Essentials of Clinical Supervision E-Book

Jane M. Campbell

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: Essentials of Mental Health Practice
• Sprache: Englisch

Seitenzahl: 556

Veröffentlichungsjahr: 2011

Beschreibung

Essentials of Supervision presents, in the popular Essentials format, the key information students need to learn in a course on supervision. Utilizing pedagogical tools such as call-out boxes, Test Yourself questions, and case studies, the author provides step-by-step guidelines for effective planning, goal setting, and evaluation, along with tips for giving constructive feedback and applying coaching strategies to motivate supervisees. She also clearly explains how to manage paperwork and describes specialized techniques, such as using video in supervision. This informative text also includes a special section on ethics authored by a leading expert in the field.

Leseprobe

Table of Contents

Title Page

Copyright Page

Dedication

Acknowledgments

SERIES PREFACE

One - INTRODUCTION TO CLINICAL SUPERVISION

THE NATURE OF SUPERVISION

FACTORS THAT CREATE DIFFICULTIES FOR SUPERVISORS

DIFFERENCES BETWEEN ADMINISTRATIVE AND CLINICAL SUPERVISION

RESEARCH IN SUPERVISION

SUPERVISOR COMPETENCIES

QUALITIES AND CHARACTERISTICS OF EFFECTIVE SUPERVISORS

INEFFECTIVE OR BAD SUPERVISORS

THE IMPORTANCE OF TRAINING SUPERVISORS

HOW TO USE THIS BOOK

Two - ETHICAL AND LEGAL ISSUES IN SUPERVISION (BY BARBARA HERLIHY)

INFORMED CONSENT

COMPETENCE

BOUNDARY ISSUES IN SUPERVISION

EVALUATION AND GATEKEEPING

LEGAL CONCERNS

Three - MODELS OF CLINICAL SUPERVISION

POPULAR APPROACHES TO CLINICAL SUPERVISION

CREATING A PERSONAL SUPERVISION MODEL

Four - FORMATS FOR CLINICAL SUPERVISION

INDIVIDUAL SUPERVISION

GROUP FORMATS FOR SUPERVISION

Five - METHODS AND TECHNIQUES FOR CLINICAL SUPERVISION

CASE CONSULTATION

WRITTEN TECHNIQUES

LIVE SUPERVISION

MODELING AND DEMONSTRATION

RECORDING CLIENT SESSIONS FOR SUPERVISION

COMPUTER TECHNOLOGY IN SUPERVISION

EXPERIENTIAL TECHNIQUES

COMBINING METHODS AND TECHNIQUES TO MAXIMIZE BENEFIT IN SUPERVISION

Six - PREPARING FOR SUPERVISION

SETTING GOALS FOR SUPERVISION

CHOOSING TOPICS FOR SUPERVISION

PLANNING FOR SUPERVISION

DOCUMENTING SUPERVISION

EVALUATION

SUPERVISION STYLE

Seven - THE BEGINNING STAGE OF SUPERVISION

BUILDING THE WORKING ALLIANCE

ORIENTATION

CREATING A SAFE PLACE

DEVELOPING SELF-AWARENESS

COMMON PROBLEMS TO ADDRESS IN THE BEGINNING STAGE OF SUPERVISION

Eight - THE INTERMEDIATE STAGE OF SUPERVISION

PROVIDING CORRECTIVE FEEDBACK

USING COACHING IN SUPERVISION

IMPLEMENTING PROBLEM-SOLVING STRATEGIES

UNDERSTANDING RELATIONSHIP DIFFICULTIES

TERMINATION OF SUPERVISEES FROM SUPERVISION

Nine - THE ADVANCED STAGE OF SUPERVISION

DEVELOPING A COLLABORATIVE RELATIONSHIP

PROMOTING TEAMWORK

IMPORTANCE OF PERSONAL AND PROFESSIONAL DEVELOPMENT

TAKING CARE OF THE CARETAKER

SUPERVISION OF SUPERVISION

ENDING SUPERVISION

CONCLUSION

References

Annotated Bibliography

Index

About the Authors

Essentials of Mental Health Practice Series

Founding Editors, Alan S. Kaufman and Nadeen L. Kaufman

Essentials of Interviewingby Donald E. Wiger and Debra K. Huntley

Essentials of Outcome Assessmentby Benjamin M. Ogles, Michael J. Lambert, and Scott A. Fields

Essentials of Treatment Planningby Mark E. Maruish

Essentials of Crisis Counseling and Interventionby Donald E. Wiger and Kathy J. Harowski

Essentials of Group Therapyby Virginia A. Brabender, Andrew I. Smolar, and April E. Fallon

Essentials of Clinical Supervisionby Jane M. Campbell

Copyright © 2006 by John Wiley & Sons, Inc. All rights reserved.

Published by John Wiley & Sons, Inc., Hoboken, New Jersey. Published simultaneously in Canada.

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Library of Congress Cataloging-in-Publication Data

Campbell, Jane M., PhD.

Essentials of clinical supervision / Jane Campbell.

p. ; cm.—(Essentials of mental health practice series)

Includes bibliographical references.

ISBN-10 0-471-23304-8 (pbk) ISBN-13 978-0-471-23304-6 (pbk)

1. Clinical psychologists—Supervision of. 2. Psychotherapists—Supervision of. 3. Counselors—Supervision of. I. Title. II. Series.

[DNLM: 1. Psychology, Clinical—organization & administration. 2. Organization and Administration. WM 105 C188e 2006]

RC467.7.C36 2006

616.89—dc22

2005047499

Dedication

This book is dedicated to all of the enthusiastic, involved, and committed clinical supervisors around the world who continue to do their best even in the most difficult and trying circumstances. The future of the mental and behavioral health professions is in your hands. Thank you.

Acknowledgments

Many of the case examples and Putting It Into Practice suggestions represent a compellation of ideas gathered from my supervision workshops and training offered across the United States these past 5 years. During these workshops, participants freely offered up creative and innovative ideas on how to solve day-today problems facing clinical supervisors everywhere and continuously validate the main premise of this book; it is the relationship supervisors build with supervisees that is core to effectiveness. I thank all of these nameless people who imparted their wisdom to me and to others in attendance at the workshops and wish to acknowledge their contributions to this book even if I am unable to thank them personally.

