Clinical Supervision

Clinical supervision plays a significant role in the preparation for quality of client care.
 

Professionals working in clinical practice obtain knowledge from formal theories, research findings, and the practice-based knowledge of expert practitioners. However, practice alone is not a sufficient means to attain competence unless it is guided by systematic feedback and reflection, which clinical supervision supports.  Without this component incorporated into clinical practice, supervisees will gain no more than the illusion that they are developing professional expertise (dawes 1994). 

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Ethical practitioners understand the value and importance of their clinical self-development and are always working on their clinical competencies through the use of supervision
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As an ethical practitioner, knowing your clinical abilities based on clinical speciality training and supervision regarding specialities of practice informs your competencies.  As stated, the complexity of the population we serve and the multi-dimensions of their problems lead ethical clinicians to reflect on the scope and limitations of their competencies. No one practitioner has all the skills, abilities or knowledge to manage the complexities of our population.  Ethical practitioners recognize this and incorporate clinical supervision to into their practice to ensure that clinical practice is being delivered in a responsible, informed, safe, ethical and evidence-based way. This ensures that we support a ‘do no harm’ approach to client care.  It must be noted that when a professional has a clinical situation beyond their training and competencies, supervision will be utilized to support development and quality client care.  The relationship between the practitioner and the clinical supervisor mirrors the relationship and connection between the practitioner and the client. Practitioners who do not access clinical supervision practice in a clinical silo, increasing risk of harm to clients. 

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Clients having addiction(s), mental health, and trauma are complicated and complex.
 

The complexity of the work is also interwoven within the context of us, as care providers.  Clinical supervision supports the development of the worker to gain insight to counter-transferences and “use of self.”  it also supporting the professional development and education of staff by integrating the theory to clinical practice. Clinical supervision supports professional development in identification of the ‘blind spots’ within ourselves. 

The role of clinical supervision is to provide clinical ‘oversight’ to ensure all aspects of the client’s welfare are monitored from a trauma informed perspective of ‘do no harm’ and that we are always working and practicing within the best interests of the client. 
 

Our clinical supervision serves three key purposes:

 

• Formative – equivalent to teaching – learning purpose;

• Normative – equivalent to ensuring client welfare;

• Restorative – providing supervisees the opportunity to express and meet needs that will help them avoid burnout (Hyrkas, 2005)
   

The british association for counselling and psychotherapy (BACP, 2007) states:
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"there is an obligation to use regular and ongoing clinical supervision to enhance the quality of services provided and to commit to updating practice by continuing professional development.”

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Our supervision services will address the four areas of clinical focus in developing supervisee competence, which supports quality of care.
 
These include:

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1. The ability to be in relationship with clients knowing that the role of counselling is relational and that the evidence to client outcome is directly linked to the quality of the therapeutic relationship.  This suggests that clinical supervision support the supervisee in developing their relational skills with clients that are developmentally advanced.  The most effective intervention we have is relational and how we continue to build our skills in the relationship is a predictor of the quality of care our client experience.  Your clients, who access your services, have complex history’s grounded in trauma, mental health, addictions, poverty, and other significant losses which all contribute to interpersonal challenges within our clients.  For this very reason, our relational skills need to be at an advanced level, where we can effectively manage transference and courter-transference reaction.
 

2. Developing the ability to use reflective practice is critical to clinical growth.  As clinicians, you require a highly-developed capacity and ability to bear, observe, think about the work we do within the counselling milieu.  Clinical supervision promotes and encourages reflective practice within the employee.
 

3. Assessing clients from a trauma-informed lens and understanding causation, which led to their addiction is the means to effective treatment.  Advancing assessment skills from a holistic and biopsychosocial perspective rather than assessing and treat addiction in isolation is a key competency to quality care and treatment.

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4. Enhancing theoretical knowledge that is consistent with the population we serve and advance concepts to the relationship support in developing quality intervention and treatment.
 

Our approach to clinical supervision incorporates the eight clinical domains to practice
 
Our approach to clinical supervision incorporates the eight clinical domains to practice Supervision aims for focus on developing the following eight core clinical domains (stoltenberg & mcneill, 2010).

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Clinical supervision will assess the supervisees for the following areas:
 

1. Intervention skills competence – confidence and abilities to carry out therapeutic interventions.

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2. Assessment competence – confidence and ability to conduct effective biopsychosocial and addiction assessments.

3. Interpersonal competency – extends beyond the formal assessment period and includes the use of self in conceptualizing client problems; its nature (also from a trauma-informed perspective) and understanding from
Different theoretical perspectives.

4. Client conceptualization – developing a working hypothesis, understanding and linking to how the client’s circumstances, history, environment, family, relationships, socioeconomic, trauma and other variable and influenced the client’s ongoing state of maladaptive coping through addictions as being a functional fit. 

5. Individual differences – an understanding of ethic and cultural influences on the individual.  Societal oppression also implicates several other marginalized groups such as patriarchy /gender, age, sexism, classism, colonialism, imperialism, lgbt to name a few.  These other areas of oppression need to be understood for how they influence our clients.

6. Theoretical orientation – pertains to the level of complexity of the client and the sophistication of the addiction counsellor/worker/program workers in understanding theoretical perspectives to guide evidence based practice.

7. Treatment plans and goals – organize the clinical goals and structure for carrying out the treatment plan in a collaborative, inclusive and intention way with clients. 

8. Professional ethics – to raise the awareness and reflective practice on how professional ethics intertwine with personal ethics implicating tensions, counter-transferences and other reactions or responses. 

 

To prepare for structured clinical supervision, supervisee’s will: 

1. Briefly describe the client’s presenting problems.

2. What assessments practices were used to inform the problem definition?

3. What are the clinical targeted goals that were established?

4. What are the objectives used to clinically work on the clinical tageted goals?

5. Describe the dynamics in session with your client including both yours and the client’s reactions.

6. What dynamic occur with culture, gender, age, and other diversities within the session?

7. How does culture and the above stated dynamic inform the presenting problem?

8. How does trauma and behavioural re-enactments inform the problem?

9. What are your conceptualizations (or expansions) of the client’s problems?

10. What theories are you using to inform your conceptualizations and your treatment plan?

11. What are the focused objectives for your sessions?

12. Are there any ethical issues that you have identified?

13. What are the transferences and counter-transference issues within your sessions? 

14. What has been the most productive part of your sessions?

15. What has been the most important part of your session?

16. Where did you struggle within the session?

17. Do you have any other personal reflection of this case? 

18. Describe your documentation in the record of car