Clinical Supervision of Substance Abuse Counselor

Clinical Supervision and
Professional Development of
the Substance Abuse Counselor
A Treatment
Improvement
Protocol
TIP
52
s
CU
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Treatment
www.samhsa.gov CLINICAL
SUPERVISION
Professional Development
of the Substance Abuse
Counselor
Treatment Improvement Protocol (TIP) Series
52
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

1 Choke Cherry Road

Rockville, MD 20857
Acknowledgments
This publication was produced under the Knowledge Application Program, contract number 270-04-7049, a
Joint Venture of The CDM Group, Inc. and JBS International, Inc., for the Center for Substance Abuse
Treatment CSAT), Substance Abuse and Mental Health Services Administration SAMHSA), U.S. Department
of Health and Human Services (HHS). Christina Currier served as the CSAT Government Project Officer.
Disclaimer
The views, opinions, and content expressed herein are those of the expert panel and do not necessarily reflect
the views, opinions, or policies of CSAT, SAMHSA, or HHS. No official support of or endorsement by CSAT,
SAMHSA, or HHS for these opinions or for particular instruments, software, or resources is intended or
should be inferred.
Public Domain Notice

All materials appearing in this volume except those taken directly from copyrighted sources are in the public
domain and may be reproduced or copied without permission from SAMHSA/CSAT or the authors. Citation of
the source is appreciated. However, this publication may not be reproduced or distributed for a fee without
the specific, written authorization of the Office of Communications, SAMHSA, HHS.
Electronic Access and Copies of Publication

This publication may be downloaded or ordered at http://www.samhsa.gov/shin. Or, please call SAMHSA’s
Health Information Network at 1-877-SAMHSA-7 (1-877-726-4727) (English and Español).
Recommended Citation
Center for Substance Abuse Treatment. Clinical Supervision and Professional Development of the Substance
Abuse Counselor. Treatment Improvement Protocol (TIP) Series 52. DHHS Publication No. (SMA) 09-4435.
Rockville, MD: Substance Abuse and Mental Health Services Administration, 2009.
Originating Office
Quality Improvement and Workforce Development Branch, Division of Services Improvement, Center for
Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 1 Choke Cherry
Road, Rockville, MD 20857.
HHS Publication No. (SMA) 09-4435.

Printed 2009
ii
Contents
Consensus Panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v
What Is a TIP? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
How This TIP Is Organized . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Part 1 ...........................................................................1
Overview of Part 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Chapter 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Central Principles of Clinical Supervision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Guidelines for new Supervisors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Models of Clinical Supervision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Developmental Stages of Counselors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Developmental Stages of Supervisors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Cultural and Contextual Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Ethical and Legal Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Monitoring Performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Methods of Observation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Practical Issues in Clinical Supervision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Methods and Techniques of Clinical Supervision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Administrative Supervision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Chapter 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Vignette 1—Establishing a New Approach for Clinical Supervision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Vignette 2—Defining and Building the Supervisory Alliance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Vignette 3—Addressing Ethical Standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Vignette 4—Implementing an Evidence-Based Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Vignette 5—Maintaining Focus on Job Performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
Vignette 6—Promoting a Counselor From Within . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Vignette 7—Mentoring a Successor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Vignette 8—Making the Case for Clinical Supervision to Administrators . . . . . . . . . . . . . . . . . . . . . . . . . . 78
Part 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Chapter 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Benefits and Rationale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87

Key Issues for Administrators in Clinical Supervision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
Administrative and Clinical Supervision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Clinical Supervision and Professional Development iii

Legal and Ethical Issues for Administrators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
Diversity and Cultural Competence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Developing a Model for Clinical Supervision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
Implementing a Clinical Supervision Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
Professional Development of Supervisors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Chapter 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Assessing Organizational Readiness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Legal and Ethical Issues of Supervision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Supervision Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
The Supervision Contract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
The Initial Supervision Sessions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Evaluation of Counselors and Supervisors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
Individual Development Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
Outline for Case Presentations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Audio- and Videotaping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
Appendix A—Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Appendix B—New York State Office of Alcoholism and Substance Abuse

Services Clinical Supervision Vision Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Appendix C—Advisory Meeting Panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Appendix D—SAMHSA Stakeholders Meeting Attendees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Appendix E—Field Reviewers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Appendix F—Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
iv
Consensus Panel
Chair, Part 1 and Part 2 Consensus Panels
David J. Powell, Ph.D. (Chair)
President
International Center for Health Concerns, Inc.
East Granby, Connecticut
Part 1 Consensus Panel Members

Bruce Carruth, Ph.D.
KAP Expert Content Director
The CDM Group, Inc.
Bethesda, Maryland
Bettye Harrison
Opioid Treatment Program Accreditation Director
CARF International
Tucson, Arizona
Sharon Hartman, M.B.A., LSW

Director of Professional Training and Education
Caron Treatment Centers
Wernersville, Pennsylvania
Pamela Mattel, M.S.W., LCSW-R, ACSW, CASAC

Executive Deputy Director
BASICS, Inc.
New York, New York
John Porter, M.S.

Northwest Frontier Addiction Technology Transfer Center
Wilsonville, Oregon
Part 2 Consensus Panel Members

Bruce Carruth, Ph.D.
KAP Expert Content Director
The CDM Group, Inc.
Bethesda, Maryland
Charles F. Gressard, Ph.D., LPC, NCC

Associate Professor, School of Education
College of William & Mary
Williamsburg,Virginia
Pamela Mattel, M.S.W., LCSW-R, ACSW, CASAC

Executive Deputy Director
BASICS, Inc.
New York, New York
Clinical Supervision and Professional Development v

What Is a TIP?
Treatment Improvement Protocols (TIPs), developed by the Center for Substance Abuse Treatment (CSAT),
part of the Substance Abuse and Mental Health Services Administration (SAMHSA) within the U.S.
Department of Health and Human Services (HHS), are best-practices guidelines for the treatment of substance
use disorders. CSAT draws on the experience and knowledge of clinical, research, and administrative experts to
produce the TIPs, which are distributed to facilities and individuals across the country. As alcohol and drug use
disorders are increasingly recognized as a major problem, the audience for the TIPs is expanding beyond public
and private treatment facilities to include practitioners in mental health, criminal justice, primary care, and
other healthcare and social service settings.
The recommendations contained in each TIP are grounded in scientific research findings and the opinion of the
TIP consensus panel of experts that a particular practice will produce a specific clinical outcome (measurable
change in client status). In making recommendations, consensus panelists engage in a process of “evidence-
based thinking” in which they consider scientific research, clinical practice theory, practice principles, and prac-
tice guidelines, as well as their own individual clinical experiences. Based on this thinking, they arrive at rec-
ommendations for optimal clinical approaches for given clinical situations. Relevant citations (to research out-
come reports, theoretic formulations, and practice principles and guidelines) are provided.
TIP Format
This TIP is organized into three parts:
• Part 1 for substance abuse clinical supervisors focuses on providing appropriate supervision methods and
frameworks.
• Part 2 for program administrators focuses on providing administrative support to implement adoption of the
counseling recommendations made in Part 1.
• Part 3 for clinical supervisors, program administrators, and interested counselors is an online literature
review that provides an in-depth look at relevant published resources. Part 3 will be updated every 6 months
for 5 years following publication of the TIP.
Ideally this TIP might be used in a series of six or so meetings in which the materials in the TIP would be
reviewed, discussed, and in other ways used as an educational and training vehicle for the improvement of clin-
ical supervision skills (with the particulars of how this training would be done determined by the trainer, based
upon her or his unique situation, needs, and preferences). Thus, after a relatively short period of time and with
few or no additional resources, this TIP could meet the challenge of fostering improvement in the delivery of
substance abuse treatment services.
Development Process
The topic for this TIP was selected following an advisory meeting of experts in substance use disorders (appen-
dix C). Two Consensus Panels of experts on clinical supervision and substance abuse treatment were convened:
one for clinical issues, and the other for administrative guidelines (p. v). The TIP then was field reviewed by an
external group of subject matter experts, who provided suggestions for further refining the document (see
appendix E).
Clinical Supervision and Professional Development vii

TIPs Online
TIPs can be accessed via the Internet at http://www.kap.samhsa.gov. The online Clinical Supervision and
Professional Development of the Substance Abuse Counselor: Part 3, A Review of the Literature, which will be
updated every 6 months for 5 years, is also available at http://www.kap.samhsa.gov.
Terminology
Throughout the TIP, the term “substance abuse” has been used to refer to both substance abuse and substance
dependence (as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision
[DSM-IV-TR] [American Psychiatric Association 2000]). This term was chosen partly because substance abuse
treatment professionals commonly use the term “substance abuse” to describe any excessive use of addictive
substances. In this TIP, the term refers to the use of alcohol as well as other substances of abuse. Readers
should attend to the context in which the term occurs in order to determine what possible range of meanings
it covers; in most cases, however, the term will refer to all varieties of substance use disorders described by
DSM-IV.
viii
Foreword
The Treatment Improvement Protocol (TIP) series supports SAMHSA’s mission of building resilience and facili-
tating recovery for people with or at risk for mental or substance use disorders by providing best practices guid-
ance to clinicians, program administrators, and payors to improve the quality and effectiveness of service deliv-
ery and, thereby, promote recovery. TIPs are the result of careful consideration of all relevant clinical and
health services research findings, demonstration experience, and implementation requirements. Clinical
researchers, clinicians, and program administrators meet to debate and discuss their particular areas of expert-
ise until they reach a consensus on best practices. This panel’s work is then reviewed and critiqued by field
reviewers.
The talent, dedication, and hard work that TIP panelists and reviewers bring to this highly participatory
process have helped bridge the gap between the promise of research and the needs of practicing clinicians and
administrators to serve, in the most scientifically sound and effective ways, people who abuse substances. We
are grateful to all who have joined with us to contribute to advances in the substance abuse treatment field.
Eric Broderick, D.D.S., M.P.H.

Acting Administrator
H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM

Director
Clinical Supervision and Professional Development ix

How This TIP Is Organized
This TIP is divided into three parts:
• Clinical Supervision and Professional Development of the Substance Abuse Counselor, Part 1.
• Clinical Supervision and Professional Development of the Substance Abuse Counselor: An Implementation
Guide for Administrators, Part 2.
• Clinical Supervision and Professional Development of the Substance Abuse Counselor: A Review of the
Literature, Part 3.
Parts 1 and 2 are presented in this publication; Part 3 is available only online at http://www.kap.samhsa.gov.
Part 1 of the TIP is for clinical supervisors and consists of two chapters. Chapter 1 presents basic information
about clinical supervision in the substance abuse treatment field. It covers:
• Central principles of clinical supervision and guidelines for new supervisors, including the functions of a
clinical supervisor.
• The developmental levels of counselors and clinical supervisors.
• Information on cultural competence, ethical and legal issues such as direct and vicarious liability, dual rela-
tionships and boundary issues, informed consent, confidentiality, and supervisor ethics.
• Information about monitoring clinical performance of counselors, the various methods commonly used for
observing counselors, the methods and techniques of supervision and administrative supervision, and practi-
cal issues such as balancing one’s clinical and administrative duties, finding the time to do clinical supervi-
sion, documentation, and structuring clinical supervision sessions.
Chapter 2 presents the “how to” of clinical supervision. Chapter 2 contains:

• Representative vignettes of clinical supervision scenarios.
• Master supervisor notes and comments that help you understand the thinking behind the supervisor’s
approach in each vignette.
• “How-to” descriptions of specific techniques.
It is strongly recommended that you read chapter 1 before reading chapter 2.

Part 2 is an implementation guide for program administrators and consists of two chapters. Chapter 1 lays out
the rationale for the approach taken in chapter 2 and will help administrators understand the benefits and
rationale behind providing clinical supervision for their program’s substance abuse counselors. Chapter 2 pro-
vides tools for making the tasks associated with implementing a clinical supervision system easier.
The following topics are addressed in Part 2:
• How to develop a model for clinical supervision and implement a clinical supervision program.
• Key issues for administrators to consider, including assessing organizational structure and readiness.
• Legal and ethical issues to consider.
• Cultural competence issues.
• Providing professional development for clinical supervisors.
Clinical Supervision and Professional Development xi

Part 3 of this TIP is a literature review on the topic of clinical supervision and is available for use by clinical
supervisors, interested counselors, and administrators. Part 3 consists of three sections: an analysis of the
available literature, an annotated bibliography of the literature most central to the topic, and a bibliography of
other available literature. It includes literature that addresses both clinical and administrative concerns. To
facilitate ongoing updates (which will be performed every 6 months for up to 5 years from first publication), the
literature review will be available only online at http://www.kap.samhsa.gov.
xii
Professional Development of
the Substance Abuse
Counselor
Part 1
Overview of Part 1
Chapter 1: Information You Need To Know
This chapter presents the basic information about clinical supervision in the substance abuse treatment field
and is organized as follows:
• Introduction (pp. 3–4)

• Central Principles of Clinical Supervision (pp. 5–6)
• Guidelines for New Supervisors (pp. 6–8)
• Models of Clinical Supervision (pp. 8–9)
• Developmental Stages of Counselors (pp. 9–10)
• Developmental Stages of Supervisors (pp. 10–11)
• Cultural and Contextual Factors (pp. 11–13)
• Ethical and Legal Issues (pp. 13–17)
• Monitoring Performance (pp. 17–20)
• Methods of Observation (pp. 20–24)
• Practical Issues in Clinical Supervision (pp. 24–29)
• Methods and Techniques of Clinical Supervision (pp. 30–32)
• Administrative Supervision (pp. 33–34)
• Resources (p. 34)
Chapter 2: Clinical Scenarios Showing How To Apply the Information

This chapter presents several realistic clinical supervision scenarios that could take place in a substance abuse
treatment agency to demonstrate the material presented in chapter 1. Master Supervisor Notes are provided to
explain the thinking behind these actions. How-to Notes instruct supervisors on using a specific technique. The
scenarios should be useful to both counselors and supervisors.
Clinical Supervision and Professional Development 1

Chapter 1
Clinical Supervisors (TAP 21-A; CSAT, 2007). The
Introduction clinical supervision competencies identify those
Clinical supervision is emerging as the crucible in responsibilities and activities that define the work of
which counselors acquire knowledge and skills for the the clinical supervisor. This TIP provides guidelines
substance abuse treatment profession, providing a and tools for the effective delivery of clinical supervi-
bridge between the classroom and the clinic. sion in substance abuse treatment settings. TAP 21-A
Supervision is necessary in the substance abuse is a companion volume to TAP 21, Addiction
treatment field to improve client care, develop the Counseling Competencies (CSAT, 2006), which is
professionalism of clinical personnel, and impart and another useful tool in supervision.
maintain ethical standards in the field. In recent
The perspective of this TIP is informed by the follow-
years, especially in the substance abuse field, clinical
ing definitions of supervision:
supervision has become the cornerstone of quality
improvement and assurance. • “Supervision is a disciplined, tutorial process
wherein principles are transformed into practical
Your role and skill set as a clinical supervisor are dis-
skills, with four overlapping foci: administrative,
tinct from those of counselor and administrator.
evaluative, clinical, and supportive” (Powell &
Quality clinical supervision is founded on a positive
Brodsky, 2004, p. 11). “Supervision is an interven-
supervisor–supervisee relationship that promotes
tion provided by a senior member of a profession
client welfare and the professional development of the
to a more junior member or members. . . . This
supervisee. You are a teacher, coach, consultant,
relationship is evaluative, extends over time, and
mentor, evaluator, and administrator; you provide
has the simultaneous purposes of enhancing the
support, encouragement, and education to staff while
professional functioning of the more junior per-
addressing an array of psychological, interpersonal,
son(s); monitoring the quality of professional serv-
physical, and spiritual issues of clients. Ultimately,
ices offered to the clients that she, he, or they see;
effective clinical supervision ensures that clients are
and serving as a gatekeeper of those who are to
competently served. Supervision ensures that coun-
enter the particular profession” (Bernard &
selors continue to increase their skills, which in turn
Goodyear, 2004, p. 8).
increases treatment effectiveness, client retention,
• Supervision is “a social influence process that
and staff satisfaction. The clinical supervisor also
occurs over time, in which the supervisor partici-
serves as liaison between administrative and clinical
pates with supervisees to ensure quality of clinical
staff.
care. Effective supervisors observe, mentor, coach,
This TIP focuses primarily on the teaching, coaching, evaluate, inspire, and create an atmosphere that
consulting, and mentoring functions of clinical super- promotes self-motivation, learning, and profession-
visors. Supervision, like substance abuse counseling, al development. They build teams, create cohesion,
is a profession in its own right, with its own theories, resolve conflict, and shape agency culture, while
practices, and standards. The profession requires attending to ethical and diversity issues in all
knowledgeable, competent, and skillful individuals aspects of the process. Such supervision is key to
who are appropriately credentialed both as counselors both quality improvement and the successful
and supervisors. implementation of consensus- and evidence-based
practices” (CSAT, 2007, p. 3).
Definitions Rationale
This document builds on and makes frequent refer-
For hundreds of years, many professions have relied
ence to CSAT’s Technical Assistance Publication
on more senior colleagues to guide less experienced
(TAP), Competencies for Substance Abuse Treatment
professionals in their crafts. This is a new develop-

ment in the substance abuse field, as clinical supervi- ing self-awareness, and transmitting knowledge
sion was only recently acknowledged as a discrete for practical use and professional growth.
process with its own concepts and approaches. Supervisors are teachers, trainers, and profes-
sional role models.
As a supervisor to the client, counselor, and organiza-
• Consultant: Bernard and Goodyear (2004) incor-
tion, the significance of your position is apparent in
porate the supervisory consulting role of case con-
the following statements:
sultation and review, monitoring performance,
• Organizations have an obligation to ensure quality counseling the counselor regarding job perform-
care and quality improvement of all personnel. ance, and assessing counselors. In this role, super-
The first aim of clinical supervision is to ensure visors also provide alternative case conceptualiza-
quality services and to protect the welfare of tions, oversight of counselor work to achieve mutu-
clients. ally agreed upon goals, and professional gatekeep-
• Supervision is the right of all employees and has a ing for the organization and discipline (e.g., recog-
direct impact on workforce development and staff nizing and addressing counselor impairment).
and client retention. • Coach: In this supportive role, supervisors pro-
• You oversee the clinical functions of staff and have vide morale building, assess strengths and needs,
a legal and ethical responsibility to ensure quality suggest varying clinical approaches, model, cheer-
care to clients, the professional development of lead, and prevent burnout. For entry-level coun-
counselors, and maintenance of program policies selors, the supportive function is critical.
and procedures. • Mentor/Role Model: The experienced supervisor
• Clinical supervision is how counselors in the field mentors and teaches the supervisee through role
learn. In concert with classroom education, clinical modeling, facilitates the counselor’s overall profes-
skills are acquired through practice, observation, sional development and sense of professional iden-
feedback, and implementation of the recommenda- tity, and trains the next generation of supervisors.
tions derived from clinical supervision.
Figure 1. Roles of the Clinical Supervisor
Functions of a Clinical Supervisor

You, the clinical supervisor, wear several important
“hats.” You facilitate the integration of counselor self-
awareness, theoretical grounding, and development of
clinical knowledge and skills; and you improve func-
tional skills and professional practices. These roles
often overlap and are fluid within the context of the
supervisory relationship. Hence, the supervisor is in a
unique position as an advocate for the agency, the
counselor, and the client. You are the primary link
between administration and front line staff, inter-
preting and monitoring compliance with agency goals,
policies, and procedures and communicating staff and
client needs to administrators. Central to the supervi-
sor’s function is the alliance between the supervisor
and supervisee (Rigazio-DiGilio, 1997).
As shown in Figure 1, your roles as a clinical supervi-

sor in the context of the supervisory relationship
include:
• Teacher: Assist in the development of counseling

knowledge and skills by identifying learning
needs, determining counselor strengths, promot-
4 Part 1, Chapter 1
The benefits that come with years of experience
Central Principles of are enhanced by quality clinical supervision.
Clinical Supervision 4. Clinical supervision needs the full support
of agency administrators. Just as treatment
The Consensus Panel for this TIP has identified cen-
programs want clients to be in an atmosphere of
tral principles of clinical supervision. Although the
growth and openness to new ideas, counselors
Panel recognizes that clinical supervision can initial-
should be in an environment where learning and
ly be a costly undertaking for many financially
professional development and opportunities are
strapped programs, the Panel believes that ultimate-
valued and provided for all staff.
ly clinical supervision is a cost-saving process.
5. The supervisory relationship is the crucible
Clinical supervision enhances the quality of client
in which ethical practice is developed and
care; improves efficiency of counselors in direct and
reinforced. The supervisor needs to model sound
indirect services; increases workforce satisfaction,
ethical and legal practice in the supervisory rela-
professionalization, and retention (see vignette 8 in
tionship. This is where issues of ethical practice
chapter 2); and ensures that services provided to the
arise and can be addressed. This is where ethical
public uphold legal mandates and ethical standards
practice is translated from a concept to a set of
of the profession.
behaviors. Through supervision, clinicians can
The central principles identified by the Consensus develop a process of ethical decisionmaking and
Panel are: use this process as they encounter new situations.
6. Clinical supervision is a skill in and of itself
1. Clinical supervision is an essential part of that has to be developed. Good counselors tend
all clinical programs. Clinical supervision is a to be promoted into supervisory positions with the
central organizing activity that integrates the assumption that they have the requisite skills to
program mission, goals, and treatment philosophy provide professional clinical supervision.
with clinical theory and evidence-based practices However, clinical supervisors need a different role
(EBPs). The primary reasons for clinical supervi- orientation toward both program and client goals
sion are to ensure (1) quality client care, and (2) and a knowledge base to complement a new set of
clinical staff continue professional development in skills. Programs need to increase their capacity to
a systematic and planned manner. In substance develop good supervisors.
abuse treatment, clinical supervision is the pri- 7. Clinical supervision in substance abuse
mary means of determining the quality of care treatment most often requires balancing
provided. administrative and clinical supervision
2. Clinical supervision enhances staff reten- tasks. Sometimes these roles are complementary
tion and morale. Staff turnover and workforce and sometimes they conflict. Often the supervisor
development are major concerns in the substance feels caught between the two roles.
abuse treatment field. Clinical supervision is a Administrators need to support the integration
primary means of improving workforce retention and differentiation of the roles to promote the
and job satisfaction (see, for example, Roche, efficacy of the clinical supervisor. (See Part 2.)
Todd, & O’Connor, 2007). 8. Culture and other contextual variables
3. Every clinician, regardless of level of skill influence the supervision process; supervi-
and experience, needs and has a right to sors need to continually strive for cultural
clinical supervision. In addition, supervisors competence. Supervisors require cultural com-
need and have a right to supervision of their petence at several levels. Cultural competence
supervision. Supervision needs to be tailored to involves the counselor’s response to clients, the
the knowledge base, skills, experience, and supervisor’s response to counselors, and the pro-
assignment of each counselor. All staff need gram’s response to the cultural needs of the
supervision, but the frequency and intensity of diverse community it serves. Since supervisors
the oversight and training will depend on the are in a position to serve as catalysts for change,
role, skill level, and competence of the individual. they need to develop proficiency in addressing the
needs of diverse clients and personnel.

9. Successful implementation of EBPs requires There are many changes ahead. If you have been pro-
ongoing supervision. Supervisors have a role in moted from within, you’ll encounter even more hur-
determining which specific EBPs are relevant for dles and issues. First, it is important to face that
an organization’s clients (Lindbloom, Ten Eyck, & your life has changed. You might experience the loss
Gallon, 2005). Supervisors ensure that EBPs are of friendship of peers. You might feel that you knew
successfully integrated into ongoing programmat- what to do as a counselor, but feel totally lost with
ic activities by training, encouraging, and moni- your new responsibilities (see vignette 6 in chapter
toring counselors. Excellence in clinical supervi- 2). You might feel less effective in your new role.
sion should provide greater adherence to the EBP Supervision can be an emotionally draining experi-
model. Because State funding agencies now often ence, as you now have to work with more staff-related
require substance abuse treatment organizations interpersonal and human resources issues.
to provide EBPs, supervision becomes even more
Before your promotion to clinical supervisor, you
important.
might have felt confidence in your clinical skills. Now
10. Supervisors have the responsibility to be
you might feel unprepared and wonder if you need a
gatekeepers for the profession. Supervisors
training course for your new role. If you feel this way,
are responsible for maintaining professional stan-
you’re right. Although you are a good counselor, you
dards, recognizing and addressing impairment,
do not necessarily possess all the skills needed to be a
and safeguarding the welfare of clients. More
good supervisor. Your new role requires a new body of
than anyone else in an agency, supervisors can
knowledge and different skills, along with the ability
observe counselor behavior and respond promptly
to use your clinical skills in a different way. Be confi-
to potential problems, including counseling some
dent that you will acquire these skills over time (see
individuals out of the field because they are ill-
the Resources section, p. 34) and that you made the
suited to the profession. This “gatekeeping” func-
right decision to accept your new position.
tion is especially important for supervisors who
act as field evaluators for practicum students Suggestions for new supervisors:
prior to their entering the profession. Finally,
supervisors also fulfill a gatekeeper role in per- • Quickly learn the organization’s policies and pro-
formance evaluation and in providing formal rec- cedures and human resources procedures (e.g., hir-
ommendations to training institutions and cre- ing and firing, affirmative action requirements,
dentialing bodies. format for conducting meetings, giving feedback,
11. Clinical supervision should involve direct and making evaluations). Seek out this informa-
observation methods. Direct observation tion as soon as possible through the human
should be the standard in the field because it is resources department or other resources within
one of the most effective ways of building skills, the organization.
monitoring counselor performance, and ensuring • Ask for a period of 3 months to allow you to learn
quality care. Supervisors require training in about your new role. During this period, do not
methods of direct observation, and administrators make any changes in policies and procedures but
need to provide resources for implementing direct use this time to find your managerial voice and
observation. Although small substance abuse decisionmaking style.
agencies might not have the resources for one- • Take time to learn about your supervisees, their
way mirrors or videotaping equipment, other career goals, interests, developmental objectives,
direct observation methods can be employed (see and perceived strengths.
the section on methods of observation, pp. 20–24). • Work to establish a contractual relationship with
supervisees, with clear goals and methods of
supervision.
Guidelines for New • Learn methods to help staff reduce stress, address
competing priorities, resolve staff conflict, and
Supervisors other interpersonal issues in the workplace.
Congratulations on your appointment as a supervisor! • Obtain training in supervisory procedures and
By now you might be asking yourself a few questions: methods.
What have I done? Was this a good career decision?
6 Part 1, Chapter 1
• Find a mentor, either internal or external to the staff. To resolve defensiveness and engage your
organization. supervisees, you must also honor the resistance and
• Shadow a supervisor you respect who can help you acknowledge their concerns. Abandon trying to push
learn the ropes of your new job. the supervisee too far, too fast. Resistance is an
• Ask often and as many people as possible, “How expression of ambivalence about change and not a
am I doing?” and “How can I improve my perform- personality defect of the counselor. Instead of arguing
ance as a clinical supervisor?” with or exhorting staff, sympathize with their con-
• Ask for regular, weekly meetings with your cerns, saying, “I understand this is difficult. How are
administrator for training and instruction. we going to resolve these issues?”
• Seek supervision of your supervision.
When counselors respond defensively or reject direc-
tions from you, try to understand the origins of their
Problems and Resources defensiveness and to address their resistance. Self-
As a supervisor, you may encounter a broad array of disclosure by the supervisor about experiences as a
issues and concerns, ranging from working within a supervisee, when appropriately used, may be helpful
system that does not fully support clinical supervision in dealing with defensive, anxious, fearful, or resist-
to working with resistant staff. A comment often ant staff. Work to establish a healthy, positive super-
heard in supervision training sessions is “My boss visory alliance with staff. Because many substance
should be here to learn what is expected in supervi- abuse counselors have not been exposed to clinical
sion,” or “This will never work in my agency’s bureau- supervision, you may need to train and orient the
cracy. They only support billable activities.” The work staff to the concept and why it is important for your
setting is where you apply the principles and prac- agency.
tices of supervision and where organizations are driv-
en by demands, such as financial solvency, profit,
census, accreditation, and concerns over litigation. Things a New Supervisor
Therefore, you will need to be practical when begin- Should Know
ning your new role as a supervisor: determine how Eight truths a beginning supervisor should commit to
you can make this work within your unique work memory are listed below:
environment.
1. The reason for supervision is to ensure quality
client care. As stated throughout this TIP, the
Working With Staff Who Are primary goal of clinical supervision is to protect
Resistant to Supervision the welfare of the client and ensure the integrity
Some of your supervisees may have been in the field of clinical services.
longer than you have and see no need for supervision. 2. Supervision is all about the relationship. As in
Other counselors, having completed their graduate counseling, developing the alliance between the
training, do not believe they need further supervision, counselor and the supervisor is the key to good
especially not from a supervisor who might have less supervision.
formal academic education than they have. Other 3. Culture and ethics influence all supervisory
resistance might come from ageism, sexism, racism, interactions. Contextual factors, culture, race,
or classism. Particular to the field of substance abuse and ethnicity all affect the nature of the supervi-
treatment may be the tension between those who sory relationship. Some models of supervision
believe that recovery from substance abuse is neces- (e.g., Holloway, 1995) have been built primarily
sary for this counseling work and those who do not around the role of context and culture in shaping
believe this to be true. supervision.
4. Be human and have a sense of humor. As role
In addressing resistance, you must be clear regarding models, you need to show that everyone makes
what your supervision program entails and must con- mistakes and can admit to and learn from these
sistently communicate your goals and expectations to mistakes.

