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Clinical Supervision of Child and Adolescen t Counselors in Residential Foster Care: A Collective Case Study by Lee A. Teufel A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy Department of Counselor Education College of Education University of South Florida Major Professor: Herbert A. Exum, Ph.D. Jennifer N. Baggerly, Ph.D. Jeffrey D. Kromrey, Ph.D. Lisa M. Lopez, Ph.D. Michelle Mitcham-Smith, Ph.D. Date of Approval: August 28, 2007 Keywords: qualitative, supervisor, superv isees, supervision delivery, supervisory relationship, developmental supervision Copyright 2007, Lee A. Teufel
Acknowledgments To my academic support system, I would like to thank the following people: Dr. Donna Anderson for being the positive and supportive impetus to my acceptance into the educational specialist program th at eventually lead me to the doctoral program; you knew the path would clear for me and I appreciate all the guidance you provided. Ms. Sandy Turner for always being a delightful person to work with while I was a graduate assistant and supporting me w ith your with your cheerful interest in my academic affairs. Thank you, Dr. Herb ert A. Exum for your challenge and support. I looked to you for cl arity and calmness when I often felt overwhelmed. Dr. Exum, you never failed me, and in addition, you added humor and wisdom to my doctoral experience. For your supervision a nd mentorship, I will be forever grateful. Thank you, doctoral committee, specifically the many members that have added time and expertise, have been and continue to be gifted contributors to my success, and I thank you: Drs. DeMarie, Lopez, Mitc ham-Smith, Baggerly, Onwuegbuzie, and Kromrey. Also, a long time in the making thank you to Dr. Jerry Osheski whom was at Ohio University when he asked me one final question during my phone interview for admission into the masters program in mental health counseling, that I will never forget. He asked, knowing that I had a lo w GPA from years of being a misplaced biology undergraduate and that I was a la te admission, So, do you want to be a counselor? and I replied Yes, with all of my heart! He so gracefully after considering my personal statement and in terview in conjunction with a difficult undergraduate career and poor GRE scores replied:ok, youre admitted into the program.
To the most caring and compassionate fr iends and family a person could ever ask for, an acknowledgment is but a mild th ank you for all you have done to help this long process. My darling mother, you are my warrior. Without you none of this could have been possible; you have supported me tirelessly and selflessly. My dream was made possible through your love. My deares t dad, you are my road less traveled. You have made all the difference in my life; th ank you for always making me feel like the best. Without such supportive parents, I could have never become the person I am today. I am forever grateful for your complete belief in the person I am and the goals I have in my life. My brother Trey, thank you for never questioning and always believing. You will always be my biggest insp iration and you are far more intelligent and witty than I could ever hope to be; th ank you for being my page master. To Ms. Emily Quist, you are a constant when ther e has been so much drama, and I could always count on you for a calming conversation from a distance. To Ms. Katherine Fuerth, the youngest of friends but the wisest of souls; you are fierce, passionate, and loyal to the end. To Ms. Amy Menna, you have been and will always be the keeper of my sanity in compromised times. You are endlessly optimistic and completely hilarious. Amy, your daily friendship has provided support, guidance, and empathy during a time in my life that seemed to have a lot of sunshine but plenty of little black rain clouds. Together, Kathy and Am y you are my spirit sisters and you have honored me with your support. To Dr. Jose E. Coll and Mr. Chris Simmons, thank you for being the best of cohorts and most fun of friends, you both were the competitive challenge I needed to finis h. And most fondly, my Honey, thank you for being my weary companion and my Buddha Please know if you are not mentioned;
you are not forgotten. In addition, thank you to all the people who have challenged my intellect, spirit, heart, or passion on the road to this very personal goal; the eagerness to emerge from your pestilence con tinues to inspire me and be ever more mindful of the compassionate possibilities in my life.
i Table of Contents List of Figures iii Abstract iv Chapter One Introduction 1 Statement of the Problem 4 Purpose of the Study 4 Significance of the Study 5 Questions of the Study 5 Conceptual Assumptions 5 Conceptual Framework 7 Definition of Major Terms 9 Scope and Delimitation of the Study 10 Overview of Dissertation Chapters 11 Chapter Two Literature Review 13 Introduction 13 Clinical Supervision Defined 13 Theoretical Models of Supervision 15 The Integrated Developmental Model 16 The Ronnestad and Skovholt Model 20 Additional Developmental Models of Supervision 25 Supervision Delivery 27 Issues Specific to Child/Adol escent Counselor Supervision 29 Summary 36 Chapter Three Method 38 Design 38 Participants 38 Study Site 38 Sample 40 Instruments 41 Pilot Study 42 Procedure 45 Data Analysis 47 Legitimation 48 Clarification of research bias 48
ii Pier Debriefing 49 Member Checks 49 External Audits 50 Transferability 51 Dependability 51 Summary 51 Chapter Four Results 52 The Supervisor 52 Sandnes 52 Sandenes in Supervision 59 The Supervisees 63 Erica 63 Erica in Supervision 65 Jenifer 67 Jenifer in Supervision 68 Paulina 70 Paulina in Supervision 72 Within-case findings 73 Across-case findings 88 Summary 95 Chapter Five Summary and Conclusions 96 Collective Case 97 Conclusions 101 Child and Adolescent Counselor Competencies 103 Supervisor Competencies 105 Limitations 106 Implications 107 Alternative Model 108 Implications for School Counseling 110 Recommendations for additional research 111 References 114 Appendices 129 Appendix A: Consent Form 130 Appendix B: Demograp hic Questionnaire 133 Appendix C: Post-Supe rvision Interview 135 Appendix D: Field notes 136 About the Author End Page
iii List of Figures Figure 1. Conceptual Framework 7
iv Clinical Supervision of Child and Adolescen t Counselors in Reside ntial Foster Care: A Collective Case Study Lee A. Teufel ABSTRACT A collective case study is the study of more than one case (Stake, 1995). One therapist supervisor and three therapist supervisees from a child and adolescent residential foster care facility were observ ed during their individua l clinical supervision and interviewed post-supervisi on. Currently, the literature on clinical superv ision seldom addresses the supervision of wo rking professional counselors; particularly those who are child and adolescent counselors (CACs). Using a qualitative approach, two fundamental questions guided this inquiry: (a) what is the nature of clinical supervision involving a supervisor who provides clinic al supervision to counselors in a child and adolescent residential foster care center that provides mental health treatment? and (b) within the clinical supervision experien ce, what issues involving chil dren and adolescents does the supervisor explore? Participants provided detailed demogra phic information about their work and educational experience. During the post-superv ision interviews participants recalled the content of the clinical su pervision, discussed their t houghts and feelings about the supervision experience, explored how the s upervision met their s upervisory needs and expanded on their beliefs about the proce ss of supervision in general. Constant
v comparative analyses, both within-case a nd cross-case, were conducted and themes emerged from the interviews. Various themes emerged that were associated with: administrative supervision, best practices case specific discussion, developmental understanding, ethical dilemmas, the personal is sues of the supervisor and supervisees, supervision practices, treatment modalities, treatment planning, and working with various systems. Within the clinical supervision of CACs in residential foster care the nature of supervision is related to disc ussing specific cases in the faci lity, the supervision practice as it is experienced within each supervisor s upervisee relationship, and a general desire to explore the best approaches when working with the children and adolescents at the facility. Collectively the superv isor and supervisees explored issues related to children and adolescents specific to individual cas es consistent with generic supervision. Implications for practice and research are also discussed.
1 Chapter One Introduction Supervision, as defined in counseling, is often an important mechanism for upholding the standards and pr actices of the profession. It provides a means for educating beginners into the profession while protecting clients and monitoring ethical practice. In counseling, increas ing emphasis is placed on not only the satisfaction of the training e xperience for the supervisee, but also on the quality of the professional as an outcome of the developm ental process of supervision. Specifically, there is a growing body of literature disc ussing and investigating the process of supervision and the efficacy of various m odels of supervision (Bernard & Goodyear, 1998, 2004; Bradley & Ladany, 2001; Goody ear & Bernard, 1998; Holloway & Carroll, 1999; Watkins, 1994). Literature on supervision is somewh at generic and often broadly defined, rarely mentioning the population of client s that supervisees counsel. Although the supervision literature does a ddress different models of s upervision, it typically does not address special skills or qualifications that a supervis or might need in order to supervise counselors who work with a particular client popul ation. This is particularly true for counselors who work with childre n and adolescents and for the professionals that supervise them. For example, child and adolescent counselors (CACs) currently do not need to have specialized training or certification to be the counselors of
2 children and adolescents. They simply n eed the same masters degree that persons who work with adults earn. Supervisors of CACs also do not currently need specialized training or certification. They onl y need to be qualified supervisors, and they only need to be a qualified supervisor if required by a state licensure board and if the supervisee is working toward licensure. Hence, although the counseling professi on does have specializations related to several areas of clinic al practice, it does not have speci alizations related to clinical supervision, and it does not have speciali zation for CACs. Within the literature specific to school counselors (Crutchf ield & Borders, 1997; Crutchfield, Price, McGarity, Pennington, Richardson, & Tsolis 1997; Herlihy, 2002; Kahn, 1999; Page, Pietrzak, & Sutton, 2001; Studer, 2006) th ere is consensus among school counselors working with children and adolescents affirmin g a general lack of clinical supervision as well as a desire for clinical supervisi on. Similarly, with the wi de range of mental health concerns and increasing prevalence of mental health issu es in children and adolescents (U.S. Public Hea lth Service, 2000) clinicians working with children and adolescents are also often asked to go beyond the scope of practice for which they were initially trained. One reason for this may be due to lack of attention from the leadership of the profession. The Council for th e Accreditation of Counseli ng and Related Educational Programs (CACREP) is an independent ag ency that reviews programs in career counseling, college counseling, community counseling, gerontological counseling, marital, couple, and family counseling/th erapy, mental health counseling, school counseling, student affairs, and counselor education and supervision. According to
3 CACREP standards, practicum and intern ship students must receive a minimum amount of supervision from university instru ctors/faculty and supe rvisors at the site where the student is completing the pract icum or internship (CACREP, 2001). Supervision within the CACREP standards is broadly defined as an average of one and one half hours per week of group supe rvision that is provided on a regular schedule over the course of the students practicum a nd internship by a program faculty member or a supervisor under the supervision of a prog ram faculty member. However, CACREP makes no distinction in the standards for the supervision of practicum or internship students based on the population of clie nts the student is counseling. Hence, it does not have st andards or competencies for child and adolescent counselors nor child and adolescent supervisors. The American Counseling Associations (ACA) Code of Ethics for counselors under the section of counselor supervision a nd client welfare broa dly defines the role of supervision process. The supervis or is obligated to be trained: Prior to offering clinic al supervision services, counselors are trained in supervision methods and techniques Counselors who offer clinical supervision services regularly pursue c ontinuing education activities including both counseling and supervision t opics and skills (ACA, 2005, p.14). Specifically, the ACA ethical code discusse s that supervisors and counselors practice within the boundaries of their competence and continue to educate themselves on appropriate practice. However, the competen cies, skills, and techniques of CACs are not addressed by this ethical code. There is no specific mention of supervising child and/or adolescent counselors in the ACA ethical code.
4 Statement of the Problem Currently, the literature on clinical supervision seldom addresses the supervision of working professional counsel ors; particularly those who are CACs. This is particularly relevant to professi onal counselors such as school counselors and mental health counselors who routinely wo rk with children and adolescents and who also express a need for more supervision in this area. This problem is compounded because the national accrediting body for professional counseling, CACREP, provides no specific competencies for CA Cs nor for those who supervise them. Hence, although the ACA code of ethics requires supervis ors and professional counselors to practice within the boundari es of their competence, the specific competencies for CACs and for their supe rvisors remain largely undefined. This poses a significant problem for professiona l counseling, for clini cal supervision and ultimately for client welfare. Purpose of the Study This study aims to contribute to the exis ting research in the field of counselor supervision specifically relati ng to child and adolescent c ounselor supervision. It is the intention of this study to illustrate th e process of child and adolescent supervision in order to determine how similar it is to generic supervision as well as to determine which issues and/or concerns arise in th e processes that are unique to child and adolescent supervision and to determine which competencies child and adolescent supervisors should have.
5 Significance of the Study Little is known about the experience of clinical supervision for CACs. The significance of this study is to document the experience of clinical supervision for CACs. The naturalistic expression of the s upervisees and supervis ors experience in supervision will yield a meaningful represen tation of current practices in child and adolescent counselor supervision. Questions Guiding the Inquiry The current study addresses the nature of supervision specific to CACs in a residential mental health treatment center for foster care children. Two fundamental questions will guide this inquiry: (a) what is the nature of cl inical supervision involving a supervisor who provi des clinical supervision to counselors in a child and adolescent residential foster care center that provides mental health treatment? and (b) within the clinical supervision experien ce, what issues involving children and adolescents does the supervisor explore? Conceptual Assumptions Several assumptions frame this st udy. First, counseling children and adolescents is fundamentally different than counseling adults. In order to counsel children and adolescents a counselor needs to understand the developmental norms of children and adolescents. Counseling ch ildren and adolescent s also requires specialized counseling skills such as play therapy. Second, clinical supervision is an impor tant process designed to fulfill the needs of the supervisee through imparting expert knowledge and the needs of the profession by acting as a gatekeeper (Holloway, 1995).
6 Third, supervising persons who work with children and adolescents is different than supervising persons who work with adults and is more challenging for supervisors. The process of guiding counselor s working in a children and adolescents mental health multidisciplinary system is challenging for supervisors (Neill, 2006). For example, the following issues need to be addressed for supervisors when supervising counselors who work with children and adolesce nts: the heightened level of ethical responsibility assumed by CACs the increased incidence of vicarious traumatization when working with childre n and adolescents whom have suffered abuse or neglect, outcome-based treatment m odalities, and the stress of collaborating with possibly dysfunctional sy stems including but not lim ited to child welfare and schools (Neill, 2006). Finally, counselors working with child ren and adolescents affirm a general lack of clinical supe rvision as well as a great desire for clinical supe rvision. This has been supported through research on school c ounselors, but the in crease in mental health issues among children in general w ould suggest this is a concern for most counselors working with this age group. I serv ed as a child and a dolescent counselor and as a child and adolescent counselor supervisor in a me ntal health setting. Based on my experience in this area, I would e xpect the content of child and adolescent supervision to address at l east the following issues: countertransference, vicarious traumatization, boundary violation, developm ental understanding of client, ethical dilemmas, personal issues of the counselor, treatment modalities, working with various systems, (i.e. parents, schools, h ealthcare), theoretical orientation, treatment planning, best practices/resear ch, case specific issues, ut ilization of supervision.
7 Conceptual Framework Figure 1. Conceptual Framework Current Clinical Skills with Children and Adolescents Individual Supervision Administrative Supervision (neutral) No Supervision (weaken / ineffective) Prior Training and Experience Clinical Supervision (strengthen / effective) Clinical Supervision Discussion Topics (*may be especially important to addre ss when working with children/adolescents) 1. Countertransference* 2. Vicarious traumatization* 3. Boundary violation* 4. Developmental understanding of client* 5. Ethical dilemmas* 6. Personal issues of the counselor 7. Treatment modalities 8. Working with various systems, i.e. parents, schools, healthcare 9. Theoretical orientation 10. Treatment planning 11. Best practices / research 12. Case specific issues 13. Utilization of supervision
8 The conceptual framework of this re search providing the impetus for this study is that clinical supervision strengthen s the clinical skills of CACs. Counselors have prior training and expe rience which influences their clinical skills, yet supervision has an essentia l function in improving skills and maintaining professional and personal efficacy. Individual supervision can be clinical or administrative in nature. Administrative supervision has a neut ral effect on clinical skills, yet within this study I believe that administrative and clinical supervision interact. Within the context of clinical supervision aspects of administrative supervision will inevitably occur. The absence of clinical supervisi on weakens clinical skills with children and adolescents. Clinical supervision shou ld reflect discussion topics such as, countertransference, treatment modalities, vicarious traumatization, working with various systems, boundary violation, theo retical orientation, ethical dilemmas, treatment planning, developmental understa nding of client, best practices and research, case specific issues, use of superv ision, and personal issues of the counselor. The current status of the literature on clinical supervision is limited to theoretical models of supe rvision, structure or conten t of supervision, effective supervision, skills associated with effective supervisors, supervisor training, and themes of time, race, gender and sexuality in supervision (Kilminster & Jolly, 2000). Despite the growing body of research re lated to working with children and adolescents and the general increase in c ounselor supervision literature (Bernard & Goodyear, 1998, 2004; Bradley & Ladany, 2001; Goodyear & Bernard, 1998; Holloway & Carroll, 1999; Watkins, 1994), ther e appears to be a lack of research
9 specifically related to supervising counselor s working with children and adolescents. More research in the afor e mentioned is needed. Definition of Major Terms Administrative supervisor. An individual who oversees aspects of personnel development and the delivery of services to consumers while also focusing on issues of staff communication, budgeting, and paperwork. (B ernard & Goodyear, 2004). Similarly, an administrative supervisor helps the supervisee participate efficiently as a part of the overall system to effectively in crease the continuity of the organization as a whole (Bradley, 1989). Clinical supervisor. An individual who oversees se rvices provided to clients while monitoring the professional devel opment of the supervisee (Bernard & Goodyear, 2004). Similarly, the clinical supe rvisor focuses on various areas of clinical process, such areas as client welfare, counseling relationship, assessment, diagnosis, clinical interv ention, prognosis, and appropr iate referral techniques (Bradley, 1989). Countertransference .The unresolved neurotic conf licts of the counselor or therapist (Hafkenscheeid, 2005). Boundary violation. An unprofessional behavior committed by a counselor or therapist that is contrary to the ethical standards of the profession regarding appropriate relationships betw een clients and therapists. Ethical dilemma. The American Counseling Asso ciation (ACA) has a set of general guidelines for ethical practice for all its members. An ethical dilemma is considering between equally undesirable alternatives on an ethical issue.
10 Functions of Supervision. Supervision (a) assesses the learning needs of the supervisee, (b) changes, shapes, and s upports the supervisees behavior, and (c) evaluates the performance of the supe rvisee (Borders, Bernard, Dye, Fong, Henderson, & Nance, 1991). Supervision. Supervision as defined by Bernard and Goodyear (2004, p. 8) is: an intervention provided by a more se nior member of a profession to a more junior member or members of that sa me profession. This relationship is: (a) evaluative, (b) extends over time, an d (c) has the simultaneous purposes of enhancing the professional se rvices offered to the client s that she, he, or they see, and serving as a gatekeeper for those who are to enter the particular profession. Supervision and clinical supervision will be used interchangeably in this document. Supervisor. A supervisor is a profes sional providing supervision. Supervisee. A supervisee is a postgraduate professional seek ing supervision (Bernard & Goodyear, 2004). Vicarious traumatization : A condition in which a counselor or therapist working with a traumatized client becomes traumatized as a consequence of treating the client; potentially the counselor of ther apist will exhibit the same symptoms as the client. (McCann & Pearlman, 1990) Scope and Delimitation of the Study Supervisory process plays a vital role in several professions: medicine, nursing social work, education, psychol ogy, and counseling (Kilminster & Jolly, 2000). Each field has potential literature to add to the discussion of clinical
11 supervision, and as such the dialogue on c linical supervision is not exclusive to counseling. The focus of the current study is the clinical superv ision of counseling, not education, medicine, or nursing. Specifically, this st udy focuses on the clinical supervision of counselors working with ch ildren or adolescents, not adults or the elderly. The treatment that the children or a dolescents are receiving is not the focus of this study. The actual clinical treatment and counseling skills used with the children and adolescents discussed in the supervisi on are also not focal points in this study, except as they relate to issues in supe rvision. Information about the children or adolescents is not a variable of interest and will remain confidential if identifiable information is revealed during the supervision process. Overview of Dissertation Chapters Chapter Two will provide a historical background of the literature on supervision. A review of rele vant developmental models of supervision is provided. In addition, this chapter will review and critically eval uate present literature on supervision specific to the c linical supervision of child and adolescent counselors. Chapter Three will discuss the design a nd methodology of the study. Within this chapter the qualitative desi gn and logic will be explor ed. Similarly, the methodology for participant selection, sampling, inst rumentation, procedure, analysis, and legitimation will be discussed. Chapter Four will present the re sults of the study by exposition of the general questions that gui ded the inquiry. Chapter Five presents a summary and the major conclusions of the study. The statement of the problem will be discussed in the context of the methodology used, followed by the subsequent findings. Conclusions will be discussed. R ecommendations for additional research
12 will be made. New research questions that emerged based on this research study will be explored. In addition, recommendations from this study for use in the field of counseling and supervision will be made.
