says, so they used different models, including “reflecting teams,” which is a structured way of providing feedback to the person presenting the case. One person assumes the role of supervisor, and the rest of the group listens to the dialogue between the “supervisor” and “supervisee.” Once their dialogue stops, the rest of the group members talk about what they heard, with the supervisor and supervisee now remaining silent. The group repeats this pattern until it has finished discussing all aspects of the case. Casile says this form of supervision helps to keep the presenting counselor from getting defensive when receiving feedback.

The group also engaged in another type of supervision in which each participant played a role in the presented case, such as counselor, client, client family member and so on. This allowed group members to explore the case from multiple viewpoints, Casile notes.

Participants found value in the peer-to-peer supervision group because it allowed for diverse perspectives. And unlike with one-on-one supervision, the group members didn’t feel pressured to demonstrate competence, Paulson and Casile say. Instead, the environment made it safe for members to ask “silly” questions they may have been embarrassed or scared to ask an individual supervisor.

Paulson and Casile emphasize that peer-to-peer supervision is not a replacement for the regular one-on-one supervision that counselors should be accessing throughout their careers. They emphasize that even veteran counselors need the benefit of an outside perspective. At the same time, they realize that many counselors aren’t securing individual supervision for one reason or another, and they believe that some kind of supervision is essential throughout a counselor’s career. Participants in peer-to-peer groups may even end up finding individual supervision opportunities through the peer contacts they make, as happened with some of the members of Paulson and Casile’s group.

To find a group of peers, Paulson and Casile advise counselors to join local professional networks, participate on Listservs or explore an ACA Interest Network (see counseling.org/aca-community/aca-groups/interest-networks).

Counselors searching for peer-to-peer supervision might also want to avoid putting too many restrictions on their definition of a peer. “Peers need not all be LPCs,” Paulson advises. “Others like school counselors or anyone in the helping professions can provide interesting perspectives. With peers, I don’t think you need to limit yourself.”

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To contact the individuals interviewed for this article, email:

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editorct@counseling.org

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Related reading: See “Unethical supervision practices and student vulnerability,” the story of one counselor’s experience with unethical supervision practices during her practicum and internship: wp.me/p2BxKN-3Jb

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