Clinical Supervision - Essay Example

Running Head: clinical supervision Bishop, V. (1998) suggests that “effective clinical supervision needs a managerial commitment to its implementation and ongoing operation”. Discuss and describe how you might gain this [Name of the writer] [Name of the institution] Bishop, V. (1998) suggests that “effective clinical supervision needs a managerial commitment to its implementation and ongoing operation”. Discuss and describe how you might gain this Since the start οf 21st century, the position and functions οf school counsellors have changed noticeably (Schmidt, 1993). The focus οf school counselling has shifted from vocational guidance to more emphasis on the use οf clinical skills, including individual and group counselling. In a recent editorial in this journal, Sink (1999) noted, "In my view, counsellor educators are training nascent school counsellors less from a clinical framework" (p. ii). Consequently, a need for more effective supervision οf school counsellors has been recognized. However, a majority οf school counsellors do not receive adequate supervision; indeed, many are supervised by school administrators who are not trained in counselling (Roberts & Borders, 1994; Sutton & Page, 1994). The American Association οf Counselling and Development School Counselling Task Force (1989; now ACA) has declared a need for counselling supervision οf practicing school counsellors (hereafter referred to as clinical supervision). However, there are few studies on the effects οf clinical supervision on veteran counsellors οf any type (Bernard & Goodyear, 1992) and even fewer on school counsellors. Research on the effects οf clinical supervision on school counsellors is rare (Crutchfield & Borders, 1997; Roberts & Borders, 1994; Sutton & Page, 1994). Just one ongoing clinical supervision program οf school counsellors was found in a literature search, but other than informal comments from the participants, the authors did not report formal evaluation findings (Henderson & Lampe, 1992). Two peer group, clinical supervision programs have been described and tested in the literature: Borders (1991) Systematic Peer Group Supervision and Benshoff and Paisleys (1996) Structured Peer Consultation Model for School Counsellors. When compared with no supervision, the quantitative research findings on both programs were not significant (Crutchfield & Borders, 1997). The counsellor participants in Crutchfield and Borders (1997) study were provided few opportunities for supervision training, and their involvement in clinical supervision was limited to the duration οf the study. As a consequence οf the lack οf clinical supervision programs and research, there was a call for school systems to design and examine methods οf school counsellor supervision. Recent Counsellor Educators and Supervisors Network (CESNET) exchanges underscore the necessity and the complexities οf establishing clinical supervision οf school counsellors. In a December 1998 article in Counselling Today, Hayes (1998) asserted that the need for practical and effective clinical supervision programs was a challenge the school counselling profession cannot ignore. Thus, the purpose οf this article is to describe and present evaluation evidence οf a long-term clinical supervision program for school counsellors. (Thomas 1995) Program History and Description Acting on the need for clinical supervision οf school counsellors, a director οf counselling and guidance, in a suburban Virginia school system in 1994, initiated a clinical supervision-training program for the systems elementary counsellors. The system had attempted peer consultation previously, but the lack οf supervision training and clear structure had impeded the program. Consequently, the school system employed a licensed practicing counsellor and credentialed supervisor to design, train, and implement a peer group clinical supervision program for the elementary counsellors (Getz, in press). The programs pragmatic design took 3 years to implement. In the first year, the consultant met once a month with the entire group οf counsellors, 17 from K-5 schools, and 4 who were middle school sixth-grade counsellors. Various clinical supervision methods were demonstrated and taught in nine clinical supervision training sessions for the counsellors the first year. The consultant gave didactic presentations and used the Discrimination Model (Bernard, 1979) to discuss the different roles οf supervisors (teacher, counsellor, consultant) and the variation οf focus in supervision (intervention, conceptualisation, personalization). Each month one οf the counsellors brought a videotape οf counselling work with a student, and the consultant demonstrated and trained the counsellors in different peer group supervision methods. Interpersonal Process Recall (Kagan & Kagan, 1997) was used as a method to stop the videotape and ask the counsellor/supervisee to recall thoughts and feelings and reasons for using particular counselling strategies. Systematic Peer Group Supervision (Borders, 1991) involved the peer supervisors in taking