5. Rely first on direct observation of your counselors various supervisory functions (teaching, consulting,
and give specific feedback. The best way to deter- and counseling).
mine a counselor’s skills is to observe him or her
Treatment-based supervision models train to a
and to receive input from the clients about their
particular theoretical approach to counseling, incorpo-
perceptions of the counseling relationship.
rating EBPs into supervision and seeking fidelity and
6. Have and practice a model of counseling and of
adaptation to the theoretical model. Motivational
supervision; have a sense of purpose. Before you
interviewing, cognitive–behavioral therapy, and psy-
can teach a supervisee knowledge and skills, you
chodynamic psychotherapy are three examples. These
must first know the philosophical and theoretical
models emphasize the counselor’s strengths, seek the
foundations on which you, as a supervisor, stand.
supervisee’s understanding of the theory and model
Counselors need to know what they are going to
taught, and incorporate the approaches and tech-
learn from you, based on your model of counseling
niques of the model. The majority of these models
and supervision.
begin with articulating their treatment approach and
7. Make time to take care of yourself spiritually,
describing their supervision model, based upon that
emotionally, mentally, and physically. Again, as
approach.
role models, counselors are watching your behav-
ior. Do you “walk the talk” of self-care? Developmental models, such as Stoltenberg and
8. You have a unique position as an advocate for the Delworth (1987), understand that each counselor goes
agency, the counselor, and the client. As a super- through different stages of development and recog-
visor, you have a wonderful opportunity to assist nize that movement through these stages is not
in the skill and professional development of your always linear and can be affected by changes in
staff, advocating for the best interests of the assignment, setting, and population served. (The
supervisee, the client, and your organization. developmental stages of counselors and supervisors
are described in detail below).
Models of Clinical Integrated models, including the Blended Model,

begin with the style of leadership and articulate a
Supervision model of treatment, incorporate descriptive dimen-
You may never have thought about your model of sions of supervision (see below), and address contex-
supervision. However, it is a fundamental premise of tual and developmental dimensions into supervision.
this TIP that you need to work from a defined model They address both skill and competency development
of supervision and have a sense of purpose in your and affective issues, based on the unique needs of
oversight role. Four supervisory orientations seem the supervisee and supervisor. Finally, integrated
particularly relevant. They include: models seek to incorporate EBPs into counseling and
supervision.
• Competency-based models.
• Treatment-based models. In all models of supervision, it is helpful to identify
• Developmental approaches. culturally or contextually centered models or
• Integrated models. approaches and find ways of tailoring the models to
specific cultural and diversity factors. Issues to con-
Competency-based models (e.g., microtraining, sider are:
the Discrimination Model [Bernard & Goodyear,
• Explicitly addressing diversity of supervisees (e.g.,
2004], and the Task-Oriented Model [Mead, 1990],
race, ethnicity, gender, age, sexual orientation)
focus primarily on the skills and learning needs of
and the specific factors associated with these types
the supervisee and on setting goals that are specific,
of diversity;
measurable, attainable, realistic, and timely
• Explicitly involving supervisees’ concerns related
(SMART). They construct and implement strategies
to particular client diversity (e.g., those whose cul-
to accomplish these goals. The key strategies of com-
ture, gender, sexual orientation, and other attrib-
petency-based models include applying social learn-
utes differ from those of the supervisee) and
ing principles (e.g., modeling role reversal, role play-
addressing specific factors associated with these
ing, and practice), using demonstrations, and using
types of diversity; and
8 Part 1, Chapter 1
• Explicitly addressing supervisees’ issues related to cific needs of the clients they serve, the goals of the
effectively navigating services in intercultural agency in which you work, and in the ethical and
communities and effectively networking with legal boundaries of practice. These four variables
agencies and institutions. define the context in which effective supervision can
take place.
It is important to identify your model of counseling
and your beliefs about change, and to articulate a
workable approach to supervision that fits the model Developmental Stages of
of counseling you use. Theories are conceptual frame-
works that enable you to make sense of and organize Counselors
your counseling and supervision and to focus on the Counselors are at different stages of professional
most salient aspects of a counselor’s practice. You development. Thus, regardless of the model of super-
may find some of the questions below to be relevant vision you choose, you must take into account the
to both supervision and counseling. The answers to supervisee’s level of training, experience, and profi-
these questions influence both how you supervise and ciency. Different supervisory approaches are appro-
how the counselors you supervise work: priate for counselors at different stages of develop-
• What are your beliefs about how people change in ment. An understanding of the supervisee’s (and
both treatment and clinical supervision? supervisor’s) developmental needs is an essential
• What factors are important in treatment and clini- ingredient for any model of supervision.
cal supervision? Various paradigms or classifications of developmental
• What universal principles apply in supervision stages of clinicians have been developed (Ivey, 1997;
and counseling and which are unique to clinical Rigazio-DiGilio, 1997; Skolvolt & Ronnestrand, 1992;
supervision? Todd and Storn, 1997). This TIP has adopted the
• What conceptual frameworks of counseling do you Integrated Developmental Model (IDM) of
use (for instance, cognitive–behavioral therapy, Stoltenberg, McNeill, and Delworth (1998) (see figure
12-Step facilitation, psychodynamic, behavioral)? 2, p. 10). This schema uses a three-stage approach.
• What are the key variables that affect outcomes? The three stages of development have different char-
(Campbell, 2000) acteristics and appropriate supervisory methods.
Further application of the IDM to the substance
According to Bernard and Goodyear (2004) and abuse field is needed. (For additional information, see
Powell and Brodsky (2004),the qualities of a good Anderson, 2001.)
model of clinical supervision are:
It is important to keep in mind several general cau-
• Rooted in the individual, beginning with the tions and principles about counselor development,
supervisor’s self, style, and approach to leadership. including:
• Precise, clear, and consistent.
• Comprehensive, using current scientific and evi- • There is a beginning but not an end point for
dence-based practices. learning clinical skills; be careful of counselors
• Operational and practical, providing specific con- who think they “know it all.”
cepts and practices in clear, useful, and measura- • Take into account the individual learning styles
ble terms. and personalities of your supervisees and fit the
• Outcome-oriented to improve counselor compe- supervisory approach to the developmental stage
tence; make work manageable; create a sense of of each counselor.
mastery and growth for the counselor; and address • There is a logical sequence to development,
the needs of the organization, the supervisor, the although it is not always predictable or rigid; some
supervisee, and the client. counselors may have been in the field for years but
remain at an early stage of professional develop-
Finally, it is imperative to recognize that, whatever ment, whereas others may progress quickly
model you adopt, it needs to be rooted in the learning through the stages.
and developmental needs of the supervisee, the spe-

Figure 2. Counselor Developmental Model
Supervision Skills
Developmental Level Characteristics Techniques
Development Needs
Level 1 • Focuses on self • Provide structure and • Observation
• Anxious, uncertain minimize anxiety • Skills training
• Preoccupied with per- • Supportive, address • Role playing
forming the right way strengths first, then • Readings
• Overconfident of skills weaknesses • Group supervision
• Overgeneralizes • Suggest approaches • Closely monitor clients
• Overuses a skill • Start connecting theory
• Gap between conceptu- to treatment
alization, goals, and
interventions
• Ethics underdeveloped
Level 2 • Focuses less on self and • Less structure provided, • Observation

more on client more autonomy encour- • Role playing
• Confused, frustrated aged • Interpret dynamics
with complexity of coun- • Supportive • Group supervision
seling • Periodic suggestion of • Reading
• Overidentifies with client approaches
• Challenges authority • Confront discrepancies
• Lacks integration with • Introduce more alterna-
theoretical base tive views
• Overburdened • Process comments, high-
• Ethics better understood light countertransfer-
ence
• Affective reactions to
client and/or supervisor
Level 3 • Focuses intently on client • Supervisee directed • Peer supervision

• High degree of empathic • Focus on personal-pro- • Group supervision
skill fessional integration and • Reading
• Objective third person career
perspective • Supportive
• Integrative thinking and • Change agent
approach
• Highly responsible and
ethical counselor
Source: Stoltenberg, Delworth, & McNeil, 1998
• Counselors at an advanced developmental level

have different learning needs and require different
Developmental Stages of
supervisory approaches from those at Level 1; and Supervisors
• The developmental level can be applied for differ-
Just as counselors go through stages of development,
ent aspects of a counselor’s overall competence
so do supervisors. The developmental model present-
(e.g., Level 2 mastery for individual counseling
ed in figure 3 provides a framework to explain why
and Level 1 for couples counseling).
supervisors act as they do, depending on their devel-
opmental stage. It would be expected that someone
new to supervision would be at a Level 1 as a super-
visor. However, supervisors should be at least at the
second or third stage of counselor development. If a
newly appointed supervisor is still at Level 1 as a
10 Part 1, Chapter 1
Figure 3. Supervisor Developmental Model
Developmental
Characteristics To Increase Supervision Competence
Level
Level 1 • Is anxious regarding role • Follow structure and formats

• Is naïve about assuming the role of supervisor • Design systems to increase organization of
• Is focused on doing the “right” thing supervision
• May overly respond as an “expert” • Assign Level I counselors
• Is uncomfortable providing direct feedback
Level 2 • Shows confusion and conflict • Provide active supervision of the supervi-
• Sees supervision as complex and multidimen- sion
sional • Assign Level 1 counselors
• Needs support to maintain motivation
• Overfocused on counselor’s deficits and per-
ceived resistance
• May fall back to being a therapist with the
counselor
Level 3 • Is highly motivated • Comfortable with all levels

• Can provide an honest self-appraisal of
strengths and weaknesses as supervisor
• Is comfortable with evaluation process
• Provides thorough, objective feedback
Source: Stoltenberg, Delworth, & McNeil, 1998
counselor, he or she will have little to offer to more minimal competency standards for effective and
seasoned supervisees. relevant practice.
Models of supervision have been strongly influenced

by contextual variables and their influence on the
Cultural and Contextual supervisory relationship and process, such as
Factors Holloway’s Systems Model (1995) and Constantine’s
Multicultural Model (2003).
Culture is one of the major contextual factors that
influence supervisory interactions. Other contextual The competencies listed in TAP 21-A reflect the
variables include race, ethnicity, age, gender, disci- importance of culture in supervision (CSAT, 2007).
pline, academic background, religious and spiritual The Counselor Development domain encourages self-
practices, sexual orientation, disability, and recovery examination of attitudes toward culture and other
versus non-recovery status. The relevant variables contextual variables. The Supervisory Alliance
in the supervisory relationship occur in the context domain promotes attention to these variables in the
of the supervisor, supervisee, client, and the setting supervisory relationship. (See also the planned TIP,
in which supervision occurs. More care should be Improving Cultural Competence in Substance Abuse
taken to: Counseling [CSAT, in development b].)
• Identify the competencies necessary for substance Cultural competence “refers to the ability to honor
abuse counselors to work with diverse individuals and respect the beliefs, language, interpersonal
and navigate intercultural communities. styles, and behaviors of individuals and families
• Identify methods for supervisors to assist coun- receiving services, as well as staff who are providing
selors in developing these competencies. such services. Cultural competence is a dynamic,
• Provide evaluation criteria for supervisors to ongoing, developmental process that requires a com-
determine whether their supervisees have met mitment and is achieved over time” (U.S. Department

of Health and Human Services, 2003, p. 12). Culture visees may have (see Constantine, 2003). Regardless,
shapes belief systems, particularly concerning issues it is your responsibility to help supervisees build on
related to mental health and substance abuse, as well the cultural competence skills they possess as well as
as the manifestation of symptoms, relational styles, to focus on their cultural competence deficits. It is
and coping patterns. important to initiate discussion of issues of culture,
race, gender, sexual orientation, and the like in
There are three levels of cultural consideration for
supervision to model the kinds of discussion you
the supervisory process: the issue of the culture of
would like counselors to have with their clients. If
the client being served and the culture of the coun-
these issues are not addressed in supervision, coun-
selor in supervision. Holloway (1995) emphasizes the
selors may come to believe that it is inappropriate to
cultural issues of the agency, the geographic environ-
discuss them with clients and have no idea how such
ment of the organization, and many other contextual
dialog might proceed. These discussions prevent mis-
factors. Specifically, there are three important areas
understandings with supervisees based on cultural or
in which cultural and contextual factors play a key
other factors. Another benefit from these discussions
role in supervision: in building the supervisory rela-
is that counselors will eventually achieve some level
tionship or working alliance, in addressing the spe-
of comfort in talking about culture, race, ethnicity,
cific needs of the client, and in building supervisee
and diversity issues.
competence and ability. It is your responsibility to
address your supervisees’ beliefs, attitudes, and bias- If you haven’t done it as a counselor, early in your
es about cultural and contextual variables to advance tenure as a supervisor you will want to examine your
their professional development and promote quality culturally influenced values, attitudes, experiences,
client care. and practices and to consider what effects they have
on your dealings with supervisees and clients.
Becoming culturally competent and able to integrate
Counselors should undergo a similar review as
other contextual variables into supervision is a com-
preparation for when they have clients of a culture
plex, long-term process. Cross (1989) has identified
different from their own. Some questions to keep in
several stages on a continuum of becoming culturally
mind are:
competent (see figure 4).
• What did you think when you saw the supervisee’s
Although you may never have had specialized train-
last name?
ing in multicultural counseling, some of your super-
Figure 4. Continuum of Cultural Competence
Cultural Destructiveness
Superiority of dominant culture and inferiority of other cultures; active discrimination
Cultural Incapacity
Separate but equal treatment; passive discrimination
Cultural Blindness
Sees all cultures and people as alike and equal; discrimination by ignoring culture
Cultural Openness (Sensitivity)

Basic understanding and appreciation of importance of sociocultural factors in work with minority populations
Cultural Competence
Capacity to work with more complex issues and cultural nuances
Cultural Proficiency
Highest capacity for work with minority populations; a commitment to excellence and proactive effort
Source: Cross, 1989.
• What did you think when the supervisee said his
or her culture is X, when yours is Y?
Ethical and Legal Issues
• How did you feel about this difference? You are the organization’s gatekeeper for ethical and
• What did you do in response to this difference? legal issues. First, you are responsible for upholding
the highest standards of ethical, legal, and moral
Constantine (2003) suggests that supervisors can use practices and for serving as a model of practice to
the following questions with supervisees: staff. Further, you should be aware of and respond to
ethical concerns. Part of your job is to help integrate
• What demographic variables do you use to identify
solutions to everyday legal and ethical issues into
yourself?
clinical practice.
• What worldviews (e.g., values, assumptions, and
biases) do you bring to supervision based on your Some of the underlying assumptions of incorporating
cultural identities? ethical issues into clinical supervision include:
• What struggles and challenges have you faced
• Ethical decisionmaking is a continuous, active
working with clients who were from different cul-
process.
tures than your own?
• Ethical standards are not a cookbook. They tell
you what to do, not always how.
Beyond self-examination, supervisors will want con- • Each situation is unique. Therefore, it is impera-
tinuing education classes, workshops, and conferences tive that all personnel learn how to “think ethi-
that address cultural competence and other contextu- cally” and how to make sound legal and ethical
al factors. Community resources, such as community decisions.
leaders, elders, and healers can contribute to your • The most complex ethical issues arise in the con-
understanding of the culture your organization text of two ethical behaviors that conflict; for
serves. Finally, supervisors (and counselors) should instance, when a counselor wants to respect the
participate in multicultural activities, such as com- privacy and confidentiality of a client, but it is in
munity events, discussion groups, religious festivals, the client’s best interest for the counselor to con-
and other ceremonies. tact someone else about his or her care.
• Therapy is conducted by fallible beings; people
The supervisory relationship includes an inherent
make mistakes—hopefully, minor ones.
power differential, and it is important to pay atten-
• Sometimes the answers to ethical and legal ques-
tion to this disparity, particularly when the super-
tions are elusive. Ask a dozen people, and you’ll
visee and the supervisor are from different cultural
likely get twelve different points of view.
groups. A potential for the misuse of that power
exists at all times but especially when working with
Helpful resources on legal and ethical issues for
supervisees and clients within multicultural contexts.
supervisors include Beauchamp and Childress (2001);
When the supervisee is from a minority population
Falvey (2002b); Gutheil and Brodsky (2008); Pope,
and the supervisor is from a majority population, the
Sonne, and Greene (2006); and Reamer (2006).
differential can be exaggerated. You will want to pre-
vent institutional discrimination from affecting the Legal and ethical issues that are critical to clinical
quality of supervision. The same is true when the supervisors include (1) vicarious liability (or respon-
supervisee is gay and the supervisor is heterosexual, deat superior), (2) dual relationships and boundary
or the counselor is non-degreed and the supervisor concerns, (4) informed consent, (5) confidentiality,
has an advanced degree, or a female supervisee with and (6) supervisor ethics.
a male supervisor, and so on. In the reverse situa-
tions, where the supervisor is from the minority
group and the supervisee from the majority group, Direct Versus Vicarious Liability
the difference should be discussed as well. An important distinction needs to be made between
direct and vicarious liability. Direct liability of the
supervisor might include dereliction of supervisory
responsibility, such as “not making a reasonable
effort to supervise” (defined below).

In vicarious liability, a supervisor can be held liable Therefore, firm, always-or-never rules aren’t applica-
for damages incurred as a result of negligence in the ble. You have the responsibility of weighing with the
supervision process. Examples of negligence include counselor the anticipated and unanticipated effects of
providing inappropriate advice to a counselor about a dual relationships, helping the supervisee’s self-
client (for instance, discouraging a counselor from reflective awareness when boundaries become
conducting a suicide screen on a depressed client), blurred, when he or she is getting close to a dual rela-
failure to listen carefully to a supervisee’s comments tionship, or when he or she is crossing the line in the
about a client, and the assignment of clinical tasks to clinical relationship.
inadequately trained counselors. The key legal ques-
Exploring dual relationship issues with counselors in
tion is: “Did the supervisor conduct him- or herself in
clinical supervision can raise its own professional
a way that would be reasonable for someone in his
dilemmas. For instance, clinical supervision involves
position?” or “Did the supervisor make a reasonable
unequal status, power, and expertise between a
effort to supervise?” A generally accepted time stan-
supervisor and supervisee. Being the evaluator of a
dard for a “reasonable effort to supervise” in the
counselor’s performance and gatekeeper for training
behavioral health field is 1 hour of supervision for
programs or credentialing bodies also might involve a
every 20–40 hours of clinical services. Of course,
dual relationship. Further, supervision can have ther-
other variables (such as the quality and content of
apy-like qualities as you explore countertransferen-
clinical supervision sessions) also play a role in a rea-
tial issues with supervisees, and there is an expecta-
sonable effort to supervise.
tion of professional growth and self-exploration. What
Supervisory vulnerability increases when the coun- makes a dual relationship unethical in supervision is
selor has been assigned too many clients, when there the abusive use of power by either party, the likeli-
is no direct observation of a counselor’s clinical work, hood that the relationship will impair or injure the
when staff are inexperienced or poorly trained for supervisor’s or supervisee’s judgment, and the risk of
assigned tasks, and when a supervisor is not exploitation (see vignette 3 in chapter 2).
involved or not available to aid the clinical staff. In
The most common basis for legal action against coun-
legal texts, vicarious liability is referred to as
selors (20 percent of claims) and the most frequently
“respondeat superior.”
heard complaint by certification boards against coun-
selors (35 percent) is some form of boundary violation
Dual Relationships and Boundary or sexual impropriety (Falvey, 2002b). (See the dis-
Issues cussion of transference and countertransference on
pp. 25–26.)
Dual relationships can occur at two levels: between
supervisors and supervisees and between counselors Codes of ethics for most professions clearly advise
and clients. You have a mandate to help your super- that dual relationships between counselors and
visees recognize and manage boundary issues. A dual clients should be avoided. Dual relationships between
relationship occurs in supervision when a supervisor counselors and supervisors are also a concern and are
has a primary professional role with a supervisee addressed in the substance abuse counselor codes and
and, at an earlier time, simultaneously or later, those of other professions as well. Problematic dual
engages in another relationship with the supervisee relationships between supervisees and supervisors
that transcends the professional relationship. might include intimate relationships (sexual and non-
Examples of dual relationships in supervision include sexual) and therapeutic relationships, wherein the
providing therapy for a current or former supervisee, supervisor becomes the counselor’s therapist. Sexual
developing an emotional relationship with a super- involvement between the supervisor and supervisee
visee or former supervisee, and becoming an can include sexual attraction, harassment, consensual
Alcoholics Anonymous sponsor for a former super- (but hidden) sexual relationships, or intimate roman-
visee. Obviously, there are varying degrees of harm tic relationships. Other common boundary issues
or potential harm that might occur as a result of dual include asking the supervisee to do favors, providing
relationships, and some negative effects of dual rela- preferential treatment, socializing outside the work
tionships might not be apparent until later. setting, and using emotional abuse to enforce power.
It is imperative that all parties understand what con- Supervision [ACES], available online at
stitutes a dual relationship between supervisor and http://www.acesonline.net/ethical_guidelines.asp).
supervisee and avoid these dual relationships. Sexual
With informed consent and confidentiality comes a
relationships between supervisors and supervisees
duty not to disclose certain relational communication.
and counselors and clients occur far more frequently
Limits of confidentiality of supervision session con-
than one might realize (Falvey, 2002b). In many
tent should be stated in all organizational contracts
States, they constitute a legal transgression as well
with training institutions and credentialing bodies.
as an ethical violation.
Criteria for waiving client and supervisee privilege
The decision tree presented in figure 5 (p. 16) indi- should be stated in institutional policies and disci-
cates how a supervisor might manage a situation pline-specific codes of ethics and clarified by advice of
where he or she is concerned about a possible ethical legal counsel and the courts. Because standards of
or legal violation by a counselor. confidentiality are determined by State legal and leg-
islative systems, it is prudent for supervisors to con-
sult with an attorney to determine the State codes of
Informed Consent confidentiality and clinical privileging.
Informed consent is key to protecting the counselor
and/or supervisor from legal concerns, requiring the In the substance abuse treatment field, confidentiali-
recipient of any service or intervention to be suffi- ty for clients is clearly defined by Federal law: 42
ciently aware of what is to happen, and of the poten- CFR, Part 2 and the Health Insurance Portability
tial risks and alternative approaches, so that the per- and Accountability Act (HIPAA). Key information is
son can make an informed and intelligent decision available at http://www.hipaa.samhsa.gov. Super-
about participating in that service. The supervisor visors need to train counselors in confidentiality regu-
must inform the supervisee about the process of lations and to adequately document their supervision,
supervision, the feedback and evaluation criteria, and including discussions and directives, especially relat-
other expectations of supervision. The supervision ing to duty-to-warn situations. Supervisors need to
contract should clearly spell out these issues. ensure that counselors provide clients with appropri-
Supervisors must ensure that the supervisee has ate duty-to-warn information early in the counseling
informed the client about the parameters of counsel- process and inform clients of the limits of confiden-
ing and supervision (such as the use of live observa- tiality as part of the agency’s informed consent proce-
tion, video- or audiotaping). A sample template for dures.
informed consent is provided in Part 2, chapter 2 Under duty-to-warn requirements (e.g., child abuse,
(p. 106). suicidal or homicidal ideation), supervisors need to be
aware of and take action as soon as possible in situa-
tions in which confidentiality may need to be waived.
Confidentiality
Organizations should have a policy stating how clini-
In supervision, regardless of whether there is a writ- cal crises will be handled (Falvey, 2002b). What
ten or verbal contract between the supervisor and mechanisms are in place for responding to crises? In
supervisee, there is an implied contract and duty of what timeframe will a supervisor be notified of a cri-
care because of the supervisor’s vicarious liability. sis situation? Supervisors must document all discus-
Informed consent and concerns for confidentiality sions with counselors concerning duty-to-warn and
should occur at three levels: client consent to treat- crises. At the onset of supervision, supervisors should
ment, client consent to supervision of the case, and ask counselors if there are any duty-to-warn issues of
supervisee consent to supervision (Bernard & which the supervisor should be informed.
Goodyear, 2004). In addition, there is an implied con-
sent and commitment to confidentiality by supervi- New technology brings new confidentiality concerns.
sors to assume their supervisory responsibilities and Websites now dispense information about substance
institutional consent to comply with legal and ethical abuse treatment and provide counseling services.
parameters of supervision. (See also the Code of With the growth in online counseling and supervi-
Ethics of the Association for Counselor Education and sion, the following concerns emerge: (a) how to main-

tain confidentiality of information, (b) how to ensure Behavioral Contracting in
the competence and qualifications of counselors pro-
viding online services, and (c) how to establish report-
Supervision
ing requirements and duty to warn when services are Among the first tasks in supervision is to establish a
conducted across State and international boundaries. contract for supervision that outlines realistic
New standards will need to be written to address accountability for both yourself and your supervisee.
these issues. (The National Board for Certified The contract should be in writing and should include
Counselors has guidelines for counseling by Internet the purpose, goals, and objectives of supervision; the
at http://www.nbcc.org/AssetManagerFiles/ethics/ context in which supervision is provided; ethical and
internetcounseling.pdf.) institutional policies that guide supervision and clini-
cal practices; the criteria and methods of evaluation
and outcome measures; the duties and responsibili-
Supervisor Ethics ties of the supervisor and supervisee; procedural con-
In general, supervisors adhere to the same standards siderations (including the format for taping and
and ethics as substance abuse counselors with regard opportunities for live observation); and the super-
to dual relationship and other boundary violations. visee’s scope of practice and competence. The contract
Supervisors will: for supervision should state the rewards for fulfill-
ment of the contract (such as clinical privileges or
• Uphold the highest professional standards of the increased compensation), the length of supervision
field. sessions, and sanctions for noncompliance by either
• Seek professional help (outside the work setting) the supervisee or supervisor. The agreement should
when personal issues interfere with their clinical be compatible with the developmental needs of the
and/or supervisory functioning. supervisee and address the obstacles to progress (lack
• Conduct themselves in a manner that models of time, performance anxiety, resource limitations).
and sets an example for agency mission, vision, Once a behavioral contract has been established, the
philosophy, wellness, recovery, and consumer next step is to develop an IDP.
satisfaction.
• Reinforce zero tolerance for interactions that are
not professional, courteous, and compassionate. Individual Development Plan
• Treat supervisees, colleagues, peers, and clients The IDP is a detailed plan for supervision that
with dignity, respect, and honesty. includes the goals that you and the counselor wish to
• Adhere to the standards and regulations of confi- address over a certain time period (perhaps 3
dentiality as dictated by the field. This applies months). Each of you should sign and keep a copy of
to the supervisory as well as the counseling the IDP for your records. The goals are normally stat-
relationship. ed in terms of skills the counselor wishes to build or
professional resources the counselor wishes to devel-
op. These skills and resources are generally oriented
Monitoring Performance to the counselor’s job in the program or activities that
The goal of supervision is to ensure quality care for would help the counselor develop professionally. The
the client, which entails monitoring the clinical per- IDP should specify the timelines for change, the
formance of staff. Your first step is to educate super- observation methods that will be employed, expecta-
visees in what to expect from clinical supervision. tions for the supervisee and the supervisor, the evalu-
Once the functions of supervision are clear, you ation procedures that will be employed, and the activ-
should regularly evaluate the counselor’s progress in ities that will be expected to improve knowledge and
meeting organizational and clinical goals as set skills. An example of an IDP is provided in Part 2,
forth in an Individual Development Plan (IDP) (see chapter 2 (p. 122).
the section on IDPs below). As clients have an indi-
As a supervisor, you should have your own IDP,
vidual treatment plan, counselors also need a plan
based on the supervisory competencies listed in TAP
to promote skill development.
21-A (CSAT, 2007), that addresses your training

goals. This IDP can be developed in cooperation with • Ratings of skills are highly variable between
your supervisor, or in external supervision, peer supervisors, and often the supervisor’s and super-
input, academic advisement, or mentorship. visee’s ratings differ or conflict (Eby, 2007).
• Good feedback is provided frequently, clearly, and
consistently and is SMART (specific, measurable,
Evaluation of Counselors attainable, realistic, and timely) (Powell &
Supervision inherently involves evaluation, building Brodsky, 2004).
on a collaborative relationship between you and the
counselor. Evaluation may not be easy for some Direct observation of the counselor’s work is the
supervisors. Although everyone wants to know how desired form of input for the supervisor. Although
they are doing, counselors are not always comfortable direct observation has historically been the exception
asking for feedback. And, as most supervisors prefer in substance abuse counseling, ethical and legal con-
to be liked, you may have difficulty giving clear, considerations and evidence support that direct observa-
cise, and accurate evaluations to staff. tion as preferable. The least desirable feedback is
unannounced observation by supervisors followed by
The two types of evaluation are formative and sum-
vague, perfunctory, indirect, or hurtful delivery
mative. A formative evaluation is an ongoing status
(Powell & Brodsky, 2004).
report of the counselor’s skill development, exploring
the questions “Are we addressing the skills or compe- Clients are often the best assessors of the skills of the
tencies you want to focus on?” and “How do we assess counselor. Supervisors should routinely seek input
your current knowledge and skills and areas for from the clients as to the outcome of treatment. The
growth and development?” method of seeking input should be discussed in the
initial supervisory sessions and be part of the super-
Summative evaluation is a more formal rating of the
vision contract. In a residential substance abuse
counselor’s overall job performance, fitness for the
treatment program, you might regularly meet with
job, and job rating. It answers the question, “How
clients after sessions to discuss how they are doing,
does the counselor measure up?” Typically, summa-
how effective the counseling is, and the quality of the
tive evaluations are done annually and focus on the
therapeutic alliance with the counselor. (For exam-
counselor’s overall strengths, limitations, and areas
ples of client satisfaction or input forms, search for
for future improvement.
Client-Directed Outcome-Informed Treatment and
It should be acknowledged that supervision is inher- Training Materials at http://www.talkingcure.com.)
ently an unequal relationship. In most cases, the
Before formative evaluations begin, methods of evalu-
supervisor has positional power over the counselor.
ating performance should be discussed, clarified in
Therefore, it is important to establish clarity of pur-
the initial sessions, and included in the initial con-
pose and a positive context for evaluation. Procedures
tract so that there will be no surprises. Formative
should be spelled out in advance, and the evaluation
evaluations should focus on changeable behavior and,
process should be mutual, flexible, and continuous.
whenever possible, be separate from the overall annu-
The evaluation process inevitably brings up super-
al performance appraisal process. To determine the
visee anxiety and defensiveness that need to be
counselor’s skill development, you should use written
addressed openly. It is also important to note that
competency tools, direct observation, counselor self-
each individual counselor will react differently to
assessments, client evaluations, work samples (files
feedback; some will be more open to the process than
and charts), and peer assessments. Examples of work
others.
samples and peer assessments can be found in
There has been considerable research on supervisory Bernard and Goodyear (2004), Powell and Brodsky
evaluation, with these findings: (2004), and Campbell (2000). It is important to
acknowledge that counselor evaluation is essentially
• The supervisee’s confidence and efficacy are corre-
a subjective process involving supervisors’ opinions of
lated with the quality and quantity of feedback the
the counselors’ competence.
supervisor gives to the supervisee (Bernard &
Goodyear, 2004).
Addressing Burnout and for you to help counselors understand “how” to coun-
sel, you can also help them with the “why.” Why are
Compassion Fatigue they in this field? What gives them meaning and pur-
Did you ever hear a counselor say, “I came into coun- pose at work? When all is said and done, when coun-
seling for the right reasons. At first I loved seeing selors have seen their last client, how do they want to
clients. But the longer I stay in the field, the harder be remembered? What do they want said about them
it is to care. The joy seems to have gone out of my job. as counselors? Usually, counselors’ responses to this
Should I get out of counseling as many of my col- question are fairly simple: “I want to be thought of as
leagues are doing?” Most substance abuse counselors a caring, compassionate person, a skilled helper.”
come into the field with a strong sense of calling and These are important spiritual questions that you can
the desire to be of service to others, with a strong pull discuss with your supervisees.
to use their gifts and make themselves instruments of
service and healing. The substance abuse treatment Other suggestions include:
field risks losing many skilled and compassionate • Help staff identify what is happening within the
healers when the life goes out of their work. Some organization that might be contributing to their
counselors simply withdraw, care less, or get out of stress and learn how to address the situation in a
the field entirely. Most just complain or suffer in way that is productive to the client, the counselor,
silence. Given the caring and dedication that brings and the organization.
counselors into the field, it is important for you to • Get training in identifying the signs of primary
help them address their questions and doubts. (See stress reactions, secondary trauma, compassion
Lambie, 2006, and Shoptaw, Stein, & Rawson, 2000.) fatigue, vicarious traumatization, and burnout.
You can help counselors with self-care; help them Help staff match up self-care tools to specifically
look within; become resilient again; and rediscover address each of these experiences.
what gives them joy, meaning, and hope in their • Support staff in advocating for organizational
work. Counselors need time for reflection, to listen change when appropriate and feasible as part of
again deeply and authentically. You can help them your role as liaison between administration and
redevelop their innate capacity for compassion, to be clinical staff.
an openhearted presence for others. • Assist staff in adopting lifestyle changes to
increase their emotional resilience by reconnecting
You can help counselors develop a life that does not to their world (family, friends, sponsors, mentors),
revolve around work. This has to be supported by the spending time alone for self-reflection, and form-
organization’s culture and policies that allow for ing habits that re-energize them.
appropriate use of time off and self-care without pun- • Help them eliminate the “what ifs” and negative
ishment. Aid them by encouraging them to take self-talk. Help them let go of their idealism that
earned leave and to take “mental health” days when they can save the world.
they are feeling tired and burned out. Remind staff to • If possible in the current work environment, set
spend time with family and friends, exercise, relax, parameters on their work by helping them adhere
read, or pursue other life-giving interests. to scheduled time off, keep lunch time personal,
It is important for the clinical supervisor to normalize set reasonable deadlines for work completion, and
the counselor’s reactions to stress and compassion keep work away from personal time.
fatigue in the workplace as a natural part of being an • Teach and support generally positive work habits.
empathic and compassionate person and not an indi- Some counselors lack basic organizational, team-
vidual failing or pathology. (See Burke, Carruth, & work, phone, and time management skills (ending
Prichard, 2006.) sessions on time and scheduling to allow for docu-
mentation). The development of these skills helps
Rest is good; self-care is important. Everyone needs to reduce the daily wear that erodes well-being
times of relaxation and recreation. Often, a month and contributes to burnout.
after a refreshing vacation you lose whatever gain • Ask them “When was the last time you had fun?”
you made. Instead, longer term gain comes from find- “When was the last time you felt fully alive?”
ing what brings you peace and joy. It is not enough Suggest they write a list of things about their job

about which they are grateful. List five people cedures to follow when impairment is identified.
they care about and love. List five accomplish- Consultation with the organization’s attorney and
ments in their professional life. Ask “Where do you familiarity with State case law are important. It is
want to be in your professional life in 5 years?” advisable for the agency to be familiar with and have
contact with your State impaired counselor organiza-
You have a fiduciary responsibility given you by tion, if it exists.
clients to ensure counselors are healthy and whole. It
How impaired must a counselor be before disciplinary
is your responsibility to aid counselors in addressing
action is needed? Clear job descriptions and state-
their fatigue and burnout.
ments of scope of practice and competence are impor-
tant when facing an impaired counselor. How tired or
Gatekeeping Functions distressed can a counselor be before a supervisor
In monitoring counselor performance, an important takes the counselor off-line for these or similar rea-
and often difficult supervisory task is managing prob- sons? You need administrative support with such
lem staff or those individuals who should not be coun- interventions and to identify approaches to managing
selors. This is the gatekeeping function. Part of the worn-out counselors. The Consensus Panel recom-
dilemma is that most likely you were first trained as mends that your organization have an employee
a counselor, and your values lie within that domain. assistance program (EAP) in place so you can refer
You were taught to acknowledge and work with indi- staff outside the agency. It is also important for you
vidual limitations, always respecting the individual’s to learn the distinction between a supervisory refer-
goals and needs. However, you also carry a responsi- ral and a self-referral. Self-referral may include a
bility to maintain the quality of the profession and to recommendation by the supervisor, whereas a super-
protect the welfare of clients. Thus, you are charged visory referral usually occurs with a job performance
with the task of assessing the counselor for fitness for problem.
duty and have an obligation to uphold the standards You will need to provide verbal and written evalua-
of the profession. tions of the counselor’s performance and actions to
Experience, credentials, and academic performance ensure that the staff member is aware of the behav-
are not the same as clinical competence. In addition iors that need to be addressed. Treat all supervisees
to technical counseling skills, many important thera- the same, following agency procedures and timelines.
peutic qualities affect the outcome of counseling, Follow the organization’s progressive disciplinary
including insight, respect, genuineness, concreteness, steps and document carefully what is said, how the
and empathy. Research consistently demonstrates person responds, and what actions are recommended.
that personal characteristics of counselors are highly You can discuss organizational issues or barriers to
predictive of client outcome (Herman, 1993, Hubble, action with the supervisee (such as personnel policies
Duncan & Miller, 1999). The essential questions are: that might be exacerbating the employee’s issues).
Who should or should not be a counselor? What Finally, it may be necessary for you to take the action
behaviors or attitudes are unacceptable? How would a that is in the best interest of the clients and the pro-
clinical supervisor address these issues in supervi- fession, which might involve counseling your super-
sion? visee out of the field.
Unacceptable behavior might include actions hurtful Remember that the number one goal of a clinical
to the client, boundary violations with clients or pro- supervisor is to protect the welfare of the client,
gram standards, illegal behavior, significant psychi- which, at times, can mean enforcing the gatekeeping
atric impairment, consistent lack of self-awareness, function of supervision.
inability to adhere to professional codes of ethics, or
consistent demonstration of attitudes that are not
conducive to work with clients in substance abuse Methods of Observation
treatment. You will want to have a model and policies
It is important to observe counselors frequently over
and procedures in place when disciplinary action is
an extended period of time. Supervisors in the sub-
undertaken with an impaired counselor. For example,
stance abuse treatment field have traditionally relied
progressive disciplinary policies clearly state the pro-
on indirect methods of supervision (process record- their treatment before they consent to counseling.
ings, case notes, verbal reports by the supervisees, Additionally, clients need to be notified of an
and verbatims). However, the Consensus Panel rec- upcoming observation by a supervisor before the
ommends that supervisors use direct observation of observation occurs.
counselors through recording devices (such as video • Observations should be selected for review (includ-
and audio taping) and live observation of counseling ing a variety of sessions and clients, challenges,
sessions, including one-way mirrors. Indirect methods and successes) because they provide teaching
have significant drawbacks, including: moments. You should ask the supervisee to select
what cases he or she wishes you to observe and
• A counselor will recall a session as he or she expe-
explain why those cases were chosen. Direct obser-
rienced it. If a counselor experiences a session pos-
vation should not be a weapon for criticism but a
itively or negatively, the report to the supervisor
constructive tool for learning: an opportunity for
will reflect that. The report is also affected by the
the counselor to do things right and well, so that
counselor’s level of skill and experience.
positive feedback follows.
• The counselor’s report is affected by his or her
• When observing a session, you gain a wealth of
biases and distortions (both conscious and uncon-
information about the counselor. Use this informa-
scious). The report does not provide a thorough
tion wisely, and provide gradual feedback, not a
sense of what really happened in the session
litany of judgments and directives. Ask the salient
because it relies too heavily on the counselor’s
question, “What is the most important issue here
recall.
for us to address in supervision?”
• Indirect methods include a time delay in
• A supervisee might claim client resistance to
reporting.
direct observation, saying, “It will make the client
• The supervisee may withhold clinical information
nervous. The client does not want to be taped.”
due to evaluation anxiety or naiveté.
However, “client resistance” is more likely to be
reported when the counselor is anxious about
Your understanding of the session will be improved being taped. It is important for you to gently and
by direct observation of the counselor. Direct observa- respectfully address the supervisee’s resistance
tion is much easier today, as a variety of technologi- while maintaining the position that direct obser-
cal tools are available, including audio and videotap- vation is an integral component of his or her
ing, remote audio devices, interactive videos, live supervision.
feeds, and even supervision through web-based cam- • Given the nature of the issues in drug and alco-
eras. hol counseling, you and your supervisee need to
be sensitive to increased client anxiety about
Guidelines that apply to all methods of direct obser- direct observation because of the client’s fears
vation in supervision include: about job or legal repercussions, legal actions,
• Simply by observing a counseling session, the criminal behaviors, violence and abuse situa-
dynamics will change. You may change how both tions, and the like.
the client and counselor act. You get a snapshot of • Ideally, the supervisee should know at the outset
the sessions. Counselors will say, “it was not a of employment that observation and/or taping
representative session.” Typically, if you observe will be required as part of informed consent to
the counselor frequently, you will get a fairly accu- supervision.
rate picture of the counselor’s competencies.
• You and your supervisee must agree on procedures In instances where there is overwhelming anxiety
for observation to determine why, when, and how regarding observation, you should pace the observa-
direct methods of observation will be used. tion to reduce the anxiety, giving the counselor ade-
• The counselor should provide a context for the quate time for preparation. Often enough, counselors
session. will feel more comfortable with observation equip-
• The client should give written consent for observa- ment (such as a video camera or recording device)
tion and/or taping at intake, before beginning rather than direct observation with the supervisor in
counseling. Clients must know all the conditions of the room.