Jane M. Campbell October 2005

SERIES PREFACE

In the Essentials of Mental Health Practice series, our goal is to provide readers with books that will deliver key practical information in an efficient and accessible style. The series features books on a variety of critical practice topics, such as interviewing, treatment planning, and outcomes assessment, to name a few. For the experienced professional, books in the series offer a concise yet thorough overview of a specific area of expertise, including numerous tips for best practices. Students will find here a prioritized assembly of all the information and techniques that must be at one’s fingertips to practice knowledgeably, efficiently, and ethically in today’s behavioral health environment.

Wherever feasible, visual cues highlighting key points are utilized alongside systematic, step-by-step guidelines. Chapters are focused and succinct. Topics are organized for an easy understanding of the essential material related to a particular practice area. Theory and research are continually woven into the fabric of each book, but always to enhance the practical application of the material, rather than to sidetrack or overwhelm readers. With this series, we aim to challenge and assist readers engaged in providing mental health services to aspire to the highest level of proficiency in their particular discipline by arming them with the tools they need for effective practice.

This text focuses on the basics of clinical supervision as both a training and a monitoring tool. Chapter 1 introduces the reader to the realities of clinical supervision in the twenty-first century and describes good and bad supervision practices. Chapter 2 explains the ethical and legal issues that are present in clinical supervision. Chapter 3 covers the current models for supervision and suggests a comprehensive model for practice. Chapters 4 and 5 go into detail about the major formats for delivery of supervision along with the most common methods and techniques. Chapter 6 stresses the importance of preparation in effective supervision and details for the reader how to set goals, plan best use of time, use proper documentation procedures, and structure evaluation in an ethical manner.

Chapters 7, 8, and 9 delineate the tasks, skills, and activities necessary at each stage of development of the supervisory relationship along with suggestions on how to solve some of the most common problems encountered by supervisors.

Alan S. Kaufman, PhD, and Nadeen L. Kaufman, EdD, Founding Editors

Yale University School of Medicine

One

INTRODUCTION TO CLINICAL SUPERVISION

Clinical supervision is an increasingly important area of specialization in the mental health field. It has become the primary means by which the entire allied health field is now taught (Getz, 1999; Neufeldt, 2003; Storm, Todd, Sprenkle, & Morgan, 2001). Extensive graduate course work is followed by mandatory hours, even years, of clinical supervision both within and outside a degree program. After graduation, most states require several thousand hours of supervised experience in order to become licensed for independent practice. In fact, for those specializing in substance abuse treatment, most professional training occurs through supervision of on-the-job experience, and not in the classroom. It is under the tutelage of an experienced practitioner that professionals, regardless of their discipline, learn the skills necessary to become competent, ethical, and effective helpers.

Additionally, clinical supervision is increasingly at the forefront of malpractice prevention. Agencies, hospitals, schools, and private practice settings are concerned about liability, and thus many are moving to mandatory clinical supervision for all employees regardless of level of education or years of experience in order to assure the highest standard of care possible for clients.

Yet even as clinical supervision grows in importance, specialized training in this area lags behind (Kaiser & Barretta-Herman, 1999; Saccuzzo, 2002; Scott, Ingram, Vitanza, & Smith, 2000). Most are promoted to supervisor because of excellent clinical skills and ability to do the work rather than because they have formal training in clinical supervision. Moreover, few receive ongoing training in supervision or supervision of supervision by practicing clinical supervisors (Baronchok and Kunkel, 1990; Page, Pietzak, & Sutton, 2001). Instead, most supervisors today rely mainly on their own background and experience as supervisees and utilize the same structure and methods their supervisors used with them (Campbell, 2001-2005). Though this is a rich tradition, there is a growing concern that supervisors are simply perpetuating the mistakes of their own supervisors and that clinical supervision as a specialization is floundering (Campbell, 2001-2005; Steven, Goodyear, & Robertson, 1998; Whiston & Coker, 2000 ; Worthington, 1987). Without any training, supervisors may be unprepared for the many changes and demands now being placed on them.

THE NATURE OF SUPERVISION

Why should clinical supervisors require specialized training? Shouldn’t the fact that supervisors are usually highly successful and skilled practitioners automatically make them effective supervisors? The answer is no. Just because one is a skilled practitioner with clients does not necessarily mean one can be a good supervisor.

Supervision is a different relationship than counseling and therapy. Succinctly put, the primary purpose of clinical supervision is to review practitioners’ work to increase their skills and help them solve problems in order to provide clients the optimal quality of service possible and prevent any harm from occurring. Therefore, it is a teaching and training role as well as a monitoring function. Because the goal of supervision is to support ethical practice with clients, practitioners at all levels of education and experience can profit from supervision. The supervisory relationship may be voluntary (sought out) or involuntary (required by law), may extend over a definite period (as in the case of graduate internships or licensure), or be required indefinitely as part of employment. Always, however, the fundamental purpose of supervision remains the same.

What sets clinical supervision aside from other types of relationships, such as psychotherapy or consultation, is the presence of an evaluative component. Evaluation may be emphasized and central to the relationship or may be under-emphasized depending on the context, purpose, and developmental needs of supervisees. For example, clinical supervision required of experienced licensed practitioners would have a different evaluative structure and purpose than supervision of prelicensed practitioners. However, the role of the supervisor is always to evaluate the quality of care being given to clients and to make suggestions for improvement when necessary.

Another important but frequently overlooked variable that needs to be considered is the fact that clinical supervision, for the majority of supervisees, is not voluntary. It is required to obtain a graduate degree, a certificate, a license to practice, to keep employment, and for malpractice prevention. The evaluative component along with the nonvoluntary nature of supervision cast issues of power, trust, safety, and control into the center of the clinical supervision experience and the supervisory relationship. This attribute also distinguishes supervision from consultation in that suggestions made by a consultant for client care are recommendations, not requirements.

Unique ethical and legal issues must also be addressed. Ethically, and by law, clinical supervisors are responsible for the actions of supervisees with clients. This fact turns clinical supervisors into not just teachers and trainers but also monitors of ethical practice in the mental health field and protectors of the community in which they live. They are responsible for overseeing the quality of client services and to prevent incompetent, impaired supervisees from serving the public. Accordingly, the role of the clinical supervisor is one of impressive responsibility and new challenges that should receive increased consideration as an area of specialized training.

DON’T FORGET

The primary task of a clinical supervisor is to protect clients from harm while promoting the competency of supervisees. The nonvoluntary nature of the relationship along with the evaluative component makes supervision a relationship of unequal power.

