ECS3399 - SECTION 3: WHY TO CHOOSE A MODEL OR METHOD
Section 3: Why to Choose a Model or Method
Models are not perfect. They approximate “trends and processes in the real world. As representations, they are necessarily incomplete and can be disproved.”
(Source: Murmson, S, Two Benefits of Using Models to Represent Scientific Processes: https://sciencing.com/two-benefits-using-models-represent-scientific-processes-10590.html) However, humans cannot operate with unlimited amounts of complexity. When it comes to highly complex processes we require a certain measure of filtering and focusing so we can work with a smaller slice, within a more limited scope. As Murmson goes on to say, “Even though they are partial and potentially flawed, models represent the world in a way that we can understand.”
The field of mental health is a fertile place for models that help us reduce complexity to a manageable degree. Even the most streamlined models of clinical supervision operate with a substantial number of variables: supervisee variables, supervisor variables, client variables, organizational variables – all of which may change in complex ways over time. Even the most energetic supervisor would have a difficult time keeping track of the movements of all these variables. A good model will help the supervisor allocate focus to the variables that will be more closely related to generating good supervisory outcomes.
In general, a good model will be one that is cohesive and internally consistent, and which will have an acceptable degree of external validity. It will be validated through real-world applications combined with study of the utilization outcomes by objective research. The research will demonstrate that the model works as intended to an acceptable degree.
In the real world, for the purposes of any individual supervisor, a good model to use will be one that generates the best outcomes in the actual supervisory work being undertaken. This may be one that the supervisor creates for him/herself, even though validation for that personal model has not been determined. If all goes well, this will not be a problem.
But choice of a model can carry real world implications from a professional and ethical standpoint for supervisors. We do not start from validated positions when we build our own model of supervision for our supervisees, in our settings, without reference to models in the literature. Preferably, we begin with the models that are known from the literature, but with some additional thoughts and considerations about how to modify the model to fit our real-world situations – without moving so far from the model that we abandon what has been validated about it.
There are numerous different models and approaches to supervision in the literature from which supervisors may choose when trying to determine how to best approach the supervisory process. We will look at several of them. Prior to examining those models and approaches, this section will attempt to address some of the reasons for choosing one or more models and approaches over others based upon the real-world context in which the supervision will be occurring.
As noted in the previous section, the starting point for Performance Management is the vision, mission and core values of the organization in which work is will be performed. This establishes a picture of the ideal state towards which the work will be aimed. Likewise, there is an ideal state concerned with how to address choices about supervisory models and approaches.
In the literature on clinical work, the Who-How-Whom factor has been posited as a good starting point for how to orient one’s self towards clinical choices most likely to provide the best services to a client. This is noted below.
Clinicians should be constantly asking:
What treatment, by whom, is the most effective for this individualwiththis specific problem, and under what set of circumstances.
(Sources: Paul, G. (1967). Outcome research in psychotherapy. Journal of Consulting Psychology, 31,109-188 and; Corsini, R. (2000). Introduction. In R. Corasini, & D. Wedding (Eds.), Current psychotherapies. 6thedition(pp. 1-15). Itasca, IL: Peacock)
Translating this ideal into guidelines for supervision, the conscientious supervisor would begin with the Who-How-Whom factor for supervision, as shown below.
Supervisors should be constantly asking:
What supervisory model, approach and techniques, by whom, will be the most effective for this individual supervised with his/her specific vision, work tasks, and clinical, personal and developmental strengths and weaknesses, at this and each future phase of supervision and under what set of circumstances.
There are a substantial number of components to keep track of in this formulation, and complexities related to many of these different components. These will be examined during this chapter. However, it is important to keep track of one key word in these definition as various choices are explored: effective.
In the end, the best models and approaches for working with supervisees will be those that are effective in reaching the goals for the supervision: competent work performance combined with ongoing professional growth and development – in a complex system of supervisee, supervisor(s), clients, and clinical setting over time.