13 Chapter Two Review of the Literature Introduction Supervision is an important aspect of the standard practices of the counseling profession and provides an avenue to edu cate beginners into the profession with valuable skills while protecting clients and monitoring ethical practice. Supervision is noted as the foremost professional trai ning model for mental health clinicians (Alonzo, 1985). Given that mental illness is now the leading cause of disability for all persons five years of age and older (U.S. Public Health Servic e, 2000), clarity on the nature of child and adolescent couns elor supervision is needed. This literature review on the supervis ion process, will address the following: how clinical supervision is defined, the theoretical models of supervision, how supervision is delivered, and the issues that are specific to child/adolescent counselor supervision. For the purposes of this di scussion counselors-in-training will be referenced as supervisees and those who pr ovide supervision will be referenced as supervisors. Clinical Supervision Defined Loganbill, Hardy, and Delworth (1982) defined supervision as an intensive, interpersonally focused one-to-one relations hip in which one person is designated to facilitate the development of therapeutic competence in the other person (p. 4).
14 Another working definition, that does not encompass that concept of group supervision, is provided by Hart (1982), who defined supervision as an ongoing educational process in which one person in the role of superv isor helps another person in the role of the s upervisee acquire appropriate professional behavior through an examination of the trainees pr ofessional activities (p. 12). Clinical supervision has emerged as a specialty in counseling (Bernard & Goodyear, 2004), providing clinicians a co llaborative outlet for professional development to improve patient care via reflective accountability in either group or individual settings (Cleary & Freeman, 2006). Supervision is not an extension of the therapeutic process. However, supervision is an intervention (Bernard & Goodyear). Supervision is critical in upholding professional ethics and laws, ensuring continuity of care for clients, and serving as the gatek eeper of a counselors overall readiness to enter the profession. Supervision has various roles, one of which is self-regulat ory. Self-regulation assists in the process and promotion of a competent and ethical professional. An important aspect of the se lf-regulatory pro cess includes licensu re boards and the process that supervisors and supervisee each undergo to become licensed in a state. State licensure boards assist in the self -regulation of the supervision process by requiring supervisees to participate in th e process of superv ision, monitor their professional behavior, and maintain contin uing education for licensure (Bernard & Goodyear, 2004). Several state licensure board s require additional course instruction in supervision prior to beco ming a board approved or qualified supervisor (Pearson, 2004).
15 Theoretical Models of Supervision There appears to be an increasing body of literature exploring the process of supervision and the various models applic able to supervision (Bernard & Goodyear, 1998, 2004; Bradley & Ladany, 2001; Goody ear & Bernard, 1998; Holloway & Carroll, 1999; Watkins, 1994). Within the broad array of clin ical supervision literature and even among supervision resear chers there is a working assumption that supervision processes are guided by developm ental considerations (Falender et al., 2004, p. 776). Even with there being several distinctly different approaches to supervision having differing goals, the fo llowing are all common to models of supervision: the development of a co llaborative relationship, a focus on the supervisee, and a structure that promotes growth for the supervisee (Barrett & Barber, 2005). Within counseling literature the focu s of supervision models is primarily developmental (Baker, Exum, & Tyler, 2002; Maki & Delworth, 1995; Heron, 1990; Gardiner, 1989; Ronnestad & Skovho lt, 2003; Stoltenberg, 1981, 1993, 2005; Stoltenberg, McNeil, Delwort h, 1998; Watkins, 1993, 1994). Most developmental models of supervis ion assume an incremental processes for supervisee growth, noting quantitative and qualitative changes in supervisee complexity such as seen in the Inte grated Developmental Model (IDM) of supervision (Stoltenberg et al., 1998). Other developmen tal models of supervision have addressed counselor/th erapist development over th e lifespan (Ronnestad & Skovholt, 2003). The IDM is generally re garded as the primary developmental supervision model in the field of couns elor supervision (Maki & Delworth, 1995). Similarly, the IDM is highly researched in terms of its theoretical validity and
16 reliability (Maki & Delworth, 1995; McNe il, Stoltenberg, & Romans,1992; Leach & Stoltenberg, 1997). The Integrated Developmental Model. Stoltenberg and Delworth (1987) developed the Integrated Developmental Model (IDM) of supe rvision based on the earlier Stoltenberg (1981) Counselor Co mplexity Model (CCM). The Counselor Complexity Model (CCM) is similar to Hogans (1964) developmental model with expansions on Hogans four-stage model of how counselor supervisees become more cognitively complex over time. The conceptu al levels are similar to Hunts (1971) Conceptual Systems Theory, which identi fied optimal environmental levels for advancement of development. Rooted in the belief that the field of counselor supervision needed a systematic developm ental model of supervision, Stoltenberg (1981) proposed four specific stages of development that were qualitatively and quantitatively different in skill leve l and knowledge regarding counselor development. Stoltenberg proposed no sp ecific time line for his levels of development, maintaining that counselor development varies from counselor to counselor, a theme he would carry forth throughout his work. Within the CCM level 1 characteristics, the supervisee is often minimally experienced, dependent on authority figures lacking self-awareness, anxious, and rule focused, yet highly enthusiastic about the learning pr ocess. Supervision environments of a level 1 supervisee often provide normative structure and encouragement while helping make connections between theory and practice more evident in the counseling experi ence (Stoltenberg, 1981, p. 61).
17 The period experienced by level 2 supervisees is a time characterized by dependency-autonomy conflict. Here the s upervisee is working to become more independent and self-aware and no longe r feels content to merely model the supervisor. With motivation often fluctu ating at this level, the supervisory environment is less supportive while cl arifying ambivalence and providing less structure to allow supervisees to assess th eir strengths and weaknesses. The level 3 supervisee has increased professional id entity and self-awareness and shows characteristics of insight, empathy, and a di fferentiated interpers onal orientation. In an effort to parallel the supervisee growth at level 3, the supervisory environment is primarily peer supportive usi ng appropriate professional confrontation. Stoltenberg (1981) discussed the final level 4 superv isee as a master counselor, able to accomplish independent practice, and they of ten serve as supervisors of other less advanced counselors. Stoltenberg and Delworth (1987), and St oltenberg, et al. (1998) expanded and refined the CCM to develop the IDM which is generally regarded as the primary developmental supervision model in the field of counselor supervision (Maki & Delworth, 1995). According to McNeil et al. (1992), the CCM failed to adequately address the possibility of s upervisees functioning at diffe rent levels of counselor development for various activities associat ed with counselor and psychotherapist development (p. 504). To accomplish a well-rounded and less static model of counselor development, the IDM perspectiv e of development is both vertical and horizontal. Hence, supervis ees can exhibit behaviors consistent with more than one level at different times with in the different domains.
18 The IDM proposes various developmenta l skills and tasks in counselor identity to be resolved and challenged al ong four different levels. Development, as discussed in the IDM of supervision, is influenced by the cognitive-developmental theorists that take both a mechanistic and organismic view of the world. The techniques and assumptions within the mode l tend to be mechanistic, with the levels of development tending to be organismic (Stoltenberg & Delworth, 1987). Similarly, the philosophical correlate of epistemological constructivism is reflected in the Stoltenberg et al. (1998) IDM belief of change over time and the important role in constructing knowledge and reality (p. 12) for counselor identity. The primary developmental tenet upheld in the IDM of supervision is that new information is processed and made into ne w knowledge via Piagets (1970) constructs of assimilation and accommodation. Individu als will apply what they already know (assimilate) and make necessary discoveries for the environment in which they find themselves (accommodate). Through the slow and tenuous process of small steps of combined assimilation and accommodation, larg er steps later emerge and cognitive development takes place (Flavell, Miller, & Miller, 2002). In combination with the work of Loevinger (1977) noting slow fo rward movement, Stoltenberg and Delworth (1987) provided a model of supervision with characteristically co mplex assimilations. The IDM of supervision has three ov erriding structures and eight skill domains. The three overriding structures ar e: self and other awareness, motivation, and autonomy. The eight specific domain s are: intervention skills competence, assessment techniques, interpersonal assessmen t, client conceptualization, individual differences, theoretical orientation, treatment goals and plans, and professional ethics
19 (Stoltenberg & Delworth). The supervisee pr ogresses through four stages, similar to the CCM moving upward in increasing complex ity with the final le vel of professional growth considered the integrative level. The level 1 supervisee is typically limited in experience and knowledge in all the specifi c domains, such as intervention skills or professional ethics. The supervisee here n eeds guidance and sufficient practice time. The overriding structure of motivation is high along with high anxiety. Autonomy is low and the supervisee is dependent on the s upervisor. The supervisee also has a high need for structure and positive feedback. Awareness is highly self-focused with a general apprehension about evaluation. Level 2 represents a transitional phase for the supervisee, with conflict of autonomy from and dependence on the superv isor often occurri ng. The structure of motivation fluctuates along with autonomy, thus at times creating an environment of possible resistance with the supervisor. Howe ver, level 2 supervisees also start to develop increased sensitivity to individual differences at this point as well as a greater ability to empathize with clients, both characteristic of increased awareness complexity. The level 3 supervisee is ab le to stabilize and focus on the idea of treatment goals and client conceptualizat ion. Within this level, the domain of motivation is consistent, autonomy emerges as self-assurance and an indicator of professionalism, and awareness is fully devel oped with the intent to attend to client needs. The final level of development is th e level 3 integrated or 3i counselor. This level represents a fully functioning c ounselor, with a current awareness of limitations and strengths.
20 The Ronnestad and Skovholt Model. The focus of counselor development is often the time spent in practicum and in ternship. However, Ronnestad and Skovholt (1993, 2003; Skovholt & Ronnestad, 1992) focuse d on not only these times but also on professional development past gradua tion throughout the lifespan. Derived from qualitative data, the model initially consisted of eight stages of therapist development and 20 themes across time. The authors in terviewed 100 counselors and therapists with varied experience at a variety of st ages in their careers (Skovholt & Ronnestad, 1992). The original stages of counselor/therapist deve lopment Ronnestad and Skovholt (1993) formulated included: one pretraining stage: (Stage 1) Conventional helper; three student stages: (Stage 2) Tran sition to Professional Training, (Stage 3) Imitation, and (Stage 4) Conditional Autonomy ; and four post-graduate stage: (Stage 5) Exploration, (Stage 6) Integration, (Sta ge 7) Individuation and (Stage 8) Integrity. Each stage addressed the following dimensi ons: Definition of Stage, Central Task, Predominant Affect, Predominant Sources of Influence, Role and Working style, Conceptual Ideas used, Learning Process, and Measures of Effectiveness and Satisfaction. In an effort to create parsimony and clarity Ronnestad and Skovholt (2003, p. 10) collapsed the stages into a simpler six-phase progression of development. The six phases are: the lay helper phase, the beginning student phase, the advanced student phase, the novi ce professional phase, the experienced professional, and the senior professional. The lay helper phase is characterized by the inclusion of persons prior to them entering professional training. Lay helpers often offer emotional support, personal
21 experience, and common sense advice, yet ar e over-involved and too strongly identify with the other peoples experi ences. Often lay helpers are fr iends, parents, or partners and they tend to provide sympathy rath er than empathy (Ronnestad & Skovholt, 2003). As lay helpers progress into the beginni ng student phase, they typically start professional training feeling ex cited, influenced by profe ssionals, highly anxious on multiple levels, and are generally goal driv en. The primary focus, for the student at this phase is achievement. Most students a ppear anxious to be competent and find the training experience somewhat thr eatening (Ronnestad & Skovholt). The advanced student phase is character istically near the end of training and the students feel more cautious with a pre ssure to do things a ppropriately as they enter the professional level. Advanced students may accept or reject the various professional models with which they come into contact criti cally assessing and evaluating these models for the purpose of internalizing certain resources (Ronnestad & Skovholt, 2003). The first few years past gr aduation typically is considered to be the novice professional phase. Within this phase counselors seek to validate their training. This is often followed by a period of disillusionment with their professional training. The phase finishes with a period of exploration abou t oneself and ones professional environment. Novice professiona ls will feel as though they can integrate their own personality into ther apy and their own natural se nse of humor in work with clients (Ronnestad & Skovholt, p. 19). The experienced professional has had multiple opportunities to experience a wide range of clients in various settings leading to an authentic percep tion of therapeutic role. The couns elors role in this phase is consistent with his or her values, intere sts, and personality, and the counselor has
22 come to understand that his or her relationship with the clie nt is critical to client change. Clear boundaries and the ability to calibrate levels of involvement with clients may also be characteristic in the phase for experienced professionals. In addition, many experienced professionals mentor, supervise, or teach novice counselors during this phase in their e xperience (Ronnestad & Skovholt). Often the supervisor is seen as a teach er within this phase and many counselors fit into this role (Ronnestad & Skovholt, 1993). Finally, the senior professi onal phase is a time of high regard from others in the field. Often having had 20 to 25 year s of professional experience, senior professionals are very unique and indivi dualized in their approaches. Many senior professionals are reluctant to explore alternat ive or new trends in the field, yet most have a continued commitment to the field as a whole. Feelings of grief and loss are common among many senior professionals due to retirement and the deaths of those close to them (Ronnestad & Skovholt, 2003). The Ronnestad and Skovholt Model (2003) also has identified 14 themes. Bernard and Goodyear (2004) describe these themes as a cognitive map for supervisors using the model. Theme 1, described as professional development involves an increasing higher-order integr ation of the professional self and the personal self. Ronnestad and Skovho lt proposed an experienced-based generalization or what they called A ccumulated Wisdom. Specifically, as the counselor develops across time, his or her identity develops, professional roles become increasingly consistent, and th ere is a progression to matching the professional role with personal values, be liefs and life experiences. In Theme 2 the
23 focus of functioning shifts dramatically over time from internal to external to internal Initially, the counselor or lay help er person is internally focused, and feelings are reflective of personal experien ce. During the training experience phases, the focus shifts to skill building and theories and is primarily external in nature. Then, finally, as training ends and the counselo r is able to move into professional experience, the focus is again internal sometimes with feelings of disillusionment about training or potential confiden ce about professional practice. Theme 3 is continuous reflection a prerequisite for optimal learning and professional development at all levels of e xperience. Related to and influenced by the work of Vygotsky (1962, 1978) and Wood, Br uner, and Ross (1976), Ronnestad and Skovholt (2003) suggest that supervisors scaffo ld supervisees learning in their zone of proximal development. Counselors should be supported to be re flective about their work and learn how to self-supervise. Theme 4, an intense commitment to learn propels the developmental processes. Most of the participants in Ronnestad and Skovoholt' (2003) study, showed no decline in professional growth. Theme 5 suggests the cognitive map changes : beginning practitioners rely on external expertise, and seasoned practitioners rely on internal expertise. Within this theme Ronnestad and Skovholt embrace a social-construc tivist perspective, stati ng both share a rejection of precisely defined realities in understa nding matters of human interaction (p.31). Further, Guiffrida (2005) states Skovho lt and Ronnestads (1 992) critical selfreflection promotes a construc tivist theoretical or ientation as a c ounselor grows and develops.
24 Theme 6 indicates that professional development is a long, slow, continuous process that can also be erratic. Development can be cyclical, and various challenges can emerge during the life course of the c ounselor to raise feelings of doubt, anxiety, exploration, learning, and ma stery (Ronnestad & Skovholt, 2003). Theme 7 is that professional development is a life-long process Ronnestad and Skovholt discuss that little is known about experi enced counselors but believe through their discussions with senior professionals, that there exis ts a commitment to continued growth and exploration in the field th roughout the lifespan. Theme 8 a ddresses the anxiety that many beginning practitioners experience a bout their professional work. Ronnestad and Skovholt believed that over time, anxiety is master ed by most professionals With experience and practice many counselors are no longer afraid of their clients and feel comfortable with their skill sets as counselors (Ronnestad & Skovholt). Theme 9 states that clients serve as a major source of influence and serve as primary teachers (Ronnestad & Skovholt, 2003). For ove rall professional growth and development, counselors need the experience of working with clients in order to build clinical skills, a theoretical orientation base, and gain positiv e client feedback (Orlinsky, Botermans, & Ronnestad, 2001). Theme 10 explores the fact that professional life influences professio nal functioning and development throughout the professional life span The influence of ones persona l life, past or present, can negatively or positively impact professi onal functioning (Ronnestad & Skovholt, 2001). Theme 11 suggests that the interpersonal sources of influence propel professional development more than impersonal sources of influence Ronnestad and Skovholt found the relationship between th e client and the counselor ranked as
25 the number one influence in counselor development followed by the relationship with supervisors, their own therapists, fam ily and friends, and younger colleagues, respectively. Theme 12 is that new counselors in the field view professional elders and graduate training with strong affective reactions Many times students, reacting to the power differential, either idealize se nior professionals or completely devalue senior professionals (Ronnestad & Skovholt). Theme 13 discusses the extensive experience with suffering that contributes to heightened recognition, acceptance, and appreciation of human variability Ronnestad and Skovholt (2001) in their work with senior professionals, report a diverse, pe rsonal, and individua lized approach to assessment and the development of insi ght. Ronnestad and Skovholt state there seems to be a parallel and interactive development of wisdom and aging (p.37). Theme 14 suggests that counselors realign from a self-a s-hero conceptualization to client-as-hero conceptualization Over time the counselor feels more confident as a professional, yet understands the limits to what can be accomplished with therapy. Thus there is a sense of humility as a counselor (Ronnestad & Skovholt, 2001). Additional Developmental Models of Supervision. Watkins (1996) discussed the existence of 25 to 30 distinct developm ental models of supervision. Many of these models reflect the conceptual constructs of the CCM and IDM with some additional similarities to the Ronnestad and Skovho lt (1993) model. Additional representative developmental models include the Loganbill, Hardy, and Delworth Model (Loganbill et al., 1982), Blochers (1983) cognitive-developmental model, and a cognitivedevelopmental model of supervision (Foste rs & McAdams, 1998) specifically applied to persons working with children.
26 The Loganbill et al. (1982) Model is a cyclical model that involves three stages with eight supervisory issues. Loga nbill et al. (1982) discuss the importance of assessing the developmental stage of the s upervisee process and a ssisting supervisees with each issue. The supervisor is requi red to assess 24 different positions of supervisee progress within the model, representing the eight issues and three stages. The three stages are: stagnation, conf usion, and integration. The eight basic supervisee issues are: competence, emo tional awareness, autonomy, theoretical identity, respect for individual differe nces, purpose and direction, personal motivation, and professional ethics (Loganbill et al.). Movement from the stage of stagnation through confusion to integrati on is accomplished via the supervisees responding to supervision issues with increased conceptual understanding. Blocher (1983) proposed a cognitive developmental approach based on the constructivist paradigms similar to th e work Kohlberg (1968), Loevinger (1976, 1977), and Piaget (1952, 1970). Supervisee s develop cognitive schemas about counseling that progress from simple to more complex. The goal of supervision is to increase the complexity of counseling c ognitive schemas. Within the context of supervision, Blocher proposed that the s upervisee and supervisor needed specific dynamics to increase cognitive functioning. These dynamics include: challenge, involvement, support, structure, feedb ack, innovation, and integration. As the supervisee and supervisor interacted with the environment, the ideal relationship would be characterized by concern, resp ect, trust, and communication by the supervisor (Blocher).
