Clinical Supervision and

Professional Development of 

the Substance Abuse Counselor

A Treatment 

Improvement 

Protocol

TIP

52
Clinical Supervision and

Professional Development 

of the Substance Abuse

Counselor

Treatment Improvement Protocol (TIP) Series

52

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Substance Abuse Treatment

1 Choke Cherry Road

Rockville, MD 20857
Acknowledgments

This publication was prepared under contract number 270­04­7049 by the Knowledge Application Program

(KAP), a Joint Venture of The CDM Group, Inc., and JBS International, Inc., for the Substance Abuse and

Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS).

Christina Currier served as the Contracting Officer's Representative.

Disclaimer

The views, opinions, and content of this publication are those of the author and do not necessarily reflect the

views, opinions, or policies of SAMHSA or HHS.

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 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 ordered from or downloaded from SAMHSA's Publications Ordering Web page at

http://store.samhsa.gov. Or, please call SAMHSA at 1­877­SAMHSA­7 (1­877­726­4727) (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. HHS Publication No. (SMA) 14­4435.

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) 14­4435

First Printed 2009

Revised 2014

ii
Please share your thoughts about this publication by completing a brief online survey at:

https://www.surveymonkey.com/r/KAPPFS

The survey takes about 7 minutes to complete and is anonymous.

Your feedback will help SAMHSA develop future products.
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 Evidence­Based 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 

Note: The information given indicates each participant's affiliation as of 2007, when the panel was convened,

and may no longer reflect the individual's current affiliation.

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., LCSW­R, 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., LCSW­R, 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) are 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). Each TIP involves the development of topic­specific bestpractice guidelines for the prevention and treatment of substance use and mental disorders. TIPs draw on the

experience and knowledge of clinical, research, and administrative experts of various forms of treatment and

prevention. TIPs are distributed to facilities and individuals across the country. Published TIPs can be accessed

via the Internet at http://store.samhsa.gov.

Although each consensus­based TIP strives to include an evidence base for the practices it recommends, SAMHSA recognizes that behavioral health is continually evolving, and research frequently lags behind the innovations pioneered in the field. A major goal of each TIP is to convey "front­line" information quickly but responsibly. If research supports a particular approach, citations are provided.

Clinical Supervision and Professional Development vii
 

Clinical Supervision and Professional Development

Foreword 

The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S.

Department of Health and Human Services that leads public health efforts to advance the behavioral health of

the nation.  SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s

communities.

The Treatment Improvement Protocol (TIP) series fulfills SAMHSA’s mission to improve prevention and treatment of substance use and mental disorders by providing best practices guidance to clinicians, program administrators, and payers. TIPs are the result of careful consideration of all relevant clinical and health services

research findings, demonstration experience, and implementation requirements.  A panel of non­Federal clinical researchers, clinicians, program administrators, and patient advocates debates and discusses their particular area of expertise 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 TIPs 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 in need of behavioral health

services. We are grateful to all who have joined with us to contribute to advances in the behavioral health field.

Pamela S. Hyde, J.D.

Administrator

Substance Abuse and Mental Health Services Administration

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

Director

Center for Substance Abuse Treatment

Substance Abuse and Mental Health Services Administration

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://store.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 relationships 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 practical issues such as balancing one’s clinical and administrative duties, finding the time to do clinical supervision, 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.

•	 “How­to” 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 provides 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://store.samhsa.gov.

xii
 

Clinical Supervision and

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. How­to 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 

Introduction

Clinical supervision is emerging as the crucible in

which counselors acquire knowledge and skills for the

substance abuse treatment profession, providing a

bridge between the classroom and the clinic.

Supervision is necessary in the substance abuse

treatment field to improve client care, develop the

professionalism of clinical personnel, and impart and

maintain ethical standards in the field. In recent

years, especially in the substance abuse field, clinical

supervision has become the cornerstone of quality

improvement and assurance. 

Your role and skill set as a clinical supervisor are distinct from those of counselor and administrator.

Quality clinical supervision is founded on a positive

supervisor–supervisee relationship that promotes

client welfare and the professional development of the

supervisee. You are a teacher, coach, consultant,

mentor, evaluator, and administrator; you provide

support, encouragement, and education to staff while

addressing an array of psychological, interpersonal,

physical, and spiritual issues of clients. Ultimately,

effective clinical supervision ensures that clients are

competently served. Supervision ensures that counselors continue to increase their skills, which in turn

increases treatment effectiveness, client retention,

and staff satisfaction. The clinical supervisor also

serves as liaison between administrative and clinical

staff. 

This TIP focuses primarily on the teaching, coaching,

consulting, and mentoring functions of clinical supervisors. Supervision, like substance abuse counseling,

is a profession in its own right, with its own theories,

practices, and standards. The profession requires

knowledgeable, competent, and skillful individuals

who are appropriately credentialed both as counselors

and supervisors. 

Definitions

This document builds on and makes frequent reference to CSAT’s Technical Assistance Publication

(TAP), Competencies for Substance Abuse Treatment

Clinical Supervisors (TAP 21­A; CSAT, 2007). The

clinical supervision competencies identify those

responsibilities and activities that define the work of

the clinical supervisor. This TIP provides guidelines

and tools for the effective delivery of clinical supervision in substance abuse treatment settings. TAP 21­A

is a companion volume to TAP 21, Addiction

Counseling Competencies (CSAT, 2006), which is

another useful tool in supervision.

The perspective of this TIP is informed by the following definitions of supervision:

•	 “Supervision is a disciplined, tutorial process

wherein principles are transformed into practical

skills, with four overlapping foci: administrative,

evaluative, clinical, and supportive” (Powell &

Brodsky, 2004, p. 11). “Supervision is an intervention provided by a senior member of a profession

to a more junior member or members. . . . 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 that she, he, or they see;

and serving as a gatekeeper of those who are to

enter the particular profession” (Bernard &

Goodyear, 2004, p. 8).

•	 Supervision is “a social influence process that

occurs over time, in which the supervisor participates with supervisees to ensure quality of clinical

care. Effective supervisors observe, mentor, coach,

evaluate, inspire, and create an atmosphere that

promotes self­motivation, learning, and professional development. They build teams, create cohesion,

resolve conflict, and shape agency culture, while

attending to ethical and diversity issues in all

aspects of the process. Such supervision is key to

both quality improvement and the successful

implementation of consensus­ and evidence­based

practices” (CSAT, 2007, p. 3). 

Rationale

For hundreds of years, many professions have relied

on more senior colleagues to guide less experienced

professionals in their crafts. This is a new developClinical Supervision and Professional Development 3
         

       

     

   

       

         

     

	 

	 

	 

	 

	 

 

 

 

 

 

 

	 

	 

	 

ment in the substance abuse field, as clinical supervision was only recently acknowledged as a discrete

process with its own concepts and approaches. 

As a supervisor to the client, counselor, and organization, the significance of your position is apparent in

the following statements:

•	 Organizations have an obligation to ensure quality

care and quality improvement of all personnel.

The first aim of clinical supervision is to ensure

quality services and to protect the welfare of

clients. 

•	 Supervision is the right of all employees and has a

direct impact on workforce development and staff

and client retention. 

•	 You oversee the clinical functions of staff and have

a legal and ethical responsibility to ensure quality

care to clients, the professional development of

counselors, and maintenance of program policies

and procedures. 

•	 Clinical supervision is how counselors in the field

learn. In concert with classroom education, clinical

skills are acquired through practice, observation,

feedback, and implementation of the recommendations derived from clinical supervision. 