particular feedback roles, tasks, or perspectives to view the videotape. Family Sculpting (Satir, 1972) was a method to create a visual metaphorical representation οf the counsellor, counselee, and the counselees family. Role-playing simulated interaction between the counsellor and counselee to rehearse new skills or strategies or to reverse roles for better understanding οf the case. The Structured Group Supervision Approach (Wilbur, Roberts-Wilbur, Hart, Morris, & Betz, 1994) gave the supervisee an opportunity to make a narrowly defined request for help and for the peers to adhere to concise feedback. During the second year, the counsellors were assigned to peer groups οf four. Each group met four times during the year so that each counsellor received at least one supervision feedback session from the three peers. The consultant developed a form for supervisees to use to structure the presentation and a form for the peer supervisors to use to give feedback. When presenting to the group, the supervisee briefly described the counselee, stated the counselling goals and desired outcomes, stated what kind οf help the supervisee wanted, and described what supervision method was desired. The peer feedback form included strengths οf the supervisee, comments about the case, and suggestions for improvement, for strategies, and for direction. The consultant met and provided supervision feedback with each group during that second year. Also, each peer group modelled its supervision process in front οf all the elementary counsellors for feedback on its supervision focus, methods, and structure. (Farrington 1998) The peer groups continued to meet on their own during the third year. The consultant was available to each group once during the year to provide feedback about the peer supervision process. They were encouraged to continue to try different supervision methods and to balance their focus on counselling skills/interventions, case conceptualisation, and the counsellors self-awareness. Now in its sixth year, the systems elementary counsellors conduct a 2-hour session οf peer supervision every other month without external supervision. Usually two counsellors receive structured supervision in each session. Additionally, the counsellors who were not supervised during that session often request specific case consultation help from their peers. For the purposes οf accountability, each group is required to write a short synopsis οf the supervision session, which is submitted to the director οf counselling and guidance. Over the 4 years οf implementation and operation prior to this study, this clinical supervision program had developed pragmatically to meet the needs οf the school counsellors. However, the program had not been systematically or comprehensively evaluated before this study (Agnew, 1998) was undertaken. The director οf counselling and guidance and school counsellor participants recognized a need to conduct a formal evaluation. Methodology Since formal program goals were not in evidence, a qualitative program evaluation based on Pattons (1980) and Stakes (1975) goals-free method was used to evaluate the school systems peer group clinical supervision program. This qualitative evaluation differentiated from a quantitative research design because none οf the variables could be controlled (Patton, 1982). Using Pattons definition, this qualitative evaluation design emphasized "(1) the systematic collection οf information about (2) a broad range οf topics (3) for use by specific people (4) for a variety οf purposes" (p. 35). The evaluation questions were formulated to (a) collect specific data (interviews, burnout scales, semantic differentials) on (b) several topics related to peer group clinical supervision (c) for use by school system officials and future researchers, (d) for decision-making in the school division, and study οf peer group clinical supervision. This study was formed around these evaluation questions: 1. As a result οf participation in the program, what counselling skills (e.g., questioning techniques) did the participants in the evaluation believe they gained or improved? 2. As a result οf participation, what changes (e.g., consultation and referral knowledge) did participants note in their own professional growth? 3. As a result οf participation, what personal gains (e.g., increased self-awareness) did participants note? 4. What, according to participants, were the strengths, weaknesses, and barriers in the peer group clinical supervision program in which they participated? Sources οf data included archival documents relating to the peer supervision program--the Job Satisfaction Blank (JSB) (Hoppock, 1935), Cummings and Nalls (1983) counsellor burnout Semantic Differential Scales (SDS), interviews, anonymous responses, and researcher-developed semantic differential scales (Agnew SDS; Agnew, 1998). Evaluative data were provided through structured interviews with 13 elementary counsellors, 1 former elementary counsellor, 12 principals, 2 assistant principals, and the counselling and guidance director. Two different sets οf SDS scales were used