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ECS3333 - SECTION 2: THE MAJOR ROLES OF CLINICAL COUNSELING / MENTAL HEALTH SUPERVISION

 

 

 

Section 2: The Major Roles of Clinical Counseling / Mental Health Supervision

The major roles of clinical counseling / mental health supervision are directly connected to the purposes of ongoing supervisee development - but with a clear understanding of the full context in which the clinical work and the supervision are occurring. First, there exist a variety of different clinical positions in which the supervisee may be working. Next, there are a number of legal, ethical, and organizational requirements and standards for work performance and task completion that may vary from organization to organization.  Finally, there is more than one option for how supervisory responsibilities may be distributed among one or more supervisors. Accordingly, there is some complex integrative work to be accomplished in providing a successful supervisory experience.

Not every supervisor will be responsible for all the supervisory roles in his/her work. Some supervisors may be responsible for just the clinical side of the supervision, leaving the administrative responsibilities to others - and vice versa. However, it is important that all the different roles be known, understood, and agreed upon by all parties to the supervision, so that successful integration of the roles may be accomplished among the supervisors.

Likewise, if the supervisory work is going to be distributed among more than one supervisor, it is important to have regular and ongoing communication between the parties to avoid role confusion, role conflict, and/or important supervisory responsibilities being overlooked.

Below are the major roles, with brief discussion to follow:

  1. Educational or developmental
  2. Administrative
  3. Bearer of clinical responsibility (in clinical supervision towards independent licensure)
  4. Leadership
  5. Supportive
  6. Gatekeeper for the profession

 

 1. Educational or developmental role

At the heart of clinical counseling supervision is the intention to develop the supervisee while assuring that clients receive competent clinical services that are ethically and legal compliant. These two interests are not always entirely compatible, and this may lead to supervisory responsibilities operating in conflict with one another. This understanding suggests that a complex balancing act may need to take place between the time allocated to helping the clinician advance his/her professional knowledge and skills versus the administrative and clinical responsibility aspects of the supervisee’s work.

Here are some of the key developmental tasks of supervision:

  1. Building knowledge and skills of clinical work
  2. Increasing the capacity for case conceptualization
  3. Teaching the parameters of the professional role
  4. Expanding the capacity for emotional awareness
  5. Assuring appropriate capacity for self-evaluation

It is important to note that the educational or development plan will have another balancing act to address. The supervisee is likely to have some idea of the ultimate evolution of his/her career – and it likely does not involve staying at his/her current position until retirement. In order to create a learning or development plan that is motivating to the supervisee, it is a good idea to gather information from the supervisee about his/her career vision early in the supervisory relationship.

The knowledge and skills needed by the clinician to move towards his/her vision may not be the same knowledge and skills needed to improve performance in his/her current position. Limited resources of time and energy may create conflicts that must be resolved by the supervisory relationship about what learning elements are prioritized. If the supervisee’s vision is entirely dismissed in this process, then it will likely lead to a diminishment of trust and commitment from the supervisee.

For this reason, it is recommended that these issues be discussed openly and honestly early, frequently, and at all points in the supervisory relationship. Furthermore, it is also recommended that the supervisee be invited to participate in the development of the learning or development plan so that he/she will be allowed to share in some of these difficult decisions.

It is also useful for the supervisor to point out the important areas of overlap between the vision of the supervisee and the skills that are being acquired in the course of his/her clinical work. Supervisees may not always possess the experience and foresight to understand the points of connection between what are seemingly mundane lessons learned working with current clients and the building of the complex array of skills that may be necessary for the ultimate reaching of the supervisee’s vision.

 

2. Administrative role

Administrative Supervision has a focus on policy and accountability. It is

“directed at helping the worker to meet organizational requirements. Specifically, administrative supervision addresses employee performance in regard to organizational goals, expectations and standards.”

(Source: NCETA, 2005, https://nceta.org/)

In order to prevent that potential conflict from arising within a single supervisor’s responsibilities, many organizations separate the administrative functions of supervision from the clinical oversight functions, assigning the tasks and responsibilities to different parties in order to protect the integrity of the clinical supervisory relationship. This may also have the advantage of protecting the supportive role of the clinical supervisor by allowing the focus to remain on the clinical work, while assigning administrative duties to another supervisor whose task is to hold the supervisee accountable to administrative matters, such as work performance and conduct.

When a supervisor holds both the clinical and the administrative oversight responsibilities, it can change the nature of the supportive role – or at least the perception on the part of the supervisee that the supervisory relationship is essentially supportive in nature. In a perfect world, with a secure and mature supervisee, the occasionally competing nature of these two roles would be a subject for straightforward ongoing discussions within the supervisory relationships. At the very least, this issue should be addressed in a substantive manner within the supervisory informed consent process.

 

3. Role as bearer of clinical responsibility

Whenever a supervisee is licensed below the independent level, there must be a supervisor assigned to assume clinical responsibility for the cases. As noted, this may mean, on occasion, that the educational or development role will take a back seat to the requirement that the client(s) receive competent clinical services. At times, clinical supervisors may even need to step in to directly handle a complex case or refer a case to another provider with sufficient competency to handle the specific needs of the client(s).

This is another complex balancing act that requires both a well-constructed informed consent process and regular, ongoing discussions between supervisor and supervisee. For reasons to be discussed later, one of the important supportive and educative functions of a good supervisor is to instill increasing confidence in the supervisee with regard to his/her mastery of clinical aptitudes.