Elizabeth Holloway, in her book, Supervision Essentials for a Systems Approach to Supervision, presents her take on the many factors involved in integrating the supervisory work within a complex system, noting a number of different contextual factors in supervision that must be factored in when working to structure the supervision in an effective way.
Contextual Factors in Supervision
- Supervisor: background, training, philosophy, supervisory profile or personality
- Supervisee: formal training and credentials, gender, age, race, ethnicity, professional goals
- Client: level of functioning, clinical profile
- Setting: inpatient versus outpatient, type of care, agency philosophy, organizational climate, sources of funding, budgetary constraints
- Training program affiliation: academic requirements, credentialing or certification programs, internships
(Source: Holloway, E: Supervision Essentials for a Systems Approach to Supervision, 2016, Washington, DC, American Psychological Association)
At the center of this complex balancing act of many parties and many factors resides the person providing the supervision, the by whom factor. In addition to understanding the supervisee sufficiently to select the right tools for good supervision, the supervisor must also understand the context in which the supervision is occurring, including organizational strengths and weaknesses, available resources and/or resource insufficiencies, and the structures and/or structural deficiencies of the organization in which the supervision is occurring.
Every supervisor will bring into this equation a collection of strengths and weaknesses in terms of his/her supervisory training, knowledge and skills, his/her own personality, preferences and professional goals, and obligations to his/her responsibilities within the organization in which the supervision is occurring.
A conscientious supervisor will engage in an honest and thorough self-assessment of each of these factors in preparation for selecting the models and approaches that may be most effectively utilized by him/her in supervision. If a specific model or approach might be a better fit for the supervisee’s needs, but is not comfortable for the supervisor to use, then the supervisor must either work to improve his/her comfort level or opt to find other models or approaches that will be equally effective. Likewise, if a model or approach would be more effective but is not in the vocabulary of the supervisor, the conscientious supervisor would take steps to fill in that knowledge/skill gap.
One of the important factors that comes into play in this area is concerned with the supervisor’s theoretical orientation. A supervisor who primarily operates from a systems-based perspective, operating within a systems-focused clinical setting, is likely to utilize a supervisory model based upon systems principles. If the supervisee is envisioning a career in private practice from a psychodynamic perspective, then it will need to be determined whether the supervision and/or the setting will possess a sufficient degree of flexibility to bridge the potential gap between the vision of the supervisee and the supervisory orientation that is likely to be utilized.
In a later module, when we examine the structure of supervision, there will be discussion on the need to determine – early in the supervisory relationship -whether there is a sufficient fit between supervisee, supervisor, and supervisory context to create a viable situation. If there is not, then it may be advisable to consider possible referral to a different supervisor or a different setting. Otherwise, the difficulty in integrating the supervisee’s goals and needs with the structure and orientation of the supervision may create insurmountable obstacles to successful supervisor work.
This leads to the second element, the individual supervised factor. Like the supervisor, the supervisee brings into the relationship a collection of strengths and weaknesses in terms of clinical knowledge and skills, his/her own personality, preferences and professional vision and goals, and obligations to his/her role and responsibilities within the organization in which the supervision is occurring. These elements will factor into decisions about which model(s) and approaches will be selected.
Of particular importance is the supervisee’s professional vision and goals. For newer clinicians in particular, the reality of clinical practice is that an entry level position is often whatever a newer clinician can secure, not what he/she would ideally like to pursue. There will be a gap between the supervisee’s vision for his/her long-term career plans – including the learning and development required to get there - and the tasks for which he/she is being paid and supervised.
Left unaddressed, this gap can lead to problems with motivation on the part of the supervisee. This, in turn, can create threats to both the performance of work roles and responsibilities and to the pursuit of a realistic learning plan. This does not take good care of either the supervisee nor the organization in which the work is being undertaken.