Functions of a Clinical Supervisor

You, the clinical supervisor, wear several important

“hats.” You facilitate the integration of counselor selfawareness, theoretical grounding, and development of

clinical knowledge and skills; and you improve functional 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, interpreting and monitoring compliance with agency goals,

policies, and procedures and communicating staff and

client needs to administrators. Central to the supervisor’s function is the alliance between the supervisor

and supervisee (Rigazio­DiGilio, 1997).

As shown in Figure 1, your roles as a clinical supervisor 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, promoting self­awareness, and transmitting knowledge

for practical use and professional growth.

Supervisors are teachers, trainers, and professional role models.

•	 Consultant: Bernard and Goodyear (2004) incorporate the supervisory consulting role of case consultation and review, monitoring performance,

counseling the counselor regarding job performance, and assessing counselors. In this role, supervisors also provide alternative case conceptualizations, oversight of counselor work to achieve mutually agreed upon goals, and professional gatekeeping for the organization and discipline (e.g., recognizing and addressing counselor impairment). 

•	 Coach: In this supportive role, supervisors provide morale building, assess strengths and needs,

suggest varying clinical approaches, model, cheerlead, and prevent burnout. For entry­level counselors, the supportive function is critical. 

•	 Mentor/Role Model: The experienced supervisor

mentors and teaches the supervisee through role

modeling, facilitates the counselor’s overall professional development and sense of professional identity, and trains the next generation of supervisors.

Figure 1. Roles of the Clinical Supervisor 

4 Part 1, Chapter 1
           

           

             

           

         

         

             

       

           

               

           

   

 

 

 

 

 

 

 

 

 

 

 

 

Central Principles of

Clinical Supervision

The Consensus Panel for this TIP has identified central principles of clinical supervision. Although the

Panel recognizes that clinical supervision can initially be a costly undertaking for many financially

strapped programs, the Panel believes that ultimately clinical supervision is a cost­saving process.

Clinical supervision enhances the quality of client

care; improves efficiency of counselors in direct and

indirect services; increases workforce satisfaction,

professionalization, and retention (see vignette 8 in

chapter 2); and ensures that services provided to the

public uphold legal mandates and ethical standards

of the profession.

The central principles identified by the Consensus

Panel are:

1. Clinical supervision is an essential part of

all clinical programs. Clinical supervision is a

central organizing activity that integrates the

program mission, goals, and treatment philosophy

with clinical theory and evidence­based practices

(EBPs). The primary reasons for clinical supervision are to ensure (1) quality client care, and (2)

clinical staff continue professional development in

a systematic and planned manner. In substance

abuse treatment, clinical supervision is the primary means of determining the quality of care

provided. 

2. Clinical supervision enhances staff retention and morale. Staff turnover and workforce

development are major concerns in the substance

abuse treatment field. Clinical supervision is a

primary means of improving workforce retention

and job satisfaction (see, for example, Roche,

Todd, & O’Connor, 2007).

3. Every clinician, regardless of level of skill

and experience, needs and has a right to

clinical supervision. In addition, supervisors

need and have a right to supervision of their

supervision. Supervision needs to be tailored to

the knowledge base, skills, experience, and

assignment of each counselor. All staff need

supervision, but the frequency and intensity of

the oversight and training will depend on the

role, skill level, and competence of the individual.

The benefits that come with years of experience

are enhanced by quality clinical supervision.

4. Clinical supervision needs the full support

of agency administrators. Just as treatment

programs want clients to be in an atmosphere of

growth and openness to new ideas, counselors

should be in an environment where learning and

professional development and opportunities are

valued and provided for all staff.

5. The supervisory relationship is the crucible

in which ethical practice is developed and

reinforced. The supervisor needs to model sound

ethical and legal practice in the supervisory relationship. This is where issues of ethical practice

arise and can be addressed. This is where ethical

practice is translated from a concept to a set of

behaviors. Through supervision, clinicians can

develop a process of ethical decisionmaking and

use this process as they encounter new situations.

6. Clinical supervision is a skill in and of itself

that has to be developed. Good counselors tend

to be promoted into supervisory positions with the

assumption that they have the requisite skills to

provide professional clinical supervision.

However, clinical supervisors need a different role

orientation toward both program and client goals

and a knowledge base to complement a new set of

skills. Programs need to increase their capacity to

develop good supervisors.

7. Clinical supervision in substance abuse

treatment most often requires balancing

administrative and clinical supervision

tasks. Sometimes these roles are complementary

and sometimes they conflict. Often the supervisor

feels caught between the two roles.

Administrators need to support the integration

and differentiation of the roles to promote the

efficacy of the clinical supervisor. (See Part 2.)

8. Culture and other contextual variables

influence the supervision process; supervisors need to continually strive for cultural

competence. Supervisors require cultural competence at several levels. Cultural competence

involves the counselor’s response to clients, the

supervisor’s response to counselors, and the program’s response to the cultural needs of the

diverse community it serves. Since supervisors

are in a position to serve as catalysts for change,

they need to develop proficiency in addressing the

needs of diverse clients and personnel.

Clinical Supervision and Professional Development 5
Part 1, Chapter 1

	 

	 

	 

	 

	 

	 

9. Successful implementation of EBPs requires

ongoing supervision. Supervisors have a role in

determining which specific EBPs are relevant for

an organization’s clients (Lindbloom, Ten Eyck, &

Gallon, 2005). Supervisors ensure that EBPs are

successfully integrated into ongoing programmatic activities by training, encouraging, and monitoring counselors. Excellence in clinical supervision should provide greater adherence to the EBP

model. Because State funding agencies now often

require substance abuse treatment organizations

to provide EBPs, supervision becomes even more

important.

10. Supervisors have the responsibility to be

gatekeepers for the profession. Supervisors

are responsible for maintaining professional standards, recognizing and addressing impairment,

and safeguarding the welfare of clients. More

than anyone else in an agency, supervisors can

observe counselor behavior and respond promptly

to potential problems, including counseling some

individuals out of the field because they are illsuited to the profession. This “gatekeeping” function is especially important for supervisors who

act as field evaluators for practicum students

prior to their entering the profession. Finally,

supervisors also fulfill a gatekeeper role in performance evaluation and in providing formal recommendations to training institutions and credentialing bodies. 

11. Clinical supervision should involve direct

observation methods. Direct observation

should be the standard in the field because it is

one of the most effective ways of building skills,

monitoring counselor performance, and ensuring

quality care. Supervisors require training in

methods of direct observation, and administrators

need to provide resources for implementing direct

observation. Although small substance abuse

agencies might not have the resources for oneway mirrors or videotaping equipment, other

direct observation methods can be employed (see

the section on methods of observation, pp. 20–24). 

Guidelines for New

Supervisors 

Congratulations on your appointment as a supervisor!

By now you might be asking yourself a few questions:

What have I done? Was this a good career decision?

There are many changes ahead. If you have been promoted from within, you’ll encounter even more hurdles and issues. First, it is important to face that

your life has changed. You might experience the loss

of friendship of peers. You might feel that you knew

what to do as a counselor, but feel totally lost with

your new responsibilities (see vignette 6 in chapter

2). You might feel less effective in your new role.

Supervision can be an emotionally draining experience, as you now have to work with more staff­related

interpersonal and human resources issues.

