201 -Overcoming Biases and Anxieties in Clinical Supervision

Providing Feedback, Addressing Anxiety and Overcoming Biases
Instructor: Dr. Dawn-Elise Snipes, PhD
Executive Director: AllCEUs.com, Counselor Education and Training
Podcast Host: Counselor Toolbox & Happiness Isn’t Brain Surgery

CEUs are available at https://allceus.com/member/cart/index/product/id/514/c/

Objectives
~ Review types of supervisory intervention
~ Identify types of biases and ways to overcome them
~ Identify types of anxieties and how to address them
Feedback and Intervention
~ Can be triaged into three levels:
~ Immediate intervention
~ Non-immediate intervention
~ Suggestions
~ Designed to enhance counselor competencies
~ Personal characteristics (self awareness, cultural competence)
~ Philosophical foundations
~ Communications (verbal and nonverbal)
~ Counseling skills
~ Adjunctive or administrative activity
~ Ethical behaviors

5 Types of Supervisory Intervention
~ Facilitative: Brings about discussion through nondirective questions
~ What might the next step be?
~ What other interventions might you have used?
~ What other explanations exist?
~ Confrontive: Addresses specific action or behavior and requires the counselor to answer a question about it
~ Why did you choose to pursue that avenue with the client?
~ What was your intent when you asked…
~ What is your timeline for preparing for the audit on January 25?

Cont…
~ Conceptual: Contributes new information and a different way of visualizing the case
~ Sally is a 27 year old female with a 7-month old child and presents with symptoms of depression
~ Depression?
~ Grief?
~ Hormone changes?
~ Stress and sleep deprivation?
~ Prescriptive: Directs the counselor to respond in a particular manner the next time a certain set of circumstances occurs
~ The next time the client begins blaming his wife for things…
~ The next time a client calls at the last minute to cancel…
Cont…
~ Catalytic: Moves the process along by asking provocative, or what if questions
~ What if the client were to gather baseline data for a week
~ What if you used the empty chair technique
~ What if the client were to try [x intervention] for 1 week
~ What if you held the client on point for X-topic
~ What if you helped the client reconceptualize the problem

~ In later practice this is often the feedback you get from colleagues when you ask for suggestions.
~ Good type of intervention for ethical issues
Feedback is
~ Supervisor's response to the data presented
~ Lack of data leads to ineffective feedback
~ Designed to:
~ Help the supervisor understand (get inside the head of) the supervisee
~ Bring about a positive change in the professional life of the counselor
~ Supportive, challenging and pragmatic
~ Not “It was a good session”
~ But “It was a good session. I liked how you… And …. I am wondering… If I had to give one suggestion or area to work on it would be….”

Effective Feedback
~ Is elicited rather than imposed
~ Supervisees should be seeking feedback
~ Is timely
~ Is communicated clearly, directly and with regard to specific issues
~ Is constructive and descriptive rather than critical or judgmental
~ When the client revealed his concern about his anger issues and you responded by saying, “well, once we get your anxiety under control, your anger will probably not be a problem” he seemed to shut down. I am wondering what you intended to communicate and what your rationale was
~ Not: “Your response to the client was totally inappropriate”
Cont…
~ Is directed toward changeable behavior
~ Stay on task
~ When clients… then you should …
~ Is not used as a disciplinary weapon
~ Constructive feedback is presented with positive feedback and/or recognition of work well done

Methods of Providing Feedback
~ Trunking or breaking down information into manageable bites
~ Make a list of all the things you want to go over. Cover one at a time
~ Rapport/Therapeutic alliance
~ Adherence/relevance to treatment plan
~ Interventions used
~ Ethical Issues
~ Providing nonthreatening but thought-provoking were challenging questions
~ Sharing one's own experiences in concrete terms
~ Providing support and encouragement
~ Suggesting alternatives
Effective Challenges are
~ Tentative
~ What would have happened if
~ I am curious why you chose
~ Help me understand what you were hearing when
~ Phrased with the tone of care and respect
~ Tied to reinforcement
~ Okay, I totally see your rationale. That was a great choice.
~ I know it felt like a lot went wrong in that session, but you seem to really have a grasp on what to do differently next time.