because each scale captured different information. Use οf the Cummins and Nails scale allowed comparison with previous studies on counsellor burnout. The 16 counsellor participants were also given the opportunity to submit anonymous responses to perceived strengths and weaknesses on any aspect οf the program; 8 returned responses to the evaluator by mail. In addition to being interviewed, the 13 counsellors who had participated in the supervision program since its inception rated the program on both the Cummins and Nails SDS and the Agnew SDS. To triangulate the interviews and other data gathered, a nine-adjective pair, seven-point Agnew SDS οf seven concepts was constructed and field-tested on four non-participating elementary counsellors for this evaluation. Three concepts measured program effects: skill gains, professional changes, and counselling relationships. Four concepts measured program strengths and weaknesses: peer clinical supervision, peer supervision sessions, supervision feedback, and administrative support. Adjective pairs were selected from Osgood, Suci, and Tannenbaum (1957) to measure three dimensions: evaluative, potency, and activity. Adjective pairs chosen in the evaluative dimension were good-bad, meaningful-meaningless, and positive-negative; in the potency dimension, free-constrained, strong-weak, and easy-difficult; and in the activity dimension, active-passive, simple-complex, and fast-slow. The scales assigned to the adjective pairs ranged between seven and one. (Driscoll 2000) Reliability and validity data for the JSB and counsellor burnout SDS developed by Cummings and Nail (1983) are described by Agnew (1998). A factor analysis conducted according to the protocol developed by Osgood et al. (1957) determined that the adjective pairs used in this evaluation fell into three dimensions: evaluative, potency, and activity. A confirmatory factor analysis conducted by the evaluator (Agnew, 1998) on the adjective pairs verified earlier findings οf Osgood et al. (1957). Evaluation Participants Thirty-two οf the school systems professionals were selected and consented to participate in the qualitative evaluation. This number represented all persons who had participated in the program and were still employed by the school system. Participants included the director οf guidance and counselling, 16 οf the systems current elementary school counsellors (3 οf the counsellors were recent hires to the system and had limited experience with the program, although they had experience in other school districts), a former elementary counsellor, 12 elementary school principals, and 2 assistant principals. All the counsellors were female; the director οf guidance was male; six οf the school administrators were female and eight were male. The mean years οf experience for school counsellors in this investigation was 11.7 years; there were no first- or second-year counsellors in terms οf overall experience. All but one school, which served a small rural elementary school population (N = 80), were located in a suburban area; the range οf school size was 80 to 600 students. Data Analysis and Findings Results from the interviews were analysed using a thematic analysis approach as described by Silverman (1993). Using transcripts, the evaluator identified themes and sub themes from the participants responses. Categories were established, and frequencies οf responses within these categories were counted. Transcripts were returned to participants prior to analysis for review to ensure accuracy οf the data. Gains Attributed to the Supervision Program Almost all (97%) οf the (29) interviewees observed and attributed positive counselling skill, professional gains, and personal gains or changes to the peer clinical supervision program (see Table 1). Also 97% οf the interviewees identified strengths, confirmed by statements found in all the anonymous responses submitted to the evaluator. The Agnew SDS also confirmed the interview findings (see Table 2). The JSB and the counsellor burnout SDS mean scores indicated that the counsellors in the peer group clinical supervision program had high job satisfaction and significantly low burnout levels. The evaluation respondents believed that the peer group clinical supervision program had increased the participants opportunities to learn counselling skills and techniques. In the interviews, all οf the counsellors believed they had gained more counselling skills by their participation in the supervision program. Peer feedback was the predominant explanation given for skill gains. Some 13 οf the 15 administrators interviewed observed some gains in counselling skill, but could not attribute the gains specifically to the clinical supervision program. All the counsellors interviewed perceived an increased sense οf professionalism that they attributed to their peer group clinical supervision experiences. As one οf the counsellor interviewees stated, "As a result οf this program, we just feel more professional." Counsellors also reported their consultation had increased and referral skills had improved. Forty-three percent (n = 6) οf the principals noted professional changes such as an increased counsellor awareness οf referral sources. The differences between the numbers in counsellors and administrators positive observations may be attributed to two factors: (1) there is a lack οf clear definition οf the word "professional," and (2) counsellors may be in a better position to assess their own professional changes. All οf the counsellors perceived personal gains as a result οf membership in the program. Three themes were predominant in most οf the counsellor interviews: increased confidence, comfort with job, and professional validation. Six (43%) οf the administrators observed personal gains. As one principal stated, "Personal gain may not be an observable characteristic." The counsellors scores on the Agnew SDS corroborated program gains and strengths. All but the skill gains in the activity dimension SDS concepts were interpreted in a positive direction. Although most οf the SDS scores were at high levels, the skill gain SDS mean score was the lowest program effect for the counsellors. The counsellors adjective pair means on the concept οf professional change were favourable. The strongest program outcome found in the SDS mean scores was the counsellors improved counselling relationships with students. Program Strengths and Weaknesses Discussion Strengths οf the supervision program were identified by all evaluation participants interviewed. One factor, improved professional relationships with other counsellors, was found in a majority οf the strength themes. In addition, the counsellors who were interviewed recognized administrative support, the structure οf the supervision sessions, and supervision training as strengths. Peer support, the strength most often cited in all the interviews, helped improve the counsellors professional and personal validation and reduced their sense οf isolation. Interviewees stipulated that the program also increased the participants professional validation, reduced their sense οf isolation, and increased their self-awareness. Four concepts--peer clinical supervision, peer supervision sessions, supervision feedback, and administrative support--were measured by the Agnew SDS to assess the programs strengths and weaknesses. Overall, the results οf these scales substantiated counsellor interview statements regarding the strengths οf the program, noting strengths such as supervision feedback and administrative support (see Table 2). Sixteen counsellors were invited to give anonymous responses to the program by returning comments using an envelope provided by the evaluator; eight did so. Most οf the anonymous responses identified program strengths. As with the interviews, strengths included peer support, self-awareness (including personal growth), supervision training, supervision feedback, and administrative support. Three weaknesses were noted from the counsellor interviews and anonymous responses: peer group relationship issues or dynamics, lack οf adequate clinical supervision time, and lack οf reinforcement οf clinical supervision techniques. Lack οf adequate time for supervision appeared to be the most serious weakness. For example, currently the peer groups hold a 2-hour supervision session every other month. Thus, it is not uncommon to have the time between "full" supervision sessions οf one counsellor to be as long as 4 to 6 months. Each counsellor in the group might receive a structured supervision once a year. Another weakness expressed by the counsellors was the real or potential relationship and/or membership issues. A wide variety οf experiences and counselling skill levels was found within a group. If the membership does not change periodically, a highly skilled counsellor may not be given needed or appropriate supervision. The comfort levels within some οf the groups were very high, which became both strength and a weakness. One οf the counsellors noted that as the members οf her group became so comfortable with each other, they began to challenge each other less. There seemed to be a need for "fresh" input for that group. There was also a need for reinforcing clinical supervision training. The director οf counselling and guidance and most οf the counsellors saw the need for more clinical supervision training for themselves and for counsellors new to the system. Although the Agnew SDS scores indicated that the counsellors perceived the supervision program to be complex and difficult, these scores were not interpreted to be weaknesses. When provided a summary οf the SDS, the counsellors identified the complexities and difficulties οf the peer clinical supervision program as strengths because it made them feel more professional. It is difficult to compare findings from this evaluative research because previous studies on clinical supervision have focused on trainees, not on practicing school counsellors. Additionally, most were not peer supervision programs. However, the findings from this qualitative evaluation supported Benshoff and Paisleys (1996) and Crutchfield and Borders (1997) qualitative findings on supervisees growth