The choice of observation methods in a particular sit- supervisor, and other supervisees in group super-
uation will depend on the need for an accurate sense vision. Permission will most likely be granted if
of counseling, the availability of equipment, the con- the request is made in a sensitive and appropriate
text in which the supervision is provided, and the manner. It is critical to note that even if permis-
counselor’s and your skill levels. A key factor in the sion is initially given by the client, this permission
choice of methods might be the resistance of the coun- can be withdrawn. You cannot force compliance.
selor to being observed. For some supervisors, direct • The use and rationale for taping needs to be clear-
observation also puts the supervisor’s skills on the ly explained to clients. This will forestall a client’s
line too, as they might be required to demonstrate or questioning as to why a particular session is being
model their clinical competencies. taped.
• Risk-management considerations in today’s liti-
gious climate necessitate that tapes be erased
Recorded Observation after the supervision session. Tapes can be admis-
Audiotaped supervision has traditionally been a pri- sible as evidence in court as part of the clinical
mary medium for supervisors and remains a vital record. Since all tapes should be erased after
resource for therapy models such as motivational supervision, this must be stated in agency policies.
interviewing. On the other hand, videotape supervi- If there are exceptions, those need to be described.
sion (VTS) is the primary method of direct observa- • Too often, supervisors watch long, uninterrupted
tion in both the marriage and family therapy and segments of tape with little direction or purpose.
social work fields (Munson, 1993; Nichols, Nichols, & To avoid this, you may want to ask your super-
Hardy, 1990). Video cameras are increasingly com- visee to cue the tape to the segment he or she
monplace in professional settings. VTS is easy, acces- wishes to address in supervision, focusing on the
sible, and inexpensive. However, it is also a complex, goals established in the IDP. Having said this, lis-
powerful and dynamic tool, and one that can be chal- tening only to segments selected by the counselor
lenging, threatening, anxiety-provoking, and hum- can create some of the same disadvantages as self-
bling. Several issues related to VTS are unique to the report: the counselor chooses selectively, even if
substance abuse field: not consciously. The supervisor may occasionally
choose to watch entire sessions.
• Many substance abuse counselors “grew up” in the
• You need to evaluate session flow, pacing, and
field without taping and may be resistant to the
how counselors begin and end sessions.
medium;
• Many agencies operate on limited budgets and
administrators may see the expensive equipment Some clients may not be comfortable being videotaped
as prohibitive and unnecessary; and but may be more comfortable with audio taping.
• Many substance abuse supervisors have not been Videotaping is not permitted in most prison settings
trained in the use of videotape equipment or in VTS. and EAP services. Videotaping may not be advisable
when treating patients with some diagnoses, such as
paranoia or some schizophrenic illnesses. In such
Yet, VTS offers nearly unlimited potential for creative
cases, either live observation or less intrusive meas-
use in staff development. To that end, you need train-
ures, such as audio taping, may be preferred.
ing in how to use VTS effectively. The following are
guidelines for VTS:
• Clients must sign releases before taping. Most pro- Live Observation
grams have a release form that the client signs on With live observation you actually sit in on a counsel-
admission (see Tool 19 in Part 2, chapter 2). The ing session with the supervisee and observe the ses-
supervisee informs the client that videotaping will sion first hand. The client will need to provide
occur and reminds the client about the signed informed consent before being observed. Although
release form. The release should specify that the one-way mirrors are not readily available at most
taping will be done exclusively for training purpos- agencies, they are an alternative to actually sitting in
es and will be reviewed only by the counselor, the on the session. A videotape may also be used either
from behind the one-way mirror (with someone else observation session. Some suggest that the supervisor
operating the videotaping equipment) or physically sit so as to not interrupt or be involved in the session.
located in the counseling room, with the supervisor Others suggest that the supervisor sit in a position
sitting in the session. This combination of mirror, that allows for inclusion in the counseling process.
videotaping, and live observation may be the best of
Here are some guidelines for conducting live
all worlds, allowing for unobtrusive observation of a
observation:
session, immediate feedback to the supervisee, model-
ing by the supervisor (if appropriate), and a record of • The counselor should always begin with informed
the session for subsequent review in supervision. Live consent to remind the client about confidentiality.
supervision may involve some intervention by the Periodically, the counselor should begin the ses-
supervisor during the session. sion with a statement of confidentiality, reiterat-
ing the limits of confidentiality and the duty to
Live observation is effective for the following reasons:
warn, to ensure that the client is reminded of
• It allows you to get a true picture of the counselor what is reportable by the supervisor and/or
in action. counselor.
• It gives you an opportunity to model techniques • While sitting outside the group (or an individual
during an actual session, thus serving as a role session between counselor and client) may under-
model for both the counselor and the client. mine the group process, it is a method selected by
• Should a session become countertherapeutic, you some. Position yourself in a way that doesn’t inter-
can intervene for the well-being of the client. rupt the counseling process. Sitting outside the
• Counselors often say they feel supported when a group undermines the human connection between
supervisor joins the session, and clients periodical- you, the counselor, and the client(s) and makes it
ly say, “This is great! I got two for the price of more awkward for you to make a comment, if you
one.” have not been part of the process until then. For
• It allows for specific and focused feedback. individual or family sessions, it is also recom-
• It is more efficient for understanding the counsel- mended that the supervisor sit beside the coun-
ing process. selor to fully observe what is occurring in the
• It helps connect the IDP to supervision. counseling session.
• The client should be informed about the process of
supervision and the supervisor’s role and goals,
To maximize the effectiveness of live observation,
essentially that the supervisor is there to observe
supervisors must stay primarily in an observer role
the counselor’s skills and not necessarily the
so as to not usurp the leadership or undercut the
client.
credibility and authority of the counselor.
• As preparation, the supervisor and supervisee
Live observation has some disadvantages: should briefly discuss the background of the ses-
sion, the salient issues the supervisee wishes to
• It is time consuming. focus on, and the plans for the session. The role of
• It can be intrusive and alter the dynamics of the the supervisor should be clearly stated and agreed
counseling session. on before the session.
• It can be anxiety-provoking for all involved. • You and the counselor may create criteria for
observation, so that specific feedback is provided
Some mandated clients may be particularly sensitive for specific areas of the session.
to live observation. This becomes essentially a clinical • Your comments during the session should be limit-
issue to be addressed by the counselor with the client. ed to lessen the risk of disrupting the flow or tak-
Where is this anxiety coming from, how does it relate ing control of the session. Intervene only to protect
to other anxieties and concerns, and how can it best the welfare of the client (should something
be addressed in counseling? adverse occur in the session) or if a moment criti-
Supervisors differ on where they should sit in a live cal to client welfare arises. In deciding to inter-

vene or not, consider these questions: What are
the consequences if I don’t intervene? What is the
Practical Issues in Clinical
probability that the supervisee will make the Supervision
intervention on his or her own or that my com-
ments will be successful? Will I create an undue
dependence on the part of clients or supervisee? Distinguishing Between
• Provide feedback to the counselor as soon as possi- Supervision and Therapy
ble after the session. Ideally, the supervisor and In facilitating professional development, one of the
supervisee(s) should meet privately immediately critical issues is understanding and differentiating
afterward, outlining the key points for discussion between counseling the counselor and providing
and the agenda for the next supervision session, supervision. In ensuring quality client care and facili-
based on the observation. Specific feedback is tating professional counselor development, the
essential; “You did a fine job” is not sufficient. process of clinical supervision sometimes encroaches
Instead, the supervisor might respond by saying, on personal issues. The dividing line between therapy
“I particularly liked your comment about . . .” or and supervision is how the supervisee’s personal
“What I observed about your behavior was . . .” or issues and problems affect their work. The goal of
“Keep doing more of . . . .” clinical supervision must always be to assist coun-
selors in becoming better clinicians, not seeking to
resolve their personal issues. Some of the major dif-
ferences between supervision and counseling are
summarized in figure 6.
Figure 6. Differences Between Supervision and Counseling
Administrative
Clinical Supervision Counseling
Supervision
Purpose • Improved client care • Ensure compliance with • Personal growth

• Improved job perform- agency and regulatory • Behavior changes
ance body's policies and pro- • Better self-understand-
cedures ing
Outcome • Enhanced proficiency in • Consistent use of • Open-ended, based on

knowledge, skills, and approved formats, poli- client needs
attitudes essential to cies, and procedures
effective job perform-
ance
Timeframe • Short-term and ongoing • Short-term and ongoing • Based on client needs
Agenda • Based on agency mission • Based on agency needs • Based on client needs
and counselor needs
Basic Process • Teaching/learning specif- • Clarifying agency expec- • Behavioral, cognitive,

ic skills, evaluating job tations, policies and pro- and affective process
performance, negotiat- cedures, ensuring com- including listening,
ing learning objectives pliance exploring, teaching
Source: Adapted from Dixon, 2004
The boundary between counseling and clinical super- • In what ways can you address these issues in your
vision may not always be clearly marked, for it is nec- counseling?
essary, at times, to explore supervisees’ limitations as • What strategies and coping skills can assist you in
they deliver services to their clients. Address coun- your work with this client?
selors’ personal issues only in so far as they create
barriers or affect their performance. When personal
Transference and countertransference also occur in
issues emerge, the key question you should ask the
the relationship between supervisee and supervisor.
supervisee is how does this affect the delivery of qual-
Examples of supervisee transference include:
ity client care? What is the impact of this issue on the
client? What resources are you using to resolve this • The supervisee’s idealization of the supervisor.
issue outside of the counseling dyad? When personal • Distorted reactions to the supervisor based on the
issues emerge that might interfere with quality care, supervisee’s reaction to the power dynamics of the
your role may be to transfer the case to a different relationship.
counselor. Most important, you should make a strong • The supervisee’s need for acceptance by or
case that the supervisee should seek outside counsel- approval from an authority figure.
ing or therapy. • The supervisee’s reaction to the supervisor’s estab-
lishing professional and social boundaries with the
Problems related to countertransference (projecting
supervisee.
unresolved personal issues onto a client or super-
visee) often make for difficult therapeutic relation-
ships. The following are signs of countertransference Supervisor countertransference with supervisees is
to look for: another issue that needs to be considered. Categories
of supervisor countertransference include:
• A feeling of loathing, anxiety, or dread at the
prospect of seeing a specific client or supervisee. • The need for approval and acceptance as a knowl-
• Unexplained anger or rage at a particular client. edgeable and competent supervisor.
• Distaste for a particular client. • Unresolved personal conflicts of the supervisor
• Mistakes in scheduling clients, missed appoint- activated by the supervisory relationship.
ments. • Reactions to individual supervisees, such as dis-
• Forgetting client’s name, history. like or even disdain, whether the negative
• Drowsiness during a session or sessions ending response is “legitimate” or not. In a similar vein,
abruptly. aggrandizing and idealizing some supervisees
• Billing mistakes. (again, whether or not warranted) in comparison
• Excessive socializing. to other supervisees.
• Sexual or romantic attraction to certain super-
visees.
When countertransferential issues between counselor
• Cultural countertransference, such as catering to
and client arise, some of the important questions you,
or withdrawing from individuals of a specific cul-
as a supervisor, might explore with the counselor
tural background in a way that hinders the profes-
include:
sional development of the counselor.
• How is this client affecting you? What feelings
does this client bring out in you? What is your
To understand these countertransference reactions
behavior toward the client in response to these
means recognizing clues (such as dislike of a super-
feelings? What is it about the substance abuse
visee or romantic attraction), doing careful self-exam-
behavior of this client that brings out a response
ination, personal counseling, and receiving supervi-
in you?
sion of your supervision. In some cases, it may be nec-
• What is happening now in your life, but more par-
essary for you to request a transfer of supervisees
ticularly between you and the client that might be
with whom you are experiencing countertransference,
contributing to these feelings, and how does this
if that countertransference hinders the counselor’s
affect your counseling?
professional development.

Finally, counselors will be more open to addressing On the other hand, having separate clinical and
difficulties such as countertransference and compas- administrative supervisors can lead to inconsistent
sion fatigue with you if you communicate understand- messages about priorities, and the clinical supervi-
ing and awareness that these experiences are a nor- sor is not in the chain of command for disciplinary
mal part of being a counselor. Counselors should be purposes.
rewarded in performance evaluations for raising
these issues in supervision and demonstrating a will-
ingness to work on them as part of their professional Finding the Time To Do Clinical
development. Supervision
Having read this far, you may be wondering, “Where
do I find the time to conduct clinical supervision as
Balancing Clinical and described here? How can I do direct observation of
Administrative Functions counselors within my limited time schedule?” Or,
In the typical substance abuse treatment agency, the “I work in an underfunded program with substance
clinical supervisor may also be the administrative abuse clients. I have way too many tasks to also
supervisor, responsible for overseeing managerial observe staff in counseling.”
functions of the organization. Many organizations
One suggestion is to begin an implementation process
cannot afford to hire two individuals for these tasks.
that involves adding components of a supervision
Hence, it is essential that you are aware of what role
model one at a time. For example, scheduling super-
you are playing and how to exercise the authority
visory meetings with each counselor is a beginning
given you by the administration. Texts on supervision
step. It is important to meet with each counselor on a
sometimes overlook the supervisor’s administrative
regular, scheduled basis to develop learning plans
tasks, but supervisors structure staff work; evaluate
and review professional development. Observations of
personnel for pay and promotions; define the scope of
counselors in their work might be added next.
clinical competence; perform tasks involving plan-
Another component might involve group supervision.
ning, organizing, coordinating, and delegating work;
In group supervision, time can be maximized by
select, hire, and fire personnel; and manage the
teaching and training counselors who have common
organization. Clinical supervisors are often responsi-
skill development needs.
ble for overseeing the quality assurance and improve-
ment aspects of the agency and may also carry a case- As you develop a positive relationship with super-
load. For most of you, juggling administrative and visees based on cooperation and collaboration, the
clinical functions is a significant balancing act. Tips anxiety associated with observation will decrease.
for juggling these functions include: Counselors frequently enjoy the feedback and support
so much that they request observation of their work.
• Try to be clear about the “hat you are wearing.”
Observation can be brief. Rather than sitting in on a
Are you speaking from an administrative or clini-
full hour of group, spend 20 minutes in the observa-
cal perspective?
tion and an additional 20 providing feedback to the
• Be aware of your own biases and values that may
counselor.
be affecting your administrative opinions.
• Delegate the administrative functions that you Your choice of modality (individual, group, peer, etc.)
need not necessarily perform, such as human is influenced by several factors: supervisees’ learning
resources, financial, or legal functions. goals, their experience and developmental levels,
• Get input from others to be sure of your objectivity their learning styles, your goals for supervisees, your
and your perspective. theoretical orientation, and your own learning goals
for the supervisory process. To select a modality of
supervision (within your time constraints and those
There may be some inherent problems with perform-
of your supervisee), first pinpoint the immediate func-
ing both functions, such as dual relationships.
tion of supervision, as different modalities fit differ-
Counselors may be cautious about acknowledging dif-
ent functions. For example, a supervisor might wish
ficulties they face in counseling because these may
to conduct group supervision when the team is intact
affect their performance evaluation or salary raises.
and functioning well, and individual supervision
when specific skill development or countertransferen- Intensive supervision with selected counselors is help-
tial issues need additional attention. Given the vari- ful in working with a difficult client (such as one with
ety of treatment environments in substance abuse a history of violence), a client using substances unfa-
treatment (e.g., therapeutic communities, intensive miliar to the counselor, or a highly resistant client.
outpatient services, transitional living settings, cor- Because of a variety of factors (credentialing require-
rectional facilities) and varying time constraints on ments, skill deficits of some counselors, the need for
supervisors, several alternatives to structure supervi- close clinical supervision), you may opt to focus, for
sion are available. concentrated periods of time, on the needs of one or
two counselors as others participate in peer supervi-
Peer supervision is not hierarchical and does not
sion. Although this is not necessarily a long-term
include a formal evaluation procedure, but offers a
solution to the time constraints of a supervisor, inten-
means of accountability for counselors that they
sive supervision provides an opportunity to address
might not have in other forms of supervision. Peer
specific staffing needs while still providing a “reason-
supervision may be particularly significant among
able effort to supervise” all personnel.
well-trained, highly educated, and competent coun-
selors. Peer supervision is a growing medium, given Group clinical supervision is a frequently used and
the clinical supervisors’ duties. Although peer super- efficient format for supervision, team building, and
vision has received limited attention in literature, the staff growth. One supervisor assists counselor devel-
Consensus Panel believes it is a particularly effective opment in a group of supervisee peers. The recom-
method, especially for small group practices and mended group size is four to six persons to allow for
agencies with limited funding for supervision. Peer frequent case presentations by each group member.
supervision groups can evolve from supervisor-led With this number of counselors, each person can
groups or individual sessions to peer groups or can present a case every other month—an ideal situation,
begin as peer supervision. For peer supervision especially when combined with individual and/or peer
groups offered within an agency, there may be some supervision. The benefits of group supervision are
history to overcome among the group members, such that it is cost-effective, members can test their per-
as political entanglements, competitiveness, or perceptions through peer validation, learning is
sonality concerns. (Bernard and Goodyear [2004] has enhanced by the diversity of the group, it creates a
an extensive review of the process and the advan- working alliance and improves teamwork, and it pro-
tages and disadvantages of peer supervision.) vides a microcosm of group process for participants.
Group supervision gives counselors a sense of com-
Triadic supervision is a tutorial and mentoring rela-
monality with others in the same situation. Because
tionship among three counselors. This model of
the formats and goals differ, it is helpful to think
supervision involves three counselors who, on a
through why you are using a particular format.
rotating basis, assume the roles of the supervisee,
(Examples of group formats with different goals can
the commentator, and the supervision session facili-
be found in Borders and Brown, 2005, and Bernard &
tator. Spice and Spice (1976) describe peer supervi-
Goodyear, 2004.)
sion with three supervisees getting together. In cur-
rent counseling literature, triadic supervision Given the realities of the substance abuse treatment
involves two counselors with one supervisor. There is field (limited funding, priorities competing for time,
very little empirical or conceptual literature on this counselors and supervisors without advanced aca-
arrangement. demic training, and clients with pressing needs in a
brief-treatment environment), the plan described
Individual supervision, where a supervisor works
below may be a useful structure for supervision. It is
with the supervisee in a one-to-one relationship, is
based on a scenario where a supervisor oversees one
considered the cornerstone of professional skill
to five counselors. This plan is based on several
development. Individual supervision is the most
principles:
labor-intensive and time-consuming method for
supervision. Credentialing requirements in a partic- • All counselors, regardless of years of experience or
ular discipline or graduate studies may mandate academic training, will receive at least 1 hour of
individual supervision with a supervisor from the supervision for every 20 to 40 hours of clinical
same discipline. practice.

• Direct observation is the backbone of a solid clini- increasing the total hours for clinical supervision to 4,
cal supervision model. still a manageable amount of time.
• Group supervision is a viable means of engaging
all staff in dialog, sharing ideas, and promoting
team cohesion. Documenting Clinical Supervision
Correct documentation and recordkeeping are essen-
With the formula diagramed below, each counselor tial aspects of supervision. Mechanisms must be in
receives a minimum of 1 hour of group clinical super- place to demonstrate the accountability of your role.
vision per week. Each week you will have 1 hour of (See Tools 10–12 in Part 2, chapter 2.) These systems
observation, 1 hour of individual supervision with one should document:
of your supervisees, and 1 hour of group supervision
• Informal and formal evaluation procedures.
with five supervisees. Each week, one counselor will
• Frequency of supervision, issues discussed, and
be observed in an actual counseling session, followed
the content and outcome of sessions.
by an individual supervision session with you. If the
• Due process rights of supervisees (such as the
session is videotaped, the supervisee can be asked to
right to confidentiality and privacy, to informed
cue the tape to the segment of the session he or she
consent).
wishes to discuss with you. Afterwards, the observed
• Risk management issues (how to handle
counselor presents this session in group clinical
crises, duty-to-warn situations, breaches of
supervision.
confidentiality).
When it is a counselor’s week to be observed or taped
and meet for individual supervision, he or she will One comprehensive documentation system is Falvey’s
receive 3 hours of supervision: 1 hour of direct obser- (2002a) Focused Risk Management Supervision
vation, 1 hour of individual/one-on-one supervision, System (FoRMSS), which provides templates to
and 1 hour of group supervision when he or she pres- record emergency contact information, supervisee
ents a case to the group. Over the course of months, profiles, a logging sheet for supervision, an initial
with vacation, holiday, and sick time, it should aver- case review, supervision records, and a client termi-
age out to approximately 1 hour of supervision per nation form.
counselor per week. Figure 7 shows this schedule.
Supervisory documents and notes are open to man-
When you are working with a counselor who needs agement, administration, and human resources (HR)
special attention or who is functioning under specific personnel for performance appraisal and merit pay
requirements for training or credentialing, 1 addition- increases and are admissible in court proceedings.
al hour per week can be allocated for this counselor, Supervision notes, especially those related to work
Figure 7. Sample Clinical Supervision Schedule
Counselor Week 1 Week 2 Week 3 Week 4 Week 5
1 hour direct observation

1 hour individual supervision
A 1 hour group 1 hour group 1 hour group 1 hour group
1 hour group supervision of A’s case
(3 hours)
B 1 hour group 3 hour group 1 hour group 1 hour group 1 hour group
C 1 hour group 1 hour group 3 hour group 1 hour group 1 hour group
D 1 hour group 1 hour group 1 hour group 3 hour group 1 hour group
E 1 hour group 1 hour group 1 hour group 1 hour group 3 hour group
with clients, are kept separately and are intended for • Discuss methods of supervision, the techniques to
the supervisor’s use in helping the counselor improve be used, and the resources available to the super-
clinical skills and monitor client care. It is imperative visee (e.g., agency inservice seminar, community
to maintain accurate and complete notes on the workshops, professional association memberships,
supervision. However, as discussed above, documen- and professional development funds or training
tation procedures for formative versus summative opportunities).
evaluation of staff may vary. Typically, HR accesses • Explore the counselor’s goals for supervision and
summative evaluations, and supervisory notes are his or her particular interests (and perhaps some
maintained as formative evaluations. fears) in clinical supervision.
• Explain the differences between supervision and
An example of a formative note by a supervisor might
therapy, establishing clear boundaries in this
be “The counselor responsibly discussed countertrans-
relationship.
ferential issues occurring with a particular client and
• Work to establish a climate of cooperation, collabo-
was willing to take supervisory direction,” or “We
ration, trust, and safety.
worked out an action plan, and I will follow this
• Create an opportunity for rating the counselor’s
closely.” This wording avoids concerns by the supervi-
knowledge and skills based on the competencies in
sor and supervisee as to the confidentiality of super-
TAP 21 (CSAT, 2007).
visory notes. From a legal perspective, the supervisor
• Explain the methods by which formative and sum-
needs to be specific about what was agreed on and a
mative evaluations will occur.
timeframe for following up.
• Discuss the legal and ethical expectations and
responsibilities of supervision.
Structuring the Initial Supervision • Take time to decrease the anxiety associated with
being supervised and build a positive working
Sessions
relationship.
As discussed earlier, your first tasks in clinical super-
vision are to establish a behavioral contract, get to
know your supervisees, and outline the requirements It is important to determine the knowledge and skills,
of supervision. Before the initial session, you should learning style, and conceptual skills of your super-
send a supportive letter to the supervisee expressing visees, along with their suitability for the work set-
the agency’s desire to provide him or her with a quali- ting, motivation, self-awareness, and ability to func-
ty clinical supervision experience. You might request tion autonomously. A basic IDP for each supervisee
that the counselor give some thought to what he or should emerge from the initial supervision sessions.
she would like to accomplish in supervision, what You and your supervisee need to assess the learning
skills to work on, and which core functions used in environment of supervision by determining:
the addiction counselor certification process he or she
• Is there sufficient challenge to keep the supervisee
feels most comfortable performing.
motivated?
In the first few sessions, helpful practices include: • Are the theoretical differences between you and
the supervisee manageable?
• Briefly describe your role as both administrative • Are there limitations in the supervisee’s knowl-
and clinical supervisor (if appropriate) and discuss edge and skills, personal development, self-effica-
these distinctions with the counselor. cy, self-esteem, and investment in the job that
• Briefly describe your model of counseling and would limit the gains from supervision?
learn about the counselor’s frameworks and mod- • Does the supervisee possess the affective qualities
els for her or his counseling practice. For begin- (empathy, respect, genuineness, concreteness,
ning counselors this may mean helping them warmth) needed for the counseling profession?
define their model. • Are the goals, means of supervision, evaluation
• Describe your model of supervision. criteria, and feedback process clearly understood
• State that disclosure of one’s supervisory training, by the supervisee?
experience, and model is an ethical duty of clinical • Does the supervisory environment encourage and
supervisors. allow risk taking?

The context in which supervision is provided affects
Methods and Techniques how it is carried out. A critical issue is how to man-
of Clinical Supervision age your supervisory workload and make a reason-
able effort to supervise. The contextual issues that
A number of methods and techniques are available
shape the techniques and methods of supervision
for clinical supervision, regardless of the modality
include:
used. Methods include (as discussed previously) case
consultation, written activities such as verbatims and • The allocation of time for supervision. If the 20:1
process recordings, audio and videotaping, and live rule of client hours to supervision time is followed,
observation. Techniques include modeling, skill you will want to allocate sufficient time for super-
demonstrations, and role playing. (See descriptions of vision each week so that it is a high priority, regu-
these and other methods and techniques in Bernard larly scheduled activity.
& Goodyear, 2004; Borders & Brown, 2005; Campbell, • The unique conditions, limitations, and require-
2000; and Powell & Brodsky, 2004.) Figure 8 outlines ments of the agency. Some organizations may lack
some of the methods and techniques of supervision, the physical facilities or hardware to use videotap-
as well as the advantages and disadvantages of each ing or to observe sessions. Some organizations
method. may be limited by confidentiality requirements,
Figure 8. Methods and Techniques in Clinical Supervision
Description Advantages Disadvantages
Verbal Reports Verbal reports of clinical • Informal • Sessions seen through eyes
situations • Time efficient of beholder
• Often spontaneous in • Nonverbal cues missed
Group discussion of clinical response to clinical situation • Can drift into case manage-
situations • Can hear counselor’s report, ment, hence it is important
what he or she includes, thus to focus on the clinical
learn of the counselor’s nature of chart reviews,
awareness and perspective, reports, etc., linking to the
what he or she wishes to treatment plan and EBPs
report, contrasted with super-
visory observations
Verbatim Reports Process recordings • Helps track coordination and • Nonverbal cues missed
use of treatment plan with • Self-report bias
Verbatim written record of a ongoing session • Can be very tedious to write
session or part of session • Enhances conceptualization and to read
and writing skills
Declining method in the • Enhances recall and reflection
behavioral health field skills
• Provides written documenta-
tion of sessions
Written/File Review of the progress • An important task of a super- • Time consuming

Review notes, charts, documenta- visor to ensure compliance • Notes often miss the overall
tion with accreditation standards quality and essence of the
for documentation session
• Provides a method of quality • Can drift into case manage-
control ment rather than clinical
• Ensures consistency of records skills development
and files
Figure 8. Methods and Techniques in Clinical Supervision (continued)
Case Discussion of cases • Helps organize information, • The validity of self-report is

Consultation/ Brief case reviews conceptualize problems, and dependent on counselor
Case decide on clinical interventions developmental level and the
Management • Examines issues (e.g., cross-cul- supervisor’s insightfulness
tural issues), integrates theory • Does not reflect broad range
and technique, and promotes of clinical skills of the coun-
greater self-awareness selor
• An essential component of
treatment planning
Direct The supervisor watches the • Allows teaching of basic skills • May create anxiety
Observation session and may provide while protecting quality of care • Requires supervisor caution in
periodic but limited com- • Counselor can see and experi- intervening so as to not take
ments and/or suggestions ence positive change in session over the session or to create
to the clinician direction in the moment undue dependence for the
• Allows supervisor to intervene counselor or client
when needed to protect the • Can be seen as intrusive to
welfare of the client, if the ses- the clinical process
sion is not effective or is • Time consuming
destructive to the client
Audiotaping Audiotaping and review of • Technically easy and inexpen- • Counselor may feel anxious
a counseling session sive • Misses nonverbal cues
• Can explore general rapport, • Poor sound quality often
pace, and interventions occurs due to limits of tech-
• Examines important relation- nology
ship issues
• Unobtrusive medium
• Can be listened to in clinical or
team meetings
Videotaping Videotaping and review of • A rich medium to review verbal • Can be seen as intrusive to
a counseling session and nonverbal information the clinical process
• Provides documentation of clin- • Counselor may feel anxious
ical skills and self-conscious, although
• Can be viewed by the treat- this subsides with experience
ment team during group clini- • Technically more complicated
cal supervision session • Requires training before
• Uses time efficiently using
• Can be used in conjunction • Can become part of the clini-
with direct observation cal record and can be sub-
• Can be used to suggest differ- poenaed (should be
ent interventions destroyed after review)
• Allows for review of content,
affective and cognitive aspects,
process relationship issues in
the present

Figure 8. Methods and Techniques in Clinical Supervision (continued)
Webcam Internet supervision, syn- • Can be accessed from any com- • Concerns about anonymity
chronistic and asynchronis- puter and confidentiality
tic • Especially useful for remote • Can be viewed as invasive to
and satellite facilities and loca- the clinical process
Teleconferencing tions • May increase client or coun-
• Uses time efficiently selor anxiety or self-con-
• Modest installation and opera- sciousness
tion costs • Technically more complicated
• Can be stored or downloaded • Requires assurance that
on a variety of media, watched downloads will be erased and
in any office, then erased unavailable to unauthorized
staff
Cofacilitation Supervisor and counselor • Allows the supervisor to model • Supervisor must demonstrate
and Modeling jointly run a counseling techniques while observing the proficiency in the skill and
session counselor help the counselor incremen-
• Can be useful to the client tally integrate the learning
Supervisor demonstrates a (“two counselors for the price • The client may perceive coun-
specific technique while of one”) selor as less skilled than the
the counselor observes • Supervisor must demonstrate supervisor
proficiency in the skill and help • Time consuming
This may be followed by the counselor incrementally
roleplay with the coun- integrate the learning
selor practicing the skill • Counselor sees how the super-
with time to process learn- visor might respond
ing and application • Supervisor incrementally shapes
the counselor’s skill acquisition
and monitors skill mastery
• Allows supervisor to aid coun-
selor with difficult clients
Role Playing Role play a clinical situa- • Enlivens the learning process • Counselor can be anxious
tion • Provides the supervisor with • Supervisor must be mindful
direct observation of skills of not overwhelming the
• Helps counselor gain a differ- counselor with information
ent perspective
• Creates a safe environment for
the counselor to try new skills
Source: Adapted from Mattel, 2007.
such as working within a criminal justice system • Clinical and management responsibilities of a
where taping may be prohibited. supervisor. Supervisors have varied responsibili-
• The number of supervisees reporting to a supervi- ties, including administrative tasks, limiting the
sor. It is difficult to provide the scope of supervi- amount of time available for clinical supervision.
sion discussed in this TIP if a supervisor has more
than ten supervisees. In such a case, another
supervisor could be named or peer supervision
could be used for advanced staff.
ance. A complete record is a useful and necessary
Administrative part of supervision. Records of supervision sessions
Supervision should include:
As noted above, clinical and administrative supervi- • The supervisor–supervisee contract, signed by
sion overlap in the real world. Most clinical supervi- both parties.
sors also have administrative responsibilities, includ- • A brief summary of the supervisee’s experience,
ing team building, time management, addressing training, and learning needs.
agency policies and procedures, recordkeeping, • The current IDP.
human resources management (hiring, firing, disci- • A summary of all performance evaluations.
plining), performance appraisal, meeting manage- • Notations of all supervision sessions, including
ment, oversight of accreditation, maintenance of legal cases discussed and significant decisions made.
and ethical standards, compliance with State and • Notation of cancelled or missed supervision
Federal regulations, communications, overseeing staff sessions.
cultural competence issues, quality control and • Progressive discipline steps taken.
improvement, budgetary and financial issues, prob- • Significant problems encountered in supervision
lem solving, and documentation. Keeping up with and how they were resolved.
these duties is not an easy task! • Supervisor’s clinical recommendations provided to
supervisees.
This TIP addresses two of the most frequently voiced
• Relevant case notes and impressions.
concerns of supervisors: documentation and time
management. Supervisors say, “We are drowning in
paperwork. I don’t have the time to adequately docu- The following should not be included in a supervision
ment my supervision as well,” and “How do I manage record:
my time so I can provide quality clinical supervision?”
• Disparaging remarks about staff or clients.
• Extraneous or sensitive supervisee information.
Documentation for Administrative • Alterations in the record after the fact or prema-
Purposes ture destruction of supervision records.
• Illegible information and nonstandard
One of the most important administrative tasks of a
abbreviations.
supervisor is that of documentation and recordkeep-
ing, especially of clinical supervision sessions. Several authors have proposed a standardized format
Unquestionably, documentation is a crucial risk-man- for documentation of supervision, including Falvey
agement tool. Supervisory documentation can help (2002b), Glenn and Serovich (1994), and Williams
promote the growth and professional development of (1994).
the counselor (Munson, 1993). However, adequate
documentation is not a high priority in some organi-
zations. For example, when disciplinary action is
Time Management
needed with an employee, your organization’s attor- By some estimates, people waste about two hours
ney or human resources department will ask for the every day doing tasks that are not of high priority. In
paper trail, or documentation of prior performance your busy job, you may find yourself at the end of the
issues. If appropriate documentation to justify disci- week with unfinished tasks or matters that have not
plinary action is missing from the employee’s record, been tended to. Your choices? Stop performing some
it may prove more difficult to conduct the appropriate tasks (often training or supervision) or take work
disciplinary action (See Falvey, 2002; Powell & home and work longer days. In the long run, neither
Brodsky, 2004.) of these choices is healthy or effective for your organi-
zation. Yet, being successful does not make you man-
Documentation is no longer an option for supervisors. age your time well. Managing your time well makes
It is a critical link between work performance and you successful. Ask yourself these questions about
service delivery. You have a legal and ethical require- your priorities:
ment to evaluate and document counselor perform-

