What happens in counseling?

William Glasser was in training to be a classical psychoanalyst in the spirit of Sigmund Freud. Glasser worked in the Vienna School for Girls (similar to a juvenile detention center in the U.S.). A 13-year-old girl was having a tantrum, and her behavior was having a negative impact on the entire facility. Traditional psychoanalysis would ask the girl the why question: "Why are you acting up?" Or "Why are you having a tantrum?"  Instead, Glasser said to the girl, "Your behavior needs to stop. Your being in pain does not give you the right to negatively affect other people."

Glasser's statement was the beginning of his development of Reality Therapy (Corey, 2016). Reality therapy avoids the why questions and works to hold clients responsible for their behavior. Glasser would document client’s charts progress notes in alignment with psychoanalysis, but he was actually developing Reality Therapy. While the Glasser example is an outlier, supervisors have no idea of what's happening in counseling without observation and feedback.

Evidence-Based Practices and observations in clinical supervision

We are in the era of Evidence-Based Practices. Yet, approximately one-third of Substance Use Disorder counselors across the country receive no clinical supervision at all (Newby, 2018). Therefore, it is close to impossible to implement Evidence-Based Practices without observation and feedback from clinical supervisors. 
 

Not so fast! Trust and rapport before observations and feedback

Supervisor observation and feedback can lead counselors to feel uncomfortable and defensive. It is essential to build trust and rapport first. Below is a list of things you can do as a supervisor to build trust and rapport before observation and feedback.
 

1. First, demonstrate that you care. There is a famous quote. "No one cares how much you know unless they know how much you care." When counselors know that you care, safety is created.
    
2. Lead with imperfection. Share some of your clinical mistakes when you were a counselor. This can help counselors be more comfortable with their mistakes as you make observations. When supervisors appear Perfect, counselors can fear the consequences when you make observations and give feedback.
    
3. Not making a big deal about every mistake. This sends the message that it’s OK to make mistakes.
    
4. Be vulnerable. This makes it easier for the counselors you supervise to be vulnerable.
    
5. Create an atmosphere of identification. Share stories about experiences you had when you were a counselor, letting counselors know that you identify with their challenges. Include some of your clinical challenges.
    
6. Periodically ask for feedback. "How am I doing as your supervisor?" Modeling openness to feedback can be instrumental in helping counselors be more open to feedback.
    
7. Transparency, predictability, and calmness. Being transparent, consistently predictable, and calm can build trust in clinical supervision before observations and feedback.

    

Observations and feedback

Once trust and rapport have been established, it is time to observe. Supervisor observation requires client approval. It is recommended that the agency create a form that clients voluntarily sign, giving permission for the supervisor to observe the session. The counselor should tell the client that the purpose of the supervisor observing the session is to provide feedback to the counselor to improve their work with clients. It is amazing how little most clients focus on the presence of the supervisor once the session begins.  Below is a list of 7 methods of observation.

1. Observe office sessions.
    
2. Shadowing. This method is used with staff whose work involves movement, walking, or home visits. Individuals whose work involves movement and home visits include case managers, peer specialists, and recovery coaches. As a supervisor, you can accompany the staff member on visits and give feedback on the spot following sessions.
    
3. Live Supervision. Agencies that utilize live supervision often have a room with a one-way mirror. The supervisor and sometimes your peers are behind a one-way mirror while the counselor and client are in a room on the other side of the mirror. The supervisor can view the session, and the counselor and client cannot see the supervisor. There is a phone on the counselor's side of the room. At some point in the session, the supervisor will call the counselor with immediate feedback and clinical recommendations for the remainder of the session.
    
4. The use of actors. A supervisor taught counselors seven skills of Motivational Interviewing. Then, they hired seven university theater majors to play the role of a client in each of the seven skill areas. Each actor was in a separate room with a script. The counselor would go from room to room, role play with the actor, and demonstrate the skill. Then they would receive feedback from their supervisor, who observed each roleplay.
    
5. Audio and Video takes. The counselor periodically tapes a session and brings the tape to supervision for feedback.
    
6. Practice. The supervisor and counselor role play clinical situations in supervision followed by feedback.
    
7. Co-facilitation. Another method of observation is co-facilitation of group, couples, or family therapy sessions. If the supervisor is the "Michael Jordan" of clinical practice, the counselor might be intimidated or in awe of the supervisor’s work. It might not be co-facilitation in the beginning. It might be 75% to 25%, with an eventual expectation of 50% to 50% of facilitation.

    

How to give feedback

After observations, it's time for feedback.

You can ask the individual you supervise:

1. How do you like to receive praise?
2. How do you prefer to receive feedback?

According to behaviorists, in giving feedback it’s often helpful to begin with the positive. Then couch the remainder of the feedback in recommendations to improve the session in the future.
 

Conclusion

Quality supervision mirrors good counseling. Just as it is helpful for counselors to incorporate timely client feedback into clinical practice, it’s also helpful for observation and feedback to be incorporated into clinical supervision. Also, just as counseling sessions are frequent, usually once a week, we recommend weekly clinical supervision sessions.

References

Corey, G. Theory and Practice of Counseling of Counseling and Psychotherapy. (2016). Cengage Learning. Boston, MA.

Newby, M. H. (2018). Addiction counselor's Perceptions of Clinical Supervision Practices. Doctor of Philosophy (Ph.D.) dissertation, Counseling, and Human Services, Old Dominion University, DOI: 10.25777/979e-me-65 https://digitalcommons.odu.edu/chs_etds/20