Roles and approaches within clinical mental health counseling

Abstract

The definition of supervision varies within the context in which it is applied, however, within the counseling profession, one seems to stand out as the most widely accepted. According to Bernard and Goodyear (2004), supervision is, “…an intervention provided by a more senior member of a profession to a more junior member or members of that same profession. This relationship is evaluative, extends over time, and has the simultaneous purposes of enhancing the professional functioning of the more junior person(s), monitoring the quality of professional services offered to the clients, she, he or they see, and serving as a gatekeeper for those who are to enter the particular profession.”



While the presented definition does appear to be applicable, it is just the groundwork for what supervision entails, as it is multifaceted, needs to be tailored to the situation and personnel involved, including the client, supervisee and the supervisor. The definition also does not address the different models, theories and methods involved, allowing much to be interpreted by those involved in such a relationship. The following paper will provide a brief overview of supervision, models and theories used within clinical mental health counseling. 

Roles and functions

     Supervision within the counseling is one of the more important and prominent part of one’s position as a member of the mental health community. However, although supervision is conducted by at least two thirds of counseling psychologists, few have received thorough training in the application of effective supervisory skills (Milne and Oliver, 2000). By requiring supervision but not providing training, the experience is unique as it is influenced by the one providing the guidance, which is influenced those who had supervised them early in their careers. 

     However, the American Psychological Association’s (APA) Office of Accreditation observed such a gap and in 1996, added supervision as one of the skills to be included in accredited programs at the doctoral and internship levels, thus addressing the need to have formal education in supervision (Peake, Nussbaum and Tindell, 2002). According to the APA, supervision covers a vast and diverse collection of responsibilities, including but not limited to: monitoring, evaluating, instructing, advising, modeling, consulting, supporting, foster autonomy within the supervisee and a responsibility to the patient, profession, system and society. Supervision also addresses legal and ethical issues that may arise, thus further emphasizing the importance of effective training within the mental health profession (www.apa.org). 

     Supervision is not complete at the end of one’s internship, as an interaction between junior and senior counselors can help to provide insight on new therapeutic interventions, different perspectives on a situation and work as a supportive environment in which to voice concerns that may arise. Supervision isn’t just a requirement among American counselors, as members of the Humanistic and Integrative section of the UK Council of Psychotherapy have to apply for membership every five years and state what style and source of supervision they are currently engaged in within their practice (www.hipcollege.co.uk). 

Models within supervision

There are several different models of supervision found within the field of counseling, including individual, group and triadic. Each has their strengths and weaknesses, including within the application and reception by the supervisee. Individual, one-on-one supervision is the most costly in resources, as time is available in limited quantities when there are several students that require supervision and only a few senior counselors to provide the needed individual interaction. However, the approach is more effective when providing feedback regarding casework and planning for future sessions (Milne and Oliver, 2000). Group supervision usually involves a small number of supervisees, which may help to foster a cohort effect, thus the students are able to teach each other through their experiences, with a senior member overlooking and guiding the process.

     The Council for Accreditation of Counseling and Related Educational Programs (CACREP) approved a third method of supervision in 2001, which is the triadic method. The premise behind the triadic approach is a working tutorial relationship between a supervisor and two counseling students, involving all three members in an open and supportive communication atmosphere (Lawson, Hein and Getz, 2009).


     Within the different models, there are is a plethora of methods used to help to facilitate effective supervision. Both audio and visual recordings of sessions conducted by the student can serve as an accurate measure of providing feedback, as the supervisor is able to see and hear what occurred within the session. Having the video of the session may also provide insight to the importance of non-verbal communication between the client and the student. However, knowing that one is being recorded may alter the behavior, of both student and client. 

     Another less obtrusive method of supervision is the bug-in-the-ear or eye, which is a method approved by CACREP, involves either a small receiver to be placed inside the supervisee’s ear in which the supervisor provides support and feedback during a session. With the bug-in-the-eye technique, the supervisor monitors the session and provides written guidance via a monitor that is behind the client. Both of these methods are effective, as they allow the supervisor to provide real-time feedback, assisting when the student may run into a challenging moment. However, they also serve as a possible distraction and added source of stress for the supervisee. Methods are more likely to be effective and well received when tailored to the individuals involved in the therapeutic relationship, which includes the supervisor, supervisee and the client.

     Just as there are different models and methods in providing effective supervision, there are a variety of theories used in mental health settings, each with strengths and weaknesses associated with their unique approaches and views. Some are psychotherapy-based in their approach to supervision, which includes psychodynamic, person-centered, experiential, psychodrama, cognitive, cognitive behavioral, multimodal, solution-focused and narrative (Pearson, 2006). Another approach is the Littrell, Lee-Borden and Lorenz Model of supervision, characterized as a developmental approach since it focuses on the supervisor’s transitional role as the supervisee passes through four sequential stage. The stages are supervisor as teacher, establishing a relationship and setting goals; continue with scaffolding of supervisee, providing feedback in perceived skill deficits; collaborative relationship between supervisor and supervisee; and finally a graduation of the supervisor to a consultant role, allowing the supervisees to take greater responsibility (Nelson, Johnson and Thorngren, 2000).

Intern expectations of supervision

     Supervision is an important aspect in the continued learning environment, providing support, feedback and establishing a supportive atmosphere in which a new counselor can thrive. Forming a positive bond with one’s supervisor during internship and as a new clinical mental health counselor can help to facilitate effective communication, which can help to enhance the experience. The type of supervision can vary depending on the work environment, clients treated, financial resources and even the culture within the community.  

     Some individuals may not feel as comfortable in one-on-one supervision and may prefer the small group or triadic models, especially if the relationship between supervisee and supervisor is not welcoming or appears cold and impersonal. As one who desires to work within the military community as a mental health counselor, it is more likely that the type of supervision that will be present will be of the group variety, due mainly to cost constraints and the availability of supervisors. In the military setting, much of the therapy is of limited duration and would fall within the solution-focused aspect of the psychotherapy-based approach. Supervisors who have specialized training in the same field would be beneficial as well, since clients who are seeking a marriage and family counselor may differ from those who are seeking a trauma therapist.


Conclusion

     Supervision, like the field of counseling itself, is quite varied. Depending on a variety of methods, models and theories to assist in developing a well-rounded counselor, able to effectively help clients during the span of their career. Developing a supportive atmosphere that allows for fostering confidence and an open dialogue between the supervisor and supervisee is tantamount to a positive and successful outcome, which is important for all parties involved. The approach must be holistic in nature, as individuals are multifaceted and are more receptive to styles that address the whole picture, rather than just small aspects.

*References available upon request