• Why am I doing this? What is the goal of this at http://www.kap.samhsa.gov). The following are
activity? examples of online classroom training programs in
• How can I best accomplish this task in the least clinical supervision in the substance abuse field:
amount of time?
• http://www.attcnetwork.org/midatlantic, Clinical
• What will happen if I choose not to do this?
Supervision for Substance Abuse Treatment
Practitioners Series.
It is wise to develop systems for managing time- • http://www.attcnetwork.org/midatlantic,
wasters such as endless meetings held without notes Motivational Interviewing Assessment: Supervisory
or minutes, playing telephone or email tag, junk mail, Tools for Enhancing Proficiency.
and so on. Effective supervisors find their times in • http://www.attcnetwork.org/northeast, Clinical
the day when they are most productive. Time man- Supervision to Support the Implementation,
agement is essential if you are to set time aside and Fidelity and Sustaining Evidence-Based Practices.
dedicate it to supervisory tasks. • http://www.attcnetwork.org/northwestfrontier,
Clinical Supervision, Part 2: What Happens in
Good Supervision.
Resources
Other training programs are given in professional
The following are resources for supervision: graduate schools, such as New York University
• Code of Ethics from the Association of Addictions School of Social Work; Smith College School for Social
Professionals (NAADAC; http://naadac.org). Work; University of Nevada, Reno, Human and
• International Certification & Reciprocity Community Sciences; and Portland State University
Consortium’s Code of Ethics Graduate School of Education.
(http://www.icrcaoda.org). For information about tools to measure counselor
• Codes of ethics from professional groups such as competencies and supervisor self-assessment tools,
the American Association for Marriage and Family along with samples, see the following:
Therapy (http://www.aamft.org), the American
Counseling Association • David J. Powell and Archie Brodsky, Clinical
(http://www.counseling.org), the Association for Supervision in Alcohol and Drug Abuse
Counselor Education and Supervision Counseling, 2004.
(http://www.acesonline.net), the American • L. DiAnne Borders and Lori L. Brown, The New
Psychological Association (http://www.apa.org), the Handbook of Counseling Supervision, 2005
National Association of Social Workers • Jane M. Campbell, Becoming an Effective
(http://www.socialworkers.org), and the National Supervisor, 2000.
Board for Certified Counselors (NBCC; • Janet Elizabeth Falvey, Managing Clinical
http://www.nbcc.org). Supervision: Ethical Practice and Legal Risk
• ACES Standards for Counseling Supervisors; Management, 2002.
ACES Ethical Guidelines for Counseling • Carol A. Falender and Edward P. Shafranske,
Supervisors Clinical Supervision: A Competency-Based
(http://www.acesonline.net/ethical_guidelines.asp); Approach, 2004.
and NBCC Standards for the Ethical Practice of • Cal D. Stoltenberg, Brian McNeill, and Ursula
Clinical Supervision. Delworth, IDM Supervision: An Integrated
Developmental Model for Supervising Counselors
and Therapists, 1998.
TAP 21-A provides detailed appendices of suggested
reading and other resources (CSAT, 2007).
Additionally, Part 3 of this document provides a liter-
ature review and bibliographies (available online only
34 Clinical Supervision and Professional Development Part 1, Chapter 1

Chapter 2
Introduction
In this chapter, through vignettes, you will meet eight clinical supervisors with a variety of skill levels, a num-
ber of their supervisees, and an administrator. The supervisors face counselors with a variety of issues. One is
unfamiliar with supervision, one has ethical issues, one is resistant to change, and another is a problem
employee. The supervisors also have issues of their own. One grapples with the challenges of a new position,
and another works to create a legacy. The vignettes, which incorporate these issues along with the principles
outlined in Part 1, chapter 1, are designed to show how clinical supervisors might manage some fairly typical
situations.
Each vignette provides an overview of the agency and of the backgrounds of the supervisor and other individu-
als in the dialog. A list of the learning objectives for each vignette is also included. Embedded in the dialog are
additional features:
Master Supervisor Notes are comments from an experienced clinical supervisor about the strategies used,
what the supervisor may be thinking, how supervisors with different levels of experience and competence might
have managed the situation, and information supervisors should have.
“How-to” Notes contain information on how to implement a specific method or strategy.
The master supervisor represents the combined experience and wisdom of the TIP Consensus Panel and pro-
vides insights into the counselor’s relationships with clients and suggests possible approaches. The notes pro-
vide some indication of the breadth of the master supervisor’s clinical skills as well as the extent to which the
supervisor moves effortlessly among clinical, supportive, evaluative, and administrative roles.
“How-to” notes reflect the collected experience of the TIP Consensus Panel along with information gleaned from
a variety of textbooks, manuals, and workbooks on clinical supervision. Not all “how-tos” will apply in every sit-
uation, but this information can be adapted to meet the specific needs of your case.
This format was chosen to assist clinical supervisors at all levels of mastery, including those who are new in
the position, those who have some experience but need more diversity and depth, and those with years of expe-
rience and training who are true master supervisors. The Consensus Panel has made significant efforts to pres-
ent realistic scenes in supervision using clinical approaches that include motivational interviewing (MI), cogni-
tive–behavioral therapy (CBT), supportive psychotherapy, crisis intervention methods, and a variety of supervi-
sory methodologies including live observation, education, and ethical decisionmaking. In all of these efforts,
basic dynamics of supervision, such as relationship building, managing rapport in stressful situations, giving
feedback, assessing, and understanding and responding to the needs expressed by the counselor are demon-
strated. The Panel does not intend to imply that the approach used by the supervisor is the “gold standard,”
although the approach shown does represent competent supervision that can be performed in real settings.
Vignette 1—Establishing a New Approach for Clinical

Supervision
Overview
This vignette illustrates the tasks of a clinical supervisor in describing a range of supervision methods to clini-
cal staff, including establishing a consistent model of direct observation. The vignette begins with the supervi-
sor describing to staff how he will implement a new method of supervision.
Background
Walt has been assigned to redesign the supervision program for a community-based substance abuse treatment
program, which includes an inpatient program, intensive outpatient program, family therapy, impaired driver
treatment, drug court program, halfway house, and educational services. The decision was made to establish an
integrated system of supervision. The agency’s staff, with ten full-time-equivalent counseling positions, has a
broad range of professional training and experience, from entry-level certified addiction counselors to licensed
social workers and licensed professional counselors. All staff, regardless of degrees and training, basically have
the same duties.
Until now, staff received primarily administrative supervision with an emphasis on meeting job performance
standards. Walt wants to make the supervision more clinical in nature, using direct methods of observation
(videotape and live observation). He anticipates program growth in the next few years and wants to mentor key
staff who can assume supervisory responsibilities in the future.
Walt has been meeting with clinical staff in small groups organized along work teams into dyads and triads to
describe the changes and new opportunities. The vignette begins with Walt meeting with two staff members to
discuss their learning needs and to present the new clinical supervision system. Al is in recovery, with 5 years
of sobriety and 3 years of experience as a counselor. Carrie has an M.S.W. degree with 6 years of work experi-
ence.
Learning Goals
1. To demonstrate a range of supervision methods, with an emphasis on direct observation through videotaping
and live observation.
2. To illustrate the mentoring, coaching, and educational functions of supervision.
3. To demonstrate how these functions can be integrated into a consistent model of clinical supervision with
fidelity to the methods and adaptability to the unique needs of each organization.
[After greetings, Walt begins the discussion about the new supervision approach.]
WALT : As you know, our CEO and senior staff have agreed that we need to establish a program of staff train-
ing and supervision that will help achieve the goals of the agency and, at the same time, help counselors
improve their skills. We’ve done a good job developing other administrative systems, and the next step is to
implement clinical supervision to address both agency goals and your individual goals for professional develop-
ment. People are moving into new roles, so new skills will be required of us.
AL: I’m not sure what I need. How will supervision enhance my skills?
WALT: Al, I think that is a great place to start. We’ve had administrative supervision so far. As we continue to
grow individually and together, we’ll need new skills. Perhaps a place for us to start is to discuss what will be
asked of us in the future, what skills we’ll need. How would it be if we had that discussion now?
AL: That sounds a little frightening. We need to know and do more? How much more blood can they get out of us?
[Laughter in the group.]
Master Supervisor Note: A new supervisor might respond differently to Al’s

comment, in a more mechanical or authoritarian manner, asserting authority,
wanting to be the expert, creating an “us vs. them” scenario. Such an approach
might discourage staff from embracing the new supervision system. An experi-
enced supervisor would be less confrontive and authoritarian and would adopt a
more consultative posture. He would be direct but not necessarily confronta-
tional.
CARRIE: I remember the good supervision I had in my M.S.W. program. This sort of reminds me of that—that
you’re suggesting we have more clinical supervision. Not to sound selfish, but what’s in it for me, to get more
supervision?
WALT: That’s a great question, Carrie. We all want to know what’s in it for us. I’d like to hear about your expe-
riences in supervision. How did you learn from that process? What direct observation did you have?
How To Provide a Rationale for Clinical Supervision

Clinical supervision has several benefits, which Walt can offer Carrie at this
point:
1. Administrative benefits: ensuring quality care, providing a tool to evaluate

the staff’s strengths and learning needs
2. Clinical benefits: improving counselors’ knowledge and skills and offering a

forum to implement evidence-based practices within an organization
3. Professional and workforce development: enhancing staff retention, improv-

ing morale, providing a benefit to enhance staff recruitment, and upgrading
the qualifications and credentials of personnel
4. Program evaluation and research: providing valuable information to deter-

mine program outcome and patient success
CARRIE: In school I found observation both frightening and helpful. At first I hated being observed and taped.
Very quickly, though, I really saw the benefits of observation and learned a lot from the experience.
WALT: It’s been my experience that almost everybody has some initial reservations about direct observation,
but at the same time nearly everyone finds it beneficial, too. I think one thing to keep in mind is that good
direct observation doesn’t focus on the negative—on what somebody did wrong. The objective is to help us look
at what we do well, give us new options, build a bigger tool box of skills, and help us to look at the larger
process of our counseling, rather than just getting stuck in applying techniques with people. As we look at our
goals and what we need to learn, I hope we can see how supervision, and particularly direct observation, will
help all of us.
CARRIE: I’m told I’ll be doing more group counseling. I certainly need further training and feedback on my
group skills. This is something we didn’t focus on much in grad school. There are other areas that I’d also like
to be more proficient in, such as doing marriage and family counseling.
WALT: Okay. That would be one place for us to begin, Carrie. How about you, Al?
AL: I’m excited. I’ve wanted to do more counseling, moving out of running DWI groups and doing assessments. I

need more training but I have concerns about being videotaped or observed. I’m going to make mistakes. I’ll be self-
conscious about that. I think videotaping a session or having a supervisor sit in will make the clients nervous, too.
How To Help Counselors and Clients Become Comfortable

With Live Observation
The following steps are recommended:
1. Acknowledge and understand the clients’ and/or counselors’ anxiety about

observation or taping.
2. Listen reflectively to these concerns without being dismissive or ignoring the

anxiety; noting that these feelings are common may help normalize the coun-
selor’s concerns.
3. Clearly state the value of direct observation and reinforce the idea that such
methods are “part of how we do business at this agency. We want to be
respectful of your concerns. And we believe strongly that it is important for
us to do so for quality assurance and improved client service.”
4. Keep the door open with the clients and counselors to continue to address
their concerns and feelings as part of their normal clinical or supervisory
process.
5. Help the counselor to allay clients’ anxiety or concerns by coaching the coun-
selor through methods for presenting the direct observation methods to the
client.
WALT: I can sure understand your sense of feeling self-conscious and your concerns that clients will, too.
You’ve never been either videotaped or observed before?
AL: No, I haven’t. In the DWI program, my supervisor sat in a few times when I first started, but it was more a
question of whether I was following the curriculum.
WALT: So, although you did have some observation before, this seems like it will be different for you. Perhaps
we could look at your goals and how supervision with observation can assist us in meeting your goals.
[A discussion follows where Al and Carrie present their ideas for supervision needs. They then discuss what
skills they need to develop in the next year.]
WALT: Perhaps we can discuss what the new supervision system will look like, how it will work, and what’s in
it for you. First, we’re going to have regular observation of all clinical staff, through either one-way mirror (if
we can get the audio working in the room), videotaping (my preferred method), or one of the supervisors will sit
in and observe counselors with clients. We hope to observe each counselor at least once a month. We’ll meet as
a group for supervision for an hour a week, and we’ll discuss the session that was videotaped or observed that
week, with one of you leading the discussion. Each person will get a turn at bat over the course of 1 or 2
months.
[Walt explains the “how-tos” of live observation and videotaping, including the concept of saliency, bringing to
supervision the one issue the counselor wishes to address. Walt presents a step-by-step process to begin doing
direct observation.]
How To Implement Direct Observation or Videotaping
1. Obtain written and verbal agreement from the clients and all concerned par-
ties to be videotaped. Clients should be informed on admission that:
• Counselor–client contact may be observed by supervisors, and/or audio or

videotaped.
• The conditions under which the tape will be used for training.
• How the taped material will be stored and destroyed after use.
2. Counselors should briefly explore client concerns about taping and observa-
tion, and respect their right not to be observed. If the client objects after the
initial exploration, the counselor must respect that choice and ask another
client.
3. On the visit before the observation occurs, remind the client that on their
next visit, their session will be taped for quality assurance purposes. Ask
them if they have any questions about that. If the client strongly objects to
the taping, discuss those concerns. If the client repeatedly objects to any
form of observation, the counselor should explore the client’s resistance, and
attempt to understand the client’s concerns and point of view. Even though a
client has signed an informed consent that discusses the possibility of direct
observation by supervisors, a client always has the right to decline any
aspect of treatment. Remember, no method of observation should ever exceed
the client’s level of comfort so as to be detrimental to the therapeutic
process.
4. At the beginning of the taping or observation, restate to the client the limits
of confidentiality and how the videotape or observation notes will be used by
the clinical supervisor and/or the counseling team. Clarify whether or how
the supervisor will observe and/or cofacilitate the session or simply observe
and intervene only as needed.
5. Be attentive to the counselor’s concerns about direct observation. It may be

helpful to begin with the idea that “observation gives us a chance to learn
from each other.” Then you can move into a discussion about the benefits
and cost-effectiveness of certain observation methods.
6. Ask the counselor to cue the tape to the most salient points of the session
and bring that section to their next supervisory session. In the beginning,
counselors might be encouraged to choose the section of a session in which
they thought they did well.
CARRIE: I’d like to hear more about why you prefer videotaping.
WALT: I prefer videotaping for several reasons: First, it is the most cost-effective way for us to observe a session.
Second, videotaping helps us allocate staff time better; we don’t have to sit in on an entire session but can just look
at the most salient points in the tape. It gives us all a chance to observe and learn from each other. Sometimes we
get a tape where a counselor has done something really special, and we can use that tape again before destroying it,
teaching a particularly powerful and effective technique. We can all learn from each other’s experiences.

[Walt describes how direct observation works, including the legal requirements such as signed releases by clients,
preparation and procedures for observation, and procedures for using tapes and observations and maintaining
confidentiality.]
Master Supervisor Note: It is important for you to prepare the counselor for
what will happen during the session. If you are sitting in the session to observe,
you should explain if and/or when you might intervene in the session, seating
arrangements for the session, nonverbal ways of communicating during the ses-
sion, and how other interruptions, should they occur, might be handled.
AL: As I said before, I’ve never been observed or taped, and that makes me nervous.
CARRIE: Well Al, I think you’ll get comfortable with it, and you’ll find it to be very helpful when it comes to
areas that you have concerns about. You said that you were concerned about mistakes, but it really won’t be
about mistakes. My supervisor in grad school had a motto I liked; she always tried to “catch counselors doing
something right.” I liked that. So, hopefully this is not about making mistakes but learning from each other.
When you see yourself on the videotape and you have someone go over it with you, they can give you pointers
about what worked and how you might have done other things differently. Over time you become comfortable
with it. Observation was very helpful to me. I think your misgivings will go away after a couple of sessions with
Walt. You’ll be surprised.
Master Supervisor Note: It may be helpful for you, as a supervisor, to find a

“champion”—someone who’s experienced direct observation and found it helpful.
Hearing positive statements about supervision from a colleague is often more
acceptable than hearing it from superiors.
WALT: That’s been my experience, too, with videotaping and direct observation. Al, you said it would make the
client nervous. Actually, we’re the ones who’re most nervous. We all want to know how we’re doing, but often
we’re afraid to ask, to get feedback and be observed.
AL: Maybe it would be better if I saw tapes of others doing counseling first.
WALT: That’s a great idea. I can present a videotape of a session I conduct. Then we can all sit and discuss
what I did. How would that work for you if we were to look at a videotape of one of my sessions for our next
supervisory meeting? I’d benefit from your reflections. It might be a good place for us to start the process.
How To Encourage Acceptance of Direct Observation
Since you should never ask a staff member to do something you are unwilling to
do, it might be helpful for you to:
1. Be the first to be taped or observed.
2. Be open to feedback from staff, setting the tone of acceptance and vulnerabil-
ity to feedback.
3. Solicit comments and suggestions from the counselors concerning what they
might have done differently and why.
4. Model acceptance by committing to trying out these suggestions in future

counseling sessions.
AL: Yeah, I like that idea.
CARRIE: That would be fine with me. I’ll volunteer to be second. It’s been a while since I was observed, but I
don’t have any problem with it.
WALT: Thanks, Carrie. So, since I’m up to bat first, let’s talk about some of the processes of observation.
[A discussion follows about what will happen in supervision when Walt presents his case.]
Master Supervisor Note: You will want to state clearly what is expected from
counselors in supervision. A supervision contract forms the basis of this state-
ment, and explains the ramifications of missing supervision sessions and what
they can expect from you and each other. For example, if a supervisee repeatedly
misses supervision sessions, this might be considered an administrative or disci-
plinary issue, much as if an employee was repeatedly late filling out paperwork
or getting to work. Also, if the supervisee does not provide the required video-
tape of a counseling session for review by the supervisor, the supervisor might
need to take action, following the organization’s policies for progressive
discipline.
WALT: There are different methods that we can use, besides videotaping, that might work better for some
clients or situations. We want to have an integrated supervision system, one that includes reviewing cases
together; periodic review of our files, such as client progress notes and treatment plans; training that meets the
needs of a variety of staff; and review of our client evaluation surveys. While I’m on that topic, we also want to
receive more input from clients about how we’re doing. There’s a new tool we hope to incorporate that routinely
asks for input from clients after each counseling session, and at the end of each day for our residential units.
AL: I have reservations about how useful information from clients might be. After all, for clients in early recov-
ery, their brains are still foggy.
WALT: Good point Al. If we ask clients regularly, though, we should get useful information about our ability to
address clients’ needs and the quality of our relationships with them. This is helpful information when we link
it to our direct observation and supervision. Sort of like watching a TV program and getting the Nielsen
Ratings about the show at the same time.

[Laughter.]
[In the discussion that follows, Walt acknowledges Al’s concerns, and Al, Carrie, and Walt talk about those con-
cerns. Walt asks how they can get past those concerns, how they can work together to have further client input
into the process.]
Master Supervisor Note: At times it is necessary for a supervisor to openly

address staff resistance. The skill is in knowing when to address and when to
deflect the resistance. Sometimes, it is useful to talk about staff resistance, to
soothe people’s discomfort before launching into the specifics of how supervision
will be accomplished. MI suggests that it is most helpful to “roll with resistance”
by reflecting back to counselors both sides of their ambivalence about the new
supervision format. Often it is best to return to the issue at a later time.
WALT: And that’s what we want to see happen with an integrated system of supervision. It will help us identi-
fy what we need to learn, the skills and competencies. To start the process, each of us will bring in a counseling
session that we think is going well, that we feel good about. How does that sound to each of you?
CARRIE: I like that: a chance for each of us to “show off” a bit.
AL: Well, if you go first, Walt, as you said. I’ll go the week after Carrie. I have all kinds of sessions where I’m
doing a good job.
[Laughter.]
CARRIE: I found it helpful in grad school for us to help each other, to avoid throwing anyone into the process
alone. Will that be possible for us?
WALT: That’s a great idea, Carrie. How did peer supervision work in grad school?
[Carrie discusses how peer supervision and team coaching work.]
Master Supervisor Note: Peer supervision is an effective form of group super-

vision. Supervisees confer in the group, discuss key topics of their counseling,
and suggest solutions for difficult situations. The participants learn better ways
to manage clinical issues, thus increasing their professionalism.
Peer supervision and team coaching have the following advantages and disad-
vantages:
1. The strengths and success of peer group supervision depend on the composi-
tion of the group, the individual members’ strengths, and the clarity of the
peer group contract. Members must agree on the time, location, and frequen-
cy of meetings, as well as the organizational structure and goals of the meet-
ings and limits of confidentiality. In these dimensions, peer supervision dif-
fers from occasional and unplanned peer consultation, a more informal
process.
2. Peer group supervision decreases professional isolation, increases profes-

sional support and networking, normalizes the stress of clinical work, and
offers multiple perspectives on any concern. Peer supervision has the
added benefits of being of low or no cost, intellectually stimulating, and fun
for supervisees.
3. Vague, ambiguous, or ambivalent goals and structure often lead to difficul-
ties in peer supervision. As with individual or clinical supervision, an inter-
personal atmosphere of reasonable safety (including respect, warmth, hon-
esty, and a collaborative openness) are critical.
4. Effectiveness and supervisee enjoyment diminish when competitiveness, crit-

icism, inconsistency of members, and absence of support are prevalent.
5. The success of peer group supervision is affected by supervisees’ varying

commitment and irregular attendance.
WALT: So, we’ve identified how this works. This is a new role for me, too, so I can use your feedback and sug-
gestions. Supervision involves a different set of skills than being a counselor.
CARRIE: Right. I took a course in school on clinical supervision and that’s exactly what the professor said.
How To Choose a Course on Clinical Supervision
Look for the following components:
1. The training should be approved by credentialing organizations to fulfill the

requirements for certification as a clinical supervisor.
2. It should meet the minimum training requirements of 30 hours.
3. The training should be provided by a trainer with the following skills: Level
3 counselor, Level 3 supervisor, excellent training experience, and ability to
provide information on both administrative and clinical supervisory issues.
4. The training should teach practical clinical supervisory skills through role-
plays and demonstrations, video- and audiotapes of supervision sessions, and
opportunities to practice clinical supervisory skills.
5. The training should be provided by a reputable training individual or

organization.
6. Online courses are also available. However, an organization should first veri-
fy if online courses are approved by their State certification board.
WALT: Let’s summarize what we’ve said. We’re moving into new treatment program strategies. Each of us has
an Individual Development Plan (IDP) stating our individual learning goals. Mentorship is an important aspect
of helping us all meet our IDP goals.
[Walt describes the process of mentorship, that each staff member will have a mentor. Some staff will mentor
each other. Walt discusses the relationship between the IDPs, clinical supervision, and the mentorship system.
Walt also discusses the issue of stages of readiness and how that affects the form and extent of mentorship each
person will receive.]
Master Supervisor Note: Mentorship is a formalized relationship between a

skilled professional and a mentee and is established to enhance the mentee’s
career by building skills and knowledge. In a series of structured sessions, a per-
son of greater experience instructs, guides, advises, provides feedback, and
coaches someone of lesser experience.

WALT: One of my tasks is to ensure that all of us get training so that any one of you could take over for me if
need be. I love to surround myself with people who can take over my job on a given day.
CARRIE: I’d be happy to both be mentored and serve as a mentor to others, if that’s what you wish. I’m feeling
a lot better than when we began this discussion today.
[Walt starts a discussion on clinical issues that might be topics for discussion in supervision, such as caseload
size and complexity, work with clients with co-occurring disorders, the impact of dual relationships with clients,
and confidentiality. The session ends with the group establishing the times for their group supervision and the
procedures for tape review and live observation.]
Vignette 2—Defining and Building the Supervisory

Alliance
Overview
This vignette illustrates the tasks of defining and building a supervisory alliance, particularly when working with
an entry-level counselor with an academic background different from that of the supervisor. The dialog is the
initial supervisory session. It illustrates how to introduce direct observation and the establishment of an IDP.
Background
Bill is a certified clinical supervisor who worked his way up through the ranks, starting as a substance abuse
counselor 20 years ago, 3 years into his own sobriety. Ten years ago he enrolled in a part-time master’s degree
program in counseling and completed the degree in 5 years. Since receiving his master’s degree, he has worked
as a clinician and supervisor in a community-based substance abuse treatment program. In addition to his
supervisory duties, he is director of the program’s intensive outpatient program (IOP).
Jan is in her first month at the agency, right out of graduate school. She is a Level 1 counselor, her first
employment since receiving her M.S.W. She had limited substance abuse treatment experience in a field work
placement and sees her current employment as a stepping stone to private practice after she receives her social
work license. Her supervision in the field placement assignment focused on social work skills and integrating
field work learning with her academic program. She averaged ten cases during her second year of field work.
The agency is a private, nonprofit organization providing comprehensive addiction treatment and education
services. Jan has been assigned to the IOP and is expected to participate in a structured internship program of
3 months wherein she will receive training in the substance abuse treatment field. The agency has a well-estab-
lished system for clinical supervision.
Learning Goals
1. To illustrate how to initiate supervision with a new counselor.
2. To demonstrate how to establish a supportive supervisory relationship and build rapport.
3. To define goals and boundaries of supervision.
4. To demonstrate how to identify supervision expectations and goals of the supervisee.
5. To illustrate how to address the developmental needs of a new counselor.
6. To show the start of a discussion on an IDP.
[After brief introductions, the discussion begins about what will occur in supervision.]
BILL: We’re excited to have you here, Jan. You may already know that supervision is an essential part of how
we help counselors in the agency. Since this is our first session together, perhaps we can explore what you want
from supervision and how I can help you. Building on your training and experience, maybe you can give me
some ideas about the areas where you wish to grow professionally.
JAN: Well, I haven’t thought about that yet. I had excellent training and experience at the EAP [Employee
Assistance Program] in the county health clinic. I’m not sure where to begin or even what I need. I recognize
the need for supervision, certainly for orientation to the agency. I’d like to know about how much supervision
I’ll get and the focus and style of supervision here. I also need supervision to meet the requirements for licen-
sure as a social worker.
BILL: I can understand that you’re really excited about starting a new job and career. You had an excellent
experience in your placement at the health clinic. I’d love to hear more about it, so perhaps you might tell me
something about that placement, what you learned, and what treatment models they used there.
JAN: Wow, there is so much to tell you about that. I averaged ten clients on my caseload. Some were just
assessments, but I did get to work longer term with several clients. I sat in on several counseling sessions,
observed the senior counselor conduct the sessions, and co-led a group and several family sessions. I had weekly
clinical supervision with my supervisor and the senior counselors. We used process recordings in school and
that was really sufficient because I would write the verbatim, give it to my supervisor, she’d make comments,
and we’d talk about it. So I didn’t really need to have her watch me work. I’ve heard from Margaret [another
counselor in the agency] that in supervision you do direct observation of counselors here and that idea is new to
me. Frankly, I’m not sure if I really need that. My model for counseling is eclectic, whatever is needed for the
client. They used a lot of cognitive–behavioral counseling approaches at the EAP. I try to meet the clients
where they are and focus my therapeutic approach to meet their needs.
[Discussion continues about Jan’s experience at her placement and academic training.]
BILL: So, we have a good sense of your background and experience. If it’s OK, I’d like to return to the earlier
question about whether you have any thoughts about what you want from our supervision together.
JAN: I’m not sure. Do all counselors here get supervision and are they all observed? I’m not sure I need that
observation, especially since the placement didn’t do that.
BILL: I appreciate your concerns about supervision. All our counselors here receive supervision. Some agencies
don’t do much direct observation of staff, but we’ve found it very helpful for a number of reasons. Here, we see
supervision as an essential aspect of all we do. We believe you have a right to supervision for your professional
development. We have great respect for our counselors and their skills and also understand that we have a
legal and ethical obligation to supervise, for the well-being of the clients.
Master Supervisor Note: Notice how Bill is laying the foundation and ration-
ale for why clinical supervision is essential to this agency. Whereas every agency
needs to develop its own, unique clinical supervision approach, there are models
and standards of clinical supervision, as discussed in Part 1, chapter 1, which
seem to be most effective. Agencies might benefit from adapting aspects of these
models.
JAN: So, everyone must have supervision and observation?
BILL: We take our legal and ethical obligations seriously. We want all of our counselors—even the most experi-
enced ones—to grow professionally, to be the best counselors they can be, for their own development and for the
welfare of the clients. As you probably learned in your M.S.W. program, vicarious liability is an emerging issue
for agencies. Counselors are legally liable for their actions. Vicariously, so are the agency and the supervisor.