FACTORS THAT CREATE DIFFICULTIES FOR SUPERVISORS

Clinical supervision is a balancing act between the needs of the supervisee and the needs of the client. This balancing act can be difficult and stressful or exciting and fulfilling depending on a number of variables. Such things as the purpose of supervision, level of competence, background and training of supervisees and supervisors, role clarity, organizational needs and organizational climate, and commitment of time and resources can all contribute to the ease or hardship of managing this complex relationship. Clinical supervision can be particularly daunting for new supervisors if they have no training or skills in clinical supervision and do not clearly understand their role, purpose, and function. Additionally, the amount and type of support given by an organizational system to clinical supervisors may help or hinder the supervisory process.

The first requirement for success as a clinical supervisor is to understand the function and purpose of supervision and how supervision is different from other relationships. Second, supervisors need to understand the ethical and legal issues that affect the supervisory relationship. Third, they need to acquire a model for supervision, learn to set goals, create structure, and use suitable methods and techniques, understand the pitfalls and problems inherent in supervision, and focus time and attention on building the supervision relationship. Last, supervisors have to find time for supervision.

This last task, finding time to supervise, is sometimes the hardest, particularly if the supervisor is still providing clinical services. Practitioners are constantly being asked to do more with less; at the same time there is increasing emphasis on the need for clinical supervision. Frequently, the clinical supervisor role is tacked onto the practitioner’s routine job duties. It is hard for these overtaxed individuals to monitor the supervisees’ quality of work and assist them to grow and develop while attempting to provide quality care to their own clients. In situations where supervisees are employees and are also receiving postdegree supervision for licensure along with their job, supervision can sometimes become even a more difficult and stressful balancing act. To find time for supervision, both supervisors and administrators have to understand the importance of clinical supervision and value it as a function not only in the organizational context but also in terms of society at large.

DIFFERENCES BETWEEN ADMINISTRATIVE AND CLINICAL SUPERVISION

Another factor that can add to difficulties and the stress level for clinical supervisors and supervisees alike is role conflict and role confusion. Dual relationships permeate supervision and are difficult to avoid. However, for countless numbers of mental health practitioners, the largest area of uncertainty and misunderstanding created by dual relationships is the overlap between clinical and administrative supervisory functions. Many clinical supervisors are required to serve in both capacities and sometimes knowing what to do is difficult at best as everyone attempts to sort out the various roles and relationships.

Although similar in certain respects, key differences do exist between the purpose and role of administrative and clinical supervisors. Understanding these differences will go a long way to clear up some of the bewilderment. The first point is to understand that administrative supervisors and clinical supervisors function under two separate models with different purposes, different missions, and different rule books. Administrators function under a business management model. The aim of an administrative supervisor is to keep an organizational system functioning in a healthy manner, accomplishing whatever is the organization’s mission. Administrative supervisors are involved in hiring, firing, promotions, raises, scheduling, unions, and other personnel duties. The focus of administrative supervision is on productivity, workload management, and accountability. Decisions are made in terms of benefit or harm to the organizational system, not individuals. Local, state, and federal regulations, such as Equal Employment Opportunity Commission (EEOC) Guidelines and the Disability Act, govern their actions.

Clinical supervisors function under a different model. The purpose of clinical supervisors is to help practitioners develop skills, overcome obstacles, increase competency, and practice ethically with clients. It is historically a teaching, training, mentoring, and monitoring position with an emphasis on developing and maintaining competence. The focus in clinical supervision is on the individual supervisee’s activities with clients. The vehicle for supervision is the review of client cases and the offer of suggestions and corrective feedback for improvement. Evaluation is ongoing and integral to the supervisory process as it is used to shape and direct learning. Even though a final summative evaluation is required in most types of clinical supervision, the essence of the supervisory process is continuous feedback throughout supervision, the intention of which is to help supervisees develop mastery and encourage ethical practice with clients.

In the administrative model, evaluation has a different intent and is mainly retrospective rather than formative. After a probationary term, the assumption is made that employees now have the necessary competencies to do the job. Once or twice a year, in what is titled a performance appraisal, employees are evaluated against a base line of these competencies and receive suggestions for improvement, warnings, or recognition for job excellence such as a promotion or a raise.

Another important area of potential confusion for clinical and administrative supervisors is differences between laws and ethical codes. As is well known to virtually everyone in the mental health field, ethical and legal standards frequently conflict. Clinical supervision as a specialized activity of the health professions falls under the ethical codes and standards for each discipline. Administrative supervisors, on the other hand, refer to laws, regulations, and management policy for their actions.

Obviously, a large area of overlap exists between the two functions of administrative and clinical supervisors, just as there is overlap between ethical codes and laws. Clinical supervisors are involved in a myriad of administrative tasks, such as documentation, time management, as well as monetary issues. Administrators, in turn, work extensively with their employees to help them increase skills. Both have to function within the laws of the community. Last, any unethical behavior on the part of a supervisee is cause for concern for both an administrator and a clinical supervisor.

However, there are many instances when the two functions contradict each other. Most prominently, successful clinical supervision is built on an important ethical premise that supervisees, in order to grow and learn, will be open, honest, truthful, and willing to admit mistakes. In return, clinical supervisors are expected to treat supervisees with respect and fairness; to maintain a commitment to growth and development; and to avoid bias, exploitation, and impaired judgment. This is the basis of ethical practice in supervision.

In the administrative model, complete openness and honesty may take on a different meaning and have very different consequences. Both supervisor and supervisees have to carefully weigh the impact of complete honesty in an organization, especially if they wish to continue to draw a paycheck.

It is therefore evident, if the supervisee is both an employee and receiving clinical supervision for an outside purpose, such as a graduate internship or license, or if the clinical supervisor is also the administrator, these dual roles can create some serious problems in supervision if not treated with care. Extra effort will be needed to manage the delicate balance between encouraging supervisees to take risks and make mistakes in order to grow and the impact of that learning process on clients.

CAUTION

There are differences in purpose and function between clinical and administrative supervision. Role conflict can sometimes lead to difficulties with supervisees.

RESEARCH IN SUPERVISION

A further difficulty facing clinical supervisors is the fact that as a specialization, clinical supervision lags well behind other areas in quality empirical research that will validate many of its assumptions and accepted practices (Davy, 2002; Ladany & Muse-Burke, 2001; Watkins, 1998). For example, only a few studies have attempted to connect the practice of supervision to actual client outcome (Freitas, 2002; Patton & Kivlighan, 1997). Most of the research and theoretical writing in this field is primarily created within and for academic settings. In the majority of cases the studies in the field of supervision consist of surveys of beginning masters- or doctoral-level students in on-campus settings during their first experience as supervisees or supervisors, and they rarely venture beyond that pool of subjects for their findings. Many of these studies also involve small numbers of subjects and hypothetical situations.