Before your promotion to clinical supervisor, you

might have felt confidence in your clinical skills. Now

you might feel unprepared and wonder if you need a

training course for your new role. If you feel this way,

you’re right. Although you are a good counselor, you

do not necessarily possess all the skills needed to be a

good supervisor. Your new role requires a new body of

knowledge and different skills, along with the ability

to use your clinical skills in a different way. Be confident that you will acquire these skills over time (see

the Resources section, p. 34) and that you made the

right decision to accept your new position. 

Suggestions for new supervisors:

•	 Quickly learn the organization’s policies and procedures and human resources procedures (e.g., hiring and firing, affirmative action requirements,

format for conducting meetings, giving feedback,

and making evaluations). Seek out this information as soon as possible through the human

resources department or other resources within

the organization.

•	 Ask for a period of 3 months to allow you to learn

about your new role. During this period, do not

make any changes in policies and procedures but

use this time to find your managerial voice and

decisionmaking style. 

•	 Take time to learn about your supervisees, their

career goals, interests, developmental objectives,

and perceived strengths.

•	 Work to establish a contractual relationship with

supervisees, with clear goals and methods of

supervision.

•	 Learn methods to help staff reduce stress, address

competing priorities, resolve staff conflict, and

other interpersonal issues in the workplace. 

•	 Obtain training in supervisory procedures and

methods.

6
Clinical Supervision and Professional Development 7

         

     

               

       

           

               

	 

	 

	 

	 

	 

	 

	 

	 

 

 

 

 

 

	 

•	 Find a mentor, either internal or external to the

organization. 

•	 Shadow a supervisor you respect who can help you

learn the ropes of your new job.

•	 Ask often and as many people as possible, “How

am I doing?” and “How can I improve my performance as a clinical supervisor?” 

•	 Ask for regular, weekly meetings with your

administrator for training and instruction.

•	 Seek supervision of your supervision.

Problems and Resources

As a supervisor, you may encounter a broad array of

issues and concerns, ranging from working within a

system that does not fully support clinical supervision

to working with resistant staff. A comment often

heard in supervision training sessions is “My boss

should be here to learn what is expected in supervision,” or “This will never work in my agency’s bureaucracy. They only support billable activities.” The work

setting is where you apply the principles and practices of supervision and where organizations are driven by demands, such as financial solvency, profit,

census, accreditation, and concerns over litigation.

Therefore, you will need to be practical when beginning your new role as a supervisor: determine how

you can make this work within your unique work

environment.

Working With Staff Who Are

Resistant to Supervision

Some of your supervisees may have been in the field

longer than you have and see no need for supervision.

Other counselors, having completed their graduate

training, do not believe they need further supervision,

especially not from a supervisor who might have less

formal academic education than they have. Other

resistance might come from ageism, sexism, racism,

or classism. Particular to the field of substance abuse

treatment may be the tension between those who

believe that recovery from substance abuse is necessary for this counseling work and those who do not

believe this to be true. 

In addressing resistance, you must be clear regarding

what your supervision program entails and must consistently communicate your goals and expectations to

staff. To resolve defensiveness and engage your

supervisees, you must also honor the resistance and

acknowledge their concerns. Abandon trying to push

the supervisee too far, too fast. Resistance is an

expression of ambivalence about change and not a

personality defect of the counselor. Instead of arguing

with or exhorting staff, sympathize with their concerns, saying, “I understand this is difficult. How are

we going to resolve these issues?”

When counselors respond defensively or reject directions from you, try to understand the origins of their

defensiveness and to address their resistance. Selfdisclosure by the supervisor about experiences as a

supervisee, when appropriately used, may be helpful

in dealing with defensive, anxious, fearful, or resistant staff. Work to establish a healthy, positive supervisory alliance with staff. Because many substance

abuse counselors have not been exposed to clinical

supervision, you may need to train and orient the

staff to the concept and why it is important for your

agency. 

Things a New Supervisor 

Should Know 

Eight truths a beginning supervisor should commit to

memory are listed below:

1.	 The reason for supervision is to ensure quality

client care. As stated throughout this TIP, the

primary goal of clinical supervision is to protect

the welfare of the client and ensure the integrity

of clinical services. 

2.	 Supervision is all about the relationship. As in

counseling, developing the alliance between the

counselor and the supervisor is the key to good

supervision. 

3.	 Culture and ethics influence all supervisory

interactions. Contextual factors, culture, race,

and ethnicity all affect the nature of the supervisory relationship. Some models of supervision

(e.g., Holloway, 1995) have been built primarily

around the role of context and culture in shaping

supervision.

4.	 Be human and have a sense of humor. As role

models, you need to show that everyone makes

mistakes and can admit to and learn from these

mistakes. 
       

           

               

               

     

       

             

         

             

           

     

       

               

   

             

       

         

               

         

             

	 

	 

	 

	 

	 

	 

	 

	 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

	 

	 

8 Part 1, Chapter 1

5.	 Rely first on direct observation of your counselors

and give specific feedback. The best way to determine a counselor’s skills is to observe him or her

and to receive input from the clients about their

perceptions of the counseling relationship. 

6.	 Have and practice a model of counseling and of

supervision; have a sense of purpose. Before you

can teach a supervisee knowledge and skills, you

must first know the philosophical and theoretical

foundations on which you, as a supervisor, stand.

Counselors need to know what they are going to

learn from you, based on your model of counseling

and supervision. 

7.	 Make time to take care of yourself spiritually,

emotionally, mentally, and physically. Again, as

role models, counselors are watching your behavior. Do you “walk the talk” of self­care?

8.	 You have a unique position as an advocate for the

agency, the counselor, and the client. As a supervisor, you have a wonderful opportunity to assist

in the skill and professional development of your

staff, advocating for the best interests of the

supervisee, the client, and your organization.

Models of Clinical

Supervision

You may never have thought about your model of

supervision. However, it is a fundamental premise of

this TIP that you need to work from a defined model

of supervision and have a sense of purpose in your

oversight role. Four supervisory orientations seem

particularly relevant. They include:

•	 Competency­based models.

•	 Treatment­based models.

•	 Developmental approaches.

•	 Integrated models.

Competency­based models (e.g., microtraining,

the Discrimination Model [Bernard & Goodyear,

2004], and the Task­Oriented Model [Mead, 1990],

focus primarily on the skills and learning needs of

the supervisee and on setting goals that are specific,

measurable, attainable, realistic, and timely

(SMART). They construct and implement strategies

to accomplish these goals. The key strategies of competency­based models include applying social learning principles (e.g., modeling role reversal, role playing, and practice), using demonstrations, and using

various supervisory functions (teaching, consulting,

and counseling).

Treatment­based supervision models train to a

particular theoretical approach to counseling, incorporating EBPs into supervision and seeking fidelity and

adaptation to the theoretical model. Motivational

interviewing, cognitive–behavioral therapy, and psychodynamic psychotherapy are three examples. These

models emphasize the counselor’s strengths, seek the

supervisee’s understanding of the theory and model

taught, and incorporate the approaches and techniques of the model. The majority of these models

begin with articulating their treatment approach and

describing their supervision model, based upon that

approach.

Developmental models, such as Stoltenberg and

Delworth (1987), understand that each counselor goes

through different stages of development and recognize that movement through these stages is not

always linear and can be affected by changes in

assignment, setting, and population served. (The

developmental stages of counselors and supervisors

are described in detail below). 

Integrated models, including the Blended Model,

begin with the style of leadership and articulate a

model of treatment, incorporate descriptive dimensions of supervision (see below), and address contextual and developmental dimensions into supervision.

They address both skill and competency development

and affective issues, based on the unique needs of

the supervisee and supervisor. Finally, integrated

models seek to incorporate EBPs into counseling and

supervision.