We need to make a “reasonable effort to supervise.”
JAN: OK, so what do you expect of me?
BILL: I’d like to explore that with you. I’m really interested in both what you expect of yourself and what you
expect of us.
JAN: Again, I never really thought about that. I want to grow as a counselor and to develop skills that I can
use in my future employment. I understood when I took this position that you do an excellent job of providing
training opportunities for staff, something I really liked about the organization.
BILL: In our agency, clinical supervision is part of a larger package of staff development efforts. We try to help
counselors improve their skills by offering the opportunity to work with a variety of different clients, using a
variety of treatment modalities, such as individual, group, couples therapy, family therapy, and psychoeduca-
tion. Also, we want staff to be able to obtain their social work or substance abuse license or certification in the
future. We want counselors to develop new skills by attending training both in-house and in workshops around
the State. We encourage and support any efforts you might make toward professional development, such as get-
ting your various levels of social work licensure. Our philosophy is that one of our greatest assets is our clinical
staff and as they develop, the agency grows too. We believe clinical supervision is critically important in this
mix. We both—you and the agency—benefit as a result.
[A discussion continues about Jan’s course work in school and her training in the field placement, and how she
can continue that learning in the agency. She articulates her clinical strengths.]
BILL: That sounds good. Those are the skills we saw in you that we thought would be helpful to our agency. In
what ways do you wish to grow professionally?
JAN: I could learn other counseling techniques beyond CBT. What do you think I need?
BILL: That’s what we can explore in supervision. I’ll need to have a sense of what you’ve learned and where
you see your skills. In addition to talking about your skills, we find it helpful to learn through observation of
our staff in action, by either sitting in with you on a session or by viewing videotapes of counseling sessions.
That way, we can explore your specific learning objectives. We all learn from watching each other work, finding
new ways of dealing with clinical issues. What do you think of that process?
JAN: As I said, I wasn’t observed in my placement and find it anxiety provoking. I don’t really like the idea of
your taping my session. It feels a bit demeaning. After all, I do have my M.S.W. I don’t recall anyone saying
anything in my interview about being videotaped. Now, that’s intimidating, to me and the clients.
BILL: Being anxious about being taped is a fairly common experience. Most counselors question how clients
will accept it. You might speak with Margaret and some of your other coworkers about their early experiences
with taping, what it was like for them, and how they feel about it now.
JAN: How often do we have to meet for supervision?
BILL: Generally I meet each counselor individually for an hour each week. Then we do weekly group supervi-
sion where each counselor, on a regular basis, gets a chance to present a case and videotape, and we, as a
group, discuss the case, and talk about what the counselor did well and how other things might have been han-
dled differently. When you present a case, we all grow and benefit.
JAN: I want to be a proficient therapist, ultimately, to work as a private practitioner. If supervision can help
me professionally, that’s good.
Master Supervisor Note: It is important for Bill to be aware of what feelings
are arising within him, particularly concerning Jan’s seeming desire to pass
through and use the agency as a route to private practice. This has happened to
Bill and the agency before. Bill acknowledges to himself his feelings of being
used by these clinicians in the past. Bill’s self-awareness of these feelings is criti-
cal and he does not respond out of anger or resentment but makes a conscious
effort to remain present to what the issues are with Jan.
BILL: I’m glad you see the value of supervision. And I admire your professional goals of wanting to be in pri-
vate practice although I must say that I have difficulties with people just “passing through our agency” on the
way to something else. But, that’s my issue, and I’ll address those concerns if they come up in our relationship.
Master Supervisor Note: In his own supervision, Bill might explore his feel-
ings about people passing through the agency, his anger or resentment, and how
he can effectively address those feelings. For example, Bill’s supervisor might
wish to explore with Bill the following questions:
1. What feelings does Jan bring out in you? When have you had these similar
feelings in the past?
2. How do you deal with negative feelings about a supervisee?
3. How do you keep from being drawn into a defensive posture where you are
justifying the agency’s use of direct methods?
JAN: Will I be criticized by others, perhaps those without as much formal training as I have? I understand you
have several nondegreed counselors here—certified addictions professionals, with lots of life experience but
without advanced degrees.
Master Supervisor Note: A Level 1 supervisor might respond angrily here. A

Level 2 supervisor might get into an argument about the quality of counselors at
the agency. Bill, as a Level 3 supervisor, does not react to Jan’s seeming criticism
of the nondegreed counselors. He responds in a supportive but direct manner, as
you will see. But perhaps Jan is making this comment in response to Bill’s previ-
ous statement that he has “difficulties with people just passing through” and this
is another reason for Bill to address this in his own supervision.
As discussed in Part 1, chapter 1, just as there are levels of counselor develop-

ment, there are also levels of supervisor development. Level 1 supervisors might
have a tendency to be somewhat mechanical in their methods, perhaps needing
to assert their leadership and position, and approaching situations somewhat
anxiously. This is especially so for supervisors who have been promoted from
within the organization. Their peers, with whom they have worked side-by-side
before, know they do not know their strengths and limitations, and hence the
new Level 1 supervisor may feel that she has to assert her authority (see
vignette 6). A Level 2 supervisor is much like the Level 2 counselor, who is driv-
en by alternating anxiety and self-confidence and who feels the need to be inde-
pendent, even though she might not as yet be able to act independently. Finally,

Level 3 supervisors have balanced their levels of self-awareness, motivation, and
autonomy. For further descriptive information on levels of counselors and super-
visors, see Part 1, chapter 1, pp. 9–11.
BILL: Perhaps it would be a good idea if you began by observing in one of my groups. Then, when you’re feeling
more comfortable with it, we can discuss what times work best for you to be observed, and what cases you’d like
me to observe. This will give you time to schedule the observation. The first time, maybe I could sit in when
you’re working on a case that you have confidence about so we can see how you accomplish the session’s goals.
JAN: OK, that makes sense to me. I like the idea of talking to others and getting their impressions of the
process and their suggestions on how to best make it work.
BILL: We also need to develop a learning plan for you, an IDP that all staff have, so that you can continue to
learn. That’s part of a supervision contract that we work on together. How does that sound?
Master Supervisor Note: It is important to develop an IDP for each super-

visee, and counselors should understand why an IDP is important for the super-
visory relationship. Jan’s IDP might focus on:
1. Increasing her understanding of addiction by reading texts on the subject

and beginning the credentialing process.
2. Discussing this material in supervision, in reference to clients in treatment.
3. Finding a social worker within or outside the agency who can assist her in
fulfilling the requirements for her social work licensure.
4. Beginning direct observation of her counseling sessions within 2–3 months

with monthly videotaping and discussion of a session.
JAN: It will be a new experience for me but it sounds like it might be helpful. I’d appreciate your helping me
look at my skills and growing as a social worker in substance abuse treatment.
BILL: I’ll provide you with as much background in substance abuse treatment as I can and also try to help you
develop as a social worker to meet your career goals.
Master Supervisor Note: Bill is working with Jan to establish a supervisory

alliance, through listening, reflection, and mutual goal setting.
JAN: Good. I hope it will broaden my skills and further my career goals. I can learn more about working with
clients’ substance abuse. I think I can learn from people in other disciplines.
BILL: Although each discipline has its unique perspective, we have a multidisciplinary team approach and
value each staff member’s contributions. We teach one another. For example, Margaret has worked in this unit
for 10 years and has a lot of experience working with the kinds of clients you’ll be treating. She is a useful
resource for you to use to improve your skills so that you can be successful here and in your career. How will
that work for you?
JAN: I’ve heard about Margaret. People have a high regard for her clinical skills. So I’m sure I can learn some-
thing from her. I still would like some more details about how the supervision works, who else is involved, and
how do we do this together.
BILL: We do individual observation and group supervision where we find common issues in our counseling,
using videotape and case presentation to trigger discussion of related issues. Everyone learns from the presen-
ter’s experience. Each counselor takes a turn presenting a case, including a videotape. We can cue the tape to
the session segment you want us to discuss. After your brief introduction of the case, we discuss how the ses-
sion went, what skills were effective, and what areas might be further developed. How does that sound?
JAN: That sounds great. Can I come to you at other times to review cases, especially while I am learning the
ropes of how things are done here?
BILL: Yes. I appreciate your wanting immediate feedback. I have an open-door policy. Although I may look
busy, I’ll try to find time when we can discuss whatever you want. You can also meet with others if you feel
comfortable doing so. We encourage teamwork. Does that seem reasonable?
JAN: Yeah. I’m pretty autonomous at this point. I think it’s great that there are other counselors and social
workers I can collaborate with. It will be really helpful for me especially since I’m new at the job, and it’s good
to be able to work together. I’m OK with supervision, and I like the fact that we’re both going to have an agen-
da, so that’s fine.
BILL: So, let’s go back to your experience. I’d love to hear more details about your internship and what you
learned there.
[Jan explains her work experience in her internship.]
JAN: In my second year I was at an EAP clinic. I had a great supervisor, Jackie. Several of my clients were
alcoholics, my first introduction to substance abuse. There was something that attracted me, to understand
more about the disorder and to contribute what I was learning in social work. Jackie was a social worker and a
really good role model. I need to understand more about substance abuse treatment, and try to marry the social
work and substance abuse fields.
[Bill and Jan continue to discuss her experience with supervision, what worked best, what she found most useful
and supportive.]
JAN: I’m a little worried about how I’ll meet my licensure requirements about being supervised by a social
worker. Will that be a problem for me?
BILL: Not at all. Margaret is an LCSW and we can ask her to provide the supervision you need for social work
licensure. This will allow Margaret to develop her supervision skills. I also think that an important part of
developing a professional identity is receiving coaching from an experienced person, and perhaps Margaret can
assist in that area too.
JAN: That sounds fair and helpful.
BILL: You mentioned that Jackie was a good supervisor. Can you tell me what she was like and what she did
that made her a good supervisor?
JAN: She was really smart. I could learn from her. When I went to talk to her she always gave me good advice.
She trusted that I knew what I was doing and didn’t micromanage me. She was open about her theories and
made linkages to issues. She trusted me to just go ahead and implement what I learned. She was easy to talk
to. If I had a problem, I could say so.
BILL: It sounds like Jackie and I have a similar orientation as supervisors, and that should make the transi-
tion easier. I hope you’ll observe from your perspective how the supervision is developing, and give me feedback
on the relationship, the process, and the outcomes from your point of view. Our first step will be to expand your
training by introducing you to a broad range of substance abuse issues. Perhaps at our next session we can
start developing a learning plan to apply your studies to clinical work. What do you think of that?

How To Write a Supervision Contract
The following elements might be included:
1. The purpose, goals, and objectives of supervision.
2. The context of services to be provided.
3. The criteria and methods of evaluation and outcome measures.
4. The duties and responsibilities of the supervisor and supervisee.
5. Procedural considerations.
6. The supervisees’ scope of practice and competence.
7. The rewards for fulfillment of the contract (such as clinical privileging or

increased compensation).
8. The frequency and method of observation and length of supervision sessions.
9. The legal and ethical contexts of supervision as well as sanctions for noncom-
pliance by either the supervisee or supervisor.
JAN: That’d be good. I like that you’re interested in my experience, about who I am. I’d like to know a bit about
you. Jackie would talk about who she was, her model of supervision, and why this work was important to her. I
felt I could trust her because I knew where she was coming from. Would you tell me more about yourself?
Bill: I’d be happy to.
[Bill provides an overview of his work, academic experiences, and primary model of counseling and supervision.]
JAN: I have a beginning understanding of the type of supervisor you are. I like that you’re direct so I don’t have
to guess at the agenda. So, we’ll work on a training plan and I’ll suggest times for you to observe a session and
videotape. Is that correct?
BILL: That seems fair and clear. Any other concerns we should talk about today?
[Further discussion follows about Jan’s anxiety about supervision. They discuss how supervision would work to
help reduce her anxiety about being scrutinized and critiqued.]
BILL: So, although you’re a bit nervous about the process, you’re ready to begin. We’ll start with your observa-
tion of me to give you an opportunity to get your feet wet. Then you can tell me when you’re ready for me to
come in and observe, maybe in the next 6 or 8 weeks.
JAN [jokingly] I think sometime in the next 6 months.
Master Supervisor Note: As a Level 3 supervisor, Bill doesn’t react to this

comment. A Level 1 supervisor might respond by saying “The timeframe is not
negotiable. You’ll begin the observation in 6 weeks.” Another response might be
to avoid the issue without affirming her. When she is noncompliant after 6–8
weeks, he’d blame her for her lack of follow through. Such responses might nega-
tively affect the relationship. A supervision of supervision issue might be to
explore what was happening for Bill and his possible ambivalence about Jan.
BILL: Thanks for your willingness to begin and try the process.
JAN: OK. So, I can pick the client?
BILL: Yes. You can pick the client or group. We’ll meet every week for about an hour.
[Bill and Jan set the time for the next supervision session and discuss what is expected for the next session and
end the discussion with both excited about the process.]
Vignette 3—Addressing Ethical Standards

Overview
This vignette illustrates the role of the supervisor as a monitor of ethical and professional standards for clini-
cians, with the goal of protecting the welfare of the client. The vignette begins with a discussion about a poten-
tial ethical boundary violation and illustrates how to address this issue in clinical supervision.
Background
Stan has provided clinical supervision for Eloise for 2 years. He’s watched her grow professionally in her skills
and in her professional identity. Lately, Stan’s been concerned about Eloise’s relationship with a younger
female client, Alicia, who completed the 10-week IOP 2 months ago and participates weekly in a continuing
care group. Alicia comes to the agency weekly to visit with her continuing care counselor. She also stops by
Eloise’s office to chat. Stan became aware of her visits after noticing her in the waiting room on numerous occa-
sions. Earlier in the day, Stan saw Eloise greet Alicia with a hug in the hall and commented that she will see
Alicia “at the barbecue.” Stan is aware that Alicia and Eloise see each other at 12-Step meetings, as both are in
recovery. Eloise feels she is offering a role model to Alicia who never had a mother figure in her life. Eloise
expresses no reservations about the relationship. Stan sees the relationship between Eloise and Alicia as a
potential boundary violation.
Learning Goals
1. To illustrate monitoring professional boundary issues of counselors in clinical supervision.
2. To demonstrate supervisory interventions to help the counselor find appropriate professional boundaries
with clients.
3. To help counselors learn and integrate a process of ethical decisionmaking into their clinical practice.
4. To demonstrate skills in addressing transference and countertransference issues as they arise in clinical
supervision.
[After brief introductory comments, the discussion begins with how Alicia is progressing in her recovery.]
STAN: If it’s OK, I’d like to share some concerns I have about Alicia.
ELOISE: Sure, I’m always ready for feedback.
STAN: When I walked through the lobby a few minutes ago I heard you say something to Alicia about seeing
her at a barbecue.
ELOISE: Right. Sarah is one of my sponsees in AA, and we’re having a barbeque at her house for some people
in recovery. She and Alicia have gotten really close, so Alicia will probably go, too.

STAN: And that’s a barbecue you might be attending?
ELOISE: Yeah. I’m fairly active with all my 12-Step friends and sponsees.
STAN: I would like to raise a concern I have about your relationship with Alicia. You take great pride in work-
ing with recovering people, helping them, and doing everything you possibly can to ensure their recovery.
ELOISE: Yes, it means the world to me. Alicia reminds me of myself when I was in early recovery. When I see
her and how hard she’s working, it inspires me because I know that struggle.
STAN: I’m pleased that you care so much about your clients and that you can identify with their struggles. I do
have concerns though, when I hear you are going to see her at a barbeque. It seems like a possible dual rela-
tionship issue for you, and I would like to know what you think about this?
ELOISE: Well, I certainly know not to sleep with my clients, or borrow money from them, or hire them to mow
my lawn, or take them on trips. But seeing Alicia at a barbecue? Come on, Stan.
Master Supervisor Note: At this point Stan might be feeling somewhat defen-
sive and may need to restrain his urge to begin disciplinary action against Eloise
for her attitude. A Level 1 supervisor might react angrily to Eloise’s tone of
voice, seeing this as a clear disciplinary issue. A Level 2 supervisor might get
caught up in an argument with Eloise about the extent of the violation. The skill
of a Level 3 supervisor is to be clear with Eloise about what a dual relationship
is without responding out of anger. As shown below, Stan needs to help her iden-
tify what a boundary violation is, how to make ethical decisions, and how to
have this discussion in the context of a supportive supervisory relationship. It is
important for Stan to help her be more aware in future situations with similar
clients and dynamics.
STAN: I’m glad we agree on those kinds of extremes because dual relationships are a big concern of our agency
and staff. A dual relationship occurs when a counselor has two relationships with a client, one personal, one
professional. Our mission is to provide professional clinical services to clients. Within those services there is a
scope of practice. When a personal relationship with a client or former client intrudes on that professional clini-
cal service, then we may have a relationship that is considered outside the parameters of what’s considered
solely professional.
ELOISE: What I understand about dual relationships is that it . . . well, help me here. For example, I know I’m
not supposed to hire anybody for any personal services or any form of exchange of money or buy anything from
a client. If they’ve been a client here, I can’t contract with them for private practice or anything like that.
STAN: Let’s talk about your relationship with Alicia and what the intent is now. You want to do everything you
can to build a safety net for her recovery. I appreciate your concern for her recovery. One goal of recovery is for
the client to achieve a sense of autonomy and make decisions on her own, to take care of herself. You play a
role. So, if we can, let’s discuss what that professional role is, and what it isn’t. When I walked through the
lobby and heard you say “I’ll see you at the barbecue,” I had some concerns.
ELOISE: You mean I shouldn’t say that in a public place?
STAN: My concern is whether going to a barbecue with a client is appropriate behavior, to have a relationship
with her outside your professional relationship as defined by our agency. When I heard your remark, I thought,
“I wonder what Eloise’s intent was and where that’s going or what might that lead to? Let me check it out to
see if I am being clear.”
ELOISE: Are you saying I shouldn’t see clients in other contexts? How reasonable is that? We live in a small
town here and run into clients all the time in the supermarket and at 12-Step meetings. So what are you say-
ing?
Master Supervisor Note: There is a difference between a dual quality to a rela-

tionship and a dual professional and personal relationship. Dual qualities are
inevitable in certain communities. A dual relationship has the potential for the
abusive use of power, where harm might be done to the client through manipula-
tion or inappropriate self-disclosure. Actions in one context might be acceptable,
whereas in another they might be harmful. A skillful supervisor would help
Eloise see this distinction and help her be better able to make sound ethical deci-
sions concerning the line between dual qualities and dual relationships.
STAN: Great observation. Yes, we find ourselves in situations that potentially have a dual quality to them. The
difference between running into clients in the supermarket and going to social activities together involves the
potential impact that action might have on the client and our use of the power we have in the relationship. You
were her counselor.
ELOISE: Yes, but I’m not her counselor anymore. She’s in continuing care now.
STAN: Okay, but she’s still a client of the agency. The ethical question is how long is a client a client? According
to our substance abuse counselor’s code of ethics, once a client, always a client in terms of our professional
responsibilities.
ELOISE: Yes, but she just stops by when she’s here. She pops in just to say hi, for not more than 5 minutes. I
don’t counsel her anymore.
STAN: Okay, that might be reasonable. Perhaps we can discuss that relationship and the impact of seeing her
outside the agency at functions.
ELOISE: Well, she goes to the women’s AA meeting that I go to. And she knows some of my sponsees. What
should we do, leave our home group because clients attend the meetings also?
STAN: It is inevitable that we will run into clients at meetings. When does that cross over the ethical boundary
and become a dual relationship? I’d like to hear your ideas about where you see that line for you.
ELOISE: I don’t want to do the wrong thing, Stan, to hurt her. My intent is to be helpful.
STAN: Again, I know you don’t want to hurt her, and I know you’re trying to help her in her recovery. We have
to be mindful of not being drawn into relationships that hurt the client or that could be perceived as dual rela-
tionships.
ELOISE: She doesn’t call me or come see me. I want you to know I’m not sponsoring her. But I didn’t know that
going to the barbecue was wrong. So, I won’t go.
Master Supervisor Note: Stan really wants to keep the focus on the larger
issue of dual relationships. Once Stan and Eloise have clarified this larger per-
spective, then it might be more appropriate to come back to the specific issue of
the barbecue. A more inexperienced supervisor might be tempted to just establish
the boundary about socializing with clients with a comment like “That would be a
wise decision (not to attend the barbecue)” but would possibly lose the potential of
helping Eloise develop more effective ethical decisionmaking skills in the process.

It would, in effect, run the risk of making the decision for Eloise, rather than
helping her come to an ethical decision on her own.
STAN: With your permission, perhaps we can talk about how we make ethical decisions about the nature of a
relationship with a client or a former client, and what’s not professionally appropriate. If it’s okay, let’s use the
conversation with Alicia in the agency lobby. How do you think that conversation might be perceived by anyone
who is walking by who hears you say you’ll meet at the barbecue?
ELOISE: I’ve never really thought about it. Well, I guess if it was someone who didn’t know me, they might
think that I was personal friends with her. That’s not a perception I want others to have.
STAN: So, you want others to see you as a professional, upholding boundaries and your code of ethics?
ELOISE: Yes, of course.
STAN: I reread the code of ethics to help evaluate whether or not there might be an issue. I was reminded of
the power differential in all counseling relationships and that as professionals in our field we need to be careful
to not engage in social relationships (or relationships that might be seen by others as social relationships) with
clients or former clients. You may recall we recently had a lawsuit over dual relationships that put the agency
in jeopardy. It got resolved in our favor but we’re particularly sensitive about our liability. It was a wake-up
call to all of us. So how can we clarify this boundary issue with your relationship with Alicia?
ELOISE: Wow, I never saw going to the barbecue as pursuing a friendship, and I certainly would not want to
jeopardize our agency’s relationship with her. I certainly don’t seek any personal gain from our time together.
Although I must admit, she does remind me of myself when I was in early recovery. Besides, she has never had
a strong, positive, maternal figure in her life. That’s something I think I can help her with. What do you think?
STAN: I admire your concern for her and it sounds like you are becoming aware of some maternal feelings for
her that might be coming close to stepping over that professional boundary. When our relationships with oth-
ers, and particularly with clients or former clients, begin to even have the possibility of affecting their recovery
in a potentially negative way, then we might be edging close to an ethical boundary violation.
ELOISE: I understand, but part of my recovery program is being in touch with other people in recovery, other
people from meetings, like Alicia.
STAN: I agree. It’s important for your own recovery that you stay connected to other people in recovery. So, the
question is: What’s the difference between seeing people in recovery at meetings, such as your sponsees or your
sponsor, and relating to clients active in treatment at our agency whom you encounter at a meeting?
ELOISE: Do I have to cut off all my recovery relationships and not go for coffee after meetings?
Master Supervisor Note: It is important for supervisors to take into account

cultural variables that might affect clinical relationships, such as differences in
ethnic, religious, and geographic factors and their impact on the counselor–client
relationship. This is not to condone unethical behavior but to be mindful of cul-
tural issues as they affect the context of counseling. For example, in some Latino
cultures some form of socializing may be expected. In Asian cultures, it is not
uncommon for a client to ask the counselor personal questions as a means of
establishing trust. Skillful supervisors assist counselors in understanding cultur-
al variables while continuing to make sound ethical decisions.
STAN: I understand the dilemma we find ourselves in as counselors. We have to go on living our lives in our
small rural community. So, how do we reconcile our daily lives with the Federal laws, agency policies, and our
code of ethics? We need to be mindful of those boundaries just because of the closeness of our community. The
interesting thing is that the clients are not bound by the same rules as we are. So, they might not see it as a
boundary violation. In fact, as often as not, clients and former clients are flattered by contact with their current
or former counselor and invite such relationships. How will we reconcile these differences? How do we know
what the ethical wall looks like before we hit it?
ELOISE: Well, I guess we need to be careful about what contexts we see clients in, whether they are actively
being counseled by us or not. Is that what you’re saying?
STAN: Yes, we do need to be mindful of the various relationships we develop with clients. I’d like to use the
barbeque as an example to discuss. Okay?
ELOISE: Sure. First, I have six sponsees. They’ve all been in recovery for different lengths of time, and they
like to get together every 3 months, all six of them, and do some kind of activity. And they invite over a bunch
of people from the 12-Step group. Sarah was having this barbecue and asked me because we go to the same
home group. She also invited Alicia. I’m not sponsoring Alicia. Does that mean I can’t go?
How To Perform Ethical Decisionmaking
Stan’s task here is to help Eloise identify potential boundary issues in a broader
context and aid her in her ethical decisionmaking. The following are steps to eth-
ical decisionmaking:
1. Recognize the ethical issues by asking whether there is potentially some-

thing harmful personally, professionally, or clinically. In what way might
this go beyond a personal issue to the agency, the profession?
2. Get the facts. What are the relevant facts? What facts are unknown to us at
this time? Who has a stake in the decisionmaking? What are the options for
action? Have all of the affected parties been consulted?
3. Evaluate alternative actions through an ethics lens. Which options will pro-
duce the most good and least harm? What action most respects the rights of
all parties? What action treats everyone fairly?
4. Make a decision and test it. If you told someone you respected what you did,
how would they react?
5. Act, then reflect again later on the decision. If you had to do it all over again,
how would you react differently?
STAN: It might help to ask yourself what happens for you when you find yourself in such a dilemma, to be your
own problemsolver.
ELOISE: Well, it’s hard to not go to social activities in this small community when I’m invited. But I can see
how some might see me in a different light because I’m a counselor. At one party, someone came up to me and
started to ask questions about problems in their marriage. I guess she figured that since I’m a counselor, she
could get some free assistance. I was really uncomfortable in that situation.
STAN: What did you do?

Master Supervisor Note: At this point Stan might:
1. Have Eloise consider her own solution.
2. Use her solution in a dialog to expand the context so she can generalize the
solution to other situations she may encounter.
3. Conclude with Eloise’s restatement of what she has learned for the future
from this discussion.
ELOISE: I told her I could not be her counselor and was there at the activity in my “civilian” clothes.
[Chuckling.] Ah, I see what you’re getting at. It’s hard to be in two relationships, a professional and a personal
one, with the same person. And I can see what you mean by how a reasonable uninvolved person might view
this situation. At the party, when that woman wanted free counseling, it was clear that that was not the con-
text or the relationship for that. That’s unprofessional. But Alicia is different.
STAN: So, you see that it is unprofessional to counsel someone outside of a professionally defined relationship.
I’d like to hear how it is different with Alicia.
ELOISE: Well, I really care for her. She reminds me of myself when I was younger. I am the mother she never
had. I feel bad for her that she’s never had a positive female, maternal role model in her life.
[Eloise cries as she expresses her concern for Alicia.]
STAN: This is difficult for you. You care very deeply for her. I can understand that in some ways she reminds
you of yourself at that point in your recovery.
ELOISE: Yes, she does.
[Her crying continues, and Eloise speaks of her concern for Alicia. After a few minutes, the two sit quietly.]
ELOISE: The last thing I want to do is to hurt her or to act in an unprofessional manner.
STAN: I value your concern for Alicia and your desire to be professional. It is difficult when we care so deeply
for our clients. We’re asked to show empathy and caring for clients, and sometimes it can be confusing if we
care too deeply. It’s like, as caring professionals, we’re always living close to that ethical slippery slope. We can
retreat into “professional white coats” and separate ourselves emotionally from clients. But that turns counsel-
ing into a sterile activity, and we’re detached and removed from their pain. But, when we care deeply, we are
drawn into the emotional world of our clients. And the boundaries can become fuzzy for us.
ELOISE: I see what you mean. I guess we can rationalize a lot of our behavior when we care so deeply. We call
that enabling behavior, don’t we, when family members do that with the person in substance abuse treatment?
So, how do we walk close to that ethical slippery slope without falling over the edge?
STAN: That’s an excellent question. Ethical decisionmaking can be difficult at times. Intent is an important
part of ethical decisionmaking.
How To Ask Questions in Ethical Decisionmaking
The following are key questions to ask at this point:
1. What would a reasonable person, counselor, or colleague do in a similar

situation?
2. What are the relevant issues regarding justice, fairness, self-advocacy, non-
malfeasance?
3. How would a person discern his or her intentions? How do you keep yourself
from self-deception about your motives, remembering that the best test for
your motives is time?
ELOISE: What do you mean by “intent?” It was my intent with Alicia to be helpful, certainly not to hurt her in
any way or to be disrespectful of our agency or of me as a professional.
STAN: When we commit to a professional relationship with a client, there is always a power differential. When
someone like Alicia comes with her need for a maternal figure, as you well described, we need to be careful of
our role in offering to fulfill that need. The power differential alone can create some opportunities for people to
misperceive what’s going on. What do you think?
ELOISE: Can it be that I took advantage of her because of my own need to be a mother figure in someone’s life?
STAN: That is always a risk we have. It could be perceived that way.
ELOISE: I feel bad that I wasn’t being very professional with her and my own needs came out.
Master Supervisor Note: It is important to remember the power differential

between supervisor and supervisee. How might key audiences (colleagues, the
community, board of directors, the press, peers) see or experience the counselor’s
behavior? What is the risk? There are many stakeholders involved who each
view the situation from their own perspective. For example, stakeholders (such
as the board of directors) might be concerned about the risks of legal liability for
the agency, the media and community with the public image of the organization,
and peers with the clinical implications of a possible boundary violation.
STAN: That’s a key insight. It’s great that you could step back from the situation and see how your caring
deeply for her spilled over in other ways.
ELOISE: You think I had power over Alicia?
STAN: As I said, when you’re a counselor to a client, there is always a power differential that we have to be
very cautious and very aware of. It may not be something we do so much as the power that the client gives us.
Now, if it is okay with you, I’d like to summarize a little.
[Stan and Eloise review what has been discussed and what actions might be appropriate for Eloise to take at
this point. They express their concerns about Alicia and how she might be hurt if Eloise abruptly cuts off the
relationship with Alicia. They strategize on how to best handle the situation in a way that would be clinically
supportive of Alicia.]

STAN: I want to talk a little about ethical decisionmaking and how we can keep within certain guidelines.
There are some questions to be asked, such as how that behavior is experienced by someone else. How would
your actions be perceived by colleagues, the community, a supervisor, and clients?
ELOISE: I appreciate your saying that; I need to think about it. It makes sense.
STAN: I’d like to review what we’ve discussed and your understanding of the issues.
ELOISE: I have a clearer understanding of how my relationship with clients after they’re discharged is as
important as when they are my active clients. I need to think and give more consideration to how that’s per-
ceived, to consider my role with clients from their perspective. In my relationship with Alicia, I’ve thought of
myself primarily as a recovering person, but I need to remember that she may perceive me primarily as her
counselor. In other words, I am wearing two hats—a counselor and a person in recovery—and I need to be clear
which hat I am wearing and when those hats are on.
STAN: So you have a sense of the potential conflict of interest depending on what hat you’re wearing and how
that might be perceived.
ELOISE: Yes. I need to think about how that reflects on the agency and how the community sees it.
[The supervision session ends with Eloise making a commitment to rethink the relationship with Alicia and
strategies for making ethical decisions in the future.]
Vignette 4—Implementing an Evidence-Based Practice

Overview
This vignette portrays supervision of two counselors at different levels of experience and orientation to imple-
ment an evidence-based practice (EBP) into their clinical work. Both counselors have reservations about adapt-
ing the way they practice and have some resistance to undertaking the new EBP. The clinical supervisor has to
address their resistance while achieving the mandate of the agency.
Background
The executive director (ED) of a mid-sized substance abuse treatment program has issued a statement to all
staff that, according to State requirements, the agency must incorporate EBPs, now a necessity for State fund-
ing. Therefore, the ED has directed the three clinical supervisors to begin the implementation of MI as a pri-
mary treatment method for treatment staff, first on a pilot basis then agency-wide. Gloria, one of the supervi-
siors, is meeting with Larry and Jaime, two program counselors, to discuss implementation of MI with their
clients. Both Larry and Jaime are aware of the mandate but have not had an opportunity to discuss the change
with Gloria until their regularly scheduled supervisory session this morning. Both have, in the last year,
expressed some resistance to undertaking a new treatment approach when they were required to attend MI
basic training.
Learning Goals
1. To demonstrate leadership by a clinical supervisor toward meeting agency goals and mission.
2. To demonstrate leadership in the face of staff who are resistant and reluctant to incorporate EBPs into
their counseling.
3. To model MI in the supervisor/supervisee relationship.
4. To illustrate fostering a spirit of learning and professional development among counselors.
5. To illustrate how a clinical supervisor can help counselors build new clinical skills, especially those that are
science-based practices.
6. To understand the resistance and impediments in the field to the implementation of EBPs.
GLORIA: I know you have some reservations about the MI implementation program. Today I want to spend
time discussing your reservations and how MI can be good for our clients and for the agency. You have both
done a tremendous service for our programs. We want to be responsive to your needs, not just impose some-
thing on you. When you’ve been doing a good job and you know that what you’re doing works, it’s hard to take
on something new that you’re uncomfortable with. I know that you’re concerned that taking on something new
could, at least initially, potentially interrupt the normal flow you have with clients.
So, there are several things that I think are important for us to consider today. First, let’s review why we are
implementing MI for staff as a tool in their counseling. Perhaps we can explore any concerns you might have,
then review why it is important to implement MI.
Second, let’s look at your concerns about how those changes might affect client care.
Third, let’s focus on how we can keep the strengths you have with your clients and be sure they don’t get lost in
the transition process. One of the beauties of MI is that it integrates well with what good counselors do natural-
ly: active listening, respect for others’ views, an appreciation of the role of resistance, good goal setting prac-
tices, and the like. Most important, MI aids in establishing and enhancing the therapeutic alliance between the
counselor and the client.
Finally, I want to spend a little time talking about where we go from here and how we are going to make the
implementation process as smooth as possible.
How To Introduce Changes in Clinical Practices
Changes in counseling methods are difficult for staff who are attached to their
model of counseling and know that it is working for them. When presenting new
policies and directions to staff, it is important that you follow these guidelines:
1. Be respectful of staff’s resistance. Instead of exhorting, arguing with, or

threatening the counselor if they do not “play ball,” seek to understand the
counselor’s concerns with words such as “Yes, this is difficult. So how can we
resolve the issue?”
2. Show respect for counselors and for the experience each brings.
3. Depending on the individual counselor, you may need to be flexible yet firm
in your approach with staff who are expressing resistance to or ambivalence
about change, being clear that the change is needed yet allowing time for the
person to adjust and providing the resources needed to aid the counselor in
making that change.
4. Recall when you were in the counselor’s role and perhaps how you experi-
enced resistance to change in supervision.