There are also a small number of empirical studies of note that include supervisors and supervisees at a more advanced stage of development in settings outside academia (Borders & Usher, 1992; Neufeldt & Nelson, 1998; Storm et al., 2001; Weaks, 2002). Not much is known about the practices and needs of advanced supervisors and supervisees who face problems of delivering service in hospitals, agencies, schools, and private practice, and, as a result, clinical supervisors outside academia are left to figure out for themselves what to do to increase their effectiveness.

Significant differences exist between clinical supervision as practiced in academic settings and the supervision offered in agencies, schools, hospitals, and treatment facilities. The most important difference is one of control. The focus in on-campus practicum and internship sites, such as a college counseling center, is on supervisee training and development. A relatively small amount of time is spent on administrative tasks, such as paperwork, scheduling, and productivity. Usually the type and severity of client problems, as well as the number of clients for each supervisee, are also controlled. Supervisors are given time to supervise and have access to state-of-the-art equipment. Supervisees may receive several hours of individual supervision per client contact from several different supervisors using live observations, videotaping, as well as group supervision. There is usually abundant time for both supervisor and supervisee to contemplate, discuss ideas, and experiment.

In the world outside of academic settings, hardly any sites make training a central focus. Clinical supervision is usually an additional task added on to the supervisor’s existing client load and results in an insufficient amount of time available for supervision. Further, clinical supervisors usually have little control over client numbers assigned to supervisees or the severity of client problems. Some supervisors even have no choice about being a supervisor, having been appointed to the job, and no input on the selection, numbers, experience, and background of those they supervise. As discussed previously, increasing numbers of clinical supervisors are also administrative supervisors, which can serve as another barrier to effectiveness. In other words, contextual issues dominate the practice of clinical supervision in these settings and make application of models, methods, and techniques from academic settings appear impractical.

SUPERVISOR COMPETENCIES

The paucity of research and lack of training in clinical supervision along with the impact of contextual factors and the multiplicity of roles required of supervisors have a direct impact on ethical practice of supervision. Ethically, one of the first demands for clinical supervisors is the necessity for them to be competent to supervise. This means that supervisors are fully trained and knowledgeable about the role and function of clinical supervisors; they have a model, skills, and strategies to effectively carry out the role. Added to that is an expectation that each supervisor is fully versed and competent in the areas of client service in which they are supervising.

DON’T FORGET

Supervisors should seek information on ethical standards and required competencies for supervision from their particular professional discipline.

A growing number of states and national organizations are attempting to assist supervisors to fulfill this expectation and become competent as clinical supervisors. For example, many states now require clinical supervisors of postdegree candidates for licensure to take a course on supervision in order to become certified. The length of these supervision courses will vary; the state of Texas demands a 40-hour course while Arizona recently instituted a 12-hour course prerequisite (with 6 hours thereafter). Both the National Board for Certified Counselors (NBCC) and the American Association for Marriage and Family Therapy (AAMFT) offer an approved supervisor credential and a standardized curriculum to obtain it. Hopefully, as added attention is placed on the ethical and legal functions of clinical supervisors in the mental health field, more states and national organizations will tackle this vital issue of supervisor competence and training in the future.

Rapid Reference 1.1

Supervisor Competencies

Supervision Skills

• Knowledge of the role and function of clinical supervisors

• Knowledge of legal, ethical, and regulatory guidelines as they apply to supervision

• Understanding of the importance of the supervisory relationship and ability to facilitate that relationship

• Competencies in all areas of client care in which supervising

• Ability to set goals and objectives and create and implement a supervision plan

• Knowledge of the models, methods, and techniques of clinical supervision

• Knowledge of strategies for supervision and ability to be flexible in style and choice of strategies

• Knowledge of the role of systems, cultural issues, and environmental factors and their impact on supervision

• Familiarity with the methods of evaluation and ability to apply them fairly

• Understanding of the existence of dual relationships and their impact on super visory objectivity and judgment

• Strategies to limit harm that may come from dual relationships in supervision

• Knowledge of multicultural issues and ability to respond to multicultural differences

• Documentation skills

• Awareness of the requirements and procedures required for licensure or certification if applicable

More often than not, however, the only requirement for a clinical supervisor is a set number of years of experience, say 2 or 3, in their field. It is left up to the majority of supervisors to determine if they have the knowledge and skills to be competent.

Rapid Reference 1.1 provides a broad list of recommended competencies for all clinical supervisors. Depending on one’s field or discipline, specific competencies pertinent to that practice should be added. Rapid Reference 1.2 contains an example of a more specialized list of competencies and skills required for counselors and psychotherapists. Those who are in substance abuse, nursing, or home services or those who work as case managers can adapt this list to fit their particular requirements.

Rapid Reference 1.2

Recommended Counseling and Psychotherapy Skills for Supervisors

• Knowledge in the areas of practice—group, individual, family, couple, child and adolescence

• Relationship skills—ability to build rapport and trust

• Ethical judgment and decision making

• Knowledge and application of ethical guidelines and standards to specific cases and situations, particularly in crisis

• Crisis management skills

• Assessment and diagnostic skills

• Conceptualization skills

• Problem-solving and goal-setting skills

• Knowledge and experience in the use of the methods and techniques of counseling and psychotherapy

• Intervention strategies—knowledge and application of a variety of intervention techniques for change

• Written skills—documentation and record keeping

• Knowledge of and ability to understand systems and the interaction between individuals, setting, environmental factors, and presenting problems

• Knowledge of multicultural issues and ability to respond to those issues

• Understanding of the role of developmental factors in client problems

QUALITIES AND CHARACTERISTICS OF EFFECTIVE SUPERVISORS

Beyond consideration of what knowledge and expertise is required for ethical practice of supervision, most supervisors, especially those new to the position, are interested in what qualities and characteristics are necessary in order to be successful and effective. It should be apparent that because of the complexity and the demands of the role, the answer to this question is not simple. For example, a study by White and Russell (1995) concerning the essential elements of marriage and family therapy supervision generated over 800 variables that influence the outcome of supervision.