27 Foster and McAdams (1998) discuss a cognitive-developmental model for supervision, specifically for the supervision of child care counselors This is the only developmental supervision model specifica lly designed and app lied to supervising child counselors. Parallel to other de velopmental models, Foster and McAdams developed a 14-week program model and curr iculum of supervision for child care counselors working with aggressive youth. Th e authors thought that the supervision process would increase the cognitive complex ity of the counselors thus increasing the desirable counseling behaviors of the couns elor. The models curriculum was derived from Sprinthall and Thies-Sprinthall (1983) (as cited in Foster & McAdams, p. 10), which promoted the following supervisory c onditions of growth : (a) a role-taking experience in helping, (b) guided reflec tion, (c) a balance between action and reflection, (d) continuity, and (e) a climate of that is both su pportive and challenging. The skills used in this supe rvision were journal responses and guided reflections, with specific mention of working children during the journal responses and guided reflections. Foster and McAdams (1983) use these techniques w ith supervisees to assist in perspective taking when addressi ng the various challenging issues presented by aggressive children. Supervision Delivery Several studies have compared the e ffectiveness of group versus individual supervision (Averitt 1989; Lanning 1971; Ray & Altekruse, 2000). Lanning and Averitt concluded that both supervision de livery methods were equally effective in the supervision of counselors. However, Ray and Altekruse concluded that group supervision is not only complementary to individual supervision but may also be
28 interchangeable with individual supervision. Ye t, individual supervis ion is seen as the primary outlet for professional development and the cornerstone to traditional counselor supervision (Ber nard & Goodyear, 2004). Individual supervision for supervisees is a one-to-one relationship with the supervisor that incorporates a variety of possible supervision interventions promoting conceptual growth in the supervisee. The methods of individual supervision can be structured or unstructured. Structured supe rvision tends to be very didactic while unstructured supervision appears more lik e consultation (Bernard & Goodyear, 2004). Supervisees can benefit from structured a nd unstructured individual supervision at all levels of their professional counselor development. In individual supervision, a supervisor can choose to use several diffe rent methods to aid in the supervision process including self-report, discussion of process notes a nd case notes or, review of audiotape or videotape (Bernard & Goodyear). Group supervision is the process of s upervisors monitoring a supervisees professional development in a group of peers(Holloway & Johnston, 1985). The purpose of group supervision is to aid othe r group members in the achievement of their goals via interaction and peer feedback (Bernard & Goodyear, 2004). This format of supervision delivery is often pr ovided by university tr aining programs at some point in clinical course work (B ernard & Goodyear). The supervision of practicum and internship students in group format is one form of group supervision. Another form of group supervision is the leaderless group, in which supervisees, peer facilitate the group supervision. Group superv ision often focuses on the facilitation of group therapy skills, as the supervisor aids in the practice of the group process with
29 supervisees in the group form at (Holloway & Johnston). Issues Specific to Child/Adol escent Counselor Supervision Often, counseling children re quires that counselors modify their roles, styles, and treatment modalities. A counselor working with children needs to develop an awareness of the various influences affec ting the child for which he or she serves, such as parents/guardians, school, and peers. Addressing the pres enting issues of the child is only part of the counseling rela tionship. Counseling children presents unique issues that may elicit countertransfer ence, vicarious traumatization, boundary violation, and questions rela ted to various ethical dile mmas for counselors. For example, working with a foster child who is also victim of abuse presents a variety of issues. A counselor needs to understand the childs de velopmental level and the appropriate counseling skills to use, but also how to address childhood trauma. The counselor of this child needs to be aware of her own emotions and thoughts when also potentially communicating with various system s of care, such as child welfare, school systems, and psychiatrists. The counselor may feel overwhelmed by the intensity of therapy sessions, deficient in her understan ding of child development or lacking in her clinical supervis ion. Thus, the child and adolescent counselor who feels issues of countertransference or vicarious traumatiza tion, may still feel compelled to advocate for the child during discussion with child we lfare or the school system potentially leading to boundary violati on or ethical dilemmas. Within the field of counselor educati on and supervision, the current scholarly research is limited relative to the topic of the supervision of co unselors working with children. The resources are plentiful when exploring issues such as play therapy
30 (Albon, 1996; Kottman, 2001; Ray, Bratton, Rh ine, & Jones, 2001; Schaefer, 1993), cognitive behavioral techni ques for children (Barrett, Duffy, Dadds, & Rapee, 2001; Jay, Elliot, Woody, & Siegel, 1991; Kenda ll, 1993; Spence, Donovan, & BrechmanToussaint, 2000), behavioral therapy (Ray, Skinner, & Watson, 1999; Romano & Roll, 2000), Attention Deficit Hyperac tivity Disorder (ADHD) (Erk, 2004; Schwiebert, Sealeander, & Tollerud, 1995; Wi cks-Nelson & Israel, 2003), child abuse and maltreatment (James & Burch, 1999; Miller-Perrin, 2001; Shapiro, Friedberg, & Bardenstein, 2006), and learning disorder s (Brown, 2005; Reis & Colbert, 2004; Thompson & Littrell, 1998). Despite the plet hora of research related to counseling children there appears to be a lack of research related to supervising persons who are counselors of children and adolescents. The current available liter ature related to the supervision of counselors working with children focuses on counselors providing group therapy to children (Rosenthal, 1975; Holmes, George, Stader, Swaim, Haigler, Myers, & deRosset Jr., 1998; Soo, 1998; and MacLennan, 1998), the supervision of school counselors (Crutchfield & Borders, 1997; Crutchfield, Price, McGarity, Pennington, Richardson, & Tsolis, 1997; He rlihy, 2002; Kahn, 1999; Page, Pietrzak, & Sutton, Jr 2001; Studer, 2006), and themes within the therapeutic relationship to be addressed in supervision such as c ountertransference and skills such as play therapy (Metcalf, 2002; Ray, 2004). The clear need for supervision of co unselors working with children is best documented in the literature on school c ounselor supervision. Within the school counselor literature there is a consensus that supervision is greatly lacking for school counselors due to their isolation from othe r counselors, and often the responsibility
31 for their supervision is assumed by non-c ounseling professionals. Crutchfield and Borders (1997) conducted an extensiv e empirical study examining the job satisfaction, counseling self-efficacy, a nd counseling effectiveness of school counselors through preand posttest measures of clinical peer supervision. The study used two treatment groups and one control gr oup to investigate the effectiveness of peer supervision over nine weeks. Due to the peer supervision format, the school counselors in the study were able to discu ss aspects of job satisfaction and explore self-efficacy. However, the lack of structur e without a trained supervisor present in peer supervision may have led to inc onstancy in discussi on about counseling interventions. The authors explained clearl y the need for superv ision specific to school counselors, indicating that future st udies should take a forward approach in fulfilling the professional development need s of school counselors (Crutchfield & Borders). Similarly, Page et al. (2001) demonstrated through survey research the statistical lack of supervision for school counselors, finding that only 13% of school counselors were receiving individual s upervision and 10% were receiving group supervision, and showing cl early that among school c ounselors, 57% desired to receive clinical supe rvision to improve primarily th eir school counseling practices. Herlihy (2002), in reviewing the current status of school counselor supervision, suggests: One reason clinical supervision has been a neglected issue in school counseling may be a perception that sc hool counselors do not have the same level of need for supervision as do clinical mental health counselors. School administrators, in particular, may conti nue to perceive the school counselors
32 role as being focused primarily on such activities as academic advising, scheduling, psychoeducation, a nd group guidance. (p. 57) However, school counselors, like child mental health counselors, deal routinely with complicated situations, including the asse ssment and treatment of depression and suicidal ideation, pre gnancy, substance abuse, school vi olence, and child abuse (Page et al., 2001). Another reas on school counselors lack clinic al supervision is the nonmandatory status of post-masters degree s upervision in most jurisdictions, contrary to mental health counselors (Herlihy, 2002). The legal and et hical issues facing school counselors need to be addressed in supervision and focus on competence, confidentiality, boundaries, accoun tability and liability, a nd evaluation. Herlihy does identify issues that are specific to worki ng with children, such as the challenge of maintaining confidentiality in a school system; dual relationships; and managing the difference between teacher, counselor, and cons ultant notes, as well as the liability of supervising a counselor who also is admi nistratively supervised by principals or guidance administrators. Although the school counselor literature clearly documents the need for supervision, the mental health li terature specific to children has yet to identify the need for child counselor supe rvision. Even more specifically, the school counselor literature (i.e., Her lihy) introduces ethical and lega l issues that describe the complexity of being a counselor who works with children. Crutchfield et al. (1997) discuss the isolation with which many school counselors must deal leading to feeli ng under supported and alone while addressing difficult situations. These au thors explain that the isola tion and lack of clinical supervision leads to counselors being le ss reflective of the counseling session and
33 uncertain about their counseling abilities. Counselors often become less skilled over time than when they first graduated with th eir degrees, thereby in creasing their stress, and their need for training about current i ssues in counseling relative to children. Kahn (1999) is specific a bout the roles that school counselors assume and the implication these roles have on supervisi on. School counselors assume many roles that are unique to other counselors whose primary or only role might be therapy. Frequently, school counselors assume the roles of individual c ounselor, consultant, coordinator, small group counselor, and larg e group guidance couns elor (Kahn). The division of responsibilities becomes an issu e in supervision and suggests the need for supervisors with differential experience, knowledge, and skills. Given the diversity of roles assumed by school counselors, th e need for diversity and expertise in a variety of issues parallels the wide range of issues the community mental health counselor working with children might face and need to be addressed in supervision. Studer (2006) elaborates on the conti nued frustration of school counselors regarding supervision when they lear n about the American School Counselor Association (ASCA) National Model. Many sc hool counselors practicing in the field have yet to be trained on the ASCA Na tional Model. School counselors entering the profession look to their school supervisors on site for a developmentally appropriate understanding of skills and procedures; yet, many of the practicing school counselors have not received training or supervisi on on the model to assist incoming students. Studer reported that 50% of 73 participants surveyed in the Southern region were still working under the traditional model. Parallel to the lack of ad equate supervision noted by Studer in the Southern region, Ba ggerly (2002) reported that Florida school
34 counselors did not receive the amount of supe rvision they needed from their district supervisors. This result was indicated by a significant difference .37, t (1,171) = 6.9, p = .00, between the mean of needed supervis ion and the mean of district supervision provided. The counselors did however, recei ve the amount of peer supervision desired, as indicated by a lack of significant difference (.00, t (1170) = .03, p = .97) between the mean of needed supervisi on and the mean of peer supervision (Baggerly). Students in training, recently graduated counselors preparing for licensure, and practicing counselors may feel isolated like the school counselor when addressing difficult therapist issues, such as of c ountertransference. Metcalf (2002) discusses countertransference in child therapy. The issue of countertransference makes forming and sustaining the therapeutic bond with chil dren difficult for the therapist. Included in the challenges for the child therapist is the active nature of the child, developing appropriate boundaries, and poten tial regression to early de velopmental stages during the therapeutic process. These challenges in the countertransfer ence processes often uncover the issues of the child (Metcalf, 2002), requiring the clinician to be aware of the process of countertransference. Howe ver the majority of the literature on countertransference pertains to adults a nd not children, and th e countertransference reaction differs in children as compared to adults. Therapists with countertransference reactions working with child ren often feel limited by th eir professional competence (Metcalf). Often a childs countertransferen ce reaction is frustra ting to a therapist lacking skills in developmentally appropr iate counseling. Children in therapy may repeatedly play out the same scene over th e course of the session (Metcalf, p. 48).
35 Metcalf did not find a signifi cant difference in the type of supervision received and the management of countertransfere nce. However, the literature on countertransference and Metc alf support the notion increa sing a counselors selfawareness and supervision to address th e issue of countertransference in child counseling, in addition to consultation, peer support, and persona l therapy (Grayer & Sax, 1986; Richards, 2000, as cited in Metcalf). Many counselors who work with children use play therapy which is based on child development theory. Similar to Pi agets (1952, 1970) theory of cognitive development, childrens play is assume d to gradually increase in complexity. Different from adult talk therapy, in play therapy children are ab le to communicate in therapy through play. According Ray (2004, p. 29) play is the natural language of children. Ray supports the use of a deve lopmental model of supervision and the conception of counselors of children as a sp ecial population that n eeds therapists with specialized training with qualified supervisor s in play therapy. Supervision of play therapy requires a supervisor who is fam iliar with the basic and advanced skills of play therapy. According to Ray, the basic sk ills of play therapy include non-verbal skills and verbal skills. The non-verbal skills are: (a) l eaning forward, (b) appearing interested, (c) seeming comfortable, (d) a pplying a congruent t one with the childs affect, and (e) applying a c ongruent tone with the th erapists response. The nonverbal skills are: (a) deliv ery quality of response, (b) tracking of behavior, (c) reflection, (d) facilitating decision-making, (e) facilita ting creativity, (f) esteembuilding, and (g) relatio nship building. The advanced ski lls of play therapy are: (a) enlarging meaning, (b) identifying play them es, (c) connecting with the child, and (d)
36 limit-setting (Ray, 2004). Summary As the mental health concerns of children and adolescents remain prevalent and the service demand remains high for counsel ors, the need for supervisor also will remain high. Kataoka, Zhang, and Wells (2002) estimated that more than 75% of children in need of mental he alth care were simply not served. Similarly, abused and neglected children or severely distur bed children are often most underserved (Cicchetti & Toth, 2003; Marsh, 2004). Superv isors who are familiar with the needs of this critical population who can develop th e skills of supervises working with these children are needed (Neill, 2006). The supervisory process is a key com ponent in addressing the training needs of supervisees and maintaining the standa rds of the profession. When educating supervisees with various competencies and sk ills, the supervisor al so is protecting the client and monitoring the ethics and laws of the counseling profession. Supervision is critical to many professions including counsel ing (Kilminster & Jolly, 2000), but little existing literature has yet to examine the supervisory process specific to the supervision of child and adolescent counselors. How clinical supervision is defined a ppears critical given the diversity of fields exploring the topic and the influx of associated theoretical models addressing supervisory process. There appears to be some consensus that counselor supervision is guided by developmental understandi ng (Falender et al. 2004) and thus developmental models of supervision were primarily explored with the addition of two cognitive-developmental models. As m odels are placed into action, supervision
37 delivery is often an individual process be tween supervisor and supervisee. Bernard and Goodyear (2004, p. 209) consider indivi dual supervision the cornerstone of supervision; however, supe rvision also can be delivered in group format. Finally, the issues specific to child/ adolescent counselor supervision within the literature are spare. Scant research ha s addressed the training needs of the child and adolescent counselor in supervision available studies have addressed the supervision of counselors providing group therapy to children (Rosenthal, 1975; Holmes, et al., 1998; Soo, 1998; and MacL ennan, 1998), the supervision of school counselors (Crutchfield & Borders, 1997; Crutchfield, et al., 1997; Herlihy, 2002; Kahn, 1999; Page, et al., 2001; Studer, 2006) and themes within the therapeutic relationship to be addressed in supervisi on such as countertransference and skills for example play therapy (Metcalf, 2002; Ray, 2004). Supervision of child and adolescent counselors still remains largely unexplored. Chapter Three will discuss the qualitative design of the study. Within this next chapter the specifics of a collective case study will be outlined and the design logic will be explored.
38 Chapter Three Method Design This study employed a qualitative desi gn, specifically a collective case study method. A collective case study is a case study of more than one case (Stake, 1995). I used a demographic questionnaire, post -supervision interv iews, and direct observation of the supervision to expl ore the various thoughts, feelings, and experiences of the supervisor and superv isees during supervision. As Stake (2005, p. 454) states the qualitative researcher is in terested in diversity of perception, even in the multiple realities within which people live. Participants Study Site. Participants for this particular study are masters-educated therapist supervisees and a masters-educated licensed therapist supervisor from a residential childrens treatment facility. The facility is familiar to me due to prior practicum students completing training at the facility and ongoing contact be tween the facility administrative staff and myself regarding th e progress of these students. Due to this connection and prior association, the facili ty was willing to participate in the study and grant access. Prior to choosing this facil ity, I had identified a nother facility with a supervisor and supervisees c ounseling children. The initial facility supervisor was a known licensed mental health counselor that I knew. However, during the month that
39 I planned to request approval from the original facility to conduct research, the supervisor resigned and accepted anothe r position supervising counselors and counseling adults. As an alte rnative choice, I explored th e current residential foster care facility in early Janu ary 2007 due to my prior a ssociation with practicum students and the facilitys exclusive c ounseling of children and adolescents. The residential foster care facility and more specifically, the intensive counseling and therapy program are porti ons of a very large not-for-profit organization serving the Central Florida re gion that was originally established in 1892. The residential facility houses female a nd male children ages 5 to 17 years who are victims of abuse neglect and abandon ment. The facility is accredited to house between 50 and 70 children at any one time. The residential foster care facility is for children and adolescents who have had prev ious multiple foster care placements. These children have remained in the child welfare system for an extended period of time. The children receive counseling, meals, and clothing, in a supportive environment until a permanent adoption or foster care family is located. Examples of services provided may be on-going behavi or modification, use of medication to control behavioral issues, and/or therapeutic suppor t for post traumatic stress disorder, etc. In addition to medication a nd therapeutic support se rvices, various other services are provided at the facility and include: intensive counseling, family therapy, foster care and adoptive kinship care to a ssist in the search for placements for the children, community-based car e to assist with case management, family support centers for parenting and prevention, and opportunities to vol unteer throughout the various programs. The participants of this particular study are from the residential life
40 staff, specifically the intensive counse ling and therapy prog ram assisting the resolution of abuse and trauma. Participants often call their program the clinic. The Sample. The sample size is four participants: three supervisees and a supervisor. Three supervisees with one superv isor were selected for this particular case study based on the Creswell (1998) suggest ed upper limits of no more than four cases. The sampling design for this st udy was a pairwise sampling design (Onwuegbuzie & Leech, 2005). The pairwise sa mple design treats all cases as a set and compares them to all other cases in order to understand the nature of clinical supervision for CACs. All are cases compared to all other cases one time in order to understand better the underlying phenomenon, assuming that the collective voices generated by the set of cases lead to da ta saturation (Onwuegbuzie & Leech, p. 11). The nature of the supervision experience wa s compared and contrasted to understand process and content, thus a constant comparative analys is with both cross-case and with-case analyses were used. The purposive sampling scheme is a convenience scheme (Onwuegbuzie & Collins, in press; Onwuegbuzie & Leech, in pr ess-a), one in which participants from a local south Florida residential childrens mental health treatment center who were conveniently available and who were willing to participate in the study were selected. I chose a setting that was known to me a nd participants that were conveniently available. For the purposes of this study one supervisor and three supervisees were interviewed at a south Florida residential ch ildrens mental health treatment center. In part, snowballing also enhanced the sampling, as the supervisor was familiar with the staff at the facility and helped in recruitment of supervisees and supervisee
41 participation in the study. There were three licensed supervisors at the residential foster care mental health treatment facility where the study took place. The supervisor chosen for this sample is responsible for the supervision of the masters-prepared therapists preparing for licensure, and conducts individual superv ision with the ther apists on staff in accordance with their facility accreditation. The supervisor is a licensed clinical social worker under the rules and st atues set forth by the Board of Clinical Social Work, Marriage and Family Therapy, and Mental Heal th Counseling in the State of Florida. Similarly, the supervisees are mastersprep ared, licensed eligible therapists, with either a masters in social work, couns eling, or psychology. Educational background and license information of the supervisor and supervisees was gathered in the demographic questionnaire and reviewed during the rapport-building stage of the interviews. Instruments I used an open-ended question format to interview the research participants. The demographic questionnaire (see, Appe ndix B) was completed via email by the research participants prio r to the observation of supe rvision. The post-supervision interviews (see, Appendix C) were faceto-face and semi-structured. I reviewed demographic information, including educat ional background and license information, prior to the start of the po st-supervision interview, as part of rapport building with both the supervisees and supervisor. The demographic questionnaire and the post-supervision interview were the same for both the supervisee and the s upervisor. The demographic questionnaire
42 covered demographic information, educati onal information, and license information. The post-supervision interview consisted of basic descriptive questions about the most recent individual clinical supervis ion experience. In addition, each supervisee and the supervisor participated in a follow-up interview. The unstructured follow-up interview was an open-ended interview fo rmat. The unstructured follow-up interview was for the purpose of member checki ng, and was conducted face-to-face. Pilot Study The questions for the demographic qu estionnaire and the post-supervision interview were pilot tested in late May 2007. The participants were asked to provide feedback about the content and quality of the demographic questions and the interview questions. One supervisor and one supervisee were recruited for the pilot study through the doctoral program in Counselor Educati on and Supervision at the University of South Florida. The supervisor was a licen sed mental health counselor, 31 years old with a masters degree in Counselor Edu cation and currently wo rking on her doctoral degree in Counselor Education and Superv ision. Her undergraduate degree was in psychology. The supervisee was as 27 year ol d registered mental health counselor intern, seeking supervision for licensure w ith a masters degree in Rehabilitation and Mental Health counseling. She was also wo rking on her doctoral degree in Counselor Education and Supervision. Each pilot st udy participant reviewed and signed the informed consent to particip ate in the research study. The intention of the pilot study was to validate the instrume ntation. Miles and Huberman (1994) argue for a lot of prior instrumentation when using multiple cases
43 to form a collective case study. It is important to focus the interview and observation schedules in an effort to decrease extran eous information for the various cases. Without prior tested instrumentation part ial or unclear questions may enter the interview, yet with prior tested instrument s and proper use, meaningful findings will emerge (Miles & Huberman, 1994). Pilot study participants answered th e following demographic questionnaire: 1. Please tell me your first name and last initial for identifying purposes only. 2. Having re-read the consent form, do you s till agree and consen t to participate in this research study? 3. What is your age? 4. What was your undergraduate major? 5. What is your masters degree specialization? 6. How long have you worked at this facility? 7. What has been your work experience with children and/ or adolescents? 8. What specialized training in counsel ing children and/or adolescents do you have? The feedback about the content of th e demographic questionnaire yielded results that impacted the final demographi c questionnaire. Each pilot participant agreed that gender and ethnicity needed to be included. In addition, both pilot participants felt question number 7 could be clearer and potentially divided into two separate questions. As a result the ques tion was divided and became: a) How long have you worked with children and/ or adolescents? b) What has been your work experience with children and/ or adolescents?
44 Pilot study participants answered th e following post-supervision interview questions: 1. Would you describe your most recen t individual supervision session? 2. What were your thoughts duri ng the supervision session? 3. What were your feelings dur ing the supervision session? 4. Would you describe the issues or topics discussed in the supervision session? 5. Please discuss how your needs were me t in the most recent supervision session? 6. Please, add any additional informati on about the supervision experience you believe to be important? Pilot study participants also provided f eedback about the content and quality of the post-supervision interview questi ons and their influenced the final postsupervision interview questions Both pilot participants thought that question number 5 was difficult to answer. They believed th at the word needs seemed personal, and when the question was asked, they were unsure of how to answer it. The pilot participant supervisee suggested placing an adjective in front of needs to clarify the intention of the question. There was some discussion about the po ssibility of using a different word other than needs. Word s, like gained and satisfied were discussed, but it was agreed that supervi sory needs related to the content of question and felt most comfortable to both th e supervisee and supervisor. The result of the participant feedback was that the question was changed to: Please discuss how your supervisory needs were met in th e most recent supervision session.