5. Consider using self-disclosure to address defensiveness with supervisees.
You can either give an example from your own training or experience, such
as, “I know it was difficult for me too when I was a supervisee,” or by
describing your own ambivalence in the present, such as, “I also have con-
cerns about the change we have to undertake and want to ensure that it
works in the best way for clients, now—what can I do?” These self-involving
statements can engage supervisees in the discussion and problemsolving.
LARRY: Well, Gloria, we’ve had the MI training, and I like its focus on active listening, the attention it gives to
the relationship and respect for the client’s perspective. But, you know, I’m basically a 12-Step facilitation guy.
That works for me and for my clients. I don’t see changing horses in the middle of the stream to achieve politi-
cal correctness.
GLORIA: Your 12-Step approach works for you, and we heartily endorse it, too. 12-Step facilitation is an essen-
tial part of everything we do at the agency. And I definitely don’t want to see us throw out the baby with the
bathwater. As you know, counseling is an ever-evolving process, and I think our task is to be able to take what
we do well and build on it with new approaches. I think MI can add to your repertoire. I think your concerns
are realistic, and we need to consider that as we move into adopting new methods. What about you, Jaime?
Master Supervisor Note: At times a supervisor might feel caught in the mid-
dle, representing policies and procedures coming down from funding sources, yet
posing implementation difficulties. An effective supervisor plays this dual role of
advocating for both administrators and leadership and the line worker and
client. Whether working on a factory floor or in a clinical setting, it is difficult
being in the middle. To aid you in this position, it is helpful to:
1. Understand the rationale of both administrators and line staff.
2. Never lose sight of where you came from. At some point in your career, you
were a supervisee. It is useful to remember what it felt like being in that
position.
3. In the example of MI, practice reflective and active listening to understand

the concerns of those above and below, and to empathize with each group’s
concerns.
JAIME: All of this discussion is really above me. I just want my Latino clients to get good care and for their
treatment needs to be respected. My clients need decent jobs and to be accepted as Latino men being sober in
their community. That’s what’s important to me. I just want to serve my clients. I know that may not be what
you want to hear, but that’s how I feel.
Master Supervisor Note: A Level 1 supervisor might respond either in a

defensive or overly directive fashion here, telling Jaime that this is something he
must do. A Level 2 supervisor might get into a struggle over what really mat-
ters, defending MI as good for Jaime’s clients, or disrespecting his statement
about what matters most to him, his clients. A Level 3 supervisor listens to
Jaime’s statement, affirms and supports him in that, and tries to engage Jaime
in the discussion. Further, Gloria is working with two counselors at different lev-
els of proficiency, so she has different expectations for their contributions and
recognizes that they have different learning needs. An effective supervisor
understands the stages of counselor development and varies the approach
depending on the stage of each staff member.
GLORIA: Jaime, I respect your commitment to the Latino clients. Larry is clear about one of the things he
knows works, 12-Step facilitation. In your experience, what works with Latino men?
JAIME: I’d agree with Larry, 12-Steps, because I go to AA myself, and I know AA works. But what’s also
important is jobs, not feeling discriminated against, not being asked for ID papers if you’ve lived here all your
life. What helps is to be with a group of sober men. That’s what helps my clients.
GLORIA: You both seem to be clear on what you see works for you and your clients. That’s a good start for us.
As you know from the recent ED’s memo to staff, the State has required all agencies to implement an EBP to
continue to receive State funds. There has been a lot of discussion at all levels about this. We’ve talked before
about our desire to move from being a good agency to a great one, being one of the best in the State. Over the
past year we’ve made incredible progress toward this goal, thanks to all the staff’s efforts. And all through this
process, we’ve been able to stay true to our 12-Step philosophy. Honestly, when I first heard about the new
State policy, I, too, was skeptical, saying to myself, “Here we go again.” But then I was reminded of the agency’s
mission to keep improving our skills for the well-being of the clients. So, discussing this together now is helpful.
I’d like to hear more from you about your concerns regarding MI.
LARRY: I don’t really give a darn about MI versus CBT versus 12-Step facilitation versus the next thing to
come down the pike. I’ve been in the field for a long time, and I know what works is my relationship with peo-
ple. I know 12-Step works, and I have to be convinced that this doesn’t interfere with having a strong relation-
ship with my clients. I think that’s the most important thing. I’m not sure I need a new way to do this. I don’t
want to have to be worried about whether I have to use this science-based thing.
GLORIA: Wow, Larry! I really hear that the most important thing to you is building strong relationships with
your clients, and it’s not so important what method you use to build strong relationships, but that the method
helps you accomplish that goal. Perhaps we can look at how MI’s approach to active listening with clients and
reflection enhances that relationship. If it builds the therapeutic alliance with the clients, that’s good. I’m curi-
ous how you feel about that.
LARRY: What I want to be sure of is that we’re not moving away from our roots: that this is not taking us away
from 12-Step. That’s what this agency is founded on, and that’s what we stood for all these years. I need to hear
that from you.
GLORIA: That’s a really excellent point. How do MI and other approaches keep us close to our roots of 12-Step
work? What do you think?
LARRY: If an approach builds the relationship with the client, I’m all for it. I know that 12-Step facilitation
does that. And I know from the course I took on MI that it also emphasizes the counselor–client relationship.
But it is also a new way of thinking and a whole new vocabulary and I don’t want to get so bogged down in
catchy phrases that I lose contact with my client.
GLORIA: Larry, I clearly hear your concerns about interfering with your relationship with your clients and
about us losing our roots.
LARRY: Maybe Jaime can do the MI stuff and I can do my 12-Step facilitation.
JAIME: What?
GLORIA: There are several different ways we can approach the implementation. We may decide that MI works
better with some client populations than others. A place to begin would be for us to learn more about how MI

can be implemented in the program. I know you’ve been to the MI training. That’s a great start. MI has some
good strategies that are congruent with a variety of client populations.
LARRY: What I heard you just say is that it doesn’t matter whether we’re on board or not.
GLORIA: That’s a dilemma. The State’s said, “You have to do it.” What they haven’t said is how you have to do
it. They said we have to do “something.” We have something to say about how we’re planning this, how we’ll
implement an EBP. I want to be sure that we hear and use your experience.
Master Supervisor Note: It is helpful to watch how Gloria handles the polariz-
ing confrontation. A Level 1 supervisor might either come down hard on Larry
for his suggestion, saying “No, we’re not doing that.” A Level 2 might argue
about it. Note the Level 3 approach, not to confront the statement by Larry but
to find a working alternative.
A master supervisor is able to manage staff confrontation and avoid becoming

defensive. To do this, it is important for the supervisor to understand that strug-
gle is a sign of staff ambivalence to change. Resistance and ambivalence are nor-
mal in any situation involving change. A master supervisor works with the
resistance, using its energy to promote change, not taking it “head-on.”
LARRY: I like the idea that we can implement the strategies that work best for our agency because that allows
us to stay close to our roots of 12 Steps.
GLORIA: So you see the value of implementing an EBP approach such as MI as long as it stays close to our 12-
Step roots. Moving ahead, I recognize that this is going to change some of our approaches, how we think about
treatment, how clients experience us.
LARRY: How are we going to do this implementation anyway? Who’s going to do the implementation, train us
in MI?
GLORIA: Perhaps I can show a videotape of a counseling session I conduct when I think I am doing effective
MI. What do you think of that idea? Would that help us all feel more comfortable with an EBP? I’m willing to
stick my neck out if you’re willing to give me feedback on what you see on the videotape.
Master Supervisor Note: A basic rule of supervision is “do not ask a super-
visee to do something you’re not willing to do first.” A second rule is that “lead-
ers bear pain, they don’t inflict it.” Master supervisors are willing to take a risk
by demonstrating their skills first before asking staff to do so. Effective supervi-
sors are able to establish trust by serving as a team leader, inspiring staff by
encouragement and motivation, communicating enthusiasm and capability, and
taking appropriate risks to initiate change. Leaders also demonstrate vision,
drive, poise under pressure, and maturity of character. They inspire rather than
command staff. Since leadership entails teaching, mentoring, and coaching, hav-
ing the title “supervisor” does not necessarily make a person a leader. To earn
respect, the supervisor should display qualities of honesty, responsibility, fair-
ness, and understanding. In this vignette, Gloria provides direction and leader-
ship by showing staff how they can implement MI together and how the training
will work. She also gives them a say in the process and allows them to keep to
their roots, learn new tools, and do so over time.
GLORIA: That’s a good question about implementation. Any approach we use needs to be respectful and build
on the counselor–client relationship. So let’s start there. First, we want to implement MI over time. It’s not
something that we’ll become instant experts at. I want to make sure that we’re well prepared and understand
what we’re doing.
[Larry and Jaime nod in agreement.]
GLORIA: Again, let’s be clear. We need to implement EBP for State funding. Remember when the agency went
smoke free: How difficult that was, how much resistance some staff expressed? But, it was something we just
needed to do, and in the end, being smoke free has had significant health benefits to staff and clients, and has
reduced the health care premiums for all personnel. I’m interested whether you see the similarity to such
changes.
LARRY: Yes, I do. The smoke-free campus has been a real benefit to all. I hope implementing an EBP is also.
GLORIA: I agree. Maybe we can return to the training issue you raised earlier. Larry and Jaime, with your
help and support, I’d like to establish a year-long training plan. First, I’d like to have an advanced trainer come
in and provide several days more of training that particularly addresses the needs and concerns of the staff.
We’d also like to contract with the trainer to establish an MI coding system that will be part of what we do in
our clinical supervision. Over the year, we’d continue our direct observation for supervision. Only now we’d look
at the interactions through the MI lens. The coding system will help us in doing so.
JAIME: I remember hearing about coding in the basic MI course I attended. Can you tell me more about that?
GLORIA: Here is a coding sheet that the trainer of that course recommended. I like the form and find it simple
and easy to use. I also think it’s consistent with what we do as counselors, and it reinforces our efforts to listen
better to clients. As in 12-Step facilitation, it helps to build an alliance with the client.
LARRY: So you’re convinced this is a good thing? You’re not just doing this to get State money?
GLORIA: From what I know about MI and have read about it, I think MI is a very useful tool for us. We’re con-
cerned about our funding, of course. But, client welfare always comes first. No, we would not be doing this sim-
ply for money. I believe this will help our clients, and that’s the bottom line, isn’t it? So, perhaps we can discuss
the skills we have as a team and how to proceed.
JAIME: I think we work well together and we seem to have good stable funding that allows us to maintain the
quality of care we offer to our clients.
LARRY: Yes, we have good teamwork and support each other. Jaime and I work well together. We’ve got a lot
of respect for each other. We’ve had the basic MI training. That’s a good start.
GLORIA: Teamwork is important.
LARRY: We do good treatment. Our clients respect us. We have good credibility out there. That’s a plus.
GLORIA: I’d also add that we have experience at successfully implementing changes.
JAIME: Three years ago we had few Latino clients and no Latino program.
GLORIA: Implementing a Latino program was a major positive step forward. The other thing I like is that we
have a good supervision system which helps us assess how we’re doing when we implement any new practice or
program, like the Latino program. It gives us a way of assessing quality.
LARRY: So, what’s going to change here?
GLORIA: We do have time for more training. It’s difficult jumping into a new approach if we don’t feel like
we’re adequately prepared for the change. One solution would be for us to devote more time in our normal clini-
cal supervision sessions (individually and in group) to MI practices, to use videotapes and role plays to continue

our learning and practice our skills. We can phase in MI over time. I’m committed to supporting you in what-
ever you need to do your job effectively. More than 150 studies have shown that MI is effective; this will
enhance our skills and give us better client outcomes. It might be helpful for us to talk to an agency that uses
MI and ask how they did it. We need to do training, as I said earlier, so we can be consistent with our core
approach. I want to integrate this in a way that makes sense for all of us. Perhaps between now and our next
meeting you’d think about two things you can do to help us write the implementation plan that will show how
we’re going to do this. We have an excellent team and do good work. I value and trust the work that we do.
Learning a new strategy requires training, mentoring, and coaching. Our relationships with the clients and
each other are the most important because that’s how we serve the clients.
[A discussion follows when they discuss the training system, who might serve as a consultant for the advanced
training, and how the coding system works and can be incorporated into the clinical supervision system. The ses-
sion ends with a mutual commitment to move to the next stage of implementation.]
Vignette 5—Maintaining Focus on Job Performance

Overview
In this supervisory session, a counselor with marital problems carries this stress into the workplace. She feels
overwhelmed by the complexity of her caseload, misses work, and cancels patient appointments. Observe how
the supervisor must address the counselor’s job performance, provide emotional support for the counselor, and,
at the same time, not get involved in the counselor’s personal life.
Background
Juanita has worked as a counselor at the agency for over a year and brings a number of valuable attributes to
her job. She is bilingual, understands the stresses and cultural dynamics faced by recent Central American
immigrants living in the United States, works well with female clients, and gets along well with other staff.
Her husband is a recovering alcoholic, and Juanita has been active in Spanish-speaking Al-Anon. She recently
received her addiction counselor credential.
Since receiving her license as a substance abuse counselor, Juanita has been given new job assignments that
involve working with more complex and difficult clients. She now conducts educational and support groups by
herself, does intake interviews, provides individual counseling to her caseload, and has recently increased her
caseload to accommodate the increased number of clients at the agency. She is also seeing several clients with
co-occurring disorders.
While she is friendly and outgoing with others, her natural response to stress is to withdraw and isolate her-
self, rather than ask for help. To Melissa, her supervisor, Juanita seems more tentative and less energetic in
their supervision sessions. She seems to be meeting most of her work performance goals established in the
supervision, but the quality of discussion about her cases and her lack of vitality in the meetings concerns
Melissa.
In the past month, Juanita has come late to work on a number of occasions and missed several client appoint-
ments. She has called in sick three times in the last 3 weeks. In supervision, she seems distracted, which is a
change from her prior behavior. Melissa, in her concern, asked in supervision “is everything OK?” Juanita
replied, “No, Jorge has been laid off his construction job, and he has been drinking.” She explains that she is
quite distressed, having trouble sleeping, and feeling overwhelmed. Though clearly worried, Juanita did not
elaborate, and Melissa did not pursue the questioning. Juanita did ask if she could talk to Melissa at another
time to discuss her personal problems and to seek Melissa’s advice on how to handle her current situation at
home. Melissa was uncomfortable agreeing to this but also was uncomfortable not responding to Juanita’s dis-
tress. She hesitatingly said that they could discuss this at the next supervisory meeting.
In the upcoming supervisory session, Melissa feels it is important to clarify the differences between providing
help for personal problems and maintaining supervision goals. Melissa also thinks it is important to address
Juanita’s job performance issues in the next meeting.
Learning Goals
1. To illustrate how work-related stresses and personal problems can interact and affect one another.
2. To demonstrate the boundary between clinical supervision and personal counseling.
3. To demonstrate how to help an employee get the help necessary to address personal (non–work-related) life
problems that affect the work environment.
4. To illustrate how to monitor and maintain adequate clinical performance when an employee is facing diffi-
cult personal dilemmas that affect job performance.
5. To demonstrate awareness of and sensitivity to cultural issues that arise in the context of personal issues
that affect job performance.
[The vignette picks up with the beginning of the next clinical supervisory session.]
MELISSA: Juanita, hi! Come on in. Before we start talking cases today, I would really like to go over some of
what we discussed last week and see where things stand.
JUANITA: That’s fine, but I think I owe you an apology about our last session. I really want to apologize for
saying all those things to you about my family and how that is affecting me and all that, and I just want to
apologize. I know it had nothing to do with anything work related. We were doing supervision and should just
have talked about cases, and I just want to assure you that that will never happen again.
MELISSA: Well, Juanita, I’m sorry you have to cope with all that’s going on, but I don’t feel you need to apolo-
gize for anything last week. I know that what’s happening is stressful to you. I hope we can work out a plan to
help you get the help you need and also be sure that the pressures you are experiencing don’t spill over into
your work with clients.
How To Address Personal Issues That Affect Job Performance
Consider the following points when you need to confront a supervisee in clinical
supervision with problems of job performance that are exacerbated by personal
difficulties, such as emotional, familial, interpersonal, financial, health, or legal
concerns:
1. You can help your supervisees see the relationship between their personal
difficulties and work-related problems. The key question you need to return
to is “How is this personal issue affecting your job performance?” This pre-
vents you from becoming the counselor’s counselor and turning supervision
into therapy.
2. You can clarify the boundaries of what constitutes acceptable job perform-
ance, as some counselors may be uncertain where the boundaries lie.
3. You should continually focus on approaches to improve job performance, pro-

viding useful suggestions and recommendations for improvement. It is also

helpful to provide measurable benchmarks by which counselors can assess
their own improvement.
4. You and your supervisee should develop a written work plan for how the
employee will take the necessary steps to improve job performance.
5. You can help the counselor examine how personal stressors might affect
interactions with coworkers or clients.
6. Finally, you and your supervisee can explore how you and the agency can
support the employee in confronting and resolving personal issues that are
affecting job performance, such as a referral to the EAP, use of personal or
sick time, rescheduling of the counselor’s time, and the like.
JUANITA: I appreciate that. I just want you to know that that’s not me. That’s not me.
MELISSA: And I appreciate that, and I want you to know that I value your work. You’ve worked hard. You’ve
really worked hard in learning not only your job, but also as a professional counselor and you’ve made a valu-
able contribution to working with our clients.
JUANITA: I love my job. I love it.
MELISSA: Juanita, I want to be really clear with you that I am concerned about what is going on in your per-
sonal life, and I want to work with you to get help for that. I don’t feel that it’s something that we should address
in supervision though, except to the extent that it affects your job performance. The goal of our supervision time
is to help you to be the best counselor possible. When personal issues come up, those may keep you from being
the best person you can be. These are important issues for you to address in your own personal counseling and
therapy. I hope that distinction is clear for you. But I really want you to hear my concern for you.
Master Supervisor Note: Although the distinction between personal counsel-

ing and supervision may be contingent on the supervisor’s theoretical orienta-
tion, and both are interpersonal relationships, there are differences between the
two, as summarized in the table below.
Personal Counseling Supervision

1. The goal is personal growth and develop- 1. The goal is to make the counselor a
ment, self-exploration, becoming a bet- better counselor.
ter person.
2. Requires exploration of personal issues. 2. Requires monitoring of client care and

facilitating professional training.
3. The focus of exploration is on the origins 3. The focus is on how issues may affect
and manifestations of cognitions, affects, client care, the conceptualization of the
and behaviors associated with life issues client problems and counseling process,
and how these issues can be resolved. and accomplishment of client goals.
To help the counselor and the supervisor differentiate between therapy and
supervision, the supervisor needs to continually ask him- or herself, “What does
this have to do with your counseling functions? How is this affecting your rela-
tionship with clients?”
JUANITA: I’m still kind of worried that I told you about my personal life, but I do want to be the best counselor
I can be.
MELISSA: I’m concerned about the time you have been missing from work and especially the times you have
had to cancel patient appointments as a result of your situation at home.
JUANITA: I know I’ve missed a couple of sessions, but I called. The clients were okay with me rescheduling,
and I’ve continued to meet with them. I don’t think there’s any problem. It was the first time I ever had to
reschedule those clients, and we caught up on their visits later in the week.
MELISSA: I hear that you were concerned about missing some sessions so you made a strong effort to recon-
nect with your clients later. I really appreciate your effort. I had a chance to review a videotape of a session you
did last week. I’m pleased with the skills you’ve developed in group counseling. In the middle of the session we
videotaped, there were some issues that came up about men that I thought might be a concern and might illus-
trate what we’re talking about. Can we view that section of the tape and discuss what was happening for you at
that point?
JUANITA: Sure, if you have the tape there.
[Together, Juanita and Melissa watch the tape, cued to the segment about clients actively drinking while in
treatment. Juanita appears surprised to see her response to the client on tape and notes the impact she might be
having on clients. For example, there was an interaction between Juanita and a male client in group where she
saw herself being judgmental and overly critical. Melissa and Juanita continue to discuss the tape and the
meaning of counter-transference in the counseling relationship. From the discussion of being angry at clients
who continue to drink, Juanita becomes aware that the sessions she has cancelled with clients were all with
drinking men.]
MELISSA: I’m glad you can stand back objectively and see the relationship between your personal issues and
your clinical functioning. So, what do you think you need to do now?
JUANITA: Well, first maybe I shouldn’t see any more male patients?
MELISSA: That is an option. But I think we can find a better resolution. For right now, let’s focus on what else
needs to change.
JUANITA: Well, I just won’t cancel any more appointments. I didn’t realize rescheduling was such a problem.
But I just won’t do it anymore. And about the missed days, I think that is beyond me now. If I need a day off
for personal reasons, I’ll schedule them in advance from now on.
MELISSA: OK. I think I would like you to go through me for the next few months if you need either time off or
if you have to cancel patient appointments. I know emergencies happen, but just let me know if you need time
off and we’ll see where we go from there.
JUANITA: I understand. I am so sorry that my personal life is intruding on my counseling. I never thought
that would happen. And I’m going to get back to my work. I’m going to make sure I get the paperwork and
everything done, and I will be on time tomorrow.
MELISSA: Let’s put the paperwork aside and talk about your work with the clients and what you need to do to
maintain your high level of work performance. Let’s get back to the countertransference. I’d like to hear more
about the clients you work with. Let’s go back to the videotape and discuss what else is happening in the session.
JUANITA: Basically, I’ve moved into working with some of the more difficult clients in the last several months.
It’s been very challenging developing plans with them and encouraging their attendance and working with
their treatment plans on a more active level because I’m definitely sensing the resistance.

MELISSA: So, not only are you working with more complex clients but you also have a higher caseload than
you had not so long ago. So your job responsibility has increased significantly recently. I think you’ll see some
different features of supervision as you continue to see clients with more complex problems and as you begin to
work in other treatment modalities, such as group. Let’s discuss how you’re dealing with the more complex
clients.
[A discussion follows, using the videotape, about how Juanita has been working with these clients, some of her
concerns about working with clients with more difficult co-occurring disorders, some specific points about coun-
seling interventions and her countertransferential reactions to men who are drinking. She acknowledges that her
reaction to the client who has relapsed is in part a response to her current life situation with her husband. Now
that Juanita recognizes where her work is being impacted by her personal issues, Melissa returns to the issue of
the EAP and re-introduces the possibility of a referral.]
Master Supervisor Note: It is important for the supervisor and counselor to

understand the impact of countertransference in a counseling relationship,
including:
1. It can distract from the therapeutic relationship.
2. A counselor’s personal issues may contaminate how he or she sees the

client’s issues.
3. The counselor may distance him- or herself or avoid discussion when the
client’s issues come too close to home, or conversely, the counselor may focus
on client issues that resemble her own.
4. The counselor may have negative reactions to the client, based on the coun-
selor’s current life issues, as Juanita did with the men in her group who
were actively drinking.
MELISSA: Juanita, you may remember that, as part of your professional development plan, we talked about a
personal care plan: knowing when you need support and where you could get it. Your Al-Anon program has
been a strong support for you, and you’ve used it in a very effective way. I’m wondering if you have used or
would consider using our EAP to help you address the crisis you are experiencing now. I think it would be help-
ful if you had the opportunity to sit down with someone and assess how things are going and what could help. I
hope you’ll use our EAP for that. As you know, using the EAP is optional. I’m not mandating that you go. But if
you think it would help, I hope you’ll take advantage of it. This booklet has some information about the EAP
and how to access their services. As you know, the EAP is strictly confidential, and nothing is reported back to
the agency. I’m also wondering how I can be of support to you.
JUANITA: Just be there for these sessions. Just be there as the supervisor when I come and have questions. I’ll
call the EAP this afternoon. Do you think they would also be willing to help Jorge if he is willing to come with me?
MELISSA: The EAP is for the whole family, and I’m sure they would be available to see Jorge too, either with
you or separately. I’m glad you are going to follow up on that.
Master Supervisor Note: Note that Melissa doesn’t ask Juanita to report back
to her about using the EAP. The EAP referral is to address personal life issues
that are not the concern of her employer. It is Melissa’s role to monitor job per-
formance and to use all of the resources that are available to help Juanita
improve her job performance. In most organizations, an employee’s use of the
EAP is not the concern of the supervisor. The focus of the supervisor needs to be
on improving job performance. Statements such as “Let me know if you use the
EAP” are not within the supervisor’s scope. Remember, the goal of clinical super-
vision is not necessarily to make the supervisee a better person, but a better
worker. It is tempting for clinical supervisors to focus on the personal issues of
staff—after all that’s what they do for a living. However, personal issues are a
part of clinical supervision only insofar as they affect the counselor’s interactions
with clients.
[Melissa and Juanita continue to discuss some of her cases and her efforts to work with more challenging clients.
At the end of the supervision session, Melissa and Juanita schedule two sessions in the coming week for Melissa
to sit in on Juanita’s sessions again. Melissa reaffirmed that she hoped Juanita would consider using the EAP to
address some of the issues in her personal life.]
Vignette 6—Promoting a Counselor From Within

Overview
In this vignette, a counselor has been promoted from within a work group to a supervisor position over the
counselors she worked with as a peer. Issues addressed include how the new supervisor handles staff resistance
and works to build a new relationship with the counselors she will now be supervising.
Background
Kate has been a counselor at the agency for 3 years. She, Maggie, and Kevin have worked together as outpa-
tient counselors, supervised by Gene, who left the agency last month to take another position. Kate has a mas-
ter’s degree in counseling, is licensed as a drug and alcohol counselor and, for the past year, has been taking
continuing education courses to develop her supervisory skills, hoping that a supervisory position would open
up in this or another agency. But the courses only gave brief reference as to how to work with and supervise
counselors who last week were her peers.
Maggie has worked at the agency 2 years longer than Kate, is a licensed drug and alcohol counselor, recently
completed her bachelor’s degree and has started working on her master’s degree. She understands that Kate
got the promotion partly because of her advanced degree but still feels she was treated unfairly in the selection
process because she has been with the agency longer.
Kevin, also a counselor, is in process of becoming licensed. He has a bachelor’s degree and has worked in the
field for about a year. He has concerns that someone who was a counselor and his peer last week can be an
effective supervisor for him now. He likes Kate and has turned to her numerous times for advice and support,
but wonders about her competence as a supervisor.

The agency director announced the promotion yesterday afternoon and suggested to Kate that she meet with
Maggie and Kevin soon. The director offered to sit in on the meeting, but Kate declined, feeling that she would
rather discuss the promotion and changes alone with Maggie and Kevin first. Since everyone had appointments
already scheduled for the morning, lunchtime was the first available opportunity for the meeting.
Learning goals
1. To demonstrate how a new supervisor can establish a leadership position and demonstrate a leadership style
with former peers.
2. To show how a new supervisor handles the potential conflict of her promotion over others with whom she has
worked.
3. To give some guidance to recently promoted supervisors to clarify their roles, develop opportunities to learn
new supervisory skills, and establish rapport with supervisees.
[Kate, Maggie, and Kevin meet over lunch to discuss Kate’s new position.]
KATE: Thanks for being willing to sit down with me and discuss how we are going to proceed in face of the
changes that were announced yesterday. I’m pleased with the promotion and excited about getting my feet wet
in this new role. I hope we can work together to continue doing the good job we have been doing.
[Long pause while Kevin and Maggie wait for Kate to proceed.]
KATE: I hope you see this as an opportunity for all of us.
[Another pause while Kate waits expectantly.]
KEVIN: Well, Kate, it’s going to be strange having you as a supervisor. Gene and I had a good relationship. He
was my boss the entire time I’ve been here, and I learned a lot from him. I knew there were going to be
changes. I guess I’d rather see you or Maggie get the promotion rather than having someone new come in from
the outside. This is quite a shift. Two weeks ago, when Gene announced he was leaving, all three of us were in
group supervision together. Now you’re our boss.
[Another pause.]
KATE: Yes, Kevin, it seems strange for me too, I have to admit. I’ve enjoyed our collegial relationship. I’ve
learned from you and appreciated your input too. I’ve even enjoyed our “grousing sessions” when we’ve felt
overworked and underpaid. [Laughter.] And I know there is going to be a shift in our relationship, but I still
want us to see ourselves, as well as new staff, as a team, focused on the best patient care we can offer.
Master Supervisor Note: It is important for new supervisors who are

promoted from inside not to try to be something they’re not. Everyone knows you
don’t know the job. Don’t try to fake it. Instead, acknowledge to staff that this is
new, that you have things to learn, and that, with their assistance, you can work
as a team. The worst mistake you can make as a new supervisor promoted from
within is to try to take the reins of leadership abruptly and without considera-
tion of staff reaction to your promotion.
KEVIN: I’d like to hear about any changes you are planning or how things might be different now that you are
running the show.
KATE: Great question, Kevin. In the past, we’ve all sat around in the lunchroom and spoken of what needs to
be different in the agency. Now, together, perhaps we have an opportunity to make some of those changes. For
example, we’ve spoken before about how we’d like to streamline the paperwork process. I know we’re all buried
in forms. How can we reduce the strain of administrative tasks we all face? How do we deal with our burnout?
So much is asked of us, and that places great strain on us. We’ve spoken about that together, how tired we can
become. How can we take better care of ourselves and of the team?
But, I want that process to unfold together. I need your help and input. Also, I want a few weeks or a month of
breaking in time before any changes are made. So, perhaps we can sit together as a group and think about
what needs to be different. I will then “run those changes up the flagpole” with the director and do what needs
to be done to bring about the changes we deem necessary. How does that sound to you?
How To Demonstrate Leadership
It is important for a new supervisor to demonstrate leadership without being

controlling or condescending, especially if promoted from within. Perceptions of
quality leadership have shifted from the traditional hierarchical, command-and-
control model to a networked, team-based approach that values participative
leadership and staff empowerment, bottom-up management, team input, and col-
laboration. Qualities of this leadership style include:
1. Taking responsibility for decisions made, never blaming others for something
you’ve done, and giving credit to others when things succeed.
2. Always putting the well-being of supervisees above personal accomplishments.
3. Not being afraid of taking appropriate risks that are in the best interests of
the organization, staff, and clients.
4. Protecting and advocating for supervisees, defending them to senior adminis-

trators and buffering them from rapid changes.
5. Not playing favorites. Most important, not giving orders just to prove who’s
boss. If you have to prove who is the boss, you are not.
MAGGIE: I have to say that I’m not very happy about this. I met with Gene and Susan [the agency director]
about ten days ago and expressed an interest in applying for the position. I didn’t hear a word until I found out
yesterday that you got the job. I want to be clear that I’m not upset with you. I’m glad for you, but I’m not
happy about the way this was handled, especially how Susan made the announcement. It makes me wonder
how decisions are really made around here.
KATE: I think if I were in your situation I’d be unhappy too. It doesn’t feel very good when there’s no communi-
cation. I understand that you were interested in the position. I am sorry about how the communication was
handled.
MAGGIE: Like I said, I’m not upset with you, but with Gene and Susan. I felt disrespected after my years of
service to the agency. That really doesn’t feel very good, like not being valued.
KATE: Yes, it feels like you should have had some communication at the least, and not have been surprised by
the decision.
MAGGIE: Yeah, it feels lousy. I wonder what my future is with the agency: if I’ll be passed over for other pro-
motions. And, quite honestly, I regret that I didn’t go back to school and finish my degree years ago, if that’s
required for a supervisory job. It makes me angry though, because they never told me that education would be
a deciding factor. I don’t even know what the criteria were for the decision.

KATE: Maggie, I can sure understand your feeling that way. And to be honest with you, I think I would have
felt much the same as you do if the decision had gone the other way. I’m sorry that’s the way this happened. If
it would be helpful to discuss your concerns with Susan, either together or alone, I’d be willing to help you
with that.
Master Supervisor Note: It would be easy for Kate at this point to triangulate
the communication, making Gene and Susan “the bad guys.” However, Kate
skillfully identifies Maggie’s feelings, provides self-reflection on how she’d feel if
in a similar situation, without polarizing the process and the others involved.
KATE: In the future, perhaps we can make suggestions to administrators on how we’d prefer the process and
communication to flow. How could this situation have been handled differently? What would have been more
helpful to you, Maggie?
[A healthy discussion follows between Kate, Kevin, and Maggie about how to improve the communication process
in the future. Maggie feels like she has a voice in the process and feels listened to and understood. Kate asks
Maggie what she needs now.]
MAGGIE: Thanks for this conversation and for your concern. Let me think about what I want to do now and
what I need. Can I get back to you on that?
KATE: Sure, we can discuss it when you’re ready.
KEVIN: I’d still like to maintain our friendship. I understand it is going to be a little different, for instance,
calling you “boss.” But the three of us have had a good thing going here. It’s been fun for this last year. I want
to keep that.
MAGGIE: Our friendship has been fun: something I’ve treasured, too. As you say, things aren’t going to be the
same. Kate is the supervisor now. And when we hire a new counselor, you are no longer the new guy on the
block. More is going to be expected of you.
KATE: I am going to miss some of what we have had together too. It would be hard to act as if we’re peers and
then have any objectivity when it comes to management decisions. We’d risk claims by others of favoritism. So,
as hard as that will be for me, I’ll need to stop doing as much socializing as I did before. I don’t understand
fully what I mean by that, but I know things will be different. I also will experience a sense of loss of some of
my clinical duties. I’m giving up some of the real satisfaction that I found in counseling, working with clients.
And I’m swapping that for new tasks. So I likely will also go through some grieving as well.
KEVIN: Thanks for your honesty, Kate. This means changes in a number of ways, for all of us. Kate, I have
confidence you’ll do a good job. Although you’ll have to get a new wardrobe and dress more like a manager.
[Laughter.]
KATE: Thank you so much for your patience and understanding. I was nervous coming into this meeting, given
how this all unfolded. I feel like we’re heading in the right direction. How do you feel we’re doing so far?
MAGGIE: I appreciate your listening to my venting and I think you understand how I’m feeling.
KEVIN: I am cautiously optimistic, which, for me, is saying something positive. After all, you know what a
cynic I am. [Laughter.]
KATE: You, a cynic, Kevin? No way! [Laughter.] There’s one more thing I would like to address before we stop
today: how we proceed. Gene had a really good system in place for clinical supervision. I would like to return to
that system and schedule that includes the efforts Gene was making to improve our supervision process. What
do you think?
[The discussion continues about what to do in clinical supervision, returning to the effective system formerly in
place.]
Master Supervisor Note: It is important to move forward, saving what was

working before, not seeking to make radical, hasty, drastic changes. Also, this is
an opportunity for Kate to demonstrate leadership by not languishing in the
present situation, not “badmouthing” administrators for how this decision was
made, while also acknowledging the emotional and professional concerns of staff.
[The session ends with a group decision to move forward in their clinical supervision.]
Vignette 7—Mentoring a Successor

Overview
This vignette illustrates the process of mentorship as a supervisor faces retirement and needs to mentor a suc-
cessor from within the agency. Mentorship is an urgently needed process in the substance abuse field as a sig-
nificant number of current leaders in the field face retirement in the near future.
Background
Margie is a certified clinical supervisor with 25 years’ experience in the field. She is in her early 60s, has
worked at the agency her entire career, and is, in fact, the longest term employee at the agency. She is
approaching retirement in the next 2 years. It is agency policy to promote from within whenever possible.
Betty has been in the field for 10 years and has been employed by this agency for 3 years. She is an excellent
counselor and is well respected by colleagues in the agency. She has the potential to be promoted to Margie’s
position as clinical supervisor. However, she has professional development issues that need to be addressed
before she could be promoted. For example, she would need training in clinical supervision skills and eventually
will need to get her certification as a supervisor. She also has a managerial style that needs to soften a bit. She
sometimes comes off as too authoritarian and abrupt. Previous attempts by other supervisors to address this
style have not been successful in changing the behavior. Margie has worked with Betty for 3 years as her clini-
cal supervisor but without a mentorship training plan.
The vignette focuses on how Margie can mentor her successor and the next generation of personnel so they
could be promoted upon her retirement. The vignette addresses the necessary systems of mentorship that can
be involved, what ought to be in Betty’s IDP, and the coaching Margie will provide to Betty.
The dialog begins with a discussion about current and future personnel issues and Margie’s pending retire-
ment. Margie’s goals in this session are to begin to define Betty’s learning needs, to establish a mentoring rela-
tionship, and to pave the way for Betty to be accepted as a supervisor by others in the agency. Margie’s
approach is to be a positive, supportive coach and to encourage Betty to begin the professional development and
training required to be a supervisor.
Learning Goals
1. To illustrate how to design a mentorship program for personnel, including the writing of mutually agreed
upon IDPs for potential successors and all clinical staff.