Very early in the supervisory relationship it is vitally important for the supervisor to work collaboratively with the supervisee to define a clear vision for the supervisee’s professional growth and long-term career goals within the profession and to address the real-world distance between the current job and the supervisee’s future plans. When agreement can be reached about the right balance between these potentially conflicting factors, it helps to clarify what models and approaches will generate the most effective receptiveness on the part of the supervisee for implementation of the learning plan. As noted, if this kind of receptiveness cannot be created, then it may indicate that the supervisory situation is simply not viable.
This process will be undertaken at the same time as a thorough assessment of the supervisee’s clinical, personal and developmental strengths and weaknesses, factors that will also help determine the correct choices for supervisory models and approaches. If a supervisee is working in a clinical setting with families and children – and eventually intends to move into private practice working with those populations – but has limited exposure to systems theory, then the supervisor may be inclined to incorporate a model like the Holloway Systems Model into the supervisory work, and apply a number of systems based approaches to increasing knowledge and skills in that area.
The will be a number of other considerations for assessing a supervisee in preparation for some of these decisions. Below is a summary of several elements that should be included in that early assessment process, which will serve as an expansion of the elements noted earlier from what Dr. Holloway presented in her formulation.
Considerations for Assessing a Supervisee
- Baseline level of competence/capacity
- Clinical knowledge and skills
- Personal capacity (e.g. ability, intelligence, life experience, training)
- Motivation, resilience, grit (influenced by self-confidence, clear goals/objectives, and perceptions of fairness and equity)
- Strengths versus barriers for performance
- Goodness of fit: supervisee to work environment
- Goals and purposes of supervisee
- Resource availability, organizational policies, actions of coworkers and leaders
- Aptitudes (knowledge and skills)
- Personality traits, e.g., introversion versus extroversion, uncertainty avoidance, etc.
- Level of personal maturity (including executive function skills development, personality development and Kegan’s Stage of social maturity)
- Learning style preferences
- Motivation for and resistance to personal and professional adaptive work
- Cultural factors, e.g., personal cultural values that support or interfere with clinical work and professional ethics
- Need for accommodation, e.g., hearing impairments, language, disability
Wherever the supervisee presents with factors that represent threats or challenges to the successful implementation of a learning plan, it will shape decisions about not only which models and approaches to bring into the supervision, but how to utilize those models and approaches effectively. For example, if a supervisee is severely deficient in terms of their level of personal maturity, then models and approaches requiring a high level of autonomous and independent work on the part of the supervisee may not be the best choice. Additionally, the models and approaches that are selected may need to be implemented with a very high level of oversight and careful scrutiny.
Conversely, if a supervisee has made a later life career change and brings into the relationship a high level of maturity and considerable life experience, then models that support a high level of autonomy and independence might be entirely preferable, and the supervisor may be able to take a more laid back approach to overseeing the learning plan.
Regardless of age and personal life experience, each supervisee is also likely to bring into the relationship preferences in terms of learning style, responding more effectively to certain approaches to knowledge transfer and skill building. Some supervisees may learn better by first being assigned reading materials on a subject area, followed by opportunities to apply the knowledge through hands-on clinical experiences.
Others may prefer the experiential learning first, followed by other methods of learning: books, video clips, etc. If the supervisor is able to ascertain these learning style preferences early in the supervisory relationship through collaborative discussions, it can improve the efficiency of the learning and development process and increase trust and buy-in to the process.
It may also be helpful to mention here that another variable in play is the supervisor’s preferred teaching style. While the Who-How-Whom factor clearly leans in the direction of modifying the supervisory process to optimize the fit for the supervisee’s needs, preferences and vision, supervisors in some contexts still retain some degree of autonomy in making determinations about which supervisees they wish to work with and how the supervision is to be approached.
For example, private practice supervisors who are selective in whom they take on to supervise can simply turn a supervisee away if they see it is not a good fit. If the supervisee’s needs, vision, and learning style are not a good fit for the supervisor’s preferred teaching style – or their theoretical orientation, choice of models and/or preferred approaches - the supervisor can simply decline to take on that responsibility.