45 Both pilot participants thought it was im portant to use non-verbal gestures and to probe when appropriate during the postsupervision interviews They were unsure about how much to say when answering the interview questions. As a result, question number 6 was slightly modified. The pilo t participant supervisor thought it was important to separate the question into tw o distinct questions. The result was the following: What else about the supervisor y experience do you believe is important? And is there anything else you would like to add to this interview? Procedure I served as the interviewer. The research design is a collective case study involving more than one case (Stake, 1995). The use of a collective case study design is appropriate in the study of supervision content given the use of interviews, the importance of sharing personal experience, a nd the setting. I used audio tapes, field notes, and transcripts as data sources. Confidentiality was maintained for all participants. Data were stored in secure location, and any participant-identifiable references will be destroyed within one year of the completion of the study (Christians, 2005). An Institutional Review Board (IRB) form was completed and approved in mid-May 2007. Consent form s were reviewed and signed by all participants, prior to the star t of the study (See Appendix A). I contacted two of the three licensed supe rvisors at the facility initially to assess the feasibility of the study at the site These were the supervisor of practicum and internship students and the supervisor of masters-prepared therapists. I contacted only two of the three licensed supervisors at the facility due to my prior knowledge that the third supervisor was a psychol ogist who worked primarily with psychology
46 students. The supervisor of the post-masters therapists works full-time at the facility, where as the other supervisor does not. In addition, the population of working counselors was the population I was seeking, not practicum and internship students. Thus, the supervisor of the post-master s therapists was my choice. I sought permission for the study from the facility management team. I had an individual meeting with the supervisor to confirm the research protocol and to review expectations. I coordinated future arrangeme nts for the interviews and observation of supervision times with the supervisor via em ail. I began data collection the first week of June 2007, and the follow-up interviews for the purpose of member checks were complete the first week of July 2007. I interviewed the supervisor and supe rvisees individually post-supervision using a digital hand-held audio recorder to record the interviews. I also took field notes (see, Appendix E) duri ng the observation of supervision. All interviews were conducted at the residential facility within the various individu al offices of the supervisees and supervisor. The post-supervision interviews (s ee, Appendix C) took place after the observation of the individual supervision session and were anticipated to take approximately 30 minutes. However, they we re much shorter: approximately 10 to 15 minutes. The interview was semi-struc tured with open-ended questions and opportunities for participant fee dback. Prior to the interview, participants completed a demographic questionnaire (see, Appendix B) with questions regarding demographic information, educational background, and licensure. I reviewed the demographic questionnaire with the participants prior to the start of the post-supervision interview
47 as part of rapport building. E ach participant had an ini tial interview and a follow-up interview. The initial inte rview consisted of basic desc riptive questions about the supervision process and questions about the professional experience of the supervisees and supervisor. The follow-up interview lasted approximately 15 to 20 minutes. The purpose of the follow-up interview was to review information gathered at the initial interview and to review the themes that emerged from the constant comparative analysis. These interviews were also semi-structured a nd employed open-ended questions, which I developed. Data Analysis I used a cross-case analysis and a within -case analysis of the post-supervision interviews from the supervisees and superv isor. I also used constant comparison analysis to aid in coding and chunking of th emes from the post-s upervision interviews prior to the within-case a nd cross-case analyses bei ng performed. The cross-case analysis was intended to provide a clearer picture of the e xperience of the participants in comparison with each other. The withincase analysis provided a way of analyzing and interpreting the participants experience in supervision as i ndividuals and not in comparison to each other. Data from both the supervisee and supervisor post-supervision interviews was transcribed. I labeled subsets of data into sm aller parts with a desc riptive title or code. Themes emerged based on these groupings. As suggested by Leech and Onwuegbuzie (in press), a way to increase th e accuracy of codes is to engage in member checking with participants. Accord ingly I asked participants to read the
48 themes generated from the constant co mparison analysis during the process of member checking in the follow-up interview. At this time they had the opportunity to add anything they had forgotten to say as well as to correct or clarify anything I had written. The transcribed material was then entered into, ATLAS.ti 5.0 (Muhr, 2004). The computer data analysis software was also used to assist in the coding of themes and analysis of data (Muhr). ATLAS.ti.5.0 was used in addition to the constant comparative analysis. Legitimation The establishment of credibility in colle ctive case studies needs to be rigorous. Stake (1995) recommends triangulation and member checking specifically for collective case studies. I used several strategi es to establish the internal credibility of the study and to promote the accuracy of th e information shared by the participants interviewed. These included: peer debrie fing, member checks, external audits, and clarification of researcher bias. Clarification of researcher bias. One of the threats to the credibility of the current study is researcher bias. I did have certain personal assumptions when interviewing participan ts or analyzing data due to my prior experience as a counselor and supervision experience in childrens mental health services. As the researcher of this particular study, I have previous experience as both a child therapist and as a supervisor of child therapists. I am a li censed mental health counselor with seven years of clinical experience working with ch ildren and adolescents and four years of experience supervising counselors who provi de therapy to children and adolescent.
49 My experience was clarified from the outset, via disclosure of assumptions, to increase the credibility of the results (Merriam, 1988). My assumptions and prejudices have shaped the research questi ons and the interpreta tion and approach to the study. My researcher bias was addresse d via peer debriefing process, member checks, and external audits. Peer debriefing. Peer debriefing was used in th is collective ca se study during the analysis phase. I met weekly with a doctoral student in counselor education familiar with the collection of qualitative data. This particular student has had a research methodology course in qualita tive design. These meetings were approximately a half hour in length, every week, with the most significant proportion of discussion comprised during the analysis phase. These meetings were productive in a several ways including: (a ) reducing my stress and anxiet y, (b) identifying efficient coding procedures, (c) exploring issues I may have missed. For example, during the analysis phase, the peer de briefer and I review ed my procedures with ATLAS.ti.5.0. During a lengthy discussion about coding, we reviewed how I used not only ATLAS.ti.5.0, but also manually did a consta nt comparative analysis of themes. She helped confirm my coding conceptualizations. Member checks Credibility increases based on th e representation of data of the participants and their subsequent memb er checks. Participants were given the opportunity during the member checking pr ocess to verify the accuracy of the transcribed interview contents. This process helped to increase the descriptive validity of the study (Maxwell, 1992). Descriptive va lidity is the factual account of the event that transpired in the interv iew. In addition, participants were given the opportunity to
50 review the themes which emerged from the constant comparison analysis. As part of the interpretive process, the participants helped to verify the themes and increased the interpretive validity of the study (Maxwell). Interpretive validity is the accuracy of participant experiences as reported and understood by th e researcher of the study (Maxwell). I asked participants for feedb ack on the accuracy of the themes and for input based on the details and categorization of the data into specific themes. When there were any discrepancies between the themes I categorized and the themes the participants believed emerged from the interviews, the discrepancies were then reviewed with the external auditor. External audits. I collaborated with an external auditor to establish further credibility of the findings. This external audi tor is also the person responsible for peer debriefing and was quite willing to review qualitative information for the experience because she is in the process of completi ng her course work for her doctorate in counselor education and supervision. Her primary motivation was professional and scholarly reciprocity. The intended meeting schedule fo r auditing was two initial meetings and four meetings during auditing, with each meeting to last approximately one hour. The focus of the auditing pro cess was to uncover my consistencies and inconsistencies in the constant comparison analysis of themes of the supervision process with child counselors. Our discu ssions focused on comparing the codes and themes that emerged from the analysis. The auditor noted a 1 for consistent findings and a 2 for inconsistent findings. Consistencies and inconsistencies in the coding of emergent themes were not discussed in an effort to maintain neutrality as a standard of confirmability in the aud iting process as recommended by Roman and
51 Apple (1990, p. 64). However, because the audi tor is also the peer debriefer issues were streamlined relativ e to coding procedure. Transferability. Transferability of findings, ofte n seen as an alternative to generalizability or external validity in quantitative re search, means the degree to which the intended research is applicable in one or more settings or contexts due to the similarity of the settings (Lincoln & Guba, 1985). Given that this study is intended to increase the curre nt understanding of supervis ion experience for CACs, it is possible to propose that the findings of this stu dy may be extended to CACs, counselors in supervision, or counselor s working with abused children and adolescents. I described in de tail the setting and context of the supervision experience of participants of the case study to enable the readers to have a clear understanding. I also used field notes from the intervie ws in addition to observations about the interview process to gather descriptive information. I used verbatim quotes when possible to provide the best examples of a participants experience and/or response. Dependability. The establishment and accomplishment of dependability in this study was made possible through the constant collaboration with a peer debriefer, external auditor, and the participants. The detailed documentation of methodology and the research process is equivalent to establishing the quali tative version of reliability but far more flexible and termed dependability (Guba & Lincoln, 1989). Summary This study was a collective case study. Th e participants were three supervisees and a supervisor from a residential foster care facility who agreed to provide
52 demographic information, have their indivi dual clinical supervision observed, and then be interviewed post-supervision. A within-case analysis and a cross-case analysis of themes were completed. Legitimation included: clarification of researcher bias, external audits, member checks, and peer debriefing. Chapter Four will present the results of the study by exploring the general questions that guided the inquiry.
53 Chapter Four Results The following chapter will present the results of the study. Each case of the collective case study is presented in detail. The cases involve one supervisor and three supervisees. These cases are illuminate d through demographic information and through observation information. Both within -case and cross-case thematic findings are presented. The Supervisor Sandnes. Sandnes is one of several supervisor s at the residential foster care facility. She is one of two supervisors for the intensive c ounseling and therapy program, and she supervises the counselors who have completed their masters degree. The other supervisor in the intensive couns eling and therapy program supervises the counselors who are currently in practicum or internship at local universities in counseling, psychology, or social work progr ams. Sandnes was chosen to participate in the study because of her work schedule a nd because she supervises the clinicians who participated in this study. Sandnes was helpful in the facilitation and the scheduling of the supervision observation and post-supervision interv iews. Similarly, she coordinated and scheduled via email with her supervisees to ensure on-time attendance to supervision and interviews. She provided several em ail communications to me confirming
54 scheduled supervision, and when there were minimal time changes, she was quick to email me an update. In person, she was noticeably busy. It appeared that she coordinates with additional em ployees other than the counsel ing or therapy staff. This function of her job appeared to take extr a time and required the ability to perform other tasks while still working with the counseling staff. Sandnes is a 36-year-old Caucasian fe male. I observed her to be wearing a wedding ring. I also observed her to be dre ssed in a casual but professional manner. Her disposition is one of warmth and frequent smiling. She reported that her undergraduate degree was in psychology with a minor in child development and family relations. Sandnes expanded on her decision to pursue psychology, noting that psychology was familiar to her and that her fa ther is a clinical psychologist. It took Sandnes four and half years to complete her undergraduate degree, and she described herself then as not focused, really immature and unclear of what she really wanted to do. She completed her undergraduate degr ee at Western Carolina University. Sandnes has a masters degree in social work from the University of South Florida and is a licensed clin ical social worker. She went to school full-time for two years in order to complete her degree. Pr ior to entering graduate school, Sandnes was working at the facility she currently works at now. When she was working in the residential part of the facility, it became clear to Sandnes that she wanted to be a therapist and work with children and families. When she returned to school to complete her masters degree, her exposure to clinicians had been primarily the social workers at the facility. Sandnes reported ad miring and respecting the social workers she worked with at the time, and due to th is admiration, Sandnes chose to purse social
55 work in graduate school. Sandnes said she felt lucky to be accepted into her masters program. Sandnes has worked at the residential fo ster care facility for 13 years. Prior to working at this facility, she develo ped her expertise w ith children through babysitting in high school and in college for three years working in two different child development centers. She reported lo ving the experience of completing a minor in child development as an undergraduate. For the first three years of her reside ntial experience, Sa ndnes worked in the residential program, spending three nights a we ek in the cottage. She felt it was an intense experience but described the expe rience as helpful in her developmental understanding of working with traumatized children. She also described feeling stressed, physically bruised, and tired. Howe ver, she believes it was also the best experiences she could have ever had. After her experience in residential po rtion of the facility, Sandnes was a Primary Caregiver for three child ren for two years. Two of th ose children still keep in contact with her and are both now adults. As a result of this experience, she feels she is a better person and certainly a better moth er from having had that time with those children. During this time she felt very luc ky in that her direct supervisor was an MSW and provided excellent feedback and guidance. Sandnes then became a Primary Trainer to teach the new staff how to work with the children at the residential foster ca re center. After three years in this position, she believed it was time to go back to school, and that is when she decided to apply to the School of Social Work. She was accepted and completed her field placement in
56 one and one half years under the guidance of a child analyst. She carried a full case load, and because, at the time, the center was not billing Medicaid, the paperwork was minimal. Therefore, she remembers much thought, planning, and training was done in regard to each client's treatment. Sandnes said she felt like a sponge and took every opportunity to learn from anyone who was willing to help her. When she graduated, she became a full-time therapist, then the assistant clinical director and now the clinical dir ector. During her work as a therapist, Sandnes worked in the Family and School Suppor t Teams program (FASST). The FASST program is an early intervention program for families and their children. FASST is also a multi-disciplinary intervention t eam comprised of schools, community members, and family representatives. Utilizing a strength-based approach, the FASST program supports children to be successful and independent at home, in school, and in the community. She recalled this inhome work experience with children and families as uniquely different than in-office work, and as an experience that greatly increased her skill base with at-risk populations. Sandnes was trained under a child analys t for three and half years during her internship and some time after completing her internship. She described her supervision during her internsh ip and the initial year and half after as psychodynamic. The residential foster care facility also pr imarily operated under th is orientation at the time as well. She reported feeling very comf ortable with this th eoretical orientation. Sandnes has since branched out to attend se veral trainings on c ognitive behavioral therapy and play therapy. She is also work ing to log the 100 clini cal hours required to become a registered play therapist.
57 Not only does Sandnes provide clinical supervision and administrative supervision, she also receives administra tive supervision on a weekly basis. She reported that she meets her clinical needs of supervision through her co-workers, the psychiatrist on staff, and by attending tr ainings. During the member check process, Sandnes described that she would like to have clinical supervisi on that was not just based on work groups, continuing educati on, or co-workers. The discussion was rather lengthy and Sandnes explored a f eeling of loss of not having clinical supervision and also a fear of losing something by not being challenged at a clinically conceptual level. She described peer s in the field that also feel a similar loss and she sees them addressing their need s through seeking additional education and certifications as a means for clinical gr owth and cognitive stimulation. Sandnes has peers in the field who have years of experien ce, similar to herself, who wish they had clinical supervision and have left agency or residential work for private practice hoping that it would provide greater challeng e. Sandnes described th is solution to the lack of clinical supe rvision for experienced therapists as a false hope with its own set of issues. Thus, Sandnes continues to addre sses her clinical supe rvision needs through the outlets she described and reported that she really looks forw ard to the training opportunities she attends as a way of networking with ot her highly trained professionals in the field who can challenge her. When asked to clarify her role as a cl inical director at the residential foster care center, Sandnes noted the following as her job responsibilitie s related to the clinicians that were interviewed:
58 1. Directs Counseling Services. Responsible for all aspects of clinical treatment on the therapeutic residential campus. 2. Selects, supervises and trains clin ical and department support staff. Responsible for completing employee eval uations on those directly supervised and for ensuring that an effective employee development, discipline and recognition programs are implemented fo r clinical employees within the framework of residential foster ca re center policies and procedures. 3. Provides input to the Residential Serv ices Director on residential staff performance as it pertains to treatment plan implementation, and coordination of efforts between clinical a nd residential staff, etc. 4. Ensures the implementation of the Pr imary Caregiver Model and that the model drives all program decisions with respect to structure, operation and systems. 5. Ensures staff completes appropriate documentation in accordance with federal, state and Council on Accreditation requirements. 6. Ensures confidentiality of client information and records. 7. May represent the residential foster ca re center on various committees, i.e. Steering Committee, Utilization Management with Hillsborough Kids, Inc. (HKI), Out-of-Home Care Committee, etc. 8. Reviews data for a quarterly report for clinical services and approves report before it is submitted. 9. Collaborates with Residential Director and Residential Manager to develop plans to address crisis situations.
59 10. Develops and conducts agency training in areas of expertise. 11. Develops and refines policies and proce dures, including infrastructure issues in assigned areas. Makes recommenda tions to the Management Team on policy revisions. 12. Supervises students and clini cal employees when necessary. 13. May carry therapy cases on an as needed basis. 14. Directs the coordination and trai ning of the interns as needed. 15. Works within the philosophy, functi on, and personnel practices of the residential foster care center. 16. Perform other duties as assigned. Sandnes in supervision. Sandnes typically conducts individual clinical supervision in her office. However, duri ng the two weeks when I observed individual supervision and interviewed her and the supervisees, the air-conditioning was broken in the majority of the building including her office. With the exception of her postsupervision interviews and one of the supervision observations (Erica), all other supervision occurred in the supervisees o ffices. This was not a normal occurrence. It was simply due to the fact that the supervis ees offices, (Jenifer and Paulinas offices respectively), did have air-conditioning and Sandness office did not. Sandnes was initially humorous about the warm temperat ure, but by the last interview, she was reporting frustration and irr itation at the lack of pr ogress in getting the airconditioning fixed. When conducting supervision, Sandnes sits at a table in th e corner of her office with the supervisee. She takes notes on what the supervisee is saying the entire
60 supervision. During the member check process, Sandnes clarified that the documentation was about what the supervisee s address in thera py with the children and adolescents. Sandnes reported that sh e is required to document that each supervisee has supervision each week and that each child and adolescent is reviewed for Medicaid and the facilitys accred itation through the Council on Accreditation (COA). The supervision session is intended to last one hour; two of the three that were observed lasted one hour, and one supervision session lasted 35 minutes. Sandnes reported herself to be someone that is always at the facility early and also punctual to appointments, unle ss there is a facility crisis she needs to address. She was 15 minutes late for one supervision sessi on due to attending to a crisis in one of the facilitys cottages where the children and adolescents live. Sandnes allowed for the supervisees to direct the discussion in supervision. The supervisees primarily discuss cases, and Sandnes reflects on their experience when conducting therapy, asks for clarific ation, and occasionally provides ideas or feedback. At the end of the supervision se ssion Sandnes shifts the clinical supervision discussion to administrative supervision. She did this in each of the three individual clinical supervision sess ions. The clinical superv ision session ends with administrative supervision issues being discu ssed. These issues, such as having one of the supervisees cover an orie ntation training, audit review, or paperwork within their computer system, were all initiated discu ssions by Sandnes and not the supervisees. Sandness supervision style appears to be a strength-based approach and non-confrontational. In supervision she us es non-directive and supportive techniques. In general Sandness supports their professional competence via praise, feedback,
61 clarification, and a positive supervisory relationship. Sandnes ope rates from a personcentered model of supervision. The personcentered model of supervision goals include, promoting supervisee self-confidence and helping th e supervisee grow in his or her understanding of himself or herself. Supervision in a person-centered model is often a modified therapeutic interview that involves genuineness, warmth, and empathy (Bernard & Goodyear, 2004). Sandnes, a person-centered supervisor, relied on the facilitative process and the context of the relationship. Sandnes made statements in supervision such as, Im proud of you to Erica at the start of supervision. During Jenifers supervision session involving a lengthy discussion about trauma, Sandnes c onfirmed Jenifers ideas and provided additional feedback while clarifying her idea s. At the end of Paulinas session she stated, awesome, you have some great st uff going on with your kids! When asked during the post-supervision inte rview what else she believed was important about the supervisory experience, Sandnes gave a different response each time she was interviewed, but each response related to developing a positive, strength-based relationship with the supervisee in whic h they feel supported. She stated the following in Ericas post-supervision interview: I think in [Indiscernible] are important to develop a relationship with people youre supervising and that they ar e not fearful in coming to you for a question or throwing out ideas. Theyre able to kind of connect with you on some level. In Jenifers post-supervis ion interview Sandnes notes: I think being very open and willing to hear whatever people come for with and not be self-conscious or worried about wh at to come forward with. I think its important to have [Indiscernible] suppor t [Indiscernible] sense of humor about what were dealing with.