2. To illustrate the process of establishing a supervisory alliance that incorporates principles of mentorship
and training.
3. To suggest how to develop and maintain a strong collaborative and professional supervisor–supervisee rela-
tionship.
MARGIE: Betty, as you know, I’m beginning to wind down my career and am looking forward to retirement in 2
years. Our agency strongly believes in the idea of fostering our own leaders and promoting people from within.
You and I have had a great relationship over these past few years. I’ve seen your skills and feel you have great
potential to grow professionally and as an important professional in this agency. Your clinical skills are excel-
lent, you always complete your paperwork on time, and you’re a joy to supervise.
Master Supervisor Note: It takes a Level 3 supervisor to be able to mentor

someone else. Level 1 and 2 supervisors might find it difficult to let go of the
reins, to essentially work themselves out of a job, and might feel threatened by
helping others develop to their own level of competence. A Level 3 supervisor
needs superior vision: the ability to look ahead and see what’s needed for the
sake of the agency and staff. This requires maturity, serenity, and wisdom.
BETTY: Thanks so much, Margie. That really feels good. I really like my job and would like to continue work-
ing here.
MARGIE: I hope you continue working here. You’re a great asset to the agency. You’ve just implemented some
innovative ideas, and you’re enthusiastic about the work. Whenever I ask you to take on an assignment, you’re
always the first to complete it. I like that. You’ve worked hard to become an excellent counselor. So, I’d like to
have an idea where you want to be in 5 years. Would you be willing to discuss that with me?
BETTY: Sure. I hope I’m still here. I like the clients, my colleagues, and this agency. I like that I get to try new
things. You’ve been supportive of that. This is a place where I’m able to make a contribution to my community.
MARGIE: So this is “home” for you: That is so evident. It’s working really well for you. Perhaps we can discuss
what’s ahead for you. What would you like to be doing differently here in the future?
BETTY: I don’t know. I’d like to continue to improve my counseling skills, maybe even advance up the ladder a
bit. I think I have good individual and group counseling skills, but I also know administration involves another
whole set of competencies.
MARGIE: You’re right, there are different skills in administration and that’s important to recognize. And I’m
excited that you want to move up.
BETTY: Oh, that scares me a bit. I like seeing clients and wouldn’t want to become a paper-pusher, not that
that’s all you do. [Laughter.]
MARGIE: I like that you want to stay anchored in clinical work. I think that is important and I appreciate your
concern for clients. That’s one reason you’re so good at counseling. You have a real caring and compassionate
nature for the people you work with.
[A discussion follows about Margie’s job and what it means to be in a supervisory position at that agency.
Margie outlines the roles and requirements of being a supervisor.]
MARGIE: Another way to look at your contribution to clients and legacy in counseling might be in the fancy
word used by Erik Ericson, who spoke of “generativity”: getting to a stage of life when you want to give some-
thing over to the next generation of people to follow you. You’re having a great impact now on your clients. As
you progress into a supervisory role, you have the potential of affecting even more clients and staff, as you train
and supervise counselors.
BETTY: What do you mean?
MARGIE: Remember years ago in school? Can you recall any teachers that left their mark on you, people that
helped you become the professional you are today?
BETTY: Yes, there were many.
[A discussion follows about these mentors and how Betty benefited from their teaching.]
MARGIE: As you supervise, you have the opportunity to touch more people’s lives. Yes, there is more dreaded
paperwork. But, at the end of my day, I go home with a rich sense of legacy that I’ve had the chance to touch
even more people’s lives as a result of being a supervisor, even more than I might have as a counselor alone.
BETTY: Yes, I see that in you. You’ve had a profound impact on my life and that of so many counselors here.
Master Supervisor Note: One of the most effective ways to lead is by example.
Mentorship should include something of attraction; people should see something
in you that they want. “Whatever she has, whatever she does, I want to have
and do that.” People are imitative; they find role models they want to be like. So,
when mentoring, use personal examples for the potential to grow and impact on
others. It is important to identify the qualities and characteristics of a positive
mentor and role model for staff, such as eliciting, rather than imposing, their
judgment; drawing ideas from the supervisee, and being positive and affirming.
Mentorship is a special kind of professional growth opportunity, differing from

other supervisory models. In mentorship, the mentee asks questions, shares con-
cerns, and observes a more experienced professional in a safe learning environ-
ment. Through reflection and collaboration, the mentee can become more self-
confident and competent in his or her integration and application of the knowl-
edge and skills gained. Mentorship addresses the unique needs, personality,
learning styles, expectations, and experiences of each person. Mentorship can be
defined in numerous ways. One definition is a working alliance offering regular
opportunities for discussion, training, and learning to occur between less experi-
enced and more experienced people in various settings, addressing practical,
hands-on work experience to enhance the knowledge, skills, attitudes, and com-
petencies of everyone.
MARGIE: So, perhaps we can discuss how you can increase your skills, both clinically and in supervision. This
is the beginning of our developing and updating your IDP. One place to start would be for you to attend clinical
supervision training. There are online courses, self-study programs, and classroom programs. I have a list of
upcoming training events. I’d encourage you to take a look at these options and see whether you’d be interested
in one of them.
BETTY: Sure, of course. I’m always open to training, especially if it’s held on the beach, in a nice location.
[Laughter.] Will the agency pay for the training? You know a counselor’s salary will only stretch so far.
MARGIE: Yes, it would be part of your IDP. We fund professional development as much as possible.
BETTY: Thanks for the vote of confidence.

MARGIE: Further, I’d like you to start doing more staff training, using your clinical experience and conducting
sessions for other staff.
BETTY: You mean like some of the presentations I do in the community, to staff here? That’s a little intimidat-
ing, presenting to my peers.
MARGIE: It can be intimidating, presenting to people you work with.
BETTY: I assume you’ll help me with that?
MARGIE: Yes. I also think you have the potential to present at State and national conferences. This would
expand your repertoire of material, hone your speaking skills, build your confidence, and help you become bet-
ter known outside the agency. We know you’re good. It’s time for others outside to see in you what we see.
BETTY: Really?
MARGIE: Really. I have a call for papers for a counselors’ conference in Cincinnati this fall. I think you should
submit a proposal. The conference’s theme is PTSD and substance use disorders. I’ve heard you present here at
the agency on this topic. The people attending the conference will be your peers. That’s a good place for us to
take another step in the mentorship process, and you can begin with an area where we know you’re especially
strong. I’ll attend the conference, too, and we can discuss afterward how it went for you. I’m interested if you’ve
ever thought of being acknowledged outside of the agency for what we all know you know.
BETTY: If I’m really honest with you, yes. I’ve gone to conferences and thought “I can talk on that subject.” But
it’s always seemed immodest to say that out loud.
MARGIE: Yes, it’s difficult stepping forward, not wanting to seem arrogant, but also acknowledging that you
might have something others would benefit from hearing. So, how about putting your thoughts together for a
proposal? It’s due in 3 weeks. You and I can review the proposal together. I’m confident it will be accepted for
presentation. When it comes to your actual presentation, you can do the outline and slides and we can discuss
your ideas.
BETTY: So is this what you meant by mentorship?
MARGIE: It’s a good place to start. I’ll never forget my mentor, Todd. He saw in me something I couldn’t see in
myself at the time. He believed in me when I was feeling uncertain and insecure about my abilities, when I
wasn’t even sure I wanted to stay in counseling for the rest of my life. He got me to do things I didn’t think I
could do. He made me really stretch and taught me some invaluable lessons I still remember. Perhaps I can
discuss what I mean by mentorship. Would that be okay with you?
BETTY: Sure, I want to hear.
MARGIE: Well, this is my own view and from my own experience, but it seems to me that mentorship is when
someone with more experience and professional maturity helps someone coming along to want to reach out for
more and develop new skills. There are lots of new opportunities for mentorship that weren’t available just a
few years ago. Mentorship is different from our supervision relationship. Together we can identify areas of
growth for you, and then we’ll meet to discuss what we need to do so you can achieve your goals.
BETTY: I am honored (and a wee bit embarrassed) that you see that potential in me, and want to invest in my
professional growth. I’m not sure anyone else has expressed that interest to me before. I’m really flattered.
MARGIE: It has been an honor for me to work with you these last 3 years. It also gives me great joy to see you
grow professionally, and perhaps advance into supervisory and administrative positions here in the future.
Speaking nationally will give you better exposure. We’ll start with that, if that’s okay. Then we’ll move on into
other areas that we identify together on your IDP.
BETTY: Okay, if you really think I can do this.
Master Supervisor Note: One of the four foci of supervision is supportive,
which includes at times cheerleading and encouragement. Often counselors may
lack the confidence in themselves to step forward. Supervision should build on
strengths, nurture assets, and support and encourage all personnel to grow.
Identifying staff with high potential for advancement is a key function of a
supervisor. Through mentorship, personnel can grow professionally, and leader-
ship succession can become a key aspect of the organization and field.
MARGIE: You can help our agency. We will see the scope and the focus of how you want to shape your career
as it moves on.
BETTY: And you would be willing to make that kind of investment in me, Margie?
MARGIE: I sure am. The agency surely is.
BETTY: You know how exciting this is? I am fluttering inside.
MARGIE: It’s exciting for me too. I enjoy seeing staff use their potential to the fullest. It’s something I can
leave behind when I retire that will last far beyond my years of service. It’s like looking into the eyes of chil-
dren and seeing the future in them that I will never realize myself. If I can help mentor you and others, that
will be the icing on the cake of my career.
BETTY: If I can grow to become a representative of the agency and to work more closely with you and learn
from your experience and your wisdom, I’d love that.
MARGIE: Here are some other ideas where you might consider growing professionally: learning about leader-
ship, creating a vision, business and financial management, continuous quality improvement, organizational
development, conflict resolution, and on and on. I know that might all sound rather intimidating at this point,
but there are many areas we can address. I’ll be there with you throughout the learning and mentorship
process.
[Discussion continues about the next steps for Betty. First, they arrange to begin to revise and update her IDP
and the strategies to reach her learning goals. The supervision session then turns to the future needs of the
agency and how Margie and Betty can be part of the evolving future. The session ends with an agreement to
begin writing an IDP and decide on the next steps for their mentorship.]
Resources on Mentorship
ATTC Leadership Institute (http://www.nattc.org/leaderInst/index.htm). After an assessment of leadership and manage-

ment interests, values, and skills, participants attend a 5-day training session designed to present the necessary body of
information. With their mentors, participants develop an individualized training plan and individualized project. They
then return to their organizations for 6 months of mentoring and working on their projects.
Michael E. Townsend Leadership Academy (http://www.mhmr.ky.gov/mhsas/files/KSAODSCatalog.pdf). A 3-day onsite

workshop continues in followup sessions throughout the year in this program sponsored by the Kentucky Division of
Mental Health and Substance Abuse.
South Carolina Addiction Fellows Program (http://www.addictionrecoveryinstitute.com/Southcarolina/welcome.htm).

Participants meet in six 3-day sessions during the year.
North Carolina Addiction Fellows Program (http://www.addictionfellows.com/). Twenty participants meet to create a
group of leaders for the field in North Carolina.

Vignette 8—Making the Case for Clinical Supervision
to Administrators
Overview
This vignette illustrates how a clinical supervisor can justify a system of supervision, along with time and
resource allocations, to agency administrators in the light of recent pressures from the administration to
increase billable hours. (Clinical supervision is not a billable expense at this agency.)
Background
Ella, a Level 2 supervisor, was recently hired to be the clinical supervisor of this agency, overseeing the work of
six counselors. Jonathan is the agency’s CEO and Ella’s immediate boss. Jonathan has directed Ella to main-
tain supervisory functions “the way your predecessor did.” Jonathan does not want to introduce any significant
tasks into the workload, especially those that are not billable or revenue generating.
Ella, on the other hand, recently attended a 30-hour class on clinical supervision and is seeking her certifica-
tion as a clinical supervisor. During the class she learned the importance of “making a reasonable effort to
supervise,” and the legal and ethical obligations of the agency to supervise. She learned about her and the
agency’s vicarious liability for the actions of the clinical staff. In the class, Ella was given the 20-to-1 guideline:
for every 20 hours of client contact, staff should receive a minimum of 1 hour of clinical supervision.
Until now, staff has received primarily consultation and support with case management. To justify more in-
depth clinical supervision, Ella needs the support and endorsement from Jonathan of the new supervision sys-
tem. Given his emphasis on billable hours and reducing nonreimbursable activities, Ella knows that introduc-
ing these changes in the agency will not be easy, but she comes to Jonathan with her plan for supervision, ask-
ing for his endorsement.
Learning Goals
1. To describe the benefits and rationale of clinical supervision.
2. To design a system of supervision that is efficient and effective, without greatly increasing staff and supervi-
sory time and resources.
3. To explore a system in which the supervisor can balance management and administrative duties, maintain a
clinical caseload, conduct training, and perform other duties as assigned.
[The vignette begins with a meeting between Jonathan and Ella to discuss her supervisory tasks and her plan. After
a short introduction in which Ella discusses her feeling of being overwhelmed by her tasks, the dialog continues.]
JONATHAN: The last time we met you were to look at how to improve the quality of our counseling and design
a new plan for supervision. What did you come up with?
ELLA: Well, first I looked at what makes us a quality agency: our strengths and skills and our weaknesses and
liabilities. We want to be the best agency possible. There are four issues that came to me. First, after the client
suicide last year, concerns were raised about our liability as an agency. Even though we took the right action,
we need to be mindful of our vicarious liability for what our staff does. I think we’re both concerned about that
issue.
Second, we’re now required by the State to eventually have all counseling staff be certified addiction counselors.
Our accrediting body is pushing us to provide better quality assurance systems with more clinical supervision.
Third, I know our organizational development plan calls for us to expand services in the near future. We need
to attract high-quality counselors. That’s difficult in a highly competitive market, with many agencies vying for
good staff. We’ve had significant staff turnover in recent years for several reasons. I found that the average
tenure of a counselor in our agency is 2 years, which, by the way, is consistent with the national average. We
know from the exit interviews that the majority of staff who leave complain that we didn’t provide as many
good training and supervision opportunities as other agencies do to support their learning and self-care needs.
It’s costing us a lot of money to have such high staff turnover.
Finally, we need to increase our billable hours. Research tells us that the better the supervision, the better staff
morale and in turn, the better the client services. This has a direct impact on our bottom line if we retain
clients in treatment longer.
[Ella gives Jonathan copies of various studies she’s compiled from her training on the cost of staff turnover, the
CSAT Manpower Study (CSAT, 2003), and a synopsis on staff development issues from the agency’s development
plan.]
Master Supervisor Note: Notice how Ella is well prepared for her presentation
to Jonathan, providing a rationale in language and terms that appeal to admin-
istrators: concerns about liability, credentialing of personnel as mandated by the
State, staffing needs and turnover, and billable hours. When presenting a pro-
posal for a clinical supervision system to senior administrators, it is wise to:
1. Use terms and language that apply and appeal to administrators
2. Be prepared with facts and figures (e.g., the CSAT Manpower Study)
3. Be clear, direct, and succinct; most administrators value clarity, directness,

and results-oriented presentations
4. State clearly the goals, objectives, timelines, and costs for the system and
have the data to support them
JONATHAN: Wow, I’m impressed. You’ve done your homework. So, what is it you’re suggesting? You know
money is a key issue right now.
ELLA: Money is an important issue. I’m suggesting that we look at our current supervision system and that we
design and offer a new system that will help counselors become credentialed, meet the requirements of our
accreditation body, reduce our high turnover rates, protect our liability concerns, improve morale, and in turn,
bring more money into the agency.
JONATHAN: That’s a tall order. And you’re going to do this without spending any money? [Laughing.] Let me
go back to what you said. I thought after last year’s suicide that we beefed up our oversight.
ELLA: Yes, we trained staff on how to deal with suicidal ideation and what actions to take. We were really sen-
sitive to suicidal symptoms and documentation of issues. We have done a good job addressing that issue.
However, I have concerns about our liabilities in general. What is going on right now that we don’t know about?
What are our counselors actually doing behind closed doors? Is there another legal issue waiting for us that we
don’t know about? That’s what I mean by our vicarious liability. Without a sound, consistent system of supervi-
sion, it will feel like we’re constantly putting our fingers in the dike.

Master Supervisor Note: When conceptualizing, justifying, and implementing
a new comprehensive supervision program each level of staff—agency adminis-
tration, supervisory staff, counselors providing direct services, and support
staff—have unique concerns about the needs and effects of clinical supervision.
Administrative staff are most likely to be concerned about some of the issues
noted below:
1. Legal and ethical requirements for supervision, such as vicarious liability,

scope of competence and practice requirements, and recent court rulings
requiring clinical supervision. It is useful to stress the agency’s fiduciary
responsibility to ensure the quality of services provided.
2. Relevant Federal, State, and credentialing or accreditation requirements for

supervision.
3. Staffing costs, such as personnel retention and turnover rates, hiring costs
and expenses associated with retraining of personnel, and impact on staff
morale. It is useful to provide any research data available in the field or
from your agency.
4. Costs associated with implementing a supervision system, such as material

and time costs and the impact on billable hours.
5. The cost benefit for implementing a supervision system, addressing: “What’s

in it for the agency? Why should we do this? What are the ramifications and
costs if we don’t?”
6. A timeline for implementation, with dates and deliverables, including bench-

marks to measure success.
It is important that support in the form of data or relevant resource materials

supplement these points.
JONATHAN: I agree. Are you telling me we’re not doing our job? That our supervisors are not supervising?
ELLA: Our counselors are working very hard. We have fine staff here. Yet, we’ve got to give them more tools to
do a better job, to continue to enhance their skills, and to ensure they recognize what they don’t know. And, as
we grow, the skills needed by staff will also grow.
JONATHAN: We’re not doing that now? We have money in the budget for training. We send people to summer
institutes every year. We have weekly training sessions. Isn’t that supposed to address those issues?
ELLA: It does, but only partly. Much of what we do in these sessions is administratively oriented, addressing
new policies, procedures, and paperwork, compliance issues, and personnel concerns. We’re not doing clinical
supervision.
JONATHAN: I’m confused. Maybe I don’t have a good understanding of what clinical supervision is. I thought
that’s what we were doing. Are we better off than we were a year ago? I need to assure the board of directors
that we’re doing a better job, that the legal concerns of last year have been addressed.
[Ella presents a brief and clear description of what clinical supervision is and how it differs from what they have
been doing, which is primarily case management.]
ELLA: We’ve made significant progress. You can assure the board of that. We’ve minimized some of our legal
risk. We’ve addressed compliance issues. That’s good! When you asked me to look at a quality assurance plan, it
was clear our weekly staff meetings and training sessions only address some of the needs. We must increase
our clinical oversight of staff. That’s not just administrative in nature. In the course on clinical supervision you
sent me to, I found a definition that I think really makes my point. First, clinical supervision is a process where
counseling principles are transformed into practical skills. Second, there are four focuses in clinical supervision:
administrative, evaluative, supportive, and clinical/educational. We’ve addressed the administrative aspects of
supervision well. We now need to increase the amount of evaluation we give staff, support them in their clinical
duties, and train them by watching them work with our clients more closely.
Master Supervisor Note: In many agencies, administrators may not have a

clinical background and thus may not understand the differences between case
management and clinical supervision. A skillful supervisor patiently educates
administrators about the distinction and stresses clinical concerns.
JONATHAN: I think I understand the difference. I’m not a clinician so I am not always familiar with terminol-
ogy. So what are you proposing we do?
ELLA: I need your endorsement and support for a system of supervision involving direct observation of counsel-
ing staff, so we shift the balance of our supervision from mostly administrative to include a clinical focus, too.
The supervision will address each counselor’s skills, what competencies they need to develop further, and how
each can best address the needs of the clients.
How To Demonstrate the Importance of Administrative Support for

Clinical Supervision
An individual developing a clinical supervision program for an agency clearly

needs to explain to an administrator what is being asked of the organization. It
is essential that administrators understand and support the supervision system.
Without that endorsement, supervision systems will not be successful. Critical
steps in this process include:
1. The endorsement of supervision to all staff should be both verbal and in

writing.
2. Clinical supervision systems need the support of staff at all levels of man-
agement and in a manner they will understand: how it will benefit them, the
agency, and the clients.
3. Staff should hear a consistent message about supervision over time, lest they
see the supervision system as the current “flavor of the month,” and believe
“this will pass as soon as another priority comes along.” Staff need to hear
that administrators have a long-term commitment to a consistent program of
quality assurance in their supervision program.
4. It is essential that administrators understand that systemic change takes

time. Although some immediate results will be seen, long-term results can
best be measured over the long term. Many staff have settled into their ways
of doing counseling and might take time to adjust to receiving clinical super-
vision and make noticeable improvements in their skills.

JONATHAN: This is making me nervous. It’s sounding like money. [Laughing.] You know the pressure we’re
under to increase billable hours and decrease activities that don’t generate revenue. Now you seem to be adding
more activities and expenses. Where’s the time coming from to do this?
ELLA: I understand the concern about increasing expenses. There are two answers. Remember the oil commer-
cial years ago, that went something like: “Pay me now or pay me later, but you’re eventually going to pay me.”
We’re paying a lot for staff turnover and decreased productivity because people are feeling unsupported by
administrators. Staff morale is lower, too. If we can provide better training and supervision, we can save the
agency considerable expense. Second, if we can train our staff better, we can perhaps increase both the quality
of our care and the number of clients we can serve. That goes right to the bottom line.
JONATHAN: Are you sure you didn’t get an M.B.A. somewhere along the way? You sound like a business per-
son. Are you saying we’re not as productive as we might be? Isn’t that an administrative issue if people are not
doing their jobs?
ELLA: If we support them further, they could do an even better job. Our counselors are excellent at what they
do. They work very hard and for long hours. Often that leads to burnout and eventually staff turnover. If we
reduced that burnout through supervision, we’d keep them here longer, and their treatment of clients would
improve. That would help our credibility in the community and eventually lead to more services and revenue.
“Pay me now or pay me later.” The choice is up to you.
JONATHAN: Okay. So what are you proposing, and what will it cost?
ELLA: For an agency our size, with only a few counselors, two clinical supervisors can do the job. At the same
time, they can attend to some administrative issues too, in addition to their own clinical work. At the training, I
learned of a system where a supervisor would spend about 3 hours a week supervising her counselors. Some of
the time is observation, and the rest is individual and group supervision. I can show you the matrix we’d use to
do this. Each counselor would be observed in action with a client at least once a month. The supervisor would
meet with the team every week and review the case presented by the counselor of the week. We’d use videotape
of counseling sessions to demonstrate the counselor’s skills and actions. The group would view sections of the
videotape, and we’d have an hour-long discussion of the tape. In some cases, instead of videotaping (it may not
be appropriate to videotape some clients), the supervisor would sit in on the actual session and observe. They’d
then follow the same individual in small group supervision discussion. To do this, I need you to provide funds to
purchase video cameras, tripods, and DVDs. We need $1,000 for this purchase. That will ensure we’re making a
reasonable effort to supervise and will significantly increase our clinical supervision system here. What do you
think?
How To Implement a Clinical Supervision System
To clarify the above statement by Ella, if a supervisor oversees the work of one
to five counselors, it typically requires 2–3 hours per week (see Figure 3 on p. 11).
This entails relying on group clinical supervision and direct observation through
audio- or videotaping or live supervision. Supervisors might need to provide
additional time for close supervision of trainees, interns, or counselors needing
specific attention. The critical aspects in rolling out a clinical supervision system
include:
1. Administrative support. This should be in the form of both written and oral
communication to all personnel showing administrators’ support for clinical
supervision.
2. Training of supervisors. Credentialing organizations require a certain num-

ber of hours of training to be certified as clinical supervisors. Simply because
a person is a good counselor does not qualify them to be a supervisor. It
requires another body of knowledge and skills to be a supervisor.
3. Educating staff about what quality supervision is and what to expect in the
new system. A session for clinical staff should be held (1–2 hours duration),
explaining the rationale for supervision, the policies, procedures, techniques,
and expectations of supervision.
4. A system of supervision of supervision, monitoring the progress of supervi-

sors in implementing the system, and providing feedback on how they are
doing. This is sorely lacking for most supervisors, at least initially. This can
be done through internal supervisors overseeing other supervisors, peer
supervision of supervisors, or externally by contracting with a master super-
visor to oversee the work of supervisors.
5. Consistency of the message that supervision is here to stay and that clinical
supervision is a requirement of the agency.
6. Time to implement the system, acknowledging and working through staff

resistance to change. Attitudes and behaviors about supervision change
slowly. Thus, administrators need to understand that it takes time to work
with personnel, to be clear about what’s expected of them, and to overcome
staff resistance.
JONATHAN: We can do that. That’s a modest expense we can afford. How do I sell this to the board?
ELLA: What did the potential law suit cost us last year in legal fees? Surely more than the cost of three cam-
eras. What does it cost us to train a new counselor when someone leaves? Surely more than the time we’re
investing in their training. Perhaps you could tell that board that if we can retain a staff member for 6–12
months longer, we’ll save the agency far more than you’ve invested in supervision. By being careful, by provid-
ing quality supervision, in the long run, it will in fact save us money by being preventive.
JONATHAN: What else can I tell the board about this supervision system?
ELLA: You can tell them that when a counselor leaves, clients react and the quality of their care decreases. The
board is interested in client satisfaction and treatment outcome. This supervision system will help with that.
JONATHAN: Okay, I’m sold. What’s next?
ELLA: First, I want to submit to you this plan I’ve developed for the supervision system. I’d ask that you read
it and next time we meet, if we concur, I’d like a written statement from you endorsing the plan. I’d also like
you to introduce the program at our next all-staff meeting. How does that sound so far?
JONATHAN: That’s fair. Then what?
ELLA: Second, we need funding for the equipment. Third, we need to identify potential supervisory candidates
from within the organization. If none can be found, we will have to look outside the agency to recruit a qualified
supervisor. Fourth, we will begin to train our supervisors in this model of supervision. This can be done
through a number of low-cost media. Fifth, we will provide an in-service training for all staff on the supervision
system. We need to be clear with staff that we’re going to be observing them with videotape and/or direct obser-
vation. Some won’t like that. Some staff will be quite resistant to the change. This will take time—likely about
a year for everybody to be on board. You and I have to be consistent over time, reinforcing the message that
this is how we’re doing clinical supervision here, regardless of staff’s credentials or years of experience. There’s
going to be a learning curve.

Master Supervisor Note: Again, it is important to be prepared for this presen-
tation with a clear statement of funding requirements, training needs, mecha-
nisms of how these needs will be met, and benchmarks for success. Further, it is
essential to get a firm commitment to the plan from administrators before the
supervisor proceeds. The supervisor should also stress the barriers and obstacles
to be overcome and how those will be addressed.
JONATHAN: Some of the distinction between case management and clinical supervision will hopefully become
clearer to me and staff as we implement the system. You’re going to have to continue to educate me about it. I’d
like to meet regularly with you, perhaps once a week during the roll-out, to discuss how we’re doing. Since the
State now requires our counselors to eventually be certified, will this help in that process?
ELLA: Absolutely. As you might recall, to be certified as an addiction counselor, the person must be supervised
by a certified supervisor. This system will meet that requirement. It will help our counselors to be certified.
[Jonathan and Ella summarize the advantages of a model for clinical supervision that includes workforce devel-
opment and a means to implement evidence-based practices, address risk-management issues and vicarious lia-
bility, create consistency within the agency, minimize reactivity, address accreditation issues, and support coun-
selor wellness.]
JONATHAN: Can you bring me a budget for what this will cost in person hours and hardware by next week?
Talk to our accountant if you need costing data. How are we going to train our supervisors? What will that
cost? What’s the most cost-effective way of conducting the staff and supervisor training? I’d like to see a 3-, 6-,
and 12-month implementation and financial plan for this. Can you provide projections as to potential cost off-
sets and savings on the other end? Can you have that for me by next week?
ELLA: Yes, I can do that by next week. I’ll also give ideas as to how supervisors can balance management and
administrative duties, maintain a caseload, and perform other duties as assigned.
of the Substance
Abuse Counselor
PART 2
Part 2:
A Guide for Administrators

Chapter 1
Clinical supervision should be an essential part of all tion’s ability to respond to risk, thereby reducing
substance abuse treatment programs. Every coun- overall liability. It also addresses human resource
selor, regardless of skill level and experience, needs issues, including staff satisfaction and retention of
and has a right to supervision. In addition, supervi- personnel. Finally, supervision provides marketing
sors need and have a right to their own clinical super- benefits by improving the overall reputation of the
vision. For more on the essential nature of clinical agency in the community and among other service
supervision, see Appendix B, New York State Office of providers.
Alcoholism and Substance Abuse Services Clinical
Supervision Statement. Unfortunately, many agencies
place a higher priority on administrative tasks (such Clinical Services Benefits
as case recordkeeping and crisis management), than The goal of clinical supervision is to continuously
on clinical supervision. This guide for administrators improve quality client care. Supervision by trained
will assist in developing a rationale for and designing and qualified supervisors helps staff understand and
a clinical supervision system for your substance abuse respond more effectively to all types of clinical situa-
treatment organization. Part 2 provides strategies and tions and prevent clinical crises from escalating. It
tools for implementing effective supervision along specifically addresses assessment, case conceptual-
with advice on allocating resources for best results. ization, treatment strategies, and discharge plan-
ning. Supervision aids in addressing the unique
needs of each client. It provides a mechanism to
Benefits and Rationale ensure that clinical directives are followed and facil-
itates the implementation and improvement of evi-
PART 2
A successful clinical supervision program begins with dence-based practices (EBPs). “Quality supervision
the support of administrators. You communicate the will become a major factor in determining the degree
value, benefits, and integral role of clinical supervi- to which EBPs are adopted in community settings”
sion in quality care, staff morale and retention, and (CSAT, 2007, p. 12). Clinical supervision also
overall professional development within the context of enhances the cultural competence of an organization
the organization’s mission, values, philosophy of care, by consistently maintaining a multicultural perspec-
and overall goals and objectives. Being able to discuss tive. “Supervision encourages supervisees to exam-
specific benefits of clinical supervision will increase ine their views regarding culture, race, values, reli-
the likelihood of internal support, enhance your orga- gion, gender, sexual orientation, and potential bias-
nization’s ability to deliver quality supervision, and es” (CSAT, 2007, p. 27).
add marketability for funding opportunities.
CSAT’s Technical Assistance Publication (TAP) 21-A,
Competencies for Substance Abuse Treatment Clinical
Administrative Benefits Supervisors, defines supervision as a “social influence
Clinical supervision enables organizations to measure process that occurs over time in which the supervisor
the quality of services. It ensures that employees fol- participates with supervisees to ensure quality care.
low agency policies and procedures and comply with Effective supervisors observe, mentor, coach, evalu-
regulatory accreditation standards while promoting ate, inspire, and create an atmosphere that promotes
the mission, values, and goals of the organization. self-motivation, learning, and professional develop-
Supervision provides administrators with tools to ment” (CSAT, 2007, p. 3). Also, supervision can
evaluate job performance, maintain communication improve client outcomes (Carroll, Ball, Nich, Martino,
between administrators and counselors, facilitate con- Frankforter, Farentinos, et al., 2006). Finally, super-
flict resolution, and hold personnel accountable for vision increases staff members’ sensitivity and
quality job performance. Clinical supervision is a responsiveness to diversity issues among staff, with
risk-management tool that increases an organiza- clients, and between staff and clients.