As indicated in the previous section, researchers are just beginning to examine in a systematic way what factors are important in successful supervision outcome. Having said that, most studies in supervision, as well as anecdotal reports by supervisees about their experiences in supervision, continually point to the fact that qualities and attributes of effective supervisors mirror those for effective counselors and psychotherapists (Anderson, Schlossberg, & Rigazio-DiGilio, 2000 ; Chung, Baskin, & Case, 1998; Getz, 1999). Supervisees, regardless of education and level of experience, want and need support and acceptance from supervisors. To summarize, some of the personal attributes that have been consistently identified across the board as essential to effective supervision are trustworthiness, authenticity, genuineness, openness, tolerance, respect, empathy, and flexibility, along with an ability to confront, a concern for a supervisee’s growth and well-being, a willingness to hear feedback, the possession of personal courage, and a sense of humor.

DON’T FORGET

Regardless of one’s specific theoretical model or the level of training or experience of the supervisee, a supportive, facilitative supervisory environment is deemed critical to effective supervision and supervisory growth. Therefore, those personal qualities that contribute to creating a nurturing environment are the most essential.

Two other important variables in a successful supervision experience are the level of commitment by supervisors to the role and to the supervisees’ growth and development. Anderson et al. (2000) concluded that the more available and involved supervisors are in supervision and the more open the supervisory environment, the better the supervisee’s experience. Thus, supervisors who take supervision seriously, work to create an open and encouraging supervisory environment, and attend to the personal growth of supervisees along with their development of technical and conceptual skills are deemed most effective. A study of clinical supervision in a public rehabilitation setting also emphasized the importance of regularly scheduled supervision sessions along with proactive teaching activities in supervisee satisfaction (Schultz, Odokie, Fried, Nelson, & Bardos, 2002). Rapid Reference 1.3 provides a description of effective supervisory behaviors. This list represents a composite of responses given by hundreds of active clinical supervisors while participating in supervision workshops across the country regarding the qualities and characteristics of an effective supervisor (Campbell, 2001-2005).

Rapid Reference 1.3

Effective Supervisory Behaviors

• Clarifies expectations and roles

• Is accessible and available

• Takes the role of supervisor seriously

• Cares about the well-being of the supervisee

• Provides frequent scheduled supervision

• Is fully present in supervision session and not multitasking

• Is invested in the supervisee’s development

• Is able to create a safe learning environment

• Recognizes and validates the strengths of the supervisees

• Creates a relaxed learning environment

• Encourages the exploration of new ideas and techniques

• Is tolerant, open, and flexible

• Open to ideas, thoughts, and feelings of supervisees

• Fosters autonomy and risk-taking

• Perceives growth as an ongoing process

• Is curious

• Has the ability to communicate effectively

• Works collaboratively

• Is supportive and encouraging

• Provides constructive criticism as well as positive reinforcement

• Is genuine and congruent

• Models appropriate ethical behavior

• Maintains consistent and appropriate boundaries

• Is competent and credible

• Is knowledgeable and up to date

• Has extensive practical experience in the area in which supervising

• Demonstrates how to get work done in the organization

• Is personally and professionally mature

• Serves as a professional role model

• Is aware of and accepts his or her own limitations and strengths

• Is willing to accept mistakes

• Is not easily rattled in a crisis

• Has a high tolerance for conflict and so is able to hang in on difficult situations and confront negative behavior

• Is courageous

• Has an awareness of personal power

• Is nonauthoritarian and nonthreatening

• Has personal integrity

• Is respectful and considerate of others, honest, truthful, and trustworthy

• Has a sense of humor and does not take him or herself too seriously

INEFFECTIVE OR BAD SUPERVISORS

No discussion of the qualities and attributes of effective supervisors would be complete without attention to the area of ineffective or bad supervisors. A small body of research is beginning to press the alarm button about the prevalence of bad or lousy supervision and its negative impact on supervisees (Chung et al., 1998; Gray, Ladany, Walker, & Ancis, 2001; Magnuson, Wilcoxon, & Norem, 2000). Shockingly, a number of these studies indicate that the rate for bad supervision experiences of some type is as high as 50 percent (Nelson & Friedlander, 2001; Worthen & McNeil, 1999).

While there are a number of descriptors for bad and ineffective supervisors, the foremost appears to be apathy or a “lack of investment in supervision” on the part of supervisors (Ellis, 2001, p. 404). This lack of interest in supervision can take the form of not being available, paying inadequate attention to supervision, being chronically late, canceling supervision appointments, failing to offer feedback or suggestions, working on paperwork or the computer during supervision sessions, allowing continuous interruptions, and being generally unproductive during supervision sessions (Ellis, 2001; Magnuson et al., 2000 ; Wulf & Nelson, 2001).

Other examples of poor supervisor behaviors run the gamut from lack of expertness, little support for autonomy, disorganization, excessively nondirective behavior, lack of attention to evaluation (such as not being forthcoming about problems with the supervisee’s skills until final evaluation), excessive criticalness, unwillingness to ask for or respond to a supervisee’s thoughts or feelings (emotional neglect), intolerance for differences in style or theoretical model, stereotypical viewpoint on multicultural differences, problems with boundary setting with supervisees (such as turning supervision into psychotherapy for supervisees), too much time spent on administrative detail and not enough on helping supervisees develop clinical expertise, or having the primary focus of supervision be helping the supervisor with his or her cases (Anderson et al., 2000; Campbell, 2001-2005 ; Ellis, 2001; Magnuson et al., 2000 ; Veach, 2001). Rapid Reference 1.4 summarizes qualities of ineffective supervisors.

DON’T FORGET

Supervisors can vary in style, theoretical models, gender, race, and ethnicity and can even not be strong on the expression of warmth and still be effective as long as supervisees see them as attempting to be helpful and genuinely invested in supervision.

These descriptors of bad or lousy supervision take the reader back to the initial problem identified at the beginning of this introduction: how clinical supervision is viewed today in organizations, how supervisors are selected and how much support is given to people in this role, and the importance of training supervisors. As long as the role and function of clinical supervisors is misunderstood or undervalued by organizations and administrators, such as when clinical supervision is tacked onto regular job duties without reducing other work demands, and supervisors are selected by convenience or availability, not skill or training, poor supervision will continue to be a recurring problem (Campbell, 2001-2005).

Rapid Reference 1.4

Qualities of Ineffective or Bad Supervisors

• Unavailable

• Inconsistent

• Inconsiderate

• Dogmatic

• Closed

• Prejudiced

• Intolerant

• Inflexible

• Arrogant

• Critical

• Disinterested

• Disorganized

• Neglectful

• Untrustworthy

• Poor at setting boundaries

DON’T FORGET

Supervisees need to be encouraged to know their rights and responsibilities and to speak up about bad or harmful supervision.