62 And I just think having a safe place to be able to talk about what you guys do here. Very supported. In Paulinas post-supervisi on interview, Sandnes summarized her general approach to supervision: I think its hardI think a lot of these therapists, they get caught up in listening at the cases that many arent so well are struggli ng with the overall stress or non air conditioning or what ever it is. That really being, you know, pointing out those things that are going really well and are really helping these kids, making a difference. When I asked Sandnes during the memb er checking process to clarify how she would like clinical supervision to be ideally she described, like it was before Medicaid and Council on Accreditati on (COA). Sandnes believes that the supervision she provided pr ior to advent of Medicai d and the introduction of accreditation policies and procedures was dist inctly different. Prior to Medicaid and COA, Sandnes described feeli ng less restricted and able to spend more time with her supervisees. With further discussion, Sandnes ma de it clear that she is aware that in supervision she has to move quickly through th ings, such as the cases and is unable to delve deeper into what the therapist is doing in therapy. Sandnes described wanting to be able to do process record ing with her supervisees. She believes that the lack of indepth discussion and process on cases is acc ounted for via clinic meetings and case reviews in a group setting. Sandnes also repo rted that she has an open door policy for all of her staff when it comes to personal issues and needs. I would expect the supervision session in a residential facility to be focused on case discussion with the general goal be ing supervisee development. Within the case discussion I would expect the topics of discussion to be highly specific to
63 counseling children and adolescents. For example, the supervisor might discuss techniques, such as play therapy, the deve lopmental level of the child, or how to review the case with child welfare. Within the promotion of supervisee development I would expect additional disc ussion specific to counseling children and adolescents. For example, the supervisor could explore issues of countertransference the counselor might have while in session with a child who was physically abused or discuss ideas for self-care for the counselor who may be experiencing vicarious traumatization. Theoretically, many supervision models are developmental and support the development of supervisees. However, Sandnes did not follow a developmental supervision model. In addition, her technique of case review appeared to be a generic form of supervision and common to many supervision experiences. The lack of developmental quality within the supervision could be due to several factors, such as lack of time for supervision within the facility, external controls according to Medicaid and accreditation, or potential l ack of prior supervisory training for Sandnes. The Supervisees Erica. Erica is a 25-year-old Caucasian fe male. I observed her to be wearing a wedding ring. She is dressed in a stylis h, contemporary, yet professional manner. She was carrying a very large bag, full of a variety of things that seemed to spill over as she sat down prior to th e start of supervision. She was the first supervisee I observed during individual supervision and interviewed post-supervision. Erica was a willing and enthusiastic participant. She expressed concern about the confidentiality of the clinical cases she di scussed in supervision after my supervision observation to
64 her supervisor. Her supervisor clarified the informed consent, as did I with the supervisor, that none of the childrens identifiable information from the clinical case discussion was being used for the study. Erica reported that she was satisfied with the answer. Erica started working at this residential foster care facility two and half years ago. She first started at this facility as an intern while completing her masters degree in social work. Erica completed her masters degree at the University of South Florida. She also currently works as a motivational caretaker in homes for persons with Aspergers Syndrome using positive rein forcement, modeling, and social skills techniques. In addition, she is currently an in-home Applied Behavior Analysis (ABA) therapist, providing care for a child with Autism disorder using ABA therapy techniques and social skills training two da ys per week. During this time, she serves as an aid and therapist during inclusionary time in a typical kindergarten classroom. She has also worked as an ABA therapist at a school for Autism and other related spectrum disorders during a summer program while completing her masters degree. In the summers, while completing her unde rgraduate degree, Erica worked as a youth camp counselor at a Je wish Community Center. Sh e has also worked as a nanny, and as a Sunday school teacher assi stant at a Synagogue. During this time Erica also volunteered with the Boys and Gi rls Club and at anothe r residential foster care facility. Erica complete d an internship at Sands Hospital for Children with Diabetes during her undergraduate degree. He r undergraduate degree is in psychology from the University of Florida. While an undergraduate, Erica wo rked as a research assistant and collaborate d on several publications.
65 Since completing her masters degree, Erica has continued to further her training. She has worked on completing a certif icate in marriage and family therapy at the University of South Florida. In add ition, she has participated in the following trainings through her current j ob or at the University of South Florida: Behavior Modification training, Applied Behavior An alysis Training for Children diagnosed with Autism & other related spectrum disorders traini ng, Crisis Management and Intervention training, Dir ective and Non-Directive Pl ay Therapy training for Traumatized Children, Diversity training, AI DS/HIV training, Introduction to Trauma training, and How to Treat Clients with Post Traumatic Stress Disorder (PTSD) training. She also reported recently attendi ng the Sexual Abuse Intervention Network (SAIN) Conference in the Tampa Bay area of Florida. Erica described always reading new research from Psychology Today and other journals and books about children, trauma, behavior analysis and/or PTSD. Erica is currently a registered clinical soci al work intern in the state of Florida. She is working on the require d clinical hours and the requ ired supervision hours in order to be eligible to take the licensure ex am to be a licensed clinical social worker. She is currently receiving her supervision for licensure at this residential foster care facility from the same supervisor that participated in the study. Erica anticipates completing all of her requi red clinical hours and supe rvision hours by August of 2008 and plans to take the social wo rk licensure exam in August 2008. Erica in supervision. When I observed Erica in supervision, she appeared rushed to start the process. The rushed behavior was not warranted because the supervision started on-time. The sense of urgency may have been compounded by the
66 supervision starting right wh en she walked in the door. As noted by the supervisor, Erica is known for being late for work. This behavior is reportedly improving. On the day I observed the supervision, Erica was suppos ed to be at the residential facility a half hour earlier than when she actually arrived. During supervision, Erica reviews her day planner and the notes in her day planner as she goes through her individual and family cases. Initially during the observation, Erica seemed nervous. Her body posture during the first half hour was tense, forward leaning and restricted, w ith arms and legs crossed. However, the second half hour, she was relaxed with her body posture leaned back in the chair and arms unfolded. Erica talked very fast during the entire s upervision session. Erica covered a great deal of info rmation during the supervision session. She currently has seven individual cases and seven family cases. Within the discussion of her cases she addressed medi cation compliance, children regressing in their behavior, and case co llaboration. She tended to provide mostly factual information and often used jargon, such as he or shes a mess, when describing cases. Erica and the supervisor discussed ot her cases in more detail, such as, an emotional phone call during family therapy, a case that is moving to terminate parental rights (TPR), and a case that is getting ready to be discharged. In addition, Erica discussed an issue with the supervis or about aggressive children and planning consistent group activities. As supervision ended, Erica started to talk about issues related to a child with sexual acting out issu es. They briefly discussed the differences between acting out sexual trauma and being a se xual perpetrator. Erica also agreed to do a portion of orientation training for the supervisor as supervision finished.
67 Erica is energetic and fast paced duri ng supervision. She generally covered the majority of her cases. However, she did not go in detail into a ny of her cases, but remained on the surface of each of her cases. Both Erica and her supervisor described her in supervision similarly. Erica stated: I usually feel pretty rushed to talk about, you know, everybody and get everything in on what's going on. I try to just get the highlights. There's so much. There's so much that you have to leave out in order to cover everybody. Similarly, the supervisor described a fee ling of wanting to slow Erica down, yet appreciating her enthusiasm: Sometimes as in yesterday's, sometimes you have to reel Er ica in a little bit because she's very -She's very enthusiastic. She has tons of ideas and kind of jumps ten feet forwar d before thinking through. Jenifer. Jenifer is a 52-year-old Caucasia n female. I observed her to be wearing a wedding ring. Jenifer was dressed in a casual, bu t professional manner. She wore glasses and at times took them off and on. She was the second supervisee I observed during individual supervision and the second I interviewed post-supervision. During the process of obtaining consent, Jeni fer showed great inte rest in what I hoped to find in my research. She questioned the assumptions of the research, and following the completion of data collection, she show ed a keen interest in relevance of supervision at the facility. However, Jeni fer was reluctant to expand on her answers to questions and was relativel y guarded in her responses. Jenifer started working at this residen tial foster care facility three years ago. Prior to working at this facility, she c ounseled children and adolescents at an outpatient mental health facility. At that out patient mental facility she also completed
68 her practicum and internship. In addition to having experience in outpatient mental health, Jenifer prior to completing her master s degree, worked in residential care, as a child care worker. It was during her work as a child care worker, that Jenifer made the decision to return to graduate school and complete her masters degree. Jenifer also reported a history of working in the school system. Jenifer completed her masters degree in family psychology and completed the degree in two years from Capella University in Minneapolis, MN. Her undergraduate degree is in history and Sp anish. She described choosing that major because she liked it and reported that it was a long time ago. Jenifer recently took the Florida Stat e Board exam for Marriage and Family therapists. She received supe rvision outside the facility from a licensed Marriage and Family therapist in order to fulfill the supe rvision requirement to take the licensure exam. She has not yet received her exam re sults. During the last few months she has been studying for the licensure exam. She al so discussed having had training in child trauma counseling. Jenifer in supervision. Prior to the supervision observation Jenifer was with a child who was being seen for medication review. She ended the session early to start supervision. The supervisor was runni ng late, and this delayed the start of supervision by 15 minutes due to her a handli ng a crisis in one of the cottages where the children and adolescents live. The superv ision occurred in Jenifers office, which was not the normal practice, but was preferab le due to the lack of air-conditioning in the supervisors office. Jenifer suggested the change in location.
69 In Jenifers office, there was clas sical music playing softly in the background, an area for play therapy, with a toys and a chalk board. Jenifer and the supervisor sat at a table on th e left side of the room. There are childrens drawings on the wall and a feelings chart posted behi nd me as I sit at Jenifers desk. In the supervision session, Jenifer i mmediately began talking about training ideas, sharing workbooks, skills, games, and therapy tools for counseling children and adolescents. For the majority of the su pervision session, Jenifer focused on issues related to techniques or the best practice when working with a child or adolescents. She discussed trauma, cognitive behavioral therapy (CBT), attending play therapy conferences, and addressing a cottage i ssue as it relates to the children and adolescents she counsels. As the superv ision continued, Jenifer discussed a few individual cases. One case in particular has an issue related to the residential staff and potential abuse reporting. W ith other cases, Jenifer expanded on some of the counseling techniques she is using with th e children, such as, narrative therapy and reflection. The supervisor gave some sugges tions for a case where a child is unwilling to explore her feelings. Jenifer appear ed defensive about the suggestions the supervisor provided, such as creating the optimal level of anxiety and striking while the iron is cold. Jenifer did no t appear very open to the supervisors suggestions. Jenifer and the supervisor discussed child trauma. Jenifer seemed reluctant to the idea of delving deeper into trauma resolution with certain children. The supervisor and Jenifer discussed research on trauma resolution a nd counseling skills with children who have a history of tr auma. As the supervision ended, Jenifer
70 discussed treatment plans and was encouraged by the supervisor to use the new kid friendly version. The discussion moved to administrative implementation of the treatment plans, and Jenifer joked about not wanting to do more work. Jenifer ended the supervision session ea rly, noting that she had a me dication review to attend with a child. The supervision session last ed approximately 35 minutes; substantially shorter than the othe r supervision sessions. Paulina. Paulina is a 42-year-old Hispan ic female. I observed her to be wearing a wedding ring. She wore casual, yet professional clothing. She had short brown hair. Her tone was most noticeable with a warm, soft spoken voice. She was the third and final supervisee I observ ed during individual supervision and interviewed post-supervision. Du ring the week of initial observation and interviews, she was at a training. Similar to the other pa rticipants, she presented herself as willing to participate in the study, yet busy with the day to day demands of the job of a residential counselor. She was also intere sted in the topic of the study and asked several questions once the interview was over. Paulinas questions and comments were related to the importance of supervis ion for counselors who work with abused or traumatized children. She made comments related the counseling at this current residential facility as being intense, and very important. Paulina started working at this residential foster care facility seven and half years ago. Prior to working at this facility she worked fo r the FASST program for five years. Prior to her experience at FASST, sh e completed her practicum and internship at this residential foster care facility but in a different program other than intensive residential counseling. She completed her pr acticum and internship with the Family
71 Preservation Project doing play therapy and psychotherapy with teenagers. The Family Preservation Project works to keep fa milies together and to keep children out of the child welfare system. The counseling in this program is extensive and targets children who are truant, runaway, and exhi bit other child management problems. Paulina completed her undergraduat e degree in Ecuador. Her major was clinical psychology and she reported th at the orientation used during her undergraduate studies was psychodynamic. Sh e also described going to college right after graduation. Paulina thinks that her degree from Ecuador is equivalent to a bachelor degree but descri bed it as much more dema nding. She believes her degree was more demanding as a result of having to complete a thesis that took an additional six to eight months after the trad itional four years to complete. Paulina completed her masters degree in social work (MSW) at the University of South Florida. She went pa rt-time and was able to complete her MSW in three years. When asked to describe any specialized training she may have received, she reported that she regularly a ttends a lot of conferences and seminars related to sand play, play therapy, worki ng with teenagers, working with children with PTSD, and anger issues. Paulina has completed the supervision and clinical work hour requirements in order to take the LCSW licensure exam. Sa ndnes, the supervisor participant of this study and Paulinas current supervisor, has supervised her for th e majority of her supervision requirement. She is currently prep aring to take the clinical social work licensure exam this year.
72 Paulina in supervision. Paulinas supervision also occurred in her office because the air-conditioning continued to be broken in the supervisors office and the majority of the building. Paulinas office, however, did have air-conditioning and she suggested that the supervision take place in her office. Paulina and the supervisor sat at a table to the right in the office while I sat at Paulinas desk chair during the supervision observation. The office had a sp ace for play therapy with toys and a sand tray. Paulina also had toys on her desk and pictures created by children hanging on the walls. Initially, Paulina appeared reserved and cautious, she had her arms crossed and her voice tone was very soft. Paulina star ted her discussion with a difficult case in which a child is not making much progress therapeutically or behaviorally in the facility. She went on to discuss, also in detail, several other cases. In her postsupervision interview, Paulin a expressed a desire to go into more detail about the cases, stating: You know, what happened in the sessi ons. Sometimes, you know, more detail of, you know, if there was something th at, you know, made a lot of sense or brought back some history or trauma or something that I didn't understand and I needed for Sandnes to help me understand where it is coming from. As the supervision continued, Paulina relaxed, and her body posture was more energetic and her voice was stronger. She de scribed some of the various techniques and counseling skills she uses with the child ren and adolescents in therapy such as, play therapy, sand tray thera py, art therapy, and genograms. As she presented the cases to the supervisor and they discussed the cases, Paulinas attitude was positive toward the children, and adolescents, therapeutic
73 progress. However, she did con ceptualize the entire case, in every detail, even if the therapy was not currently effective. Pau linas affect would match the case she was describing. When she described a difficult cas e, she appeared somber and low, and when she described a case that was progre ssing in a positive direction her energy was up and her voice was louder. As supervis ion ended, Paulina was asked to provide a receipt for a clinical training she was at last week in or der to receive reimbursement, and she was also reminded of other administrative issues. Within-case findings Erica and Sandnes. Within the post-supervision interviews of Erica and Sandnes following their individual supe rvision session, several common themes emerged. It was evident from each of their post-supervision interviews that several topics are covered in the one hour superv ision session. Both the supervisor, Sandnes, and the supervisee, Erica, make an effort to take full advantage of the time they have. Various topics were covered in the superv ision and both reported an urgency to get through all the information. Each of them fe lt a desire to discu ss individual cases. Sandnes stated, so I mean theres a lot of catching up and getting up to speed on certain cases. We have so many cases that change so rapidly, and we kind of needed to be on the same page there. Similarly, Erica reported, I was feeling rushed, and I was feeling pressured to ju st try to make sure I ran through everybody and hit all the highlights and all the important things. Er ica goes through a list of her cases during supervision and Sandnes looks fo r updates related to Ericas cases. Erica speaking about her process of discussing cas es, offers these statements: Basically what we do is we start off with just a br ief description of whats going on with each
74 of my kids. I usually start with indivi duals at first and then I go to my family cases. I always think that I need to get to each one of my kinds. I usually have like a mental list of what I go through. Sandnes reviews the process Erica goes th rough, noting she gave some updates on some kids that had been discharged and how theyre doing. And then its just overall summary on the clients. Erica and the other counselors work w ith various other systems. These other systems include, but are not limited to HKI (Hillsborough Kids, Inc.), the court system, child welfare, doctors including psychiatrists, and schools. Erica, in supervision with Sandnes discusses her coll aboration with these various systems as part of her treatment with children and adolescents, We talked about following up with a couple of e-mails to HKI regarding a 30day letter that we ju st put in for some kids. Furthermore, Erica states: [I] talk about how theyre doing in therapy and then any case management stuff. Like if theres anything going on with them with HKI or the court system, family application stuff, any letters that need to be written to the court or anything like that and then any problem behavior. Sandnes also discussed working with various systems and highlighted an inclusion of discussion about appropriate therapeutic practices within the supervision session. Sandnes reported: Going into the other ones looking at a lo t of court situations where the parents are either going to be reunified or th ey're looking to get a TPR and the kid is kind of in limbo and talking about what a ffect that has on the child here. Talk about medications. Wanted to speak w ith our psychiatrist on medications for certain kids, some that maybe need an adjustment or something. They just need to be looked at in general.
75 Working with various systems, in addition to working with programs within the same facility were challenging for Erica. Work ing with other programs and also dealing with families in the most therapeutica lly appropriate and boundary clear way, provided much discussion during the s upervision session. The ethical issue of boundaries resulted in both Erica and Sandne s discussing it in the post-supervision interview. Erica reported: Its helpful for her to reinforce that I need to make sure everybody knows that theyre being on the speaker phone, because sometimes I like to be sneaky and not let everybody know that theyre on speaker, even though you have to. Sandnes was clearer than Erica that the sp eaker phone and family therapy discussion in supervision; was a discussion about boundaries. Sandnes stated: Like I was thinking the boundary issues like when she was talking about one of the children work with one of the people from Search, its our aftercare adoptions department. Theres some boundary issues with that. And I clarified with her last week, but she didnt seem to get the whole One is that she stopped that one and [Indiscer nible] shes created anot her incident with them. I think also talking to her about general reminders about boundaries and whatnot where I had reminded her that you need to tell people their on speaker phone [Indiscernible] calls, because that s not really a good idea not to tell people. In an effort to address individual case specific issues and boundaries, Erica and Sandnes both reported key personal elements in the process of supervision. Each of them describe what they think is im portant in the supervisory process. Erica stated:
76 Other therapists here know about them, but Sandnes knows more in detail about whats going on with them and what they came in with and their diagnosis and what theyre dea ling with on a regular basis. Erica goes on to discuss the supervisory relationship in th e following context, so its always comforting to be able to talk, just to kind of talk and be able to vent about whats going on with them. Similarly she describes thinking th e following, I think its important to have supe rvision because I think you n eed that reassurance that somebody else knows whats going on in your sessions. Sandnes would agree with Erica, when she stated, shes making decisi ons all by herself. No t that you cant, but some things we just need to run by [Indiscernible]. Sandnes goes on to explore her rationale for decision making and the supervisory relationship: I think in [Indiscernible] are importa nt to develop a relationship with the people youre supervising and that they are not fearful in coming to you for question or throwing out ideas. Theyre able to kind of connect with you on some level. Not that youre their fr iend, but youre a friend empl oyee and able to be approached and go over situations wher e you dont have people just making decisions on their own or making them [Indiscernible] or hiding things from you and not reporting everything to you. And available for feedback. In addition, Sandnes states: You go either talk things out. I mea n, thats real important also. And the ability to let people know they can come and [Indis cernible] vent to you. You may not be a therapist, but you can let off some [Indiscernible]. [Indiscernible] stressful field, and you see such terrible things every single day. You could really need that time to go let it off. As Erica and Sandnes ended their supe rvision, Sandnes shifted the clinical supervision into administrative supervis ion. Erica commented only minimally on the administrative supervision in the post-s upervision interview, noting that they
77 reviewed her schedule. However, Sandne s focused more discussion in the postsupervision interview on the aspect of administrative supervision, noting how it met her supervisory needs, I needed someone to cover a training topic for an orientation. And I definitely needed to get somebody to do that, so that was covered. Similarly, Sandnes discussed what she believed to be important administrative information: clarifying some things, and I needed to go over what we were doi ng in training today and that we had the audit coming up. We were looking at that kind of stuff, so be aware of that stuff. Within the post-supervision interviews of Erica and Sandnes the themes of individual case discussion, working with va rious systems, ethical dilemmas, the best practices when working with children and adolescents, the personal aspects of supervision, and administrative supervision emerged. These themes were consistent in Ericas and Sandness interviews. I believe that because the themes are consistent between Erica and Sandnes, their percepti ons of what happened in the supervision experience are also similar. In additi on, Erica and Sandnes both perceived similar meaning from the supervision experience. Erica and Sandnes cover a great deal of information within the supervision se ssion. The relationship between Erica and Sandnes demonstrates Ericas need for a pproval and guidance from Sandnes. This supervisee dependent relationship at times is challenged as Erica searches for her own independence when she challenges boundaries and makes clinical decisions on her own. I attribute the quality of this relationship to Ericas developmental level as a therapist, having only graduated with her mast ers degree in social work one year ago.