In all models of supervision, it is helpful to identify

culturally or contextually centered models or

approaches and find ways of tailoring the models to

specific cultural and diversity factors. Issues to consider are:

•	 Explicitly addressing diversity of supervisees (e.g.,

race, ethnicity, gender, age, sexual orientation)

and the specific factors associated with these types

of diversity;

•	 Explicitly involving supervisees’ concerns related

to particular client diversity (e.g., those whose culture, gender, sexual orientation, and other attributes differ from those of the supervisee) and

addressing specific factors associated with these

types of diversity; and 
	 

	 

	 

	 

	 

	 

	 

	 

	 

	 

	 

	 

	 

	 

Clinical Supervision and Professional Development 9

•	 Explicitly addressing supervisees’ issues related to

effectively navigating services in intercultural

communities and effectively networking with

agencies and institutions. 

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

of counseling you use. Theories are conceptual frameworks that enable you to make sense of and organize

your counseling and supervision and to focus on the

most salient aspects of a counselor’s practice. You

may find some of the questions below to be relevant

to both supervision and counseling. The answers to

these questions influence both how you supervise and

how the counselors you supervise work:

•	 What are your beliefs about how people change in

both treatment and clinical supervision? 

•	 What factors are important in treatment and clinical supervision? 

•	 What universal principles apply in supervision

and counseling and which are unique to clinical

supervision?

•	 What conceptual frameworks of counseling do you

use (for instance, cognitive–behavioral therapy,

12­Step facilitation, psychodynamic, behavioral)?

•	 What are the key variables that affect outcomes?

(Campbell, 2000)

According to Bernard and Goodyear (2004) and

Powell and Brodsky (2004),the qualities of a good

model of clinical supervision are: 

•	 Rooted in the individual, beginning with the

supervisor’s self, style, and approach to leadership.

•	 Precise, clear, and consistent.

•	 Comprehensive, using current scientific and evidence­based practices.

•	 Operational and practical, providing specific concepts and practices in clear, useful, and measurable terms.

•	 Outcome­oriented to improve counselor competence; make work manageable; create a sense of

mastery and growth for the counselor; and address

the needs of the organization, the supervisor, the

supervisee, and the client. 

Finally, it is imperative to recognize that, whatever

model you adopt, it needs to be rooted in the learning

and developmental needs of the supervisee, the specific needs of the clients they serve, the goals of the

agency in which you work, and in the ethical and

legal boundaries of practice. These four variables

define the context in which effective supervision can

take place.

Developmental Stages of

Counselors

Counselors are at different stages of professional

development. Thus, regardless of the model of supervision you choose, you must take into account the

supervisee’s level of training, experience, and proficiency. Different supervisory approaches are appropriate for counselors at different stages of development. An understanding of the supervisee’s (and

supervisor’s) developmental needs is an essential

ingredient for any model of supervision. 

Various paradigms or classifications of developmental

stages of clinicians have been developed (Ivey, 1997;

Rigazio­DiGilio, 1997; Skolvolt & Ronnestrand, 1992;

Todd and Storn, 1997). This TIP has adopted the

Integrated Developmental Model (IDM) of

Stoltenberg, McNeill, and Delworth (1998) (see figure

2, p. 10). This schema uses a three­stage approach.

The three stages of development have different characteristics and appropriate supervisory methods.

Further application of the IDM to the substance

abuse field is needed. (For additional information, see

Anderson, 2001.)

It is important to keep in mind several general cautions and principles about counselor development,

including: 

•	 There is a beginning but not an end point for

learning clinical skills; be careful of counselors

who think they “know it all.”

•	 Take into account the individual learning styles

and personalities of your supervisees and fit the

supervisory approach to the developmental stage

of each counselor.

•	 There is a logical sequence to development,

although it is not always predictable or rigid; some

counselors may have been in the field for years but

remain at an early stage of professional development, whereas others may progress quickly

through the stages.
	 

	 

10 Part 1, Chapter 1

Figure 2. Counselor Developmental Model

Developmental Level Characteristics Supervision Skills

Development Needs Techniques

Level 1 • Focuses on self

• Anxious, uncertain

• Preoccupied with performing the right way

• Overconfident of skills

• Overgeneralizes

• Overuses a skill

• Gap between conceptualization, goals, and

interventions

• Ethics underdeveloped

• Provide structure and

minimize anxiety

• Supportive, address

strengths first, then

weaknesses

• Suggest approaches 

• Start connecting theory

to treatment

• Observation

• Skills training

• Role playing

• Readings

• Group supervision

• Closely monitor clients

Level 2 • Focuses less on self and

more on client

• Confused, frustrated

with complexity of counseling

• Overidentifies with client 

• Challenges authority

• Lacks integration with

theoretical base

• Overburdened

• Ethics better understood

• Less structure provided,

more autonomy encouraged

• Supportive

• Periodic suggestion of

approaches

• Confront discrepancies

• Introduce more alternative views

• Process comments, highlight countertransference

• Affective reactions to

client and/or supervisor

• Observation

• Role playing

• Interpret dynamics

• Group supervision

• Reading

Level 3 • Focuses intently on client

• High degree of empathic

skill

• Objective third person

perspective

• Integrative thinking and

approach

• Highly responsible and

ethical counselor

• Supervisee directed

• Focus on personal­professional integration and

career

• Supportive

• Change agent

• Peer supervision

• Group supervision

• Reading

Source: Stoltenberg, Delworth, & McNeil, 1998

•	 Counselors at an advanced developmental level

have different learning needs and require different

supervisory approaches from those at Level 1; and

•	 The developmental level can be applied for different aspects of a counselor’s overall competence

(e.g., Level 2 mastery for individual counseling

and Level 1 for couples counseling).

Developmental Stages of

Supervisors

Just as counselors go through stages of development,

so do supervisors. The developmental model presented in figure 3 provides a framework to explain why

supervisors act as they do, depending on their developmental stage. It would be expected that someone

new to supervision would be at a Level 1 as a supervisor. 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
Clinical Supervision and Professional Development

               

   

           

         

         

       

           

           

           

   

 

 

 

 

 

 

 

 

 

 

	 

	 

	 

Figure 3. Supervisor Developmental Model

Developmental

Level Characteristics To Increase Supervision Competence

Level 1 • Is anxious regarding role

• Is naïve about assuming the role of supervisor

• Is focused on doing the “right” thing

• May overly respond as an “expert”

• Is uncomfortable providing direct feedback

• Follow structure and formats

• Design systems to increase organization of

supervision 

• Assign Level I counselors

Level 2 • Shows confusion and conflict

• Sees supervision as complex and multidimensional 

• Needs support to maintain motivation

• Overfocused on counselor’s deficits and perceived resistance

• May fall back to being a therapist with the

counselor

• Provide active supervision of the supervision

• Assign Level 1 counselors

Level 3 • Is highly motivated

• Can provide an honest self­appraisal of

strengths and weaknesses as supervisor

• Is comfortable with evaluation process

• Provides thorough, objective feedback

• Comfortable with all levels

Source: Stoltenberg, Delworth, & McNeil, 1998

counselor, he or she will have little to offer to more

seasoned supervisees. 

Cultural and Contextual

Factors 

Culture is one of the major contextual factors that

influence supervisory interactions. Other contextual

variables include race, ethnicity, age, gender, discipline, academic background, religious and spiritual

practices, sexual orientation, disability, and recovery

versus non­recovery status. The relevant variables

in the supervisory relationship occur in the context

of the supervisor, supervisee, client, and the setting

in which supervision occurs. More care should be

taken to:

•	 Identify the competencies necessary for substance

abuse counselors to work with diverse individuals

and navigate intercultural communities.