On this side of the ledger, it can be discouraging for a supervisee’s learning process to have a supervisor step in and take over or refer a case. On the other hand, it does not take good care of either the supervisee or his/her client(s) to have the supervisee operating well outside of his/her area of competence and getting both supervisee and supervisor in legal and/or ethical trouble. If this issue is covered in some detail during the informed consent process, it can establish a framework in which the supervisee has some preparation for these kinds of situations and is better protected from potential blows to his/her confidence.

 

4. Leadership role

The next important role of the supervisor is the leadership role. This role has several important aspects and functions within the supervisory relationship. First, successful adherence to this role will model to the supervisee the importance of assuming responsibility and accountability within the field of mental health: having the difficult conversations, making the right decisions, stepping up to the plate even when it is difficult to do so. Great leaders operate with integrity, and integrity is a core value in the field of mental health.

Taking care of the clinical needs of the client is a high order consideration in this commitment to integrity, since this forms the key purpose of clinical work. However, this requires commitment on the part of each clinician, a willingness to put aside one’s own self-interested needs and desires to the degree required to attend to what each case requires. A supervisor who operates with integrity at a high level will be more likely to inspire and motivate his/her supervisees to manage this aspect of clinical practice: to place self-interest in a secondary position to clinical purpose.

Second, this role involves viewing the entire system within which the clinical work and supervisory development work is occurring and working conscientiously and proactively to manage and direct the elements of that system towards the optimal outcomes than can legitimately and realistically be attained. This generates trust on the part of the supervisee, and this trust creates more openness on the part of the supervisee, allowing for a more effective transfer of knowledge and skills.

As an example, if there is dysfunction at an organization within which the supervisee is working, and the supervisee is downstream from that dysfunction in ways that generate distress or unhappiness, there will inevitably be disruptions to the supervisory relationship. Great leaders put themselves forward to address systemic elements that negatively affect the experience of their supervisees - and place themselves as agents of change at a systemic level. They advocate for better work conditions, improved systems and structures, and more positive interactions between different parties within the organization.    

Third, this role involves defining, clarifying and operationalizing the mission that both the clinical work and the supervisory processes will be pursuing.  Clinical work – and the supervisory actions that support the development of excellence in clinical work – should be envisioned as fundamentally mission driven processes. Operating with integrity is the behavioral manifestation of the commitment to mission, but it is also of great importance for the supervisor to identify and name the mission, to make the mission explicit and specific - in language and terms that the supervisee can understand. 

With a clear understanding of the mission, it is easier for the clinical supervisee to comprehend why certain choices of actions are superior to others – based upon how well the various choices support or work against the completion of the mission. This will allow the supervisee to integrate, at a much deeper level, the knowledge and skills that are being presented during the supervisory process. It will also impart a deeper sense of resonance and meaning to the education, allowing for much better storage of the knowledge and skills, and better integration with the supervisee’s pre-existing aptitudes.

It is also easier for supervisors to address resistance to a mission driven orientation at times when supervisees struggle with putting aside self-interest in their clinical work. And this will happen for almost all clinicians when they begin to discover the complexities and demands of clinical work. Early discussions on the importance of pursuing the right mission will create a shared frame of reference for exploring this challenge, and will help guide the supervisee towards the right commitments to purpose.

Characteristics of Effective Leaders

For supervisors who are serious about their role as a leader, it is helpful to understand the key characteristics of great leaders. Great leaders tend to possess the following important characteristics: 

- The ability to create buy-in to the mission

- The ability to effectively communicate and champion the vision and core values of the treatment process

- The ability to build motivation for the treatment and change process

- The ability to shape the therapeutic culture in which the changes are to occur

Great leaders also tend to possess some skills that operate in the clinical arena, including those clinical skills that are useful for people in all leadership positions. These include:

- The ability to manage oneself and one's emotions

- The ability to project integrity, create credibility and build trust

- The ability to project a clear and coherent sense of meaning about what is being done and why it is being done

- The ability to manage problems and work towards positive change

- The ability to resolve conflict and negotiate differences

- The ability to transfer tools and skills effectively to the other parties involved in the change process

 

5. Supportive role

Next, clinical counseling supervision is concerned with professional development within a highly complex field of practice, with very high levels of responsibilities even at the first point of entry - when new practitioners are poorly prepared for handling those responsibilities. The transition from academic learning to actually working with people with serious problems can be an eye-opening experience for newly minted practitioners.

It is not unusual for supervisees to radically underestimate how overwhelming the early stage of this growth process can be. It is important that supervisors do not underestimate this same phenomenon. Clinicians who are unable to navigate this transition process because they do not receive adequate levels of support in supervision may end up being lost to the profession, either because they drop out and move on to other fields of work, or because they cannot reach a level of competence where supervisors feel comfortable enough to recommend them forward.

Accordingly, mental health supervision will need to include a considerable focus on the supportive role or function to protect or sustain the confidence and commitment of the supervisee during this difficult early transition process and through to the point where the supervisee begins to be able to operate more independently. This suggests the importance of good assessment on the part of the supervisor to determine how much support is needed, as well as the importance of building trust and open communication to acquire that information from the supervisee.

In a later section, when a specific adult learning model is presented, there will be further discussion of this important element of supervision for mental health clinicians. 

 

6. Role as gatekeeper for the profession

Finally, the clinical counseling supervisor also has the role of gatekeeper to the profession. Not all supervisees will demonstrate the capacity to handle the responsibilities of a mental health professional operating at the independent level. One of the key responsibilities of the conscientious clinical counseling supervisor is to delay the entry of supervisees into the field before their competency level has reached a point where clients are no longer at risk.

This key responsibility, and some of the complications associated with it, will be covered in some detail in the next section when the responsibilities of supervision are addressed.

 

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