Supervisors who work for organizations that hire newly minted clinicians as employees will often not have that luxury. In such cases, they may need to learn a number of different teaching styles in order to work effectively with a broad variety of supervisees with different strengths, weaknesses, needs, and learning style preferences. They may also need to have a larger vocabulary of supervisory models and approaches to choose from when they are trying to develop the most effective learning plan.
To summarize and create a more condensed record of what will be involved, the following considerations will be part of the picture that determines models and approaches to supervision:
- The demands of the supervisee’s role, tasks and responsibilities
- The supervisee’s learning vision, preferences and career goals
- The supervisee’s experience level and developmental issues
- The supervisee’s learning style
- The supervisor’s goals for the supervisee
- The supervisor’s theoretical orientation
- The supervisor’s own goals for the supervisory experience
Additionally, the supervisory model or models selected will need to contend with another important factor: a supervisory process that evolves over time. This means that the supervisee’s needs may change as he/she moves through different phases of clinical growth. While the phases of supervision may be better viewed from the perspective of a continuum of learning and development, Among other theoreticians, Falender and Shafranske have denoted three general phases of supervision that point in the direction of different kinds and levels of supervisory oversight.
Phases of Supervision
- Level 1 supervisees are generally entry-level students who are high in motivation, yet high in anxiety and fearful of evaluation;
- Level 2 supervisees are at mid-level and experience fluctuating confidence and motivation, often linking their own mood to success with clients; and
- Level 3 supervisees are essentially secure, stable in motivation, have accurate empathy tempered by objectivity, and use therapeutic self in intervention.
(Source: Falender, C & Shafranske, E, Clinical Supervision: A Competency Based Approach, 2004, Washington DC, American Psychological Association)
Clearly, when a supervisee is at Level 1, approaches to supervision will be more oriented towards helping the supervisee manage anxiety and diminish worries about the ability to handle the challenges of clinical work. At Level 3, the anxiety and worry has diminished, allowing for the supervision to focus on other aspects of the clinical work, and allowing the approaches to be more directed to clinical growth.
Sandra Rigazio-DiGilio and her colleagues described an alternative way of viewing the learning or developmental process in supervision, based upon the degree to which supervisees can organize and utilize the assessment information from their clinical interactions in increasingly complex ways. As noted in the title of the work, this is a cognitive developmental approach that de-emphasizes the emotional elements present in the different phases of supervisee development.
Systemic Cognitive Developmental Supervision: Four Orientations
- Sensorimotor/Elemental: Understands clinical interactions through direct sensory experience, but cannot organize information into meaningful hypotheses. Needs a directive supervisory environment
- Concrete/Situational: Understands cause and effect in clinical interactions, but needs help in formulating interventions and treatment plans. Benefits from a coaching supervisory environment.
- Formal/Reflective: Can analyze clinical interactions from multiple perspectives, but still needs help in deciphering patterns across cases or in relation to self. Benefits from a more consultative supervisory environment
- Dialectic/Systemic: Can challenge assumptions underlying conceptualization of cases, but still needs help in formulating complex treatment plans integrating multiple points of view and treatment approaches. Benefits from collaborative supervisory environment.
(Source: Rigazio-DiGilio, S. A., Daniels, T. G., & Ivey, A. E. (1997). Systemic cognitive-developmental supervision: A developmental-integrative approach to psychotherapy supervision. In C. E. Watkins, Jr. (Ed.), Handbook of psychotherapy supervision (pp. 223-245). Hoboken, NJ, US: John Wiley & Sons Inc.)
Because clinical supervision involves both emotional and cognitive developmental processes, both of these formulations are important for understanding the different phases of growth that supervisors must assess as decisions are being made on the use of models and approaches. With this section complete, attention will now be turned to the different methods and techniques for professional development that will be part of supervision.