•	 Identify methods for supervisors to assist counselors in developing these competencies.

•	 Provide evaluation criteria for supervisors to

determine whether their supervisees have met

minimal competency standards for effective and

relevant practice.

Models of supervision have been strongly influenced

by contextual variables and their influence on the

supervisory relationship and process, such as

Holloway’s Systems Model (1995) and Constantine’s

Multicultural Model (2003).

The competencies listed in TAP 21­A reflect the

importance of culture in supervision (CSAT, 2007).

The Counselor Development domain encourages selfexamination of attitudes toward culture and other

contextual variables. The Supervisory Alliance

domain promotes attention to these variables in the

supervisory relationship. (See also the planned TIP,

Improving Cultural Competence in Substance Abuse

Counseling [CSAT, in development b].)

Cultural competence “refers to the ability to honor

and respect the beliefs, language, interpersonal

styles, and behaviors of individuals and families

receiving services, as well as staff who are providing

such services. Cultural competence is a dynamic,

ongoing, developmental process that requires a commitment and is achieved over time” (U.S. Department

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12 Part 1, Chapter 1

of Health and Human Services, 2003, p. 12). Culture

shapes belief systems, particularly concerning issues

related to mental health and substance abuse, as well

as the manifestation of symptoms, relational styles,

and coping patterns. 

There are three levels of cultural consideration for

the supervisory process: the issue of the culture of

the client being served and the culture of the counselor in supervision. Holloway (1995) emphasizes the

cultural issues of the agency, the geographic environment of the organization, and many other contextual

factors. Specifically, there are three important areas

in which cultural and contextual factors play a key

role in supervision: in building the supervisory relationship or working alliance, in addressing the specific needs of the client, and in building supervisee

competence and ability. It is your responsibility to

address your supervisees’ beliefs, attitudes, and biases about cultural and contextual variables to advance

their professional development and promote quality

client care.

Becoming culturally competent and able to integrate

other contextual variables into supervision is a complex, long­term process. Cross (1989) has identified

several stages on a continuum of becoming culturally

competent (see figure 4).

Although you may never have had specialized training in multicultural counseling, some of your supervisees may have (see Constantine, 2003). Regardless,

it is your responsibility to help supervisees build on

the cultural competence skills they possess as well as

to focus on their cultural competence deficits. It is

important to initiate discussion of issues of culture,

race, gender, sexual orientation, and the like in

supervision to model the kinds of discussion you

would like counselors to have with their clients. If

these issues are not addressed in supervision, counselors may come to believe that it is inappropriate to

discuss them with clients and have no idea how such

dialog might proceed. These discussions prevent misunderstandings with supervisees based on cultural or

other factors. Another benefit from these discussions

is that counselors will eventually achieve some level

of comfort in talking about culture, race, ethnicity,

and diversity issues.

If you haven’t done it as a counselor, early in your

tenure as a supervisor you will want to examine your

culturally influenced values, attitudes, experiences,

and practices and to consider what effects they have

on your dealings with supervisees and clients.

Counselors should undergo a similar review as

preparation for when they have clients of a culture

different from their own. Some questions to keep in

mind are:

•	 What did you think when you saw the supervisee’s

last name?

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.
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•	 What did you think when the supervisee said his

or her culture is X, when yours is Y?

•	 How did you feel about this difference?

•	 What did you do in response to this difference?

Constantine (2003) suggests that supervisors can use

the following questions with supervisees:

•	 What demographic variables do you use to identify

yourself?

•	 What worldviews (e.g., values, assumptions, and

biases) do you bring to supervision based on your

cultural identities?

•	 What struggles and challenges have you faced

working with clients who were from different cultures than your own?

Beyond self­examination, supervisors will want continuing education classes, workshops, and conferences

that address cultural competence and other contextual factors. Community resources, such as community

leaders, elders, and healers can contribute to your

understanding of the culture your organization

serves. Finally, supervisors (and counselors) should

participate in multicultural activities, such as community events, discussion groups, religious festivals,

and other ceremonies.

The supervisory relationship includes an inherent

power differential, and it is important to pay attention to this disparity, particularly when the supervisee and the supervisor are from different cultural

groups. A potential for the misuse of that power

exists at all times but especially when working with

supervisees and clients within multicultural contexts.

When the supervisee is from a minority population

and the supervisor is from a majority population, the

differential can be exaggerated. You will want to prevent institutional discrimination from affecting the

quality of supervision. The same is true when the

supervisee is gay and the supervisor is heterosexual,

or the counselor is non­degreed and the supervisor

has an advanced degree, or a female supervisee with

a male supervisor, and so on. In the reverse situations, where the supervisor is from the minority

group and the supervisee from the majority group,

the difference should be discussed as well.

Ethical and Legal Issues

You are the organization’s gatekeeper for ethical and

legal issues. First, you are responsible for upholding

the highest standards of ethical, legal, and moral

practices and for serving as a model of practice to

staff. Further, you should be aware of and respond to

ethical concerns. Part of your job is to help integrate

solutions to everyday legal and ethical issues into

clinical practice.

Some of the underlying assumptions of incorporating

ethical issues into clinical supervision include:

•	 Ethical decisionmaking is a continuous, active

process.

•	 Ethical standards are not a cookbook. They tell

you what to do, not always how.

•	 Each situation is unique. Therefore, it is imperative that all personnel learn how to “think ethically” and how to make sound legal and ethical

decisions.

•	 The most complex ethical issues arise in the context of two ethical behaviors that conflict; for

instance, when a counselor wants to respect the

privacy and confidentiality of a client, but it is in

the client’s best interest for the counselor to contact someone else about his or her care.

•	 Therapy is conducted by fallible beings; people

make mistakes—hopefully, minor ones. 

•	 Sometimes the answers to ethical and legal questions are elusive. Ask a dozen people, and you’ll

likely get twelve different points of view.

Helpful resources on legal and ethical issues for

supervisors include Beauchamp and Childress (2001);

Falvey (2002b); Gutheil and Brodsky (2008); Pope,

Sonne, and Greene (2006); and Reamer (2006). 

Legal and ethical issues that are critical to clinical

supervisors include (1) vicarious liability (or respondeat superior), (2) dual relationships and boundary

concerns, (4) informed consent, (5) confidentiality,

and (6) supervisor ethics.

Direct Versus Vicarious Liability 

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). 

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In vicarious liability, a supervisor can be held liable

for damages incurred as a result of negligence in the

supervision process. Examples of negligence include

providing inappropriate advice to a counselor about a

client (for instance, discouraging a counselor from

conducting a suicide screen on a depressed client),

failure to listen carefully to a supervisee’s comments

about a client, and the assignment of clinical tasks to

inadequately trained counselors. The key legal question is: “Did the supervisor conduct him­ or herself in

a way that would be reasonable for someone in his

position?” or “Did the supervisor make a reasonable

effort to supervise?” A generally accepted time standard for a “reasonable effort to supervise” in the

behavioral health field is 1 hour of supervision for

every 20–40 hours of clinical services. Of course,

other variables (such as the quality and content of

clinical supervision sessions) also play a role in a reasonable effort to supervise. 

Supervisory vulnerability increases when the counselor has been assigned too many clients, when there

is no direct observation of a counselor’s clinical work,

when staff are inexperienced or poorly trained for

assigned tasks, and when a supervisor is not

involved or not available to aid the clinical staff. In

legal texts, vicarious liability is referred to as

“respondeat superior.”