during supervision. Use οf Findings The evaluation findings regarding effectiveness and impact οf this particular program were submitted to the school system that devised the program. Every school system or district has its own identity and distinctive characteristics. What works well in one system may not, without modification, work well in another. Hence, the peer group clinical supervision method described here might be implemented in other school systems or districts by tailoring it to the needs οf those counsellors in that school system. Some elements uncovered by this evaluation may be essential in implementing a school counsellor peer clinical supervision program. These include: * Administrative support (i.e., time for supervision sessions) * Clinical supervision training (i.e., review and feedback οf tapes) * School counsellors knowledge οf the purpose and potential benefits οf peer clinical supervision * Adequate funding * Adequate time for clinical supervision (more than 2 hours bi-monthly) * Built-in periodic clinical supervision training (at least annually to be sure new counsellors are trained) Reference: Agnew, D. T. (1998). An evaluation οf the Getz-Roanoke County School Systems School Counsellor Peer Group Clinical Supervision Program. (Unpublished doctoral dissertation, Virginia Polytechnic Institute and State University, Blacksburg, Virginia). Dissertation Abstracts International, 59-10A, 3742. American Association for Counselling and Development School Counselling Task Force. (1989). School counselling: A professional at risk [Final Report]. Alexandria, VA: American Association for Counselling and Development. Benshoff, J. M., & Paisley, P. O. (1996). The structured peer consultation model for school counsellors. Journal οf Counselling and Development, 74, 314-318. Bernard, J. M. (1979). Supervisor training: A discrimination model. Counsellor Education and Supervision, 19, 60-69. Bernard, J. M., & Goodyear, R. K. (1992). Fundamentals οf clinical supervision. Boston: Allyn & Bacon. Borders, L. D. (1991). A systematic approach to peer group supervision. Journal οf Counselling and Development, 69, 248-252. Crutchfield, L. B., & Borders, L. D. (1997). Impact οf two clinical peer supervision models on practicing school counsellors. Journal οf Counselling and Development, 75, 219-230. Cummings, O. W., & Nail, R. L. (1983). Relationships οf leadership style and burnout to counsellors perceptions οf their jobs, themselves, and their clients. Counsellor Education and Supervision, 22, 227-234. Getz, H. G. (in press). Training in peer group clinical supervision: Professional development for elementary school counsellors. Virginia Counsellors Association Journal. Hayes, L. L. (1998,December). Supervision οf school counsellors debated. Counselling Today, pp. 1, 19. Henderson, P., & Lampe, R. E. (1992). Clinical supervision οf school counsellors. The School Counsellor, 39, 151-157. Hoppock, R. (1935). Job satisfaction. New York: Arno Press. Kagan, H. K., & Kagan, N. I. (1997). Interpersonal process recall: Influencing human interaction. In C. E. Watkins, Jr. (Ed.), Handbook οf psychotherapy supervision (pp. 296-309). New York: Wiley. Osgood, C. E., Suci, G. J., & Tannenbaum, P.H. (1957). The measurement οf meaning. Urbana, IL: University οf Chicago Press. Patton, M. Q. (1980). Qualitative evaluation methods. Beverly Hills, CA: Sage. Patton, M. Q. (1982). Practical evaluation. Newbury Park, CA: Sage. Roberts, E. T., & Borders, L. D. (1994). Supervision οf school counsellors: Administrative, program, and counselling. The School Counsellor, 41, 149-157. Satir, V. (1972). Peoplemaking. Palo Alto: Science & Behaviour Books. Schmidt, J. J. (1993). Counselling in schools, Essential services and comprehensive programs. Boston: Allyn & Bacon. Silverman, D. (1993). Interpreting qualitative data: Methods for analysing talk, text, and interaction. London: Sage. Sink, C. A. (1999). Professional school counselling in transition. Professional School Counselling 3(1), ii. Stake, R. (1975). Evaluating the arts in education, a responsive approach. Columbus, OH: Merrill. Sutton, J. M., Jr., & Page, B. J. (1994). Post-degree clinical supervision οf school counsellors. The School Counsellor, 42, 32-39. Wilbur, M. P., Roberts-Wilbur, J., Hart, G., Morris, J. R., & Betz, R. L. (1994). Structured group supervision (SGS): A pilot study. Counsellor Education and Supervision, 33, 262-279. Butterworth A., Carson J., White E., Jeacock J., Clements A., Bishop V. (1997) It is Good to Talk: An Evaluation οf Clinical Supervision and Mentorship in England and Scotland. Manchester University, Manchester. Bond M., Holland S. (1998) The surface picture: the development and value οf clinical supervision. Skills οf Clinical Supervision for Nurses. Open University Press, Buckingham. Driscoll J. (2000) Practising Clinical Supervision: a Reflective Approach. Bailliere Tindall, London. Farrington A. (1998) Clinical supervision: issues for mental health nursing. Mental Health Nursing, 18; 1: 19-21. Thomas, S. (1995), Clinical Supervision, Journal οf Community Nursing 9; 10: 12­18. Read More