Professional Development Key Issues for
Benefits Administrators in Clinical
Quality clinical supervision has been shown to
increase staff retention through professional skills Supervision
development and increased competency (Bernard &
Goodyear, 2004). Supervision provides the forum for
Administrative and Clinical Tasks
expanding current clinical practices, intellectual stim-
ulation, emotional support, and improvement in criti- of Supervisors
cal thinking (see CSAT, 2007). Supervision is part of Supervisors wear many hats. In most organizations,
an organization’s career ladder, as it supports staff in the administrative and clinical supervisor is the same
obtaining and maintaining professional credentials. It person (see also the section that follows,
also provides information and guidance about key Administrative and Clinical Supervision, p. 89). Most
contextual factors that may influence their work per- clinical supervisors still carry a client caseload (albeit
formance such as culture, lifestyles, and beliefs. reduced somewhat from that of a line counselor), per-
form administrative duties, write grant proposals,
serve as project managers, and supervise the clinical
Workforce Development Benefits performance of counselors. Each role involves differ-
Supervision by trained and qualified supervisors is ent expectations and goals. It is important for admin-
an essential tool in the recruitment and retention of istrators to be aware of each of these roles and for
personnel, as counselors often rate training and supervisors to be prepared to perform effectively in
development as critical factors in their selection of administrative, organizational, and clinical roles.
employment. In addition, supervision has been
Kadushin (1976) outlines multiple administrative
shown to improve staff morale and motivation by
tasks for a clinical supervisor: staff recruitment and
making staff feel valued and appreciated (Bernard
PART 2
selection; orientation and placement of employees;

& Goodyear, 2004). It also assists in promoting
work planning and assignments; monitoring, coordi-
counselor wellness, and promotes the overall devel-
nating, reviewing, and evaluating work; staff commu-
opment of the substance abuse treatment field by
nication both up and down the chain of command;
upgrading the credentials, knowledge, skills, and
advocating for client and clinician needs; acting as a
attitudes of personnel.
buffer between administrators and counselors; and
acting as a change agent and community liaison.
Program Evaluation and Research Munson states, “As part of their administrative
Benefits responsibilities, supervisors are often required to
manage program transitions and modifications.
Implementation of program evaluation and/or
Departments and programs can be altered, restruc-
research is often misunderstood by counselors and
tured and merged” (1979, p. 72).
viewed as more work that is unrelated to quality
client care. Supervision can mediate in this area by
providing staff with the rationale for the initiative, Assessing Organizational
connecting it to client outcomes, and communicat- Structure and Readiness for
ing achievements and challenges to the evaluators.
Clinical supervision can also provide the mecha-
Clinical Supervision
nism for data gathering and information retrieval In implementing a clinical supervision program, an
in support of the new projects and programmatic important first step will be to evaluate the agency’s
innovations. preparedness to support the functions of clinical
supervision by identifying the agency’s culture and
organizational structure. Organizational readiness
scales and attitude inventories can be helpful in the
process of assessing and adopting EBPs. You need to • Methods and techniques. How familiar is the
assess the following: organization with individual, group, and peer
supervision? How familiar is the organization with
• How decisions are made within the organization
case progress note review, case consultation meth-
(centralized versus decentralized, vertical or
ods, direct observation, live supervision, audio- or
horizontal).
videotaping, and role playing?
• How authority is defined and handled (top down,
bottom up, through the chain of command, or ad
hoc). Assessing an organization’s readiness for a clinical
• How power is defined and handled (reward, coer- supervision system may also include such questions
cion, legitimate power through status, prestige, as: “What stage of readiness for implementing a clini-
titles, expert power through skills and experience, cal supervision system are the board of directors,
or referent power through respect for an individ- other administrative staff and clinical supervisory
ual—or all of the above). staff (if any), direct care staff, and support personnel?
• How information is communicated (structured/for- What are some of the organizational, administrative,
mal/informal, on a need-to-know basis, bidirection- and clinical barriers to implementing a clinical super-
al feedback and communication). vision system?” Potential barriers include lack of
• How the organizational structure influences super- familiarity with supervision methods and techniques,
visory relationships, process, and outcome. the need for further training of supervisors, and lack
• The overall cultural proficiency of the organization. of technical equipment such as video cameras. It is
helpful to develop a timeframe for addressing the
most important barriers. What would you as an
The following organizational issues should be consid-
administrator like to see happen and who should be
ered by an agency before a clinical supervision system
part of the process for implementing clinical supervi-
is implemented:
sion? (See Tools 1 and 2 in chapter 2.)
PART 2
• Organizational context. How consistently do staff
adhere to agency philosophy and culture? To what
extent will clinical supervisors teach and support Administrative and
this philosophy?
• Clinical competence. What specific knowledge, Clinical Supervision
skills, and attitudes are expected of substance This section is a comprehensive look at the issues fac-
abuse counselors? What is each counselor’s base- ing supervisors in their dual roles. In the substance
line competence and learning style? What is the abuse treatment field, one of the major challenges
level of cultural competence of staff? facing supervision is the reality that most supervisors
• Motivation. How should the staff’s motivation and perform both administrative and clinical supervisory
morale be characterized? functions. The numerous conflicts and ambiguity that
• Supervisory relationships. What is the nature of result from these roles can pose serious problems for
relationships between administrators and front- administrators, supervisors, and supervisees.
line workers? How healthy or unhealthy are those Determining the distinction between the roles of clini-
relationships? cal and administrative supervision can be difficult
• Environmental variables. To what extent do because there are no uniform definitions of these
administrators expect supervisors to proactively functions. Most writing on administrative supervision
teach ethical and professional values? Do staff is in the context of the evaluative and record-keeping
have a common set of goals? How does the organi- functions of a supervisor.
zation promote professional development? How is
progress toward those goals monitored and sup- To the extent possible, administrative supervision
ported? What is the cultural, racial, religious, gen- should be distinguished from clinical supervision.
der, and sexual orientation mix of the clients Bradley and Ladany (2001) state that administrative
served by the organization? supervisors “help the supervisee function effectively
as a part of the organization,” with an emphasis on

“organizational accountability, case records, referrals, tasks assigned to staff that were outside their
and performance evaluations” (p. 5). In contrast, clini- scope of competence?
cal supervisors focus on the services received by the
client, including the therapeutic relationship, assess- Confidentiality. Has the organization adhered to all
ment, interventions, and client welfare. While these laws of confidentiality (i.e., the Health Insurance
tasks may be seen as substantially different, many Privacy and Portability Act [HIPAA], 42 CFR, Part
are complementary. Therefore, you and the supervi- 2)? To what extent has the organization balanced the
sors need to be mindful of the different roles and of counselor’s and client’s right to privacy and perform-
the inherent ethical, relational, and role conflict ance review? Has the organization adhered to its duty
issues. Best supervision practices will work to keep to warn, to report, and to protect?
the dual roles as clear as possible. • Informed consent and due process. This requires
that supervisees and clients be fully informed as
to the approach and procedures of the agency’s
Legal and Ethical Issues actions (see Tools 4 and 19). Have the clients and
for Administrators counselors been informed about treatment
parameters and supervision requirements? Have
You play a vital role in clarifying legal and ethical all required forms and documents been read and
issues for your organization, especially for clinical signed by all relevant parties? Is there a fair
supervisors and counseling personnel. You are invalu- process that encourages conflict resolution and
able in providing information and support for super- ensures the person a process of appeals?
visors and staff. • Supervisor and counselor scope of competence.
Are supervisors and counselors operating within
You and your supervisors need to define and docu-
their scope of practice and competence? Are
ment (in writing) the legal and ethical standards for
supervisors and counselors meeting minimal
the agency. You can draw from the staff’s professional
PART 2
standards of competence regarding cultural and

codes of ethics as well as accepted best practices. All
contextual awareness, knowledge, and skills? Are
personnel should be consistently and continually
they effectively working within the wider client
trained in the agency’s legal and ethical standards, as
systems and networking appropriately with wider
well as in changing case law and legislation affecting
community services and institutions?
clinical practice. You need to reinforce your support
• Dual relationships. A dual relationship exists
for supervisors who face situations where legal and
when a supervisor and supervisee or counselor
ethical issues may arise. You should help supervisors
and client have an additional relationship outside
develop a process for ethical decisionmaking as super-
the primary professional relationship. Guidelines
visors as well as a process for teaching ethical deci-
for supervisory relationships prohibit supervising
sionmaking to counselors.
current or former clients (a difficult issue in the
Among the key issues for you and your supervisors substance abuse field where it is not uncommon
are the following: for an agency to hire and supervise former clients
in recovery). Do any supervisors have current or
• Direct and vicarious liability. Important factors
former romantic or sexual partners, business
affecting liability include the supervisor’s power of
associates, family members, or friends among
control; the counselor’s duty to perform a clinical
their supervisees? Is the distinction clear
service; the time, place, and purpose of the service;
between the teaching and supervisory roles when
the motivation for responding the way the coun-
students are being supervised? Are supervisors
selor responded; and the supervisor’s expectations
mindful of crossing over from the supervisory
for action. Critical legal questions for administra-
relationship to social activities with supervisees
tors are: Did you make a reasonable effort to
that may impair objectivity? Do supervisors avoid
supervise? Was there any dereliction of duty? Did
excessive self-disclosure in supervision and avoid
treatment create any harm, wrongdoing, or dam-
comments or actions that might be interpreted as
age to the client, the organization, or the commu-
sexual? Do you and your supervisors respect and
nity? Did you and the supervisor give appropriate
recognize professional boundaries in all aspects of
advice concerning the counselor’s actions? Were
your relationships? When in doubt, do you variables affect their interactions with clients.
consult with colleagues? Administrators should be watchful for problems that
can arise in the supervisory relationship when super-
visors are of a different race, culture, or ethnicity
You should provide comprehensive legal and ethical
than their supervisees. Fong and Lease (1997) have
orientation to all employees, review codes of ethics at
identified four areas that might present challenges:
the time of hire, and require employees to sign a
statement that they will abide by these codes. You 1. Unintentional racism. Well-intentioned supervi-
will want to review agency adherence to these codes sors who are unaware of how their racial identity
periodically under the umbrella of a quality assur- affects their relationships with supervisees may
ance or compliance program. Clinical supervisors avoid talking about race or culture.
should be proactive and provide documentation that 2. Power dynamics. The power differential in the
describe and conceptualize client problems addressing supervisory relationship may be exaggerated in
potential legal and ethical dilemmas, document all dyads where the supervisor is part of the domi-
clinical directives given, and offer counselors a writ- nant group and the supervisee is a member of a
ten summary of recommendations. Finally, you minority group.
should review liability insurance coverage and sug- 3. Trust and vulnerability. Supervisees who are in a
gest that supervisors and counselors maintain their vulnerable position are, at the same time, encour-
own personal professional liability and malpractice aged to trust their supervisors, when they may
insurance. have little reason to do so.
4. Communication issues. Differing communication
For further legal and ethical issues, the reader is
styles among cultural groups can result in misun-
referred to the forms in this section.
derstandings.
Diversity and Cultural
PART 2
An excellent exercise for you and your supervisors is
to evaluate how supervisors measure up to multicul-
Competence tural supervision competencies. Bradley and Ladany
An important responsibility for supervisors is to con- (2001) list the following in what they term the “super-
tinually improve their cultural competence in order to visor-focused personal development” domain:
teach and support staff. Cultural competence is gained • “Supervisors actively explore and challenge their
through education and training, supervised clinical own biases, values, and worldview and how these
work, and ongoing exposure to the population being relate to conducting supervision;
served. All potential supervisors should be required to • Supervisors actively explore and challenge their
receive training in cultural competence. It is the super- attitudes and biases toward diverse supervisees;
visor’s responsibility to initiate discussions of differ- • Supervisors are knowledgeable about their own
ences in race, ethnicity, gender, religion, socioeconomic cultural background and its influence on their atti-
status, sexual orientation, or disability regarding both tudes, values, and behaviors;.
clinical work with clients and supervisory and team • Supervisors possess knowledge about the back-
relationships. This promotes the acceptance of diversi- ground, experiences, worldview, and history of cul-
ty and cultural issues as appropriate topics of discus- turally diverse groups; and
sion and allows the supervisor the opportunity to • Supervisors are knowledgeable about alternative
model culturally competent behaviors. helping approaches other than those based in a
To appreciate the importance of cultural competence, North American and Northern European context”
counselors must first recognize “the power of their (pp. 80–81).
own cultural assumptions to influence their thinking
and their interactions with others” (Bernard &
Goodyear, 2004, p. 118). From there, supervisors can
help supervisees understand how their own diversity

ment of an implementation plan” (p. 7). To ensure a
Developing a Model for smooth transition to the new supervision program, an
Clinical Supervision agency will need to perform the following tasks:
[d]efining or clarifying the rationale, purpose and
An organization must develop a model for clinical
methods for delivering clinical supervision; [e]nsuring
supervision that best fits its needs. What are its
that agency management fully understands and sup-
underlying needs, goals, and objectives? What mod-
ports the changes that need to be made; [p]roviding
els are available to assist in reaching your organiza-
training and support in supervisory knowledge and
tional goals? The model should be selected in light of
skill development; and [o]rienting clinicians to the
the organization’s mission, philosophy of treatment,
new supervision rationale and procedures” (p. 7).
and orientation. You need to assess the organiza-
These tasks are part of an implementation process
tion’s readiness for implementing a supervision sys-
whereby the changes are introduced over a limited
tem and barriers that might impede the process.
period of time that allows for procedures to be devel-
What are the organization’s capacities for implemen-
oped and tested and clinicians to provide feedback
tation? Once implemented, how will the program’s
and adjust to the supervisory process. “The broad
quality be evaluated? How will continuous quality
goal is to create a continuous learning culture within
improvement strategies be incorporated into the
the agency that encourages professional development,
supervision model? And if the program is successful,
service improvement, and a quality of care that maxi-
how will it be sustained?
mizes benefits to the agency’s clients” (p. 8).
An effective model for clinical supervision will keep
More detailed guidelines for implementing and phas-
the target clear: ensuring that the client receives bet-
ing a clinical supervision system into existing
ter treatment as a result of the clinical supervision
processes include:
system. In addition:
1. You need to be clear as to the organization’s goals
• It will begin with the supervisors’ unique manage-
PART 2
of supervision, viewing supervision as a way of

ment or leadership style, their levels of proficiency
supporting and reaching the agency’s mission.
in supervision, the organization’s philosophy about
2. You should be familiar with the skills and compe-
clinical supervision, and the specialized client
tencies outlined in TAP 21-A (CSAT, 2007) and
needs for clinical services.
other experience and/or credentialing require-
• It will improve counselor competence, make work
ments. The competence of the designated supervi-
more manageable, encourage staff to stretch
sors is central to the successful design and imple-
beyond their current capabilities, build mastery
mentation of the program. In some cases, agen-
and growth, and meet the needs of the client,
cies will need to invest in additional training for
counselor, agency, and credentialing bodies.
potential clinical supervisors. Ask yourself the fol-
• It will encourage supervisees to grow professional-
lowing about your supervisors:
ly in their understanding of culture, race, religion,
• Has the supervisor had formal training and is
gender, and sexual orientation as these issues are
he or she credentialed in counseling, sub-
present clinically.
stance abuse, and clinical supervision?
• At what level of supervision proficiency are
Implementing a Clinical the clinical supervisors?
• Has the supervisor received supervision of his
Supervision Program or her clinical skills?
• What is the supervisor’s relationship with
TAP 21-A (CSAT, 2007) describes the importance of staff?
using a clearly articulated process for implementing a • What is his or her level of cultural proficiency
new model of clinical supervision in both State and and ability to work with culturally diverse
local agency settings as follows: “If agencies are to clients?
improve their supervisory practices by adding activi- 3. It is essential that a clear statement of support
ties identified as clinical supervision competencies, a from senior administration be provided both ver-
set of guidelines is needed to support the develop- bally and in writing to all levels of administra-
tion, counselors, and support staff. This state- 8. If the organization is sizable or the clinical staff is
ment should provide a rationale (see p. 95) for large, it is sometimes helpful to initiate a pilot
implementing clinical supervision. The impor- supervision system in selected units of the organi-
tance of this step cannot be overemphasized. zation. This is an issue that can be addressed by
4. The next step in implementing a clinical supervi- the Change Team. If organizational staff are par-
sion system is to create a Change Team from ticularly resistant to implementing the supervi-
within your organization to spearhead the effort. sion program, it may be helpful to demonstrate
Selecting the appropriate agency representatives the efficacy of a quality supervision program via a
to be the link between you and the supervision pilot program.
system will ensure internal communication and 9. Supervisors should prioritize discussing the
support. The Team should comprise individuals supervisory agreement or contract with each
committed to quality care and the supervision supervisee and invest time to determine the
process. They need to be somewhat familiar with training needs and goals for each counselor. This
the process of supervision and have a clinical is the beginning of an Individual Development
background. Supervisors need to have a thorough Plan (IDP), outlining the counselor’s knowledge,
understanding of the agency’s model and tech- skills, attitudes, and cultural competence. It is
niques of supervision. The Change Team leader essential that the supervisor observe the coun-
will ensure participation and followup with the selor in action before rating her or his abilities.
organization’s clinical supervisors. Planning spe- Rating scales provide the baseline from which to
cific steps to ensure sustainability of the system begin supervision. Both supervisors and coun-
is integral to long-term success. selors should develop and complete rating scales
5. You, the Change Team, and clinical supervisors and IDPs. Dialog on areas of agreement and dis-
should read and understand the importance of agreement at the outset form a vital part of the
the standards outlined in TAPs 21 (CSAT, 2006) supervision process. This discussion also provides
and 21-A (CSAT, 2007). Each counselor should the supervisor with an opportunity to praise staff
PART 2
have a copy of TAP 21 (Addiction Counseling members for their strengths.
Competencies—The Knowledge, Skills, and 10. Supervisors should schedule formal, frequent, and
Attitudes of Professional Practice [CSAT, 2006]). regular individual supervisory sessions. These
It is important for clinical supervisors to meet sessions, similar to individual sessions with
with the Change Team to discuss the skills and clients, need to be respected and protected from
competencies in TAP 21-A, and to identify both unnecessary interruptions or distractions. The
the organization’s strengths and areas needing supervisory sessions should be documented and
improvement. The Team should draft formal poli- follow the prescribed focus outlined in the IDP.
cies and procedures to articulate expectations and 11. To begin direct observation, design an implemen-
guidelines. tation strategy (assuming the organization has
6. An all-staff meeting should feature the organiza- recognized the value of direct observation; see
tion’s view of clinical supervision and how it will Part 1, chapter 1), and establish a weekly rota-
implement the supervision system. The formal tion schedule for the observation of each coun-
policy and procedure should be distributed and selor over the next 3 months. Initially, the clinical
discussed. All clinical staff involved in the system supervisor can provide direct observation feed-
should attend this briefing, presented by the back to counselors individually and then move
Change Team leader and key clinical supervisors. toward a group supervision model whenever prac-
7. Provide necessary training, time, and funding for tical and possible to promote team building and
supervisors. Because the training requirement for efficiency. To help with sustainability, the super-
credentialing as clinical supervisors is typically visor should discuss supervision at every opportu-
participation in a 30-hour class on supervision, nity. Staff needs to see that supervision will be
you need to ensure that all supervisors receive conducted on a regular basis, and that frequency
training before proceeding to comprehensive will be determined by the agency’s needs and
implementation. those of the individual counselor and team.

12. Provide feedback and review the IDP. Through • Competencies. It is important that the supervi-
the observation, the supervisor and counselor can sors of supervisors be Level 3 counselors and
discuss the strengths and challenges of the coun- preferably Level 3 supervisors (see Figures 5
selor’s performance. The developing IDP should and 6 in Part 1, chapter 1). They need to be
outline in detail the areas for improvement and certified clinical supervisors and to have had
how these changes will be further observed and supervision as supervisors themselves so they
monitored. Learning goals evolve as continued have experience with this type of supervision.
observation leads to further suggestions for Administrators should give them the responsi-
improving performance. bility and authority to perform this task and
13. Supervisors should document their direct obser- to require that tapes be provided for review in
vation using various forms that exist for this pur- a timely fashion. Supervisors should develop
pose. The documentation should include times of the competencies sufficient to attain their cre-
meetings and observation, a brief statement of dentials as a certified clinical supervisor.
the content of the clinical session observed, • Record-keeping system. A logging system
review procedures (audio or video tape), feedback should maintain records on the initial coun-
provided, and mentoring and teaching offered. selor–supervisor sessions and the supervision
14. Incentive plans can be developed to encourage of supervisors sessions.
counselors to become seriously involved in their • Recruiting personnel. If your agency does not
professional development. have an internal person to provide the super-
15. Create a sustainable treatment team. Over time, visor’s supervision, it is recommended that
some staff will leave and others will join the you contract for such services with external
team. It is important for you and your supervisors sources. Over time, the external supervisor
to work with the team to create an atmosphere of should train an internal person to assume
learning that supports the agency’s commitment this role.
PART 2
to clinical supervision. This means including the

clinical supervision policy and procedures in the
orientation of new staff. It definitely means that Phasing in a Clinical Supervision
the team will continue to meet for supervision on System
a regular basis. The steps below have been found to be helpful in
16. Develop a system of supervision of clinical super- phasing in clinical supervision systems in an orderly
visors, particularly for those who are new to their manner. Although the list is provided sequentially,
role. Supervisors need to continually build and the needs of an agency will determine the timeframe
improve their supervisory skills as well as have a and selection of objectives.
forum to discuss staff challenges. Some agencies
have created supervisory peer groups where the Phase I: Organization and Creation of a
supervisors present and receive feedback on their Structure
supervision, other agencies hire a consultant to • Assess and describe the agency culture (including
provide supervision, while some regional coali- assets and deficits), selecting assets to build on
tions have established monthly forums. and/or deficits for remediation regarding clinical
Some of the primary elements in a supervision of supervision.
supervisors system include: • Assess the facility’s policies and procedures to
• Direct observation. This may best be done by determine the feasibility and practicality of a clini-
periodically (e.g., once a calendar quarter) cal supervision system (i.e., presence of clinical
videotaping a supervision session and having supervisory staff, availability of direct observation
the supervisor’s supervisor review the video- technology, etc.).
tape. They then discuss what occurred during • Examine job descriptions to determine staff scope
the supervision, with the supervisor’s supervi- of practice and competence.
sor providing feedback and recommendations.
• Reach consensus among the Change Team about are sound. Review the counselor’s ability to per-
the definition of clinical supervision and its key form the TAP 21 competencies, the activities and
components for that agency. functions performed by a substance abuse coun-
• Publicize this consensus statement to all person- selor that form the basis of the standards required
nel, introducing staff to the new supervisory model in many States for credentialing. Also see the
and clearly communicating expectations for the Northwest Frontier Addiction Technology Transfer
delivery and outcomes of clinical supervision Center Performance Rubric at
before program implementation. http://www.nfattc.org.
• With all personnel, discuss and introduce clinical
supervision policies and procedures.
Phase IV: Improving Performance
• Review the organization’s cultural competence as
it relates to the client populations served. Proficiency in the Addiction Counseling Competencies
• Develop documentation and accountability systems. (CSAT, 2006) and the International Certification and
Reciprocity Consortiums 12 Core Functions should be
the subject of continuous assessment and professional
Phase II: Implementation
development during clinical supervision. Additional
• Implement a supervisory contract, including specific performance concerns include:
informed consent, with all staff to improve the
• Continually align the clinical supervision goals to
supervisory working alliance.
the agency’s mission, values, and approach;
• Assess the quality of the supervisory relationship
• Create risk management policies and practices
and devise interventions to strengthen the learn-
and monitor adherence;
ing alliance.
• Address the cultural competence of personnel in
• Conduct counselor assessments to establish com-
supervision;
petency baselines.
• Consistently address a deepening of counselor
• Design initial supervisory goals and measurable
PART 2
knowledge, skills, and attitudes about legal and
objectives for each counselor.
ethical issues;
• Use strengths-based approaches where appropri-
• Use formative and summative evaluation and
ate and possible in clinical supervision, supporting
feedback procedures to inform the clinical supervi-
counselors’ positive actions with clients.
sion process;
• Develop a system of supervision of supervision.
• Develop quality improvement plans for the agency,
Some programs use the same taping and monitor-
including clinical supervisory procedures;
ing systems for supervisors that are used between
• Overtly address and encourage counselor and staff
counselors and clients, with supervisors expected
wellness programs;
to videotape their supervision sessions at least
• Invest in counselor and staff training; and
once a month, and receive supervision of their
• Foster your staff from within, continually seeking
supervision by the team of supervisors and/or
individuals with the potential to become tomor-
their supervisor.
row’s supervisors.
Phase III: Establishing a Training Plan and

Learning Goals Documentation and Record
• Complete a written IDP for each counselor. Keeping
• Provide focused, on-the-job training. Overseeing documentation and record keeping is an
• Identify clinical supervision quality indicators to essential administrative task, as maintaining a
monitor the quality assurance program for the supervisory record has multiple purposes for adminis-
agency. trators, supervisors, and counselors. One of the pri-
• Periodically review job descriptions and evaluation mary purposes of documentation is to serve as the
procedures to ensure that counselor competencies legal record for the delivery of supervision: a reason-
able effort was made to supervise. The supervisory

record is also important in developing a thoughtful • A risk management review summary, including
plan for both quality client care and professional concerns about confidentiality, duty to warn situa-
development. The supervisory record serves to: tions, crises, and the recommendations of the
supervisor concerning these situations.
• Improve client care.
• Model good record-keeping procedures for personnel.
The entire documentation record can be brief and in
• Afford and enhance ethical and legal protection.
summary form. (See Tools 10–12 in Part 2, chapter 2,
• Provide a reliable source of data in evaluating the
including checklists and summary statements to
competencies of counselors.
reduce the volume of work for the supervisor.)
• Provide information concerning staff ability to
assess and treat clients.
• Reflect staff understanding of the dynamics of Evaluation
behavior and the nature and extent of the prob- Although training in how to conduct productive and
lems treated. constructive evaluations of personnel is rare, evalua-
• Assess staff cultural competence and proficiency. tion of personnel is a critical administrative task of
• Provide information about the clinical supervisor’s supervisors and administrators. The goals of evalua-
ability to assess counselor competencies and the tion include, but are not limited to, reviewing job per-
nature of the clinical supervisory relationship. formance; assessing progress toward professional
• Provide information about the clinical supervisor’s development goals; eliciting future learning goals;
clinical and supervisory competence. assessing fitness for duty and scope of competence;
and providing feedback to staff on adherence to
A good clinical supervision record should include the agency policies, procedures, and values.
following elements:
There are a number of issues that shape the feedback
• Requirements for counselor credentialing (certifi- process, including:
PART 2
cation/licensure) and the extent to which each

counselor meets those requirements. • How does the agency define a “good” counselor?
• The counselor’s regularly updated resume and a What knowledge, skills, and attitudes are critical?
brief summary of his or her background and clini- What level of cultural competence is needed?
cal expertise. • How does a supervisor measure general affective
• A copy of the informed consent document, signed qualities, such as counselor’s empathy, respect,
by the supervisor and the supervisee. genuineness, concreteness for clients?
• A copy of the clinical supervision contract, signed • What standardized tools will be used to support
by the supervisor and the supervisee. the evaluation? There are few evaluation instru-
• The IDP, updated minimally twice a year and ments with psychometric validity or reliability.
preferably every 3 months.
• A copy of the formative and summative evalua- The IDP can be the basis for evaluation. Each coun-
tions the supervisor has given to the supervisee selor should have a development plan that takes into
and all relevant updates to these evaluations. consideration her or his counseling developmental
• A log of clinical supervision sessions, dates, times; level (see Stoltenberg, McNeill, & Delworth, 1998),
a brief summary of key issues discussed; recom- learning needs and styles, job requirements, client
mendations given by the supervisor and actions needs, and the agency’s overall goals and objectives.
taken by the counselor; documentation of cancelled A sample IDP is provided in chapter 2 (Tool 15).
or missed sessions by either the supervisor or
How do administrators and supervisors evaluate per-
supervisee; and actions taken by the supervisor
sonnel and assess job performance? There are two
when supervision sessions are missed.
forms of evaluation: formative and summative.
• A brief summary of each supervision session,
Formative evaluation focuses on progress, is regularly
including specific examples that support learning
provided, and gives feedback to the employee regard-
goals and objectives.
ing his or her attainment of the knowledge, skills,
and attitudes necessary to the job. It addresses the
question, “Are you going in the right direction?” The Supervisees prefer:
quality of the supervisory relationship determines the
• Clear explanations.
success of the formative evaluation process.
• Written feedback whenever possible.
Summative evaluation is a formal process that rates
• Feedback matched to their counseling develop-
employees’ overall ability to do their job and their fit-
ment level.
ness for duty. It answers the question, “Does the
• Encouragement, support, and opportunities for
employee measure up?” In substance abuse counsel-
self-evaluation.
ing, summative evaluation takes into account many
• Specific suggestions for change.
variables: the range and number of clients seen, the
issues and problems addressed by the counselor, the
Feedback should be:
general themes in training and supervision, skill
development, self-awareness, how learning goals have • Frequent.
been translated into practice, and the employee’s • As objective as possible.
strengths, expertise, limitations, and areas for future • Consistent.
development. Summative evaluation also addresses • Credible.
the nature of the supervisory relationship and goals • Balanced.
for future training. • Specific, measurable, attainable, realistic, and
timely: SMART.
The best evaluations occur when there is open
• Reduced to a few main points.
exchange of information and ideas between the
supervisor and counselor, where specific examples
are gleaned from the ongoing supervisory documen- Supporting Clinical Supervisors in
tation, and expectations are again reviewed and Their Jobs
agreed upon. Some organizations have moved to Being a supervisor in any setting is a difficult job.
360-degree assessments, with input from many lay- The supervisor represents the concerns of administra-
PART 2
ers of the organization. Tool 13 in chapter 2 is a tors, counselors, and clients. Supervisors advocate on
counselor evaluation of a supervisor. The quality behalf of those above and below them in the organiza-
and quantity of feedback from a supervisor is an tion chart. Hence, it is imperative that you provide
important part of supervision, according to super- support for the clinical supervisor in the agency and
visees (Bernard & Goodyear, 2004). Formalized feed- in the job.
back and evaluation is designed to review the ongo-
ing, frequent feedback provided over time in a To show support for clinical supervision, review the
supervisory system (see Tool 14). organization’s receptivity to supervision: Is its cli-
mate for change, tolerance, and commitment con-
Conducting an evaluation involves exercising authori- ducive to efficient implementation of a clinical super-
ty and power. When supervisors evaluate counselors, vision system? Also, assess the magnitude of the pro-
they are also evaluating themselves and their effec- posed supervision system and the critical factors
tiveness as supervisors with particular supervisees. needed for success. “The agency structure and the
The evaluation process brings up many emotions for supervisory program within it define the parameters
both parties. In providing feedback, supervisors of the supervisory relationship. Decision-making
should: processes, autonomy within units, communication
norms, and evaluative structures are all relevant to
Provide positive, as well as constructive, feedback:
the supervisory function” (Holloway, 1995, p. 98).
• Differentiate between data-based and qualitative
To assess the organization’s receptivity to supervi-
judgments about job performance.
sion, you should address the following issues:
• State observations clearly and directly.
• Prioritize key areas for review rather than flood 1. To what degree does the organization value
the counselor with an all-inclusive review. accountability and have clear expectations of its
personnel?

2. How is supervision tied to an employee’s ongoing You support clinical supervision when you help
performance improvement plan or performance supervisors build an organizational climate in which
incentive program? they can do quality work. This entails the following
3. To what extent does the organization have effi- factors:
cient and effective systems in place to manage
1. Allocating time for clinical supervision. Since
day-to-day operations?
supervision is not (in most cases) a revenue-gen-
4. To what extent does the organization view itself
erating activity, administrators may tend to mini-
as a learning environment, encouraging inquisi-
mize the importance of quality clinical supervi-
tiveness, creativity, innovation, and professional
sion and fail to provide the needed time to “make
development?
a reasonable effort to supervise.” A matrix pre-
5. To what extent does the organization value
sented in Part 1, chapter 1 gives guidelines to
upward and downward communication and rela-
supervisors for organizing their time and provid-
tionships by creating opportunities for staff to be
ing quality supervision.
heard? Does the organization understand that the
2. Making clinical supervision an agency priority.
learning alliance and relationship is key to suc-
You can support the clinical supervisor with a
cessful supervision?
clear statement of the importance of supervision
6. In what ways is the organization a dynamic,
and provide the resources needed to perform this
growing organism that values everyone’s
function. This might include the acquisition of
contribution?
taping equipment, provision of one-way mirrors,
7. To what extent does the organization “provide
etc. Staff need to hear unequivocally that supervi-
diversity training and other experiences that
sion is a necessity and a requirement for all per-
empower [a counselor] to become an advocate for
sonnel, regardless of years of experience, academ-
the organization’s target population and an agent
ic background, skill and counselor developmental
of organizational change” ? (CSAT, 2007, p. 31)
levels, and status within the organization.
PART 2
8. How does the organization view teamwork, and

Supervisors also need supervision.
what structures are in place to support the team-
3. Supporting creative methods for supervision. As
building process?
this TIP advocates for direct methods of supervi-
9. How do lines of authority and communication
sion through one-way mirrors, video/audio taping,
operate in the organization? How do formal and
and live observation, you can state clearly that
informal decisionmaking processes that influence
“at our agency we observe.” Other methods for
the supervisors’ functions work?
clinical supervision might include group or peer
10. To what extent do administrators know about and
supervision models (see Part 1, chapter 1).
understand the process and practices of clinical
4. Building and supporting a record-keeping process
supervision? What training do they need in this
for clinical supervision. This entails providing
regard?
time and tools for the documentation related to
11. What is the common ground in understanding the
clinical supervisory and administrative functions.
relationship between the administrative and clini-
Supervisory notes need to be integrated with clin-
cal functions of the supervisor?
ical notes and human resource files. One good
12. If the organization does not have trained and
documentation system is the Focused Risk
motivated clinical supervisors, what is your plan
Management Supervision System (FoRMSS;
for recruiting new supervisors and/or training
Falvey, Caldwell, & Cohen, 2002). Assisting in
current supervisors who will be able to take on
organizing the supervisory process by investing in
this new responsibility?
activities that will increase productivity over
13. Are the job descriptions and roles clear, current,
time, setting and adhering to priorities, and
and accurate for all personnel?
increasing coping skills repertoire to manage mul-
14. How much supervision of their supervision will
tiple tasks through cross-training and team build-
the supervisors receive from administrators or
ing. You also need to periodically review job
other consultants?
descriptions, personnel strengths and aptitudes,
and cultural competence, and reorganize work-
loads accordingly. You should periodically review • Creating IDPs with all supervisors. Even as every
the purpose and function of every meeting and client needs a treatment plan and every staff
seek to streamline meeting times for economy and member needs an IDP, every clinical supervisor
efficiency. also needs an IDP. Supervisors’ IDPs are jointly
5. Assisting supervisors in implementing agency pri- developed and monitored by the clinical supervisor
orities, such as the adaptation of EBPs to fit the and his or her supervisor.
agency’s goals and objectives. Hence, if an organi- • Helping supervisors develop a professional identi-
zation is implementing an EBP, it is imperative ty as a supervisor. This entails encouraging the
that supervisors also be trained in how to super- supervisor to be credentialed as a clinical supervi-
vise that practice, perhaps even before counselors sor. They should also receive ongoing training
are trained. required for recertification.
6. Assisting supervisors in other personnel func- • Providing time for them to work with a mentor
tions, such as working with impaired profession- (either someone within the organization or an out-
als and providing an employee assistance pro- side consultant).
gram (EAP) as a resource to supervisors and • Requiring an annual minimum number of clinical
supervisees. You and your supervisors need to supervision training hours.
work together when staff are involved in ethical • Offering time and resources for supervisors to par-
or legal issues that might impair the organiza- ticipate in State or local support groups for super-
tion’s function and credibility, and the supervisor visors.
needs to keep the administrator informed of all • Providing job performance evaluations on a regu-
actions taken throughout the process. lar and timely basis.
7. Supporting supervisors in developing cultural
competence within the organization. This entails
hiring culturally competent clinical supervisors
and staff and providing personnel training on cul-
PART 2
tural issues. It also requires supporting supervi-
sors in developing and improving cultural compe-
tence in counselors.
of Supervisors
You both support clinical supervisors in their func-
tion and monitor their professional development and
performance by:
• Building a system to monitor, evaluate, and pro-

vide feedback to clinical supervisors. Supervision
of one’s supervision is lacking in many organiza-
tions. Every clinical supervisor is entitled to and
needs to have some form of supervision of their
supervision, either live or online.

Clinical Supervision of Substance Abuse Counselor

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Clinical Supervision and

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

1 Choke Cherry Road

Public Domain Notice

Electronic Access and Copies of Publication

HHS Publication No. (SMA) 09-4435.

What Is a TIP? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii

How This TIP Is Organized . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi

Benefits and Rationale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87

Clinical Supervision and Professional Development iii

Appendix A—Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127

Appendix B—New York State Office of Alcoholism and Substance Abuse

Appendix C—Advisory Meeting Panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139

Appendix D—SAMHSA Stakeholders Meeting Attendees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141

Appendix E—Field Reviewers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143

Appendix F—Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145

Part 1 Consensus Panel Members

Sharon Hartman, M.B.A., LSW

Pamela Mattel, M.S.W., LCSW-R, ACSW, CASAC

John Porter, M.S.

Part 2 Consensus Panel Members

Charles F. Gressard, Ph.D., LPC, NCC

Pamela Mattel, M.S.W., LCSW-R, ACSW, CASAC

Clinical Supervision and Professional Development v

Clinical Supervision and Professional Development vii

Eric Broderick, D.D.S., M.P.H.

H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM

Clinical Supervision and Professional Development ix

Chapter 2 presents the “how to” of clinical supervision. Chapter 2 contains:

It is strongly recommended that you read chapter 1 before reading chapter 2.

Clinical Supervision and Professional Development xi

• Introduction (pp. 3–4)

Chapter 2: Clinical Scenarios Showing How To Apply the Information

Clinical Supervision and Professional Development 1

Clinical Supervision and Professional Development 3

Functions of a Clinical Supervisor

As shown in Figure 1, your roles as a clinical supervi-

• Teacher: Assist in the development of counseling

Clinical Supervision and Professional Development 5

Clinical Supervision and Professional Development 7

Models of Clinical Integrated models, including the Blended Model,

Clinical Supervision and Professional Development 9

Level 2 • Focuses less on self and • Less structure provided, • Observation

Level 3 • Focuses intently on client • Supervisee directed • Peer supervision

Source: Stoltenberg, Delworth, & McNeil, 1998

• Counselors at an advanced developmental level

Level 1 • Is anxious regarding role • Follow structure and formats

Level 3 • Is highly motivated • Comfortable with all levels

Source: Stoltenberg, Delworth, & McNeil, 1998

Models of supervision have been strongly influenced

Clinical Supervision and Professional Development 11

Figure 4. Continuum of Cultural Competence

Cultural Openness (Sensitivity)

Source: Cross, 1989.

Clinical Supervision and Professional Development 13

Clinical Supervision and Professional Development 15

Clinical Supervision and Professional Development 17

Clinical Supervision and Professional Development 19