Dual Relationships and Boundary

Issues

Dual relationships can occur at two levels: between

supervisors and supervisees and between counselors

and clients. You have a mandate to help your supervisees recognize and manage boundary issues. A dual

relationship occurs in supervision when a supervisor

has a primary professional role with a supervisee

and, at an earlier time, simultaneously or later,

engages in another relationship with the supervisee

that transcends the professional relationship.

Examples of dual relationships in supervision include

providing therapy for a current or former supervisee,

developing an emotional relationship with a supervisee or former supervisee, and becoming an

Alcoholics Anonymous sponsor for a former supervisee. Obviously, there are varying degrees of harm

or potential harm that might occur as a result of dual

relationships, and some negative effects of dual relationships might not be apparent until later.

Therefore, firm, always­or­never rules aren’t applicable. You have the responsibility of weighing with the

counselor the anticipated and unanticipated effects of

dual relationships, helping the supervisee’s selfreflective awareness when boundaries become

blurred, when he or she is getting close to a dual relationship, or when he or she is crossing the line in the

clinical relationship. 

Exploring dual relationship issues with counselors in

clinical supervision can raise its own professional

dilemmas. For instance, clinical supervision involves

unequal status, power, and expertise between a

supervisor and supervisee. Being the evaluator of a

counselor’s performance and gatekeeper for training

programs or credentialing bodies also might involve a

dual relationship. Further, supervision can have therapy­like qualities as you explore countertransferential issues with supervisees, and there is an expectation of professional growth and self­exploration. What

makes a dual relationship unethical in supervision is

the abusive use of power by either party, the likelihood that the relationship will impair or injure the

supervisor’s or supervisee’s judgment, and the risk of

exploitation (see vignette 3 in chapter 2).

The most common basis for legal action against counselors (20 percent of claims) and the most frequently

heard complaint by certification boards against counselors (35 percent) is some form of boundary violation

or sexual impropriety (Falvey, 2002b). (See the discussion of transference and countertransference on

pp. 25–26.)

Codes of ethics for most professions clearly advise

that dual relationships between counselors and

clients should be avoided. Dual relationships between

counselors and supervisors are also a concern and are

addressed in the substance abuse counselor codes and

those of other professions as well. Problematic dual

relationships between supervisees and supervisors

might include intimate relationships (sexual and nonsexual) and therapeutic relationships, wherein the

supervisor becomes the counselor’s therapist. Sexual

involvement between the supervisor and supervisee

can include sexual attraction, harassment, consensual

(but hidden) sexual relationships, or intimate romantic relationships. Other common boundary issues

include asking the supervisee to do favors, providing

preferential treatment, socializing outside the work

setting, and using emotional abuse to enforce power.

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Clinical Supervision and Professional Development

 

It is imperative that all parties understand what constitutes a dual relationship between supervisor and

supervisee and avoid these dual relationships. Sexual

relationships between supervisors and supervisees

and counselors and clients occur far more frequently

than one might realize (Falvey, 2002b). In many

States, they constitute a legal transgression as well

as an ethical violation.

The decision tree presented in figure 5 (p. 16) indicates how a supervisor might manage a situation

where he or she is concerned about a possible ethical

or legal violation by a counselor.

Informed Consent

Informed consent is key to protecting the counselor

and/or supervisor from legal concerns, requiring the

recipient of any service or intervention to be sufficiently aware of what is to happen, and of the potential risks and alternative approaches, so that the person can make an informed and intelligent decision

about participating in that service. The supervisor

must inform the supervisee about the process of

supervision, the feedback and evaluation criteria, and

other expectations of supervision. The supervision

contract should clearly spell out these issues.

Supervisors must ensure that the supervisee has

informed the client about the parameters of counseling and supervision (such as the use of live observation, video­ or audiotaping). A sample template for

informed consent is provided in Part 2, chapter 2 

(p. 106).

Confidentiality

In supervision, regardless of whether there is a written or verbal contract between the supervisor and

supervisee, there is an implied contract and duty of

care because of the supervisor’s vicarious liability.

Informed consent and concerns for confidentiality

should occur at three levels: client consent to treatment, client consent to supervision of the case, and

supervisee consent to supervision (Bernard &

Goodyear, 2004). In addition, there is an implied consent and commitment to confidentiality by supervisors to assume their supervisory responsibilities and

institutional consent to comply with legal and ethical

parameters of supervision. (See also the Code of

Ethics of the Association for Counselor Education and

Supervision [ACES], available online at

http://www.acesonline.net/members/supervision/. 

With informed consent and confidentiality comes a

duty not to disclose certain relational communication.

Limits of confidentiality of supervision session content should be stated in all organizational contracts

with training institutions and credentialing bodies.

Criteria for waiving client and supervisee privilege

should be stated in institutional policies and discipline­specific codes of ethics and clarified by advice of

legal counsel and the courts. Because standards of

confidentiality are determined by State legal and legislative systems, it is prudent for supervisors to consult with an attorney to determine the State codes of

confidentiality and clinical privileging.

In the substance abuse treatment field, confidentiality for clients is clearly defined by Federal law: 42

CFR, Part 2 and the Health Insurance Portability

and Accountability Act (HIPAA). Key information is

available at http://www.hhs.gov/ocr/privacy/. Supervisors need to train counselors in confidentiality regulations and to adequately document their supervision,

including discussions and directives, especially relating to duty­to­warn situations. Supervisors need to

ensure that counselors provide clients with appropriate duty­to­warn information early in the counseling

process and inform clients of the limits of confidentiality as part of the agency’s informed consent procedures. 

Under duty­to­warn requirements (e.g., child abuse,

suicidal or homicidal ideation), supervisors need to be

aware of and take action as soon as possible in situations in which confidentiality may need to be waived.

Organizations should have a policy stating how clinical crises will be handled (Falvey, 2002b). What

mechanisms are in place for responding to crises? In

what timeframe will a supervisor be notified of a crisis situation? Supervisors must document all discussions with counselors concerning duty­to­warn and

crises. At the onset of supervision, supervisors should

ask counselors if there are any duty­to­warn issues of

which the supervisor should be informed. 

New technology brings new confidentiality concerns.

Websites now dispense information about substance

abuse treatment and provide counseling services.

With the growth in online counseling and supervision, the following concerns emerge: (a) how to main15
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tain confidentiality of information, (b) how to ensure

the competence and qualifications of counselors providing online services, and (c) how to establish reporting requirements and duty to warn when services are

conducted across State and international boundaries.

New standards will need to be written to address

these issues. (The National Board for Certified

Counselors has guidelines for counseling by Internet

at http://www.nbcc.org/Assets/Ethics/NBCCPolicy

RegardingPracticeofDistanceCounselingBoard.pdf)

Supervisor Ethics

In general, supervisors adhere to the same standards

and ethics as substance abuse counselors with regard

to dual relationship and other boundary violations.

Supervisors will:

• Uphold the highest professional standards of the

field.

• Seek professional help (outside the work setting)

when personal issues interfere with their clinical

and/or supervisory functioning.

• Conduct themselves in a manner that models

and sets an example for agency mission, vision,

philosophy, wellness, recovery, and consumer

satisfaction.

• Reinforce zero tolerance for interactions that are

not professional, courteous, and compassionate.

• Treat supervisees, colleagues, peers, and clients

with dignity, respect, and honesty.

• Adhere to the standards and regulations of confidentiality as dictated by the field. This applies

to the supervisory as well as the counseling

relationship.