78 Further discussion of their relationship to the collective case will emerge in the crosscase findings and in the co llective case discussion. The supervision experience between Sandnes and Erica was somewhat unique because it serves three purposes: c linical supervision, li censure supervision and administrative supervision. The prim ary purpose observed and noted during the post-supervision interviews was supposed to be clinical supervision. However, aspects of licensure supervision may have b een present since the process of clinical supervision is also preparing Erica for licen sure as a licensed clinical social worker. In addition, at the end of ev ery clinical superv ision session, Sandnes includes aspects of administrative supervision. However, since Sandnes does not operate from a developmental supervision model and curre ntly is providing a form of generic supervision within a person-centered superv ision model, it is unlikely that Ericas counseling competencies will be challenged within clinical supervision. Erica in supervision with Sandnes, as described from a developmental perspective, is dependent on her supervis or for structure, positive feedback and clarification. Erica, howev er, does show motivation, a ge neral sense of confidence, and enthusiasm about her therapeutic work. In addition, she is aware of client progress but needs to be challenged on appropriate boundaries with the clients family. Of all the superv ision sessions observed and discussed post-supervision, Sandnes and Erica covered the most conceptu ally in the supervision session. Erica reportedly continues to struggle with bounda ry issues, yet she is defensive when Sandnes addresses the issue. This behavi or is characteristi c of the supervisee developmental level 2 in the Integrated Developmental Model (IDM), when a
79 supervisee shows dependencyautonomy conflict (Stolten berg, et al., 1998). Erica is no longer content to simply model Sandnes, but still is dependent on her for support and feedback. Jenifer and Sandnes. Within the post-supervision interviews of Jenifer and Sandnes common themes emerged consistent with their experi ence in individual supervision with some individual differences. Jenifer was quick to start the process of supervision and immediately started talking about training and the facilitys push to develop additional resources for best practices when working with children and adolescents. Sandnes was eager to hear about her ideas bu t also wanted to explore other clinical aspects with Jenifer. Jenife r reported how they di scussed trainings, we discussed some of the educatio nal aspects of clinic traini ng, and thats something that we reviewed recently in clinic meetings. Sandnes explored in more detail Jenifers discussion about training, a bunch of traini ng and brought in material to show me so we can get enough stuff as were gathering up resources for this summer. In addition Sandnes mentioned the facilitys eagerness for, getting more training on CBT. Because Jenifer wanted to explore her individual cases, Sandnes seemed glad to see a shift in the focus from idea development to indivi dual case exploration. Jenifer expressed a desire to discuss individual cases: I didnt get to a lot of individual kids A lot of times Ill just go through the kids and kind of keep her up to date on whats going on wit my kids, but I didnt really get a chance to do that. I usually have a li st, and I didnt get to all my list today either.
80 Similarly, she stated, [I wa s] wondering if I was goi ng to get through the list, because I do have some other stuff other stuff I need to talk to Sandnes about. Sandnes enjoys Jenifers ideas in supervisi on, but expresses relief about hearing about the cases. Similar to Jenifer, she wanted to explore the individual case issues. I get excited. I love working [Indisc ernible] people have some ideas, and Jenifer always has new and different ideas almost every single time we meet. I was a little excited. I was relieved and sometimes when Jenifer and I meet, she likes to focus on all her ideas and stuff as opposed to talking more about what shes doing with the kids. Jenifer and Sandnes did not a ppear to report similar beliefs about the supervisory experience. Jenifer reported s upervision as feeling, just kind of impatient. Trying to get through it all kind of like its a chore. Sim ilarly Jenifer stated: Kind of like youre a student again. You re kind of like list ening, but at the same time, youre almost like you feel like youre a student but also youre a colleague. So its kind of a little bit of an odd feeling when youve got both positions. Sandnes also reported feeling conflicted re lated to two positions, but her feelings about the supervisory process are rooted in a relationshi p not a behavioral chore. Sandnes described the following conflict between clinical and administrative implementation: And I love hearing it and then I star t thinking about what could go wrong with it, which is pretty bad. Because I think if shes come up with some really cool things for the treatment plan, its go ing to be a nightmare switching anything on our computers and stuff and other inco mplete and nightmare in battle and possibly could cost money, which we don t have to do right now. And I know it would be better for the kids, its just the whole other administrative part of it. Sandnes, described efforts to make superv ision an open and supported environment. There is minimal indication that Jenife r connects with Sandnes efforts. Sandnes
81 describes, I think being very open and willi ng to hear whatever people come for with and not to be self-conscious or worried about what to come forward with. Additionally Sandnes stated that, I think its important to have [Indiscernible] support [Indiscernible] sense of humor a bout what were dealing with. Jenifer responded and appeared to minimize her respon se, I pretty well usually feel like Im listened to. Whether something happens that I suggest of not, thats I just generally feel like its productive in a way. Sandnes did mention certain things ab out the individual supervision session that Jenifer did not. Sandnes expanded on th e attempts both she and her clinical staff are making in treatment planning to make it more developmentally appropriate. She noted that Jenifer is implementing the new tr eatment plan, so that helped me in my goal of showing that were attempting to be kid friendly. So I can show the auditor that we are attempted to be kid friendly. Jenifer and Sandnes ta lked at great length about childrens trauma, and Jenifer menti oned that they talked about trauma, we talked a lot about the trauma issues th e kids face. However, Sandnes went into greater detail about the specificity of th e discussion and the impact she was trying to get across in the supervision, i.e. kids trauma, differe nt started talking about [Indiscernible] re traumatizing to [Indi scernible] experience reexperience their trauma. Within the post-supervision interviews of Jenifer and Sandnes the themes of individual case discussion, the best practices when wo rking with children and adolescents, and the persona l aspects of supervision emerged. These themes were consistent in Jenifers and Sandnes interview. Sandnes s post-supervis ion interview
82 yielded the additional theme of developmental appropriate understanding of children and adolescents when treatment planning. I believe Jenifer and Sandnes would have a similar perception about what happened in s upervision, given their similar description of the supervision content. However, it se ems that Jenifer and Sandnes would have a different perception as to why the supervis ion transpired the wa y that it did. Sandnes with-in supervision is clearly focused on th e relationship she has with her supervisees and promoting her agenda of case review. Je nifer, on the other hand, sees supervision as an opportunity to develop ideas and expl ore possibilities. Jenifer and Sandnes have alternative agendas and differing perceptions that contribute to the quality of their supervisory relationship. Their supervisor y relationship appears to be a working relationship that leaves Je nifer wanting more developmental stimulation and Sandnes primarily frustrated in her redirection to discussion about generi c case review. Further discussion of their relationship to the coll ective case will emerge in the cross-case finding and in the collective case discussion. The supervision experience with Jeni fer and Sandnes serves two purposes: clinical supervision and administrative s upervision. The observed supervision session and the post-supervision interviews revealed that clinical supervision is primarily occurring, however at the end of the s upervision session, San dnes does shift to administrative supervision. Jenifer did not e that she has outside supervision for licensure, in her efforts to become a license d marriage and family therapist. It appears that the outside influence of additional supervision and potentially divergent professional identities may have contributed to a perfunctory supervisory relationship between Jenifer and Sandnes. Jenifers deve lopmental supervision needs to stimulate
83 her professional competence appear to be fulfilled outside of supervisory relationship with Sandnes. Jenifer appears aware of the generic nature of the clinical supervision between her and Sandnes. Jenifer, described from a developmental supervision perspective is autonomous, with consistent motivation. As I observed her in supervision, she showed some doubts about the effectiveness of her therapeutic approach but was focused on what was best for the client. Within the supervision session and as described by Sandnes, Jenifer is often very focused on ideas and developing different skills. This is a common practice for a superv isee that is at the developmental level 3 of the IDM, in which the supervisee is focusing on developing a more personalized approach to practice and trying to unders tand the self in therapy (Bernard & Goodyear, 2004). Jenifer appears to have her developmental supervisory needs satisfied via outside supervisi on and thus frequently explor es conceptual ideas instead of processing therapeutic issues. Sandnes, at times, is frustrated by the lack of case discussion, yet operating from a person-cente red supervision style, she does not confront Jenifers tendency to focus on ideas versus cases. Paulina and Sandnes. Within the post-supervision interviews of Paulina and Sandnes common themes emerged that were consistent between each other. Each reported a similar experience in individual supervision with minor differences in personal reflection. Both Paulina and Sa ndnes described reviewing cases specific issues and focusing on long-term planning. Pa ulina reported that she talked about, what is happening and what is their longterm plan, and how each what is happening with them, indication, and just the whole of each child and what [Indiscernible]
84 sessions. Sandnes paralleled what Paulina stated, noting that she went over the majority of her cases and whats going on with them but focusing on long-term plans as well as what theyre current doing in therapy. Paulina displays a level of reflectio n about the individual case discussion and Sandnes is complementary of her wo rk in therapy with the children and adolescents. Paulina describes: the other thing that was interesting is I kind of caught myself, like with the ones that are doing work, just getting more into [Indiscernible]. And then whenever I talk about the ones that ar e [Indiscernible], oka y, [Indiscernible] calming. You know, even with me, my reactions. Similarly Paulina reflects about her skills in the therapy session and uses this as personal time in supervision: Im getting someplace. Competent and doing some work and getting excited about the future for some of the children. Or in other cases, just being more concerned and trying to look and se e what would work or, you know, how could I help. And with the ones that you know, that specifically would one that never came to see me say okay. You know. What else could I have done? You know. Or maybe just rea lize even if I would do anything, she would never even come. She was not, you know, a client for therapy. Sandnes makes an effort to complement this in her post-supervision interview. She comments, that shes a really good therapist. A lot of her (Indiscernible), little things that shes come up with are researched. Sandnes believes that Paulina is humble and not boastful in her ab ilities, describing Paulina as: Shes just modest. Shes not real forcef ul in our meetings constantly telling people this is how it should be done a nd this is how I work with kids or whatever, but shes just a really good, solid, therapist with these kids. She uses a variety of different things, and they really connect with her. And she just does really well with them.
85 Within their individual supervision Paulina and Sandnes primarily focused on the discussion of specific cases and specifically some of Paulinas more challenging cases. Sandnes noted feelings of frustration and administrative concern, while Paulina looked for f eedback and assistance in developing additional approaches. Sandnes described the followi ng with regards to her and Paulinas discussion about Paulinas difficult cases, at the beginning, we started with such a downer case, which is such a hopeless thing thats spun off the kid that sure makes you feel like what are we doing here. She adde d, I get very frustrated. Paulina felt the following based on her supervisory expe rience, for me knowing that maybe Im on the right track. Im getting that feedback from Sandnes saying yeah. This is where its coming from, or this is wh at the childs working with. Sandnes and Paulina differed on their expressed needs in supervision. Sandnes had concerns related to administration and indivi dual case specific issues, whereas Paulina wanted additional indi vidual personal fee dback within the supervisory process which related to indi vidual case specif ic issues. Sandnes expressed administrative issues in the individual supervis ion with Paulina when she stated: I have to look at utilization manageme nt as well as how long these kids have been here, where our plan is, what were doing, and really from the very first day of them getting here, when do we discharge them and how are we getting them to the next level. And being able to hear her plan on cases. Paulina expressed a desire for additional pe rsonal feedback and more assistance in the development of best approaches when worki ng with the children and adolescents. She described:
86 I think sometimes I would like to get more maybe other ideas of like okay, how to do it better. I haven't been that direct of like okay. Tell me maybe what I could do or how could I just help or, you know, be not stuck or things like that. Or be more specific li ke okay, you know, what was happening. Like for something during the sessions, maybe -You see, that's something that I used to do before. Like the process recording. Similarly, Paulina referenced wanting to pro cess issues related to countertransference, stating, whenever you bring things from your own stuff that many times, I dont know. In addition she discussed wanting to talk about my health. Me. Saying okay, you know. When you are doing those things, ok ay, you brought back things from you maybe you should check, in the supervision experience. Within the post-supervision intervie ws of Paulina and Sandnes the themes of individual case discussion, the personal aspects of supervision, and the best practices when working with children a nd adolescents emerged. These themes were consistent in Paulinas and Sandness interviews. Sandness post-supervision interview yielded the additional theme of administrative supervision. While within Paulinas post-supervision interview the theme of c ountertransference emerged. I believe that Paulina and Sandnes would perc eive what happened in the supervision experience very similarly. Due to their exte nsive history as supervisor and supervisee, and given their positive affirmations of each other, I also believe they would report similar perceptions as to why the supervis ion occurred the way th at it did. The quality of their relationship is very fluid, and ther e is a clear routine to their supervision process. This supervisory relationship ha s lasted almost two years and can be attributed to a similar belief system about supervision and counseling. Further discussion of their relationship to the coll ective case will emerge in the cross-case finding and in the collective case discussion.
87 The supervision experience between Paulina and Sandnes serves three purposes: clinical supervisi on, licensure supervision, and administrative supervision. During the process of observing the supe rvision and reviewin g the process of supervision during the post-supervision interviews it emerged that primarily Paulina and Sandnes engage in clinical supervision. Th eir clinical supervisi on is also part of Paulinas licensure requirement to become a licensed clinical social worker. Paulinas professional competencies have been prom oted through her supervisory relationship with Sandnes and also thr ough additional outlets such as clinic meetings and trainings. Since Sandnes does not operate from a developmental supervision model, it is not clear how Paulinas development was di rectly promoted in clinical supervision. Potentially, Paulinas desire to fill the gaps of a generic supervision format, given her desire to delve deeper into cases and issues such as countertransf erence, propelled her own development. However, Paulina did appear to be very satisfied by the supervisory relationship which was promot ed by the person-centered supervision model Sandnes does appear to use. It wa s also evident during the observation of supervision and as reported by both Paulin a and Sandnes, that at the end of the clinical supervision, Sandnes shifts the discussion to administrative supervision. Paulina described from a developmenta l supervision perspe ctive is not only confident in her skill set and autonomous, but also di splays a wide array of competencies with a personalized approach. She described herself as competent, reflected affect when describing cases, and conceptualized cases both positive and negative. This awareness of strengths and weaknesses, combined with an integrated personalized approach is char acteristic of the developmen tal level 3i (In tegrated) of
88 the IDM. Sandnes is highly supportive and co mplementary of Paulina, believing that she is a really good therapist. With Paulina functioning at an integrated level and Sandnes supervising her with a person-cen tered approach, the supervision session was observed to have aspects of peer supervision and peer collaboration. Across-case findings The experience of the participants in supervision as reported in the postsupervision interviews in comparison to each other yielded similar and different themes. These themes included: admini strative supervision during clinical supervision, best therapeutic practice when working with children and adolescents, discussion of case specific issues, understand ing of child or adol escent development, ethical dilemmas, personal needs of the couns elor or supervisor as they relate to supervision, supervision practices, treatm ent modalities, treatment planning, and working with various systems. In addition, to recurrent themes there were recurrent topics. These recurrent topics are often part of a theme. Howe ver, topics were actually stated by the participants, whereas themes were the categor ies I chose to repres ent recurrent topics. The recurrent topics of the study were: bounda ry issues, cases, clarification, court, decisions, discharge, education, feedback, feelings, ideas, kids, long-term planning, research, supervision, schedule, training, tr auma, and venting. With the addition of less common topics to the recurrent t opics, the themes emerged. There were similarities and differences across the cases in the topics discussed and the themes that emerged.
89 Consistently across the cases, both su pervisees and the supervisor reported the practice of listing or trying to go thr ough each specific child case, adolescent case or the family case of a child or adolescent a nd the issues associated with the cases. It was this practice that resulted in comments such as: Erica stated, Basically what we do is we start off with just a brief descri ption of whats going on with each of my kids. I usually start with i ndividuals at first and then I go to my family cases. Sandnes, similarly when discussing Erica, su pervision stated, So I mean theres a lot of catching up and getting up to speed on certa in cases. We have so many case that change so rapidly, and we kind of needed to be on the same page there. Jenifer described her normal routine in supervision as, a lot of times Ill just go through the kids and kind of keep her up to date on whats going on with my kids. Sandnes paralleled her comments with and then also kids specific situations and ways of working with them and their trauma and wh at our goals are here Finally Paulina similarly stated, The children, of each one of the session and what is happening Sandnes agreed and stated that, Paulina w ent over the majority of her cases and whats going on with them but focusing on long-term plans as well as what theyre current doing in therapy. The practice of listing cases or reviewing cases appears common to any supervision session. The supervisor and supervisees were similar in their discussion of the themes of the practice of supervision a nd the personal needs of the counselor in supervision. They all described the practi ce of supervision as an opportunity for feedback and ideas, and the supervisory experience as pe rsonally supportive. Erica described looking to Sandnes to provide extra thoughts when she stated, you know,
90 for any extra ideas or support that she might want to provide. She went on to state that Sandnes, also will provide me with books and things like that that I get to borrow and look through. Jenifer similarl y described the following as important about supervisory practice, just the educati on I guess, the education part of it. Um, I dont get a lot of feedback without direct supervision or observation of therapy. Paulina was similar in her response, And if theres anything specifically very, you know, that Im concerned then I stand or talk more about it and then get feedback of what would be best. I observed Sandnes s howing an effort to provide feedback and ideas to her supervisees. Parallel to the theme of the practi ce of supervision is the theme of the personal needs of the counselor in superv ision. Sandnes, as a supervisor, creates a supervisory environment of support, where supervisees can relate to her and share their emotions. Erica consistently noted the ability to vent and shared feelings of reassurance and support when in superv ision with Sandnes. In supervision with Sandnes, Jenifer described feeling listened to. Similarly, Paulina noted, for me knowing that maybe Im in the right track. Im getting that feedback from Sandnes saying yeah. Across the cases, the supervisees and the supervisor were also similar in their discussion of the best therapeutic pr actices for children and adolescents. The specific counseling skills and techniques the supervisees use in therapy were discussed in supervision and I observed the supervisee and supervisor reviewing these skills as they pertained to the cases. Howe ver, during the post-s upervision interviews, only one participant highlighted the best therapeutic practices that were discussed in
91 detail. Jenifer and Sandnes discussed in de tail, trauma training, and talked a lot about the trauma issues the kids face. In addition, Sandnes noted that Paulinas therapeutic approaches with the childr en are researched. The focus of the supervision session is case re view and divergence from case review potentially makes the next supervision rushed. Thus, explora tion of child specific competencies in supervision discussion appears to not be promoted, given only one supervisees exploration. Additional, in-d epth discussion on child trauma and therapy would align the supervision session with a non -generic supervision format. During each clinical supervision session, Sandnes would introduce administrative supervision issues at the e nd of the clinical su pervision session. Each time that she discussed administrative issues the administrative issues were different, but consistently, across cases, Sandnes discussed administra tive topics at the end of clinical supervision. San dnes expressed having an administrative mindset during clinical supervision, noting: I have to look at utilization manageme nt as well as how long these kids have been here, where our plan is, what were doing, and really from the very first day of them getting her, when do we discharge them and how are we getting them to the next level. At the end of clinical supervision she di scussed a variety the administrative issues including: grant reimbursement for a tr aining Paulina attende d, schedule changes, reviewing the audit results, hurricane emergency plans, having Erica cover a topic in the orientation training, and converting th e new kid friendly treatment plan paperwork to their facilitys computer system.
92 Differences also emerged in the themes across the cases. The most noticeable difference was the mention of outside supervision by Jenifer and its relevance to the theme the practice of superv ision. Jenifer discu ssed feeling different in supervision: If its one of my kids in a family se ssion or something that, you know, I have supervision outside the resi dential facility because Im a marriage and family therapist and theyre social workers. So I receive that. Another difference was the theme of ethi cal dilemmas and issues, specifically boundaries, countertransference a nd transference. Erica disc ussed the importance of talking about transference, wh en in fact I think she mean t countertransference, stating And, you know, if somebodyif a client is re ally bothering you for some reason, to be able to discuss that transference, you know those personal feelings that come up in therapy all the time. I think thats incredib ly important. Paulina discussed wanting to possibly explore her countertransference i ssues, however did not explicitly discuss countertransference during supervision. Sandnes discu ssed the importance of addressing boundary issues within Ericas s upervision session, but did not in any of the other supervision sessions stating like I was thi nking the boundary issues like when she was talking about one of the ch ildren work with on of the people And I was thinking, oh, we need to go back to that again. I didnt rea lly totally address it with her yesterday. Sandnes was observed consistently discussing the implementation of a developmentally appropriate treatment pl ans for the children at the residential treatment facility. Sandnes al so reported and discussed th e kid friendly treatment
93 plan in a post-supervision interview. The use of this specific treatment plan was important to Sandnes as noted by the following: Well, I toldI didnt ask. I told people they are to use this class (Indiscernible) I was really glad that she asked and clarif ied and didnt just blow it off or not utilize it, because we have (Indiscernible) every single week, and I really wanted it to be incorp orated right now on everybodys plan. So that helped me in my goal of showing that were attempting to be kid friendly. I observed each supervisee di scussing the kid friendl y treatment plans during supervision with Sandnes, but none of the supervisees mentioned the developmentally appropriate treatment plans dur ing the post-supervision interviews. This discussion in supervision, across all supervis ions was an opportunity for the process of supervision to be specific to child and adolescent th erapy. Sandnes made an effort to shift the generic case review discussion to specific tr eatment planning techniques for children and adolescents in each superv ision session. Despite this effort to be non-generic in supervision, the supervisees did not relay the same level of support for the developmentally appropriate technique across the cases. The supervisees, Erica, Jenifer, and Pa ulina, consistently review cases in supervision. In addition, the s upervisees also make an effort to discuss the most appropriate practice when working with a child or adolescent in therapy. The dominant themes across the interviews with the supervisees were the review of cases and the best therapeutic practices when wo rking with children and adolescents. The lack of specificity or ability to delve d eeper into the cases promoted the generic nature of the supervision. Each supervisee consistently felt a pressure to review each case, thus limiting her ability to explore in more detail the best practices when
94 working with children and adolescents in th erapy or other issues they personally may have believed relevant to couns eling children and adolescents. The supervision that Sandnes provided to Erica, Jenifer, and Paulina was consistently geared to review the child and adolescent cases. The dominant themes across all of Sandness in terviews were her review of cas es, her desire to address the personal needs of the supervisee, and her di scussion of administra tive supervision at the end of clinical supervision. As noted by Sandnes, this pract ice of case review during weekly clinical supervision is re quired by their facility accreditation and by Medicaid. Sandnes described during the follo w-up interview, memb er check process, wishing that the supervision experience coul d be like it was before accreditation and Medicaid. She was cognizant that as a supe rvisor she was only reviewing cases and not going into detail. The lack of detail duri ng the review of the cases maintained the generic or surface quality of the supe rvision. Sandnes operates from a personcentered model of supervision during superv ision, to address the primary supervision goal of case review, and the pot ential other issues of best therapeutic practice when working with children and adolescents, a de velopmental understanding of the child or adolescent, ethical dilemmas, personal need s of the counselor, treatment modalities, treatment planning, and working with various systems. Despite reporting that her personal theoretical orientation is ps ychodynamic and that she would do process recording with her supervisees, Sandnes appears handicapped by time and external controls. Her supervision style is limited to facilitating self-confidence in the supervisee via support, unde rstanding, and process.