THE IMPORTANCE OF TRAINING SUPERVISORS

If supervision is a different relationship than counseling or psychotherapy, everyone would ethically be bound to receive training in order to achieve full competency in the role. To be effective and successful as a clinical supervisor in today’s world, supervisors need to understand the nature of supervision, what it is, and what it isn’t. They need to take into account the hierarchical nature of clinical supervision and the factor of low or no choice that places issues such as safety and trust into the foreground of any supervision experience. Additionally, today’s clinical supervisors have to be mindful of all of the contextual and systems variables that influence the supervisory relationship and develop skills and strategies to effectively manage their impact.

The importance of training supervisors needs also to be emphasized. No longer can supervisors rely merely on their experiences in supervision or their expertise with clients to be effective supervisors. Supervision training has been found to improve confidence and self-awareness, contribute to a decrease in dogmatism and criticalness on the part of supervisors, and in the case of a residential treatment center, even lead to a rejuvenation on the part of the staff (Foster & McAdams, 1998; McMahon & Simons, 2004; Steven et al., 1998).

In closing, clinical supervision is a complex topic with many issues that need to be addressed. With understanding, forethought, and planning, the role can be exciting and fulfilling. Through modeling, teaching, training, and mentoring, clinical supervisors have an opportunity to shape the future of the mental health field. The purpose of this book is to provide clinical supervisors with essential information and practical ideas to increase competence and effectiveness, promote ethical practice, stimulate innovation, and generate excitement for this important role.

HOW TO USE THIS BOOK

Writing a handbook for the field of clinical supervision is a daunting task. Clinical supervisors come in all shapes and sizes and from a range of backgrounds, disciplines, and education levels. Some have a vast body of clinical and counseling experience from which to draw, so, consequently, many of the ideas in the book will seem elementary, whereas others lacking that wealth of experience or training in counseling and therapy may wish for more elucidation. For some readers this book will provide a foundation and excellent source of new ideas, while for others it will serve as a review of previously gained knowledge.

DON’T FORGET

Supervision is supervision: The purpose of supervision is to review supervisees’ work in order to provide clients with the highest quality of care and prevent harm. This purpose of supervision is the same, regardless of discipline, setting, level of education, and training level of supervisors.

The material should be applicable to all types of supervision circumstances regardless of the supervisor’s discipline, practice, setting, and level of education. However, each reader will need to tailor the information to his or her unique needs in the setting in which he or she practices. For example, some of the suggestions are more relevant for those providing counseling and psychotherapy services than for those operating in a case-management format or providing psychoeducation services. Also, a number of core ideas are repeated throughout the book so that those who do not read the book straight through but wish to simply read one section or chapter will receive all pertinent material.

For the purpose of clarity and ease of reading, certain terms are employed in this book. The term client rather than patient was selected as a generic term to refer to the person receiving services. Clinical supervision, rather than counselor or psychotherapy supervision, was selected for the same reason. The supervisor is the person giving clinical supervision and the supervisee is the person receiving the supervision. Supervisee rather than trainee was selected because in many instances, supervision involves practitioners far beyond the entry stage. The term mental health field is meant to encompass behavioral health specialties such as substance abuse, school counseling, and nursing along with social work, marriage and family counseling, and other social service providers.

Putting It Into Practice

A Common Error in Clinical Supervision

Susan, a licensed social worker at a community agency, was appointed clinical supervisor. She was seen as a highly skilled therapist who did excellent work with clients. She was well organized, timely with her paperwork, and a good team member. Although she had received no formal training in supervision, Susan felt confident that with her expertise she could be an excellent supervisor and looked forward to the challenge. However, within a few weeks, problems began to occur. Susan was puzzled, confused, and unsure how to proceed.

Teaching Point: Although expertise in the area of clinical practice is a necessary component of effective supervision, the supervisory relationship is different in nature from psychotherapy and counseling. Success and competency in one area does not preclude success in the other. To be effective, supervisors need to understand the purpose of supervision and its nature and quality and seek out specialized training in this important field.

TEST YOURSELF

1. The role of the clinical supervisor is teacher, trainer, mentor, monitor, and evaluator. True or False?

2. If clinical supervisors have 3 years of experience working with clients, they can automatically be good supervisors. True or False?

3. There is a significant body of empirical research in clinical supervision to reassure all supervisors in their practice. True or False?

4. Two factors that distinguish clinical supervision from consultation and psychotherapy are

a. the evaluative component and the nonvoluntary nature of the relationship.

b. there are no real differences.

c. clinical supervision is usually more fun to do because supervisees can ignore what supervisors ask them to do and do what they want.

d. supervisees don’t have advanced degrees and only meet for supervision when there is a crisis.

5. The qualities and characteristics of an effective supervisor mirror those of an effective psychotherapist. True or False?

6. There is little cause for concern that clinical supervision can ever be harmful to supervisees. True or False?

7. The primary cause of most lousy supervision is

a. lack of attention given to the role.

b. misinformation about purpose and function of supervisors.

c. high criticalness and dogmatism.

d. only a.

e. only c.

f. a, b, and c.

8. There are no significant differences between an administrative supervisor and a clinical supervisor. True or False?

9. Clinical supervisors, in order to practice ethically, need only refer to their state laws and agency policies. True or False?

10. When appointed administrative supervisor along with clinical supervisor, you would need to

a. work hard to establish clear boundaries between the two roles.

b. not do much because both roles are the same.

c. be glad for the promotion because putting the two roles together will be less work.

d. understand potential for harm that may come from role conflict and confusion with supervisees.

e. do both a and d.

f. do both b and c.

11. As everyone knows the role of a clinical supervisor, there is no need for training in supervision. True or False?

12. Name two key features present in clinical supervision that supervisors must know about in order to be effective as a clinical supervisor.

13. Clinical supervision can be stressful at times. One factor that can contribute to stress in supervision is

a. organizational needs.

b. lack of organizational support for supervision.

c. role confusion.

d. no training in supervision.

e. low level of competence as a supervisor.

f. all of the above.

14. Supervisees, regardless of education and experience, want and need support and acceptance from their supervisors. True or False?

15. Two important variables for success as a supervisor are

a. aloofness, and absolute certainty that they are right at all times.

b. willingness to give supervisees constant and continuous detailed corrective feedback about what they are doing.

c. commitment to the role of clinical supervisor and to supervisees’ growth and development.