Monitoring Performance

The goal of supervision is to ensure quality care for

the client, which entails monitoring the clinical performance of staff. Your first step is to educate supervisees in what to expect from clinical supervision.

Once the functions of supervision are clear, you

should regularly evaluate the counselor’s progress in

meeting organizational and clinical goals as set

forth in an Individual Development Plan (IDP) (see

the section on IDPs below). As clients have an individual treatment plan, counselors also need a plan

to promote skill development.

Behavioral Contracting in

Supervision

Among the first tasks in supervision is to establish a

contract for supervision that outlines realistic

accountability for both yourself and your supervisee.

The contract should be in writing and should include

the purpose, goals, and objectives of supervision; the

context in which supervision is provided; ethical and

institutional policies that guide supervision and clinical practices; the criteria and methods of evaluation

and outcome measures; the duties and responsibilities of the supervisor and supervisee; procedural considerations (including the format for taping and

opportunities for live observation); and the supervisee’s scope of practice and competence. The contract

for supervision should state the rewards for fulfillment of the contract (such as clinical privileges or

increased compensation), the length of supervision

sessions, and sanctions for noncompliance by either

the supervisee or supervisor. The agreement should

be compatible with the developmental needs of the

supervisee and address the obstacles to progress (lack

of time, performance anxiety, resource limitations).

Once a behavioral contract has been established, the

next step is to develop an IDP.

Individual Development Plan

The IDP is a detailed plan for supervision that

includes the goals that you and the counselor wish to

address over a certain time period (perhaps 3

months). Each of you should sign and keep a copy of

the IDP for your records. The goals are normally stated in terms of skills the counselor wishes to build or

professional resources the counselor wishes to develop. These skills and resources are generally oriented

to the counselor’s job in the program or activities that

would help the counselor develop professionally. The

IDP should specify the timelines for change, the

observation methods that will be employed, expectations for the supervisee and the supervisor, the evaluation procedures that will be employed, and the activities that will be expected to improve knowledge and

skills. An example of an IDP is provided in Part 2,

chapter 2 (p. 122).

As a supervisor, you should have your own IDP,

based on the supervisory competencies listed in TAP

21­A (CSAT, 2007), that addresses your training

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goals. This IDP can be developed in cooperation with

your supervisor, or in external supervision, peer

input, academic advisement, or mentorship. 

Evaluation of Counselors

Supervision inherently involves evaluation, building

on a collaborative relationship between you and the

counselor. Evaluation may not be easy for some

supervisors. Although everyone wants to know how

they are doing, counselors are not always comfortable

asking for feedback. And, as most supervisors prefer

to be liked, you may have difficulty giving clear, concise, and accurate evaluations to staff. 

The two types of evaluation are formative and summative. A formative evaluation is an ongoing status

report of the counselor’s skill development, exploring

the questions “Are we addressing the skills or competencies you want to focus on?” and “How do we assess

your current knowledge and skills and areas for

growth and development?” 

Summative evaluation is a more formal rating of the

counselor’s overall job performance, fitness for the

job, and job rating. It answers the question, “How

does the counselor measure up?” Typically, summative evaluations are done annually and focus on the

counselor’s overall strengths, limitations, and areas

for future improvement. 

It should be acknowledged that supervision is inherently an unequal relationship. In most cases, the

supervisor has positional power over the counselor.

Therefore, it is important to establish clarity of purpose and a positive context for evaluation. Procedures

should be spelled out in advance, and the evaluation

process should be mutual, flexible, and continuous.

The evaluation process inevitably brings up supervisee anxiety and defensiveness that need to be

addressed openly. It is also important to note that

each individual counselor will react differently to

feedback; some will be more open to the process than

others.

There has been considerable research on supervisory

evaluation, with these findings:

•	 The supervisee’s confidence and efficacy are correlated with the quality and quantity of feedback the

supervisor gives to the supervisee (Bernard &

Goodyear, 2004).

•	 Ratings of skills are highly variable between

supervisors, and often the supervisor’s and supervisee’s ratings differ or conflict (Eby, 2007). 

•	 Good feedback is provided frequently, clearly, and

consistently and is SMART (specific, measurable,

attainable, realistic, and timely) (Powell &

Brodsky, 2004).

Direct observation of the counselor’s work is the

desired form of input for the supervisor. Although

direct observation has historically been the exception

in substance abuse counseling, ethical and legal considerations and evidence support that direct observation as preferable. The least desirable feedback is

unannounced observation by supervisors followed by

vague, perfunctory, indirect, or hurtful delivery

(Powell & Brodsky, 2004). 

Clients are often the best assessors of the skills of the

counselor. Supervisors should routinely seek input

from the clients as to the outcome of treatment. The

method of seeking input should be discussed in the

initial supervisory sessions and be part of the supervision contract. In a residential substance abuse

treatment program, you might regularly meet with

clients after sessions to discuss how they are doing,

how effective the counseling is, and the quality of the

therapeutic alliance with the counselor. (For examples of client satisfaction or input forms, search for

Client­Directed Outcome­Informed Treatment and

Training Materials at http://www.goodtherapy.org/

client­directed­outcome­informed­therapy.html) 

Before formative evaluations begin, methods of evaluating performance should be discussed, clarified in

the initial sessions, and included in the initial contract so that there will be no surprises. Formative

evaluations should focus on changeable behavior and,

whenever possible, be separate from the overall annual performance appraisal process. To determine the

counselor’s skill development, you should use written

competency tools, direct observation, counselor selfassessments, client evaluations, work samples (files

and charts), and peer assessments. Examples of work

samples and peer assessments can be found in

Bernard and Goodyear (2004), Powell and Brodsky

(2004), and Campbell (2000). It is important to

acknowledge that counselor evaluation is essentially

a subjective process involving supervisors’ opinions of

the counselors’ competence. 

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Addressing Burnout and

Compassion Fatigue

Did you ever hear a counselor say, “I came into counseling for the right reasons. At first I loved seeing

clients. But the longer I stay in the field, the harder

it is to care. The joy seems to have gone out of my job.

Should I get out of counseling as many of my colleagues are doing?” Most substance abuse counselors

come into the field with a strong sense of calling and

the desire to be of service to others, with a strong pull

to use their gifts and make themselves instruments of

service and healing. The substance abuse treatment

field risks losing many skilled and compassionate

healers when the life goes out of their work. Some

counselors simply withdraw, care less, or get out of

the field entirely. Most just complain or suffer in

silence. Given the caring and dedication that brings

counselors into the field, it is important for you to

help them address their questions and doubts. (See

Lambie, 2006, and Shoptaw, Stein, & Rawson, 2000.) 

You can help counselors with self­care; help them

look within; become resilient again; and rediscover

what gives them joy, meaning, and hope in their

work. Counselors need time for reflection, to listen

again deeply and authentically. You can help them

redevelop their innate capacity for compassion, to be

an openhearted presence for others. 

You can help counselors develop a life that does not

revolve around work. This has to be supported by the

organization’s culture and policies that allow for

appropriate use of time off and self­care without punishment. Aid them by encouraging them to take

earned leave and to take “mental health” days when

they are feeling tired and burned out. Remind staff to

spend time with family and friends, exercise, relax,

read, or pursue other life­giving interests. 

It is important for the clinical supervisor to normalize

the counselor’s reactions to stress and compassion

fatigue in the workplace as a natural part of being an

empathic and compassionate person and not an individual failing or pathology. (See Burke, Carruth, &

Prichard, 2006.) 