95 Summary The results of the clinical superv ision observation and the demographic questionnaires were presented in detailed descriptions of each case. Similarly, the results of the post-supervision interviews were presented via w ith-in case and crosscase analyses. Several themes emerged from these analyses and included: administrative supervision duri ng clinical supervision, best therapeutic practice when working with children and adolescents, case sp ecific issues, understa nding of child or adolescent development, ethical dilemma s, personal needs of the counselor or supervisor as they relate to supervision, supervision practices, treatment modalities, treatment planning, and working with various systems. Chapter Five will discuss the main conclusions of the study. The statement of the problem will be explored in rela tion to the methodology used, followed by the subsequent findings. Conclusions will be discussed. Implications will be described. Recommendations for additional research will be made based on this study.
96 Chapter Five Summary and Conclusions The following chapter will present a summ ary of the collective case and the major conclusions of the study. The statement of the problem will be discussed in the context of the methodology used, foll owed by the subsequent findings. Recommendations for additional research will be made. Implications for new research questions that emerged based on this research study will be explored. In addition, recommendations from this study for use in the field of counseling and supervision will be made. To summarize, how clinical supervisi on is defined appears critical given the diversity of fields explori ng the topic but there appears to be some consensus that counselor supervision is gui ded by developmental principl es (Falender et al. 2004). As models are placed into action, supervision delivery is often an individual process between supervisor and supervisee. As seen in the collec tive case study, the interaction between the s upervisee and supervisor took place during individual supervision. Bernard and Goodyear (2004, p. 209) consider individual supervision the cornerstone of supervision, however, superv ision also can be in the format of group. The issues specific to child and adoles cent counselor supervision within the literature are minimal. Rarely does res earch address the need s of the child and
97 adolescent counselor in supervision. The current study sought to contribute to the existing research in the field of counselor supervision specifica lly relating to child and adolescent counselor supe rvision. It was the aim of th is study to illustrate the process of child and adolescent supervision in order to determine how similar it is to generic supervision as well as to determine which issues and or concerns arise in the processes that are unique to child and adolescent supervision and to determine which competencies child and adoles cent supervisors should have. Collective Case Collectively, the clinical supervisi on experience for child and adolescent counselors in residential fo ster care as reported thr ough the experiences of the represented cases was both similar and di fferent. As a group their similarities are greater than their differences especially in their experi ence in supervision. They each participate in weekly indivi dual clinical superv ision for one hour, and each participant has the same clinical supervisor, who is al so a participant. As they work together, counsel children and adolescents in the same facility, and participate within the same supervision paradigm, these cases have a collective identity. Singularly, each participant is identifiably her own i ndividual. The supervisor, Sandnes is a 36-year-old Caucasian female with 17 years experience working with children and adolescents, with the majority of her experience having been at this residential facility. She is also a licensed clinical social worker. The supervisees, Erica, Jenifer, and Paulina each have cons iderable experience, represent more than one cultural group, and are at different stages in their careers developmentally. Erica is a 25-year-old Caucasian female with f our years experience working with children
98 and adolescents and is a regist ered clinical social work in tern. Jenifer is a 52-year-old Caucasian female with seven years experi ence working with children and adolescents and she is a registered marriage and family intern. She recently took the marriage and family licensure exam. Paulina is a 42-year-o ld Hispanic female with seven and half years experience working with children and adolescents and is a registered clinical social work intern. She has completed all the requirements to take the licensure exam for clinical social work, and she plans to take the exam this year. Seen from a developmental supervision perspective, Sa ndnes is supervising three very different supervisees. Each is at a different level developmentally as de fined by the IDM of supervision (Stoltenbe rg, et al., 1998). The three supervisees are each at different development stages, as supervisees, according to the IDM. Erica would be consid ered a level 2 supervisee, in which she remains highly dependent on Sandnes, but is working to make the transition from being dependent to being autonomous. Sa ndnes demonstrated a delicate balance on the most appropriate way to approach Erica so as to not offend he r. At times, Erica would appear confident in her skills and ot her times unclear regarding the appropriate direction to take the therapy. However, she was generally very client-aware and focused on her cases. Jenifer would be c onsidered a level 3 supervisee. She was primarily focused on developing additional skills and competencies during the supervision session, as a means of devel oping her own personal style in therapy. Jenifer was clearly autonomous, and she wa s also aware of bot h clients and self. Paulina would be considered a level 3i (i ntegrated) supervisee. She was flexible during the supervision session and discussed her strengths and w eaknesses. Paulina,
99 while exploring case conceptualization, dem onstrated a personalized approach; that addressed multiple therapeutic competencies. The difference between Jenifer and Paulina is that Paulina is fully integrated in her identity as a counselor, whereas Jenifer is continuing to search for her personal style as a counselor. These different developmental levels c ould be challenging for a supervisor. However, Sandnes approached her superv isees primarily from a person-centered model of supervision. She may have been in terested in supporting the development of her supervisees, but due to accreditation and Medicaid requirements to review each case each week in supervision, Sandnes felt the need to move quickly in supervision and remain supportive. The lack of direct confrontation and delving deeper into the professional functioning of her supervisees, such as in the domains suggested in Stoltenberg, et al. (1998) (e .g. intervention skills compet ence, assessment techniques, interpersonal assessment, client conceptual ization, individual di fferences, theoretical orientation, treatment plans and goals, a nd professional ethics) appeared too time consuming in the clinical supervision hour for Sandnes. In supervision, collectivel y the cases appeared to represent the typical residential child and adolescent counse lor and supervisor. The counselors and supervisor in clinical su pervision discuss the child and adolescent cases and the specific details of the cases, the best therapeutic practices when working with children and adolescents in counseling, the developmental understa nding of the child or adolescent, ethical dilemmas, the personal needs of the counselor or supervisor as they relate to supervisio n, supervision practices, treat ment modalities, treatment planning, working with various systems, and administrative superv ision issues during
100 clinical supervision. Consistently the part icipants reviewed cases during clinical supervision. This practice is consistent with generic supe rvision, as is the discussion of best therapeutic practices when work ing with clients, ethical dilemmas, the personal needs of the counselor, supervision practices, treatment modalities, treatment planning, and administrative supervision. During the member checking process I discovered that it was an accreditation require ment that the clinicians not only have individual supervision one hour per week, but they also mu st document the review of each child and adolescent case during the supervision. Individual supervision is typically seen as the prim ary outlet of supervisory process (Bernard & Goodyear, 2004). The supe rvisees and supervis or all reported in various degrees that during the individual cl inical supervision re viewing cases was a consistent practice which lead to additi onal discussion of th e best therapeutic practices, understanding of the child or adolescent development, ethical dilemmas, treatment modalities, treatment planning, and working with various systems. As part of their supervisory experien ce the supervisees and supervisor also explored how their personal needs were met in superv ision. It was through the supervisors strength-based, non-confronta tional, and positive style of supervision, generally considered a person-centered model of s upervision, that the supervisees reported feeling listened to, reassure d about their work, and a general sense of competence. In addition, despite the individual supervision being designated as cl inical supervision, each supervision experience did have elements of administrative supervision. Consistently administrative supervision occurr ed at the end of the clinical supervision experience.
101 Conclusions The current study set out to address th e clinical supervision of working professional counselors; in par ticular the clinical supervis ion of CACs. At this time, CACREP, the national accrediting body fo r professional counseling, provides no exact clarification on the competencies fo r CACs nor for those who supervise them. Hence, although the ACA code of ethics requires supervis ors and professional counselors to practice within the boundari es of their competence, the specific competencies for CACs and for their supe rvisors remain largely undefined. This poses a significant problem for professiona l counseling, for clinic al supervision and ultimately for client welfare. Although, the majority of participants in this study were clinical social workers, the results of the study could still be useful to child and adolescent counselor supervision since CACREP also defines social work as a related field and allows for practicum and internship students to be s upervised by such professionals. This study may be as relevant to a relate d field as it is to counseling. The subsequent findings of this re search concluded thematic findings representative of not only a clinical supervision experience but also a clinical supervision experience that was specific to CACs. The nature of the supervision experience as reported by the supervisees and supervisor involved primarily discussion of the child and adolescent cases a nd a general review of the issues related to the cases. In addition, the nature of the supervision experience was described as primarily supportive environment for feedb ack, reassurance and clarity. Given this supervisory experience the supervisee and s upervisor reported disc ussing a variety of
102 issues while exploring the child and adoles cent cases. The supervisees and supervisor did discuss additional issues relative to the children and adolescents which related to the best therapeutic practices when wo rking with children and adolescents in counseling, the developmental understanding of the child or a dolescent, ethical dilemmas, treatment modalities, treatme nt planning, and working with various systems. However, collectively the supe rvision format was surface case review, lacking in-depth discussion of therapeu tic issues and supervisee developmental concerns. I concluded that this practice of case review with minimal exploratory discussion and supervisee development was prescribed by facility accreditation and by Medicaid. As a means of coping with prescriptive supervision, the supervisor, Sandnes, appears to choose to provide person-centered supervision which is empathetic and supports the confidence of the therapist in a system that is not conducive to in-depth client conceptua lization or supervisee development. It is important to note that these supe rvisees and supervis or did address the issues that were covered in the counseli ng sessions with the child and adolescents. Studies have shown that child ren and adolescents in reside ntial foster care settings have substantially more issu es related to family dynami cs, multiple placements, and service history, and depict the childre n and adolescents as having emotional disabilities and disrupt ive behaviors far greater than traditional foster care children and adolescents (Breland-Noble, Farmer Dubs, Potter, & Burns, 2005; Handwerk, Friman, Mott, & Stairs, 1998; Wulczyn, K ogan, & Harden, 2003). The mental health concerns of children and adolescents re main prevalent and the service demand remains high for counselors, the need for supervision also will remain high. It is
103 estimated that more than 75% of children in need of mental health care were simply not served (Kataoka, Zhang, & Wells 2002) In addition, abused and neglected children or severely disturbed children ar e often most underserved (Cicchetti & Toth, 2003; Marsh, 2004). Supervisors of child and adolescent counselors who are familiar with the needs of this critical population are in high demand (Neill, 2006). As such, addressing the case specific issues, the best therapeutic practices, the developmental understanding, potential ethical dilemmas, treatment modalities, treatment planning, and working with various systems are all cr itical topics to ad dress in supervision when working with children or adolescents in residential foster care. However, these topics were reviewed as they pertained to certain cases, not discussed in detail, due to the sense of urgency to cover each case. Child and Adolescent Counselor Competencies. CACs need specific competencies. Children and adolescents have specific developmental, educational, personal, social, and behavior al needs. The competencies of a child and adolescent counselor should reflect a knowle dge and skill base specific to the needs of children and adolescents. Their knowledge and skills should be based in counseling interventions and theory. Specifically, CACs should develop competencies specific to children and adolescents in the profe ssional domains of: intervention skills competence, assessment techniques, interpersonal assessment, client conceptualization, individual differences, theoretical orie ntation, treatment plans and goals, and professional ethics. In order to accomplish professional competence CACs need to not only fulfill their masters educati onal requirements, but also take graduate courses in child development, counseling children, family counseling, play therapy,
104 and consultation and collaboration. Child and adolescent counselors have a specific skill set different from generic counselors. Counseling children requ ires an in-depth understanding of child and adolescent development, child and a dolescent cognition, child and adolescent social development, and counseling skill s and interventions specific to children, adolescents, families, parents, and care givers. In addition, child and adolescent counselors often require skills beyond the skills of a generi c counselor regarding case collaboration with the school system, the le gal system, and child welfare. Child and adolescent counselors are able to conceptu alize child and adolescent clients according to the clients therapeutic needs in a way that is developmentally and cognitively appropriate. A child and adolescent counsel or uses child and a dolescent therapeutic specific skills and techniques in therapy, such as play therapy, to address the needs of the client. The participants of this study de monstrated potential in numerous competencies related to interv entions skills specif ic to children such as play therapy, family therapy, consultation and collaborati on, client conceptua lization, theoretical orientation, treatment plans, and professional ethics. However, the participants in the study primarily focused on the competency of client conceptualiz ation. The majority of discussion within the supervision session was focuse d on case discussion with a lack of in-depth discussion about inte rvention skills, treatment plans and goals, professional ethics, individual differences, and interpersonal assessment. There was minimal discussion about theoretical orientation.
105 Supervisor Competencies. The supervisors of CACs also need specific competencies. In addition, to being a competent child and adolescent counselor, a supervisor CACs needs to understand supervision theory and how to implement supervision theory in her professional envi ronment. A child and adolescent supervisor needs to understand the variety of issues su ch as, the increased incidence of vicarious traumatization when working with trau matized youth, evidenced based treatment modalities, the stress of collaborating with possibly dysfunctional systems including but not limited to child welfare, and intr icate knowledge about how to work with interdisplinary treatment teams of school psychologists to psychiatrists the CACs will face. A supervisor of CACs must not only have the knowledge base that supervising CACs is different than superv ising adult counselors, but al so have supervision skills specific for CACs. To ensure the superviso rs clinical and professional competence, their developmental needs should be promot ed through continued c linical supervision and training on issues specific to children and adolescents. The supervisor in this study is ve ry knowledgeable. She has extensive experience within the facility and understands the details of residential foster care. The supervisors ability to educate, collabo rate and consult with her supervisees about the system in which they work is an excel lent asset to her supe rvision practice. In addition, to her knowledge about the facility a nd system of residential foster care, the supervisors competence in understanding chil d and adolescent development is also an asset to her supervision practice. Desp ite the depth of knowledge and experience competence it is unclear how much supervision theory the supervisor actually applies. Her competence in supervision appears stun ted by outside controls and additional
106 education and support could help to prope l her supervision pr ocess forward. Given the opportunity, I would recommend that Sa ndnes not only fulfill the competencies I have proposed for supervisors of CACs, but also given her observed and reported circumstance also find more time for providi ng supervision to her supervisees, have her own clinical supe rvision, and encourage her not to be fearful of confronting her supervisees. Limitations As future research seeks to develop additional competencies for CACs and additional competencies for the supervis ors of CACs, it would be important to consider the variables that might have in fluenced the outcomes of the current study. There are a number of factors that may have influenced the results of the study. First, the facility is a residential foster care facility. Residential settings are held to accrediting standards and third party payers which greatly influence the quality of service and the type of service. As a resu lt, the type of supervision was impacted by an external body rather than the decision of the clinical supervisor. Potentially other settings would not have similar limitations Second, the supervisor and two of the three supervisees are clinical social workers and not counsel ors. Clinical social work is a related field to counseling. However, most social workers have a different theoretical orientation or e ducational background than couns elors and they also have a different traditions related to supervis ion. Third, only one supervisor was observed and interviewed post-supervision for this case study. Although, this provided a clear and in-depth picture of how she provides supervision, using only one supervisor participant can illuminate only one supervisor y process perspective. The factor of the
107 limited discovery time and environmental fa ctors was a limitation. For this particular study, supervision was observed only one time per particip ant and then the participants were interviewed after that supervision session. Potentially additional supervision observations, then a post-supe rvision interview would have provided a clearer picture of the nature of supervis ion for a collective ca se of CACs. Thus, another limitation related to only intervie wing each supervisee and supervisor once post-supervision is that the results may ha ve been a reflection of an atypical day. Forth, the scope of practice under wh ich supervisees counsel was broad. Specifically, the supervisees of this study ar e asked to counsel children with various, if not vague, presenting problems and labels leading to invariably unclear description of case conceptualizations a nd feeding into the child c ounselor role of multi-task professional. Fifth, it became clear during the initial interview and rapport building stage of the study that additional demographi c information could have been gathered. Only minimal information about each particip ant was asked, such as, age, gender, and ethnicity. Additional information about marital status, children, and family history could have added, potentially critical informa tion about their ability to relate to and counsel children and adoles cents. Finally, the two week s during the observation of supervision and during the post-supervis ion interviews, the air-conditioning was broken in the majority of the residential foster care facility. I believe that the uncomfortable conditions at the facility truly limited the participants willingness to expand on open-ended questions. Implications This study is an exploratory study of th e clinical supervision for CACs. My
108 study focused on what is the natu re of clinical supervision in residential foster care, particularly what issues involving children and adoles cents are explored in the supervision session. However, ot her studies are needed about supervision theory as it applies to professional practice. It is apparent from this study that theory to practice is not always a workable reality. Supervisors and supervisees working with children and adolescents need a specialized supervis ion model. As seen in this study, the supervisor was resigned to be ing a person-centered supervis or, when potentially in an ideal setting she would have been a developmental supervisor. Alternative Model. One potential model for the supervision of CACs in residential foster care is a developmental strength-based model of supervision (Coll, Simmons, & Teufel, 2006). A strength-based perspective as defined by Baker (1999) is an orientation that emphasize the cl ients resources, capabilities, support systems, and motivation to meet challe nges and overcome adversity It emphasizes the clients assets that are used to achieve and maintain individual and social wellbeing (p. 468). In a developmental st rength-based model of supervision, the supervisor would use strengths to address deficits to in turn promote development of the supervisee. In the current residential foster care facility with CACs, one could apply a developmental strength-based supervision m odel based on the supervisors desire to be supportive, but also delve deeper into s upervisory issues. It has been noted that supervisors can create an atmosphere that is supportive and one that uses a strengths perspective. Cohen (1999) states that th e supervisor can create a central strengthbased orientation in supervision, by promo ting supervisee success, rather than
109 exerting resources to seek questi ons, problems, and dissatisfaction. The first step in developing a supervisi on model that focuses on strengths is to change the supervisors focu s to supervisee successes rath er than supervisee skill deficits. A supervision session that focuse s on the strengths, success, and initiatives can provide a motivating, learning envir onment that supports supervisees and the supervisor (Cohen, 1999). The supervisor should emphasize supervisees successes in a given case, in order to use its implications in other situations. For example, when a supervisee effectively uses a technique on a pa rticular case, the supervisor uses that example to strengthen a supervisees ab ility in other cases. This process of supervision should also include a focus on appropriate self-awareness and selfcriticism, to enhance self-growth (C ohen, 1999). Glasser and Suroviak (1989) demonstrate that even with the most distressed population, using a strength perspective can change the i ndividuals view of resignation to resilience. That is, the individual eventually develops a systematic plan that encourages self-improvement. The model is based on an integrative model that assesses supervisee competencies on three different stages of development from Stoltenberg and Delworth (1998). A strengths-b ased model promotes self -efficacy through both the development of autonomy and the development of competency. A strengths model allows supervisees to progress faster in the dimension of autonomy and selfefficacy, than they would in a traditional developmental model. Hence, supervisees quickly develop both selfand otherawaren ess, consistent motivation, and a positive self-concept (Coll, et al., 2006). In addition, to exploring a developmenta l strength-based supervision model as
110 it applies to supervisors who work with CACs it is also important to address the lack of specific skills for CACs and for CACs supervisors. Counselor Education programs need to address skills and competencies for CACs and CACs supervisors. It is important for Counselor Education programs to identify the needs of their students and continue to offer electives and certifi cate programs that address specialty areas, such as play therapy and counseling ch ildren. Courses in child development, counseling children, family counseling, c onsultation, and play therapy should be required of students who are obtaining school counseling masters degrees or students obtaining a mental health masters degrees th at are planning on working with children, adolescents or families. Supervision cour ses within Counselor Education programs should be clear to highlight the importance of supervis ing within competence area and the skills to be an effective CACs s upervisor. Thus, if you are going to supervise CACs it is important to develop competenci es in counseling children and adolescents, in addition to being an effective supervisor. Implications for School Counseling. Specifically, the literature on school counselor supervision poin ted to a clear need for increased supervision. The consensus that superv ision is lacking for school counselor implies a need for not only more supervision for school counselors, but also specificity is needed in the competencies and standards of supervisi on provided to school counselors. School counselors routinely feel isolated from ot her counselors and of ten the responsibility for their supervision is assumed by non-c ounseling professionals. School counselors often deal with serious mental health issu es, aggression, abuse, a nd behavioral issues. When supervision is assumed by a non-counseli ng professional the implication is that
111 the supervision is administra tive supervision. A school couns elor, like a mental health counselor of children and adolescents need s clinical supervisi on to increase their skills and competencies when working w ith children and adolescents. In addition, clinical supervision when provided by a co mpetent supervisor ensures the standards and practices of the school counseling profession, such as the American School Counselor Association (A SCA) National Model. Recommendations for additional research Adding to the literature on the clinical supervision of CACs is an important component in the development of compet encies for supervisors of child and adolescent counselors. Studies are needed that expand on theoretical assumptions and move into professional practice. Future re search needs to address the theoretical components of supervision competencies for specialty areas and for professional areas that apply outside of th e educational settings of pr acticum and internship. Such studies would focus on the supervision expe rience and the applica tion of supervision theory in settings. Another suggestion for research is to study more closely the experienced supervisor. An experienced supervisor, sim ilar to an experienced counselor, has had many opportunities to experience a wide range of clients in numerous settings leading to an authentic perception of therapeutic role. The experienced supervisor, mentors, teaches and supervises novice supervisees. Experienced supervisors may or may not be receiving clinical superv ision. Examining the various pr actices of an experienced supervisor and how they satisfy their supe rvisory needs would add to the literature on master therapists. The various roles of e xperienced supervisors is also a topic of
112 interest. Almost half of supe rvisees report that their clinical supervisor was also their administrative supervisor (Evans, 1993; Kenfield, 1993; Tromski-Klingshirn & Davis, 2007). Most supervisees found that having a clinical supervisor as an administrative supervisor was a benefit not only to the supervis ee but also to the supervision experience and the client (T romski-Klingskirn & Davis). Additional research needs to address the impact of th e administrative role on the quality of the clinical supervision experience when in clinical supervis ion. Similarly, when there is a blended role of administra tive and clinical supervision, whatever the factors that contribute to administrative supervision being a benefit to clinical supervision need to be explored. The current study addressed CACs in re sidential foster care, but future research could address specifically just superv isors in residential foster care or just CACs in residential foster care. A study of only supervisors or only CACs would further the detail of demographic, soci al, gender, cultural, and/or perception information about their supervisory experien ce. It is possible that the results may have reflected a hesitation to say someth ing negative about the supervisor or the supervision process. Future studies and inte rview questions should make an effort to explore individual differences and superv ision satisfaction. Similarly, the current study was a case study. Additional research c ould have a participant pool to compare the experiences of CACs in s upervision in residential care to CACs in supervision in outpatient care. Given the high influence of managed care, such as Medicaid, future research needs to investigate the impact of managed care sta ndards on supervision quality and supervisee satisfact ion in residential and outpati ent settings. Related to the
113 impact of managed care and quality assuranc e standards, the devel opment of a tool or a form for child and adolescent supervisors to help them better manage their time during the supervision session for the purposes of quality assurance appears greatly needed given the current study. Greater in-depth exploration of the issues specific to children and adolescents discussed in the supervision session needs to be addressed in the literature. Given the need for developmentally appropriate practi ce when working with children in therapy (Myers, Shoffner, & Briggs Kielty, 2002; Ivey & Ivey, 1990, 1998); future studies need to investigate whether the treatment provided is congruent with the treatment discussed in supervision among CACs. As supervision litera ture expands and improves its empirical basis, greater atten tion needs to be paid to the process of supervisee development specific to CACs. M odels of supervision need to address competencies that explore supervisee de velopment in specialty areas, such as counseling children. Accrediting bodies and national associations need to support research on the supervision of CACs, and thus increase the likelihood of specific competencies for supervisors of child and a dolescent counselors. In order to achieve such goals, counselor supervis ion, as the gatekeeper of those who are to enter the particular profession (Bernard & G oodyear, 2004, p. 8) should address the development of child and adolescent counselors.