Effective Challenges are
~ Built upon steps which have already been successfully accomplished
~ You have learned the technique and practiced it in supervision, how do you feel about trying it with clients next week.
~ Focused on specific and concrete behaviors
~ Review your tapes for how many times you used an audible pause
Countertransference
~ Countertransference: Projecting unresolved personal issues onto a client or supervisee)
~ Signs
~ A feeling of loathing, anxiety, or dread at the prospect of seeing a specific client or supervisee
~ Unexplained anger or rage at a particular client
~ Distaste for a particular client
~ Mistakes in scheduling clients, missed appointments
~ Forgetting client’s name, history
~ Drowsiness during a session or sessions ending abruptly
~ Excessive socializing

Countertransference cont…
~ Examples of supervisee transference include:
~ The supervisee’s idealization of the supervisor.
~ Distorted reactions to the supervisor based on the supervisee’s reaction to the power dynamics
~ The supervisee’s need for acceptance by or approval from an authority figure.
~ The supervisee’s reaction to the supervisor’s establishing boundaries
Countertransference cont…
~ Supervisor countertransference include:
~ The need for approval as a knowledgeable and competent supervisor.
~ Unresolved personal conflicts of the supervisor activated by the supervisory relationship.
~ Reactions to individual supervisees, such as dislike or idealizing some supervisees (whether or not warranted) in comparison to other supervisees.
~ Sexual or romantic attraction to certain supervisees.
~ Cultural countertransference, such as catering to or withdrawing from individuals of a specific cultural background
Transference & Countertransference
~ Supervisors need to be aware that
~ Transference reactions that may arise even from the way you decorate your office
~ Not all emotional reactions to clients are countertransference
~ Not all countertransference reaction to harmful
~ Can give you information about reactions the supervisee might bring up in others
~ The difference between healthy personal or therapeutic responses to clients and unhealthy responses arise from the supervisor’s own unresolved conflicts.
~ Compassion for a therapist struggling with a client who has relapsed vs. anger at the therapist for not doing it “right”
Determining Skill Levels
~ Supervisors should not:
~ Assume a developmental level based on the counselor's experience and training (biases toward programs or prior placements)
~ Assess counselor simply on the basis of initial impressions
~ Determine developmental level simply on the basis of performance in one or two domains
~ Supervisors should use several sources of information to assess counselor's development including assessments by
~ Former supervisors
~ Measurements administered by the current supervisor
~ Counselor self-assessments
~ Client ratings
~ Work samples

Biases Affecting Supervision
~ Recency: Remembering only what happened last week, not six months ago
~ Overemphasis on one factor (rapport) as opposed to the bigger picture (counseling techniques, documentation, ethics…)
~ Unforgivingness leading to an inability to acknowledge improvement
~ Prejudice based upon negative attributions
~ Favoritism
~ Grouping or stereotyping
~ Indiscrimination, being either too approving or too critical
Protecting Against Biases
~ Use standardized rating scales for all employees/supervisees
~ Creating behaviorally anchored rating scales
Sources of Anxiety for Supervisees
~ Beginner's quandary or the fear of the unknown
~ Role plays
~ Co-facilitation bridge
~ Live (remote) observation
~ The spun glass theory that their clients are delicate objects
~ Have supervisees list all of the things the client has survived
~ Have supervisees put themselves in the client’s shoes
Sources of Anxiety for Supervisees
~ Performance and approval anxiety
~ Ensure early and frequent successes
~ Always remember to point out the positive
~ Remind supervisees that this is a learning process that takes YEARS
~ Validate their anxiety with self-disclosure… “The first time I…
~ Dominance anxiety (unwillingness to speak up)
~ Reinforce the notion that the supervisee knows the client better than you do
~ Point out how much more effective it is if the client asserts his/her rationale/needs/wants
~ Ensure the individual development plan is tailored around the supervisees stated goals

Dealing with Anxiety
~ Identify the supervisees anxious behaviors/defense mechanisms
~ Tardiness
~ Overuse of/dependence on the supervisor
~ Irritability
~ “Forgetting” to talk about a certain client or use an agreed upon intervention
~ Assist the supervisee and recognizing and exploring the cognitive pattern, and the needs it expresses
~ Need for control
~ Need for approval
~ Need for perfection
~ Lack of trust in the client
Cont…
~ Challenge the irrational beliefs with questions
~ Every client I have has relapsed
~ None of my clients like me
~ I am a bad therapist because he dropped out…
~ Assist the supervisee in constructing (and remembering to use) rational and logical thoughts related to the anxiety or anger
~ My client is so resistant. She blocks me at every turn…
~ My client has no respect for my time. He always cancels at the last minute
~ Ask the supervisee to write down the name of each client and state what aspect of each case worries him or her

Summary
~ Feedback can be anxiety provoking for supervisors and supervisees
~ Develop a metaphor
~ Remember the intent and spirit
~ Ensure you provide positive as well as constructive feedback
~ If supervisees are doing well, pose hypotheticals to ensure they are able to respond to a variety of situations
~ Types of anxiety include
~ Beginners quandary
~ Spun glass
~ Need for approval
~ Dominance

Summary
~ Biases include:
~ Transference
~ Prior experiences with students from that program
~ Cultural
~ Other individual factor
~ Recency
~ Unforgivingness
~ Overemphasis on one factor
~ Grouping or stereotyping
~ Indiscrimination