Answers: 1.True; 2. False; 3. False; 4. a; 5.True; 6. False; 7. f; 8.True; 9. False; 10. e; 11. False; 12. Evaluation (hierarchical nature) and nonvoluntary nature of the relationship (low to no choice); 1 3. f; 14. True; 15. c

Two

ETHICAL AND LEGAL ISSUES IN SUPERVISION (BY BARBARA HERLIHY)

As was emphasized throughout the introductory chapter, a key goal of supervision is to ensure that clients receive competent, ethical services. A number of ethical issues inevitably arise and must be dealt with in supervision. Some issues that pertain both to the relationship between supervisor and supervisee and the relationship between supervisee and client include securing informed consent, ensuring competence, and maintaining relationship boundaries. A supervisory function that has both legal and ethical implications is gatekeeping for the profession. Legal issues that cause concern among supervisors are vicarious liability and malpractice. These topics are examined in this chapter.

INFORMED CONSENT

Informed Consent for Supervisees

The rationale for informed consent in counseling can be stated in simple terms: Clients have a right to know what they are getting into when they come for counseling (Remley & Herlihy, 2005) . This same principle applies equally to the supervisory relationship. Supervisees have a right to be fully informed, at the outset, about what supervision will entail.

The right of supervisees to receive informed consent creates a responsibility on the part of the supervisor to provide supervisees with a great deal of information. No matter how thoroughly supervisees are prepared, supervision will inevitably hold some surprises for them. However, these surprises should be due to the learning process itself and the complexity of human functioning, not due to carelessness or omissions on the part of the supervisor (Bernard & Goodyear, 2004). Information that supervisors should discuss with supervisees during their initial meeting includes the following:

• Purposes of supervision. All supervision shares the same general purpose of fostering the professional growth and enhancing the skills of the supervisee while protecting the client from harm. It is not unusual, however, for supervisees to embark on the supervisory process with a kind of tunnel vision that is focused on the end goal of completing a prescribed number of clock hours to fulfill an internship requirement or to obtain a license to practice. When a supervision relationship is undertaken with the intent of having the supervisor sign off on the required hours, there is little chance that supervision will be a growth-producing experience for the supervisee (Remley & Herlihy, 2005). Beginning the supervisory relationship with a discussion of the goals and purposes of supervision helps to establish that professional growth will be the focus of supervision.

• Information about the supervisor. Supervisees need to know that their supervisors are qualified by training, experience, and credentials so that they will feel confident that the supervisory relationship will benefit them. Therefore, supervisors need to describe their qualifications. Because there are likely to be differences in perspective that need to be negotiated (particularly when the supervisor and supervisee are from different disciplines within the mental health field), supervisors should explain their theoretical orientations and supervisory styles and discuss any potential problems that could be created by differences that exist.

• Expectations, roles, and responsibilities. Just as clients sometimes have very little notion of what to expect in counseling, supervisees may enter a supervisory relationship having given little thought to the specific responsibilities they will be expected to fulfill. The supervisor has a responsibility to explain the nature of the supervisory relationship, how evaluation will be conducted, and how boundaries will be managed. If the supervisor is providing administrative as well as clinical supervision to the supervisee, distinctions between the responsibilities of the two roles should be clarified.

Supervisors need to make their requirements clear regarding what they expect from their supervisees in terms of taking responsibility for their own learning. Does the supervisor want them to make and review tapes of their counseling sessions? Come to supervision sessions prepared with specific questions? Do outside reading and attend professional development seminars? Present cases for consultation? A crucial question to address is how the supervisee will be evaluated, including processes, procedures, and timing for ongoing and summative evaluation.

Some writers (Bernard & Goodyear, 2004; Remley & Herlihy, 2005) have recommended the use of a written supervision agreement that is reviewed and signed by both parties. This kind of contract can articulate the details of the supervisory relationship and help to avoid later misunderstandings.

• Logistics of supervision. A discussion of logistics should lead to an agreement on a myriad of details: frequency of supervision sessions, duration of sessions, fees and payment arrangements (if applicable), forms of documentation that will be required from both the supervisor and supervisee, modalities of supervision that will be used (such as video-or audiotaping, live supervision, case consultation, group and individual supervision), procedures for handling emergency situations, and any contractual obligations of both parties that will need to be fulfilled.

• Ethical and legal considerations. It is risky business for supervisors to assume that their supervisees have been taught and know all they need to know about ethical and legal counseling practice. Supervisors are, to some extent, responsible for the acts of their supervisees. Supervisors can protect themselves and safeguard the welfare of their supervisees’ clients when they ascertain at the beginning of the supervisory relationship whether there are areas of ethical and legal practice in which the supervisee may need further instruction or clarification (Remley & Herlihy, 2005). When deficits in knowledge or skill are noted, the supervisor would be wise to assume an instructional role and assure that the supervisee acquires the needed competencies.

Rapid Reference 2.1 summarizes the elements of informed consent for supervision. More detailed information and examples can be found in Chapter 6 under documentation of supervision.

Rapid Reference 2.1

Elements of Informed Consent for Supervisees

• Purposes of supervision

• Information about the supervisor

• Expectations, roles, and responsibilities

• Logistics of supervision

• Ethical and legal considerations

Informed Consent for Clients of Supervisees

The supervisee’s clients must be informed that their counselor is under supervision. Sometimes supervisees are tempted to gloss over the fact that they are under supervision, out of a fear that their clients may have less confidence in their abilities to provide competent services. Supervisors should ensure that these fears do not inhibit supervisees from informing clients of their supervision status. If clients seem uneasy about the idea that a supervisor, who is a faceless stranger to them, will be listening to audiotapes of their counseling sessions or watching from behind a one-way mirror, arrangements might be made (if possible) for the client to meet the supervisor to express any concerns and ask questions directly (Remley & Herlihy, 2005).

Clients need to understand how supervision affects their confidentiality. Because supervisors will have access to confidential client information, clients should be informed regarding what information about them will be shared, with whom, and for what purposes. Will the supervisor be reviewing tapes of counseling sessions? Reading clinical case notes? Observing counseling sessions from behind a one-way mirror? If the supervisee is receiving group supervision as well as individual supervision, clients need to know this and also to understand that the supervisee will protect their identities when discussing their cases within the group format.

Sharing client information with a clinical supervisor is ethically acceptable and is not considered a breach of the client’s confidentiality. The umbrella of confidentiality is understood to be extended to other professionals (such as supervisors, consultants, or fellow members of a treatment team) with whom a counselor shares client information when the purpose is to improve services to clients (Remley & Herlihy, 2005).