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130 Appendix A Consent Form Informed Consent to Participate in Research Information to Consider Before Taking Part in this Research Study Researchers at the Universi ty of South Florida (USF) study many topics. To do this, we need the help of people who agree to take part in a research study. This form tells you about this research study. We are asking you to take part in a res earch study that is called: Clinical Supervision of Child and Adolescent C ounselors in Residential Foster Care: A Collective Case Study. The person who is in charge of this research study is: Lee A. Teufel. The research will be done at your facility Purpose of the study The purpose of this study is to doc ument the experience of clinical supervision for child and adolescent counselors and a supervisor working in a residential treatment facility. Your participation in this study w ill help increase the knowledge about the supervision of child and adolescent counselors. Study Procedures If you take part in this study, you will be asked participate in: 1) a 30 minute interview about your professional background and your most recent experience in individual supervision; and 2) a 15 to 20 minute interview to review the content of the initial in terview and review the themes of the interview analysis by the researcher. Alternatives You have the alternative to choose not to participate in this research study. Benefits I dont know if you will get any benefit s by taking part in this study.
131 Risks or Discomfort There are no known risks to those w ho take part in this study. Compensation I will not pay you for the time you vo lunteer while being in this study. Confidentiality I must keep your study records confident ial. I will maintain any and all field notes for one year after the comple tion of the study. They will be kept confidential and kept secure. Transcribed interviews will be reviewed by an external auditor and peer debriefer who wil l also maintain confidentiality. However, certain people may need to s ee your study records. By law, anyone who looks at your records must k eep them completely confidential. The only people who will be allow ed to see these records are: The research team, including the Principal Investigator, external auditor, and peer debriefer. Certain government and university people who need to know more about the study. For example, indi viduals who provide oversight on this study may need to look at your re cords. This is done to make sure that we are doing the study in the ri ght way. They also need to make sure that we are protecting your rights and your safety.) These include: o the University of South Florida Institutional Review Board (IRB) and the staff that work for the IRB. Other individuals who work for USF that provide other kinds of ov ersight may also need to look at your records. o the Florida Department of Health people from the Food and Drug Administration (FDA), and people fr om the Department of Health and Human Services (DHHS). I may publish what we learn from this study. If I do, I will not let anyone know your name. I will not publish anything else that would let people know who you are. Voluntary Participation / Withdrawal You should only take part in this study if you want to volunteer. You should not feel that there is any pressure to take part in the study, to please the investigator or the research staff. You are free to participate in this research or withdraw at any time There will be no penalty or loss of benefits you are entitled to receive if you stop taking part in this study. Decision to participate or not to participate will not affect your job status. Questions, concerns, or complaints
132 If you have any questions, concerns or complaints about this study, call Lee A. Teufel at (813) XXX-XXX. If you have questions about your rights, general questions, complaints, or issues as a person taking part in this study, call the Division of Research Integrity and Compliance of the Universi ty of South Flori da at (813) 974-9343. If you experience an adverse event or unanticipated problem call Lee A. Teufel at (813) XXX-XXX. If you have questions about your rights as a person taking part in this research study you may contact the Flor ida Department of Health Institutional Review Board (DOH IRB) at (866) 433-2775 (toll free in Florida) or 850-2454585. Consent to Take Part in this Research Study It is up to you to decide whether you want to take part in this study. If you want to take part, please sign the form, if the following st atements are true. I freely give my consent to take part in this study. I understand that by signing this form I am agreeing to take part in research. I have received a copy of this form to take with me. Signature of Person Taking Part in Study Date Printed Name of Person Taking Part in Study Statement of Person Obta ining Informed Consent I have carefully explained to the person taking part in the study what he or she can expect. I hereby certify that when this person signs this form, to the best of my knowledge, he or she understands: What the study is about. What procedures/interventions/inves tigational drugs or devices will be used. What the potential benefits might be. What the known risks might be. I also certify that he or she does not have any problems that could make it hard to understand what it means to take part in this research. This person speaks the language that was used to explain this research.
133 This person reads well enough to understand this form or, if not, this person is able to hear and understand when the form is read to him or her. This person does not have a medical/ psychological problem that would compromise comprehension and theref ore makes it hard to understand what is being explained and can, theref ore, give informed consent. This person is not taking drugs that ma y cloud their judgment or make it hard to understand what is being explained and can, therefore, give informed consent. ______ Signature of Person Obtainin g Informed Consent Date Printed Name of Person Ob taining Informed Consent
134 Appendix B: Demographic Questionnaire Clinical Supervision of Child and Adolescen t Counselors in Residential Foster Care: A Collective Case Study Demographic Questionnaire : 1. Please tell me your first name and last initial for identifying purposes only. 2. Having re-read the consent form, do you s till agree and consen t to participate in this research study? 3. What is your age? 4. What is your gender? 5. What is your ethnicity? 6. What was your undergraduate major? 7. What is your masters degree specialization? 8. How long have you worked at this facility? 9. a. How long have you worked with children and/ or adolescents? b. What has been your work experience w ith children and/ or adolescents? 10. What specialized training in counsel ing children and/or adolescents do you have?
135 Appendix C: Post-Supervision Interview Clinical Supervision of Child and Adolescen t Counselors in Residential Foster Care: A Collective Case Study Interview Protocol Descriptive Questions : 1. Please describe your most recent individual supervision session? 2. What were you thinking duri ng the supervision session? 3. What were the feelings you experi enced during the supervision session? 4. What issues or topics do you recall being discussed in the supervision session? 5. Please discuss how your supervisory n eeds were met in the most recent supervision session? 6. What else about the supervisory expe rience do you believe is important? 7. Is there anything else you would like to add to this interview?
136 Appendix D: Field notes June 4, 2007 Lee A. Teufel 10:00AM Supervision Observation No. 1 Field notes oc: room is warm, air conditioning not worki ng. The supervisor and supervisee sit in right corner of the office at a table. I sat in the superviso rs chair, close to her office desk. they started supervision ve ry quickly, the supervisee was running late, she had initially planned on being th ere early, but ended up bei ng there at exactly 10AM. They jumped right into talking about thi ngs at a very quick pace. Both seemed nervous. 1. discussion about caseload, discharge 2. assigning random, versus issue based 3. family dynamics of cases 4. students leaving 5. specific cases 6. issues related to medication compliance, counselor comments a mess, regression, oc: seems to be telling factual info rmation, supervisee talks very fast. Supervisor is taking notes the entire time. Supervisee is reviewing notes and cross referencing datebook. 7. discussion about case co llaboration with HKI 8. turning point in family therapy 9. emotional phone call with child and mom 10. TPR case 11. within TPR case unique therapeutic issues, some diagnostic issues 12. kid is ok in therapy if general discus sion of abuse, no specifics in therapy 13. possible PTSD 14. discharge case, follow-up services, family therapy oc: both supervisor and supervisee seem relaxed now, leaned back body position. Time is hour into supervision session. 15. aggressive children 16. regression 17. explosive/impulsive behaviors
137 18. wanting, planning consistent group activities 19. boundaries 20. sexual behavior 21. supervisor provided supervisee a book about sexual behaviors 22. both supervisor and supervisee commen ted on how hot it was in the room 23. paused to get an additional fan 24. issues related to sexual acting out, these issues may be acting out trauma versus perpetrator 25. placement issues for children 26. supervisor noted that she was running out of room to write about everything supervisee was talking about 27. asked supervisee to over a training on daily notes, it is an ad ministrative training, administrative issues oc: I was thinking that this di scussion is clearly not related to clinical supervision. It does not relate to cases. It is clearly administrative supervision. 28. the training is related to BEHAS, and daily notes on the computer, computer issues 29. audit people, audit reviews, monthly/weekly paperwork 30. billing, psychiatric and summar ies need to be completed oc: again I was thinking as the supervisor finished, she finished with administrative issues and not clinical issues, I was wonderi ng if this was a comm on practice of hers.
138 June 6, 2007 Lee A. Teufel 2:15PM Supervision Observation No. 2 Field notes oc: supervisor was rushed and running late She appeared to be multi-tasking with other staff. Supervisee once supervision st arted jumped immediately into topics. oc: observation occurred in the supervisees office. The air conditioning continues to be broken. However there is air conditioning in the supervisees office, but not the supervisors office. Supervisor and supervisee sit at a small table in the left of the room, I sat in the counselors chair close to her office desk, in the right of the room. There was classical music playing in the background, very faint. 1. sharing workbooks, skills, games, therapy tools 2. they want to get their list together by the end of summer to order what they want 3. training/tool technique for treatment planning 4. goals in clouds (then rate on a scale), more visual 5. supervisee had been using it 6. trauma screening inventory, manualized form 7. web training on how to d eal with certain issues 8. need to find training on CBT, play therapy conferences 9. Lopez (dorms in residential) there are facility issues 10. cleaning and clothing 11. corrective experiences 12. move to discussing child issues and specifically abuse report issue 13. Child name, family issues, case plans 14. I statements difficult, some feelings 15. Child name, narrativ e story, reflection 16. Supervisor gave some sugges tions for safety reflections 17. defuse the power of it oc: the supervisee didnt seem very open to the suggestion, seem s resistant to the suggestion, supervisee questioned how much to push the issue of trauma and abuse resolution. 18. the supervisor expanded on the idea of creating optimal level of anxiety and striking while the iron is cold. 19. supervisor and supervisee debated the id ea of going deeper with trauma resolution 20. discussion explored supervisors experien ce with population and prior training in area 21. idea of experiencing things currently 22. coping, planting seeds for future positive coping
139 23. research that has been done, developmentally 24. discussion around case examples 25. long term cases versus short term cases 26. short term cases 27. with short term cases treatment planning may need to look for trend for future, may be more effective 28. treatment plan are not currently kid fr iendly, needs to change, way to complex 29. need to configure a way with computer to use new forms, but we dont want more work 30. possibly talk to bill oc: again I was thinking to myself the supe rvisor ended with some discussion of an administrative focused discussion, i.e. confi guring treatment plans to their computer systems. This discussion was not related to the various clinical issues discussed.
140 June 12, 2007 Lee A. Teufel 9:20PM Supervision Observation No. 3 Field notes 1. supervisee asked if she should start with kids oc: supervisor is taking notes, supervisee has hands and arms crossed over chest supervisee is soft spoken. oc: observation occurred in supervisees office. Air conditioning continues to be broken in the entire building. Supervisee does have air conditioning in her office. Supervisor and supervisee sat to the right of the room a table; I sat in the counselors chair, more in the middle of the room. 2. Child name 3. one child having significant difficulty 4. talks about hurting self 5. other systems involved 6. child attachment to residential foster care 7. aggressive behaviors 8. ask for med review and then will likely refuse meds 9. supervisor is open to idea of med review 10. supervisee is worried about the follow-up of medication 11. should talk to him about refusal and resistance 12. probably going to ther apeutic foster care 13. all siblings are in disruptive placements 14. for the first time he cursed at the supervisee, yesterday 15. supervisee plans on continuing to be supportive 16. Child name 17. doing good 18. talked to caseworker 19. potential sibling placement for adoption or foster 20. incredible in therapy/play 21. in sand tray she displa ys sibling interaction 22. comparison between siblings and parents 23. also did feeling identification with light bright with colors 24. case is probably going to go TPR 25. Erica the other counselor di dnt start family therapy 26. more sibling visitation 27. Child name 28. didnt want to come to therapy 29. didnt want to do treatment plan
141 30. meds were adjusted 31. issues with other staff and coming to therapy 32. there needs to be consistency with staff on no hitting 33. raised the issue of mixed messages 34. how does the child relate to people he cares about 35. gave pictures 36. together in session with Child name 37. working through loss and anger 38. idea of cant be wrong with these kid to Child name 39. they had everything and now they dont have anything 40. cloud sheet for treatment plan with Child name 41. helps with kids, they like it, kids understand, rate self 42. Child name 43. Erica has the family for family therapy 44. they may be doing a relative placement 45. supervisee had done a genogram 46. supervisee wanted to explore the family dynamics, grandfather is a possible alcoholic 47. talk about feeling 48. she said she liked gran dmother and grandfather 49. role play and feelings 50. proud of self, no bad behaviors 51. family dynamic issues 52. special education needs, possible IEP 53. Child name 54. doing great with transition 55. whole month of transition, once a week with family 56. anxious in session 57. session and in general preparing to say goodbye 58. Child name 59. better behavior in the cottage 60. looks more organized 61. wants to call Caretaker name, she will ask why arent you calling me 62. possible placement 63. doesnt want to come to family, phone call issue with family 64. phone call and primary therapist oc: it appears that the primary therapist cant also be the family therapist, to avoid dual role. However in this case the primar y therapist has been making the phone calls; at least temporally until a nother therapist is assigned through session, supervisee relaxes body posture, voice is clear and strong 65. hard to place, back and forth in therapy 66. Caretaker name has never seen one of her tantrums 67. Child name and Child name
142 68. work together 69. play therapy together 70. finishing therapy, cr eates great anxiety 71. they need a closing ritual 72. need to match with a family 73. minimal behavior issues 74. Child name, gone 75. Child name 76. supervisee notes that he is so ready to me, knows the plan 77. going to Boston 78. play, behavior, assertive 79. educational needs are questionable 80. supervisee, pauses, let me think? 81. want me to go through all of them 82. want to control everything laughter oc: I am thinking that the supervisee really tends to focus on the positive 83. Child name 84. didnt want therapy oc: supervisee seems low, somber 85. supervisee reports that this is a difficult case 86. both supervisor and supervisee discuss how the child can be distorted in behavioral presentation 87. Child name 88. talked with worker 89. treatment plan review oc: supervisor now moves into more administrative based issues 90. asks the supervisee, if she brought her rece ipt from the training she went to last week 91. reminds supervisee of clinic today 92. in clinic today, they are going to discu ss new policy on suicide, audit, and sign hurricane evacuation policy, due Friday in senior management meeting
About the Author Lee A. Teufel received a Bachel ors Degree in Psychology with a concentration in Biological Sciences from Ohio University in 1998 and a Masters degree in Education with a concentration in Community Counseling also from Ohio University in 2000. She worked in an outpatient mental health center counseling children and adolescents affected by abuse a nd neglect. In addition, she has worked in inpatient treatment centers, including priv ate contractors for the Department of Juvenile Justice. While in the Ph.D. program at the University of South Florida, Ms. Teufel was an active graduate student, wo rking as the graduate assistant in the department of Counselor Education. Ms. Teuf el has presented at national, state, and local conventions on issues re lated to family reunificati on, foster care placement, counseling children, counseling critical n eeds populations, and counseling in higher education. She is passionate about counsel or supervision and counseling children and adolescents.
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Teufel, Lee A.
Clinical supervision of child and adolescent counselors in residential foster care :
b a collective case study
h [electronic resource] /
by Lee A. Teufel.
[Tampa, Fla] :
University of South Florida,
ABSTRACT: A collective case study is the study of more than one case (Stake, 1995). One therapist supervisor and three therapist supervisees from a child and adolescent residential foster care facility were observed during their individual clinical supervision and interviewed post-supervision. Currently, the literature on clinical supervision seldom addresses the supervision of working professional counselors; particularly those who are child and adolescent counselors (CACs).^ Using a qualitative approach, two fundamental questions guided this inquiry: (a) what is the nature of clinical supervision involving a supervisor who provides clinical supervision to counselors in a child and adolescent residential foster care center that provides mental health treatment? and (b) within the clinical supervision experience, what issues involving children and adolescents does the supervisor explore?Participants provided detailed demographic information about their work and educational experience. During the post-supervision interviews participants recalled the content of the clinical supervision, discussed their thoughts and feelings about the supervision experience, explored how the supervision met their supervisory needs and expanded on their beliefs about the process of supervision in general. Constant comparative analyses, both within-case and cross-case, were conducted and themes emerged from the interviews.^ Various themes emerged that were associated with: administrative supervision, best practices, case specific discussion, developmental understanding, ethical dilemmas, the personal issues of the supervisor and supervisees, supervision practices, treatment modalities, treatment planning, and working with various systems. Within the clinical supervision of CACs in residential foster care the nature of supervision is related to discussing specific cases in the facility, the supervision practice as it is experienced within each supervisor supervisee relationship, and a general desire to explore the best approaches when working with the children and adolescents at the facility. Collectively the supervisor and supervisees explored issues related to children and adolescents specific to individual cases consistent with generic supervision. Implications for practice and research are also discussed.
Dissertation (Ph.D.)--University of South Florida, 2007.
Includes bibliographical references.
Text (Electronic dissertation) in PDF format.
System requirements: World Wide Web browser and PDF reader.
Mode of access: World Wide Web.
Title from PDF of title page.
Document formatted into pages; contains 142 pages.
Advisor: Herbert A. Exum, Ph.D.
x Counselor Education
t USF Electronic Theses and Dissertations.