LAC & LAMFT SUPERVISION

My Personal Model of Supervision

My theory of therapy is solution focus.  My theory of supervision is also solution focus.  My theory of supervision and therapy will show isomorphism when I maintain my belief that clients and supervisees have it inside of themselves to solve their own problems (O’Hanlon & Wilk, 1987).   I will not conduct therapy with my supervisee, but I will assist the supervisee in exploring incidences when he has been beneficial to his client (De Shazer, 1988).  Isomorphism will occur when I do not establish hierarchies between me and my supervisee, and co-create a positive reality for the supervisee (Freedman & Combs, 1996).  Just as I do with clients, when the supervisee gets stuck, I will assist the supervisee in doing something different so that the supervisee may try different approaches (De Shazer, 1985).  A solution focused approach is isomorphic when the role is to assist client and supervisee in exploring solutions in the context of problem solving.

Hierarchy in Solution Focused Supervision

Sometimes I cannot use isomorphic approaches with both client and supervisee.  It is necessary, at times, for the supervisor to assume an expert role in the relationship with the supervisee.  I will need to take a directive approach if the supervisee is harming the client, when I am evaluating the supervisee, completing legal formalities, and when I am fulfilling my function as a gatekeeper (Todd & Storm, 2002).  It is at these times I will need to take on a more directive role.

It will be healthy for me to model the duality of my role with the supervisee, both as an expert and as an equal co-constructor.  The therapist cannot always maintain an equal relationship with the client.  There are times when the therapist will need to collect fees, discharge a client, refer a client elsewhere, set boundaries with a client, or testify in court.  All of these behaviors require a hierarchical position.  In solution focused therapy, the therapist only attempts to maintain an equal standing with the client as they seek to co-create reality.  It would create confusion if the therapist allowed the client to also co-create the therapist’s business or other functions.  As a supervisor, if I establish a hierarchical relationship when a regulatory role is needed and a joint relationship when problem solving, then I am demonstrating to my supervisee how to maintain appropriate relationships with their clients.  Such a distinction in the dual role of client/therapist and supervisor/supervisee is healthy.  The lack of such boundaries would create confusion and result in ethics violations.

Measuring Success in Supervision

The solution focused supervisor does not hold a view of a normal way for families or supervisees to be (Becvar & Becvar, 2003; Todd & Storm, 2002).  The solution focused supervisor uses the supervisee’s goals as the focus of supervision. The effectiveness of the solution focused supervisor is measured in the supervisor’s ability to assist the supervisee in reaching his goals. Supervisors that focus on the supervisee’s concerns are often rated highly by supervisee’s (Storm & Todd, 2002).

Solution focused work uses scaling questions and very specific identifiable goals (Guise, 2005; Todd, & Storm, 2002).  This lends very easily to using quantitative measures.  Quantitative measures increase the ease in which complimentary and exception questions may be utilized.  The solution focused supervisor uses the supervisee’s description of the goals not a normative view of goals (Todd & Storm, 2002).  The solution focused supervisor may collaboratively construct a quantitative form of measurement that would identify steps of attainment toward the supervisee’s goals (Storm & Todd, 2002).  This form can be constructed utilizing questions often asked in conjunction with using the miracle question, such as, “what will it look like when you have reached stated goal” and “what steps will you have taken to reach stated goal” (Guise, 2005; Todd & Storm, 2002).  The steps and end goal can then be written down, in chronological order, with a likert rating scale written at the bottom of each step.  This can be used in collaboratively measuring the supervisee’s progress.  It will be necessary to use some normative goals that are identified by licensing boards when examining the supervisee’s progress, these goals will include paperwork, confidentiality, and other lawful or ethical standard (Todd & Storm, 2002).

It is also necessary for the supervisee to evaluate the supervisor (Storm & Todd, 2002).  This should also be done using the supervisee’s goals.  The supervisee should be assisted in exploring what he wants in supervision and identifying if these goals are met.  This will help the supervisor in adjusting their supervision to meet individual supervisee needs (Storm & Todd).