Privileged communication is the legal counterpart to confidentiality. Supervisees need to know whether their relationships with their clients are considered to be privileged under the law in the state where they practice. Generally, the answer depends on whether the supervisor’s communications with clients are privileged. Privilege is usually extended to assistants and supervisees of professionals who themselves have privileged communication with their clients (Remley & Herlihy, 2005).

From an ethical perspective, it is important for supervisors to remember that they share the same obligations to client confidentiality as does the supervisee. Supervisors must maintain the confidentiality of any materials in their possession that may contain identifying information about clients, and they need to ensure that tapes of sessions are erased after they have served their purpose.

COMPETENCE

In the past, it was generally assumed that a professional who was a skilled practitioner would also make a good supervisor. Today, it is recognized that being a highly competent practitioner of one’s profession does not necessarily translate into being a competent supervisor and that supervision requires a specialized knowledge base and unique skills.

DON’T FORGET

Clients of supervisees must be informed that their counselor is working under supervision.

Competence in supervision is an elusive concept that can be difficult to define, particularly because competence is not an either-or characteristic. Competence exists on a continuum with maximum professional effectiveness on one end and gross negligence or incompetence at the other extreme. Generally speaking, however, competence as a supervisor is viewed as a quality that can be intentionally acquired through training, credentials, and experience.

To become a competent supervisor, it is necessary to acquire specific training in supervision. Professional organizations of most mental health professions make this obligation explicit to their members. For example, the Association for Counselor Education and Supervision’s (ACES) Ethical Guidelines for Counseling Supervisors (1993) require that those who undertake a supervisory role receive training in supervision before taking on that role, and the National Association for Social Workers (NASW) Code of Ethics (1999) requires social workers to have the knowledge and skills needed to supervise properly. Best-practice standards for competent supervision in counseling, as described in the ACES “Standards for Counseling Supervisors” (1990), include the following knowledge and skill components:

• Effectiveness as a counselor

• Attitudes and traits such as sensitivity to individual differences, motivation and commitment to supervision, and comfort with the authority inherent in the supervisory role

• Knowledge of and skill in applying ethical, legal, and regulatory dimensions of supervision

• Understanding of the professional and personal nature of supervision and the impact of supervision on the supervisee

• Understanding of the methods and techniques of supervision

• Appreciation for the process of counselor development as it unfolds in supervision

• Skill in case conceptualization and case management

• Ability to evaluate performance fairly and accurately and to provide constructive feedback

• Knowledge of oral and written reporting and recording procedures

• Knowledge of the rapidly expanding body of theory and research about supervision

Credentials are another possible means to gauge competence as a supervisor. Although a license or certification is required to practice most mental health professions, there is no standardized credentialing process for supervision. Counselor licensure boards in some states (e.g., California, Louisiana, Ohio, Texas) require those who supervise counselor interns not only to be licensed as counselors but also to hold a separate credential as a board-approved supervisor. The American Association for Marriage and Family Therapy (AAMFT) also offers an approved supervisory credential. The Center for Credentialing and Education (CCE), an affiliate of the NBCC, offers a national supervisory credential, but it is a voluntary credential. As was noted in the introductory chapter, supervisor competence is a vital issue that remains to be addressed on a consistent basis by the mental health professions.

The third criterion for achieving competence is clinical experience. Supervisors are expected to be well experienced in the areas of client services in which they are supervising. It would be impossible for any supervisor to have the breadth and depth of experience that would be needed to be competent to supervise in every specialty area, in every practice setting, and with every type of clientele who might present for services. Therefore, those who intend to provide supervision should be very clear about the kinds of cases they would not supervise (e.g., genetic counseling, child sexual abuse, or gerontological counseling if the supervisor lacks experience with these issues) and the kinds of settings that are outside their range of experience (e.g., inpatient treatment facilities for the chronically mentally ill if the supervisor’s experience is limited to the school setting).

In many cases, supervisors do not have the luxury of choosing whom they will supervise. Difficult questions regarding supervisor competence arise when professionals are required to supervise the work of someone from a different discipline than their own or to provide supervision of work with a clientele with whom the supervisor has little training or experience. Supervisors in these situations are vulnerable to accusations of practicing beyond the boundaries of their competence, which would be an ethical violation. Several options are available to professionals who are required by their employers to provide supervision in such instances, although none of the options are particularly appealing. The supervisors can seek additional training to learn about the unfamiliar discipline or clientele, they can state to their employers their objections to being required to provide the supervision and explain the rationale for their objections, or they can themselves seek supervision of their supervision. Having a record of one’s objections could help to provide a defense against any future charge of practicing beyond one’s competence. Working under supervision of supervision while seeking further training would help to ensure that adequate services are provided while supervisors are stretching their boundaries of competence to encompass the new supervisory responsibilities.

Multicultural Competence

An aspect of supervisor competence that is receiving a great deal of attention in the literature is multicultural competence. In our increasingly diverse society, it is essential that supervisors are multiculturally competent. It is impossible for supervisors to give supervisees knowledge and skills that the supervisors do not themselves possess (Haynes, Corey, & Moulton, 2003). The type of supervision relationship that is most effective in facilitating supervisee growth is a progressive relationship in which the supervisor is at a more advanced level of cultural identity development than the supervisee (Helms & Cook, 1999). Thus, before beginning to supervise, supervisors must gain personal awareness and insight regarding their own multiple cultural identities. These identities have been shaped by experiences of privilege and marginalization based membership in various cultural groups (based on such factors as socioeconomic class, gender, race or ethnicity, sexual orientation, religion, and disability status). Supervisors must first assess their own levels of cultural identity development and then address the cultural identity development of their supervisees. If they neglect to do this, they may inadvertently perpetuate stereotyping, misdiagnosis, and culturally insensitive practice on the part of their supervisees (Hays & Chang, 2003). By contrast, research has shown that addressing cultural identity development makes the supervisory relationship and process more effective (Ladany, Brittan-Powell, & Pannu, 1997; Ladany, Inman, Constantine, & Hofheinz, 1997).

Because it is the supervisor who holds the power in the supervisory relationship, it is the supervisor’s responsibility to raise the issue of cultural diversity in supervision (Bernard & Goodyear, 2004; Estrada, Frame, & Williams, 2004; Haynes et al., 2003; Ryde, 2000). Many supervisors feel anxious about addressing cultural differences. In a study by Constantine (1997), 40 percent of supervisees reported that their supervisors seemed reluctant to bring up and discuss cultural issues. However, if supervisors remain silent, they will be sending the implicit message to their supervisees that such topics are taboo. The question is not whether to bring diversity into the conversation but how to do so.