Interventions Used in Supervision

Todd and Storm (2002) identified several interventions commonly used by solution focused supervisors.  Identifying and amplifying expectations is a common intervention that solution focused supervisors use. This intervention calls for the supervisee to bring in video tapes showing times he did well as a therapist. The supervisor asks the supervisee to identify how they conducted the session in such a positive manner. The supervisee may even be asked to compare the good segments with the bad segments in therapy.  The supervisee can explore the difference between the two segments and how he can expound upon the positive exceptions.  Supervisees inevitably cooperate with supervisors is the idea that a supervisee always cooperates with the supervisor, he just does it with varied response patterns.  One response pattern is that the supervisee will do what the supervisor says.  Another response pattern is that the supervisee will follow a variation of the supervisor’s advice.  A third response pattern is that the supervisee will do the opposite of what the supervisor says. Once a response pattern has been recognized, the supervisor can anticipate the supervisee’s response and adjust accordingly.  Supervisors keep change talk happening when they use language that presupposes change will and is occurring.  This positive, futuristic, language keeps the therapist looking for exceptions that are occurring.  Compliments and cheerleading help the supervisee recognize their strengths as the supervisor constantly points them out and comments on them.  Scaling questions keep the supervisee focused on their goals and progress toward goals.  This provides a clear focus for supervision.  Pretend the Miracle Happened is a technique also used in supervision.  The supervisor asks relatively the same questions they would a client regarding how interaction will look when a miracle occurs, how it did occur, and how to continue it.  The supervisee is also asked to act, in session, as if the miracle has occurred.  Video tapes are then reviewed to dissect changes that have occurred as a result of the change in the therapist’s behavior.  If something does not work, do something different is an approach used when the supervisee/supervisor relationship appears stuck.  The idea is that any change in a direction will jolt the relationship, and therefore the supervisee in a different direction.  Videotapes are often used so that strengths of the supervisee can be identified and encouraged (Todd & Storm, 2002).

Diagnosing

According to Todd and Storm (2002) the postmodern therapist is under legal and ethical standards that sometime fall outside of the realm of postmodern thinking.   If the supervisee asks to learn how to diagnosis, I would be obligated to teach the supervisee how to diagnose, even though postmodern supervisions discourage such labeling (Todd & Storm, 2002).  The way I would go about assisting my supervisee in learning how to diagnose would be from a solution focused perspective.  Knowing that my client has received prior training in diagnosing, I would build upon my supervisee’s strengths, finding exceptions to his remarks about his inability to diagnose (Walter & Peller, 1992).  Then I would have my client do more of the positive exceptions while building upon the positive narrative of his ability to diagnose (Freedman & Combs, 1996; Walter & Peller, 1992).  The post-modern supervisor cannot always escape the hierarchy position (Todd & Storm, 2002).  I may find it necessary to instruct my supervisee, but I would do so in a solution oriented manner.   I would present the material in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (2013) and I would identify it as a resource.  I would talk about how the supervisee can utilize resources at his disposal, thus keeping with the vision of solution focus.

Poor Supervisee Performance

Storm and Todd (2002) and Todd and Storm (2002) encouraged caution when determining underlying factors regarding supervisee success rates.  Poor performance may also be related to insufficient evaluation opportunities, maladaptive systemic interactions, or inappropriate hierarchies being played out.   A different intervention in the supervision process may result in the supervisor behaving differently.

As a supervisor, I would need to look at myself.  I would need to ask myself if I am recognizing and identifying talents in a way that would assist the supervisee to connect with clients.  I would need to determine if I am spending enough time reviewing tapes where I could find an exception to the supervisee’s difficulty.  The role of supervision is a two sided sword and both the role of the supervisor and the role of the supervisee must be examined.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental

            disorders (5th ed.). Arlington, VA:  American Psychiatric Publishing.

Becvar, S. D. & Becvar, J. R. (2003). Family therapy: A systemic integration (5th ed.) Boston,

            MA.: Pearson Education, Inc.

De Shazer, S. (1985). Keys to solution in brief therapy. New York: W. W. Norton & Company.

De Shazer, S. (1988). Clues: Investigating solutions in brief therapy. New York: W.W.

            Norton & Company.

Freedman, J., & Combs, G. (1996). Narrative Therapy: The social construction of preferred

            reality. New York: W.W. Norton Company.

Guise, W. R. (Ed.). (2005). Study guide for the marriage and family therapy national licensing

            examination (4th ed.). Jamaica Plain, Ma.: The Family Solutions Corporation.

O’ Hanlon, B., & Wilk, J. (1987). Shifting contexts. New York: Guilford Press.

Storm, L. C., & Todd, C. T. (2002) The reasonably complete systemic supervisor resource guide.

            Lincoln, NE: Authors Choice Press.

Todd, G. T., & Storm, L. C. (2002). The complete systemic supervisor. New York: Authors

            Choice Press.

Walter, L. J., & Peller E. J. (1992). Becoming solution-focused in brief therapy. Levittown, PA:

            Brunner/Mazel.