Rest is good; self­care is important. Everyone needs

times of relaxation and recreation. Often, a month

after a refreshing vacation you lose whatever gain

you made. Instead, longer term gain comes from finding what brings you peace and joy. It is not enough

for you to help counselors understand “how” to counsel, you can also help them with the “why.” Why are

they in this field? What gives them meaning and purpose at work? When all is said and done, when counselors have seen their last client, how do they want to

be remembered? What do they want said about them

as counselors? Usually, counselors’ responses to this

question are fairly simple: “I want to be thought of as

a caring, compassionate person, a skilled helper.”

These are important spiritual questions that you can

discuss with your supervisees. 

Other suggestions include:

•	 Help staff identify what is happening within the

organization that might be contributing to their

stress and learn how to address the situation in a

way that is productive to the client, the counselor,

and the organization. 

•	 Get training in identifying the signs of primary

stress reactions, secondary trauma, compassion

fatigue, vicarious traumatization, and burnout.

Help staff match up self­care tools to specifically

address each of these experiences. 

•	 Support staff in advocating for organizational

change when appropriate and feasible as part of

your role as liaison between administration and

clinical staff.

•	 Assist staff in adopting lifestyle changes to

increase their emotional resilience by reconnecting

to their world (family, friends, sponsors, mentors),

spending time alone for self­reflection, and forming habits that re­energize them. 

•	 Help them eliminate the “what ifs” and negative

self­talk. Help them let go of their idealism that

they can save the world. 

•	 If possible in the current work environment, set

parameters on their work by helping them adhere

to scheduled time off, keep lunch time personal,

set reasonable deadlines for work completion, and

keep work away from personal time. 

•	 Teach and support generally positive work habits.

Some counselors lack basic organizational, teamwork, phone, and time management skills (ending

sessions on time and scheduling to allow for documentation). The development of these skills helps

to reduce the daily wear that erodes well­being

and contributes to burnout. 

•	 Ask them “When was the last time you had fun?”

“When was the last time you felt fully alive?”

Suggest they write a list of things about their job

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about which they are grateful. List five people

they care about and love. List five accomplishments in their professional life. Ask “Where do you

want to be in your professional life in 5 years?”

You have a fiduciary responsibility given you by

clients to ensure counselors are healthy and whole. It

is your responsibility to aid counselors in addressing

their fatigue and burnout. 

Gatekeeping Functions

In monitoring counselor performance, an important

and often difficult supervisory task is managing problem staff or those individuals who should not be counselors. This is the gatekeeping function. Part of the

dilemma is that most likely you were first trained as

a counselor, and your values lie within that domain.

You were taught to acknowledge and work with individual limitations, always respecting the individual’s

goals and needs. However, you also carry a responsibility to maintain the quality of the profession and to

protect the welfare of clients. Thus, you are charged

with the task of assessing the counselor for fitness for

duty and have an obligation to uphold the standards

of the profession. 

Experience, credentials, and academic performance

are not the same as clinical competence. In addition

to technical counseling skills, many important therapeutic qualities affect the outcome of counseling,

including insight, respect, genuineness, concreteness,

and empathy. Research consistently demonstrates

that personal characteristics of counselors are highly

predictive of client outcome (Herman, 1993, Hubble,

Duncan & Miller, 1999). The essential questions are:

Who should or should not be a counselor? What

behaviors or attitudes are unacceptable? How would a

clinical supervisor address these issues in supervision?

Unacceptable behavior might include actions hurtful

to the client, boundary violations with clients or program standards, illegal behavior, significant psychiatric impairment, consistent lack of self­awareness,

inability to adhere to professional codes of ethics, or

consistent demonstration of attitudes that are not

conducive to work with clients in substance abuse

treatment. You will want to have a model and policies

and procedures in place when disciplinary action is

undertaken with an impaired counselor. For example,

progressive disciplinary policies clearly state the procedures to follow when impairment is identified.

Consultation with the organization’s attorney and

familiarity with State case law are important. It is

advisable for the agency to be familiar with and have

contact with your State impaired counselor organization, if it exists. 

How impaired must a counselor be before disciplinary

action is needed? Clear job descriptions and statements of scope of practice and competence are important when facing an impaired counselor. How tired or

distressed can a counselor be before a supervisor

takes the counselor off­line for these or similar reasons? You need administrative support with such

interventions and to identify approaches to managing

worn­out counselors. The Consensus Panel recommends that your organization have an employee

assistance program (EAP) in place so you can refer

staff outside the agency. It is also important for you

to learn the distinction between a supervisory referral and a self­referral. Self­referral may include a

recommendation by the supervisor, whereas a supervisory referral usually occurs with a job performance

problem.

You will need to provide verbal and written evaluations of the counselor’s performance and actions to

ensure that the staff member is aware of the behaviors that need to be addressed. Treat all supervisees

the same, following agency procedures and timelines.

Follow the organization’s progressive disciplinary

steps and document carefully what is said, how the

person responds, and what actions are recommended.

You can discuss organizational issues or barriers to

action with the supervisee (such as personnel policies

that might be exacerbating the employee’s issues).

Finally, it may be necessary for you to take the action

that is in the best interest of the clients and the profession, which might involve counseling your supervisee out of the field. 

Remember that the number one goal of a clinical

supervisor is to protect the welfare of the client,

which, at times, can mean enforcing the gatekeeping

function of supervision. 

Methods of Observation

It is important to observe counselors frequently over

an extended period of time. Supervisors in the substance abuse treatment field have traditionally relied

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on indirect methods of supervision (process recordings, case notes, verbal reports by the supervisees,

and verbatims). However, the Consensus Panel recommends that supervisors use direct observation of

counselors through recording devices (such as video

and audio taping) and live observation of counseling

sessions, including one­way mirrors. Indirect methods

have significant drawbacks, including:

•	 A counselor will recall a session as he or she experienced it. If a counselor experiences a session positively or negatively, the report to the supervisor

will reflect that. The report is also affected by the

counselor’s level of skill and experience.

•	 The counselor’s report is affected by his or her

biases and distortions (both conscious and unconscious). The report does not provide a thorough

sense of what really happened in the session

because it relies too heavily on the counselor’s

recall.

•	 Indirect methods include a time delay in

reporting.

•	 The supervisee may withhold clinical information

due to evaluation anxiety or naiveté.

Your understanding of the session will be improved

by direct observation of the counselor. Direct observation is much easier today, as a variety of technological tools are available, including audio and videotaping, remote audio devices, interactive videos, live

feeds, and even supervision through web­based cameras. 

Guidelines that apply to all methods of direct observation in supervision include:

•	 Simply by observing a counseling session, the

dynamics will change. You may change how both

the client and counselor act. You get a snapshot of

the sessions. Counselors will say, “it was not a

representative session.” Typically, if you observe

the counselor frequently, you will get a fairly accurate picture of the counselor’s competencies.

•	 You and your supervisee must agree on procedures

for observation to determine why, when, and how

direct methods of observation will be used. 

•	 The counselor should provide a context for the

session.

•	 The client should give written consent for observation and/or taping at intake, before beginning

counseling. Clients must know all the conditions of

their treatment before they consent to counseling.

Additionally, clients need to be notified of an

upcoming observation by a supervisor before the

observation occurs.

•	 Observations should be selected for review (including a variety of sessions and clients, challenges,

and successes) because they provide teaching

moments. You should ask the supervisee to select

what cases he or she wishes you to observe and

explain why those cases were chosen. Direct observation should not be a weapon for criticism but a

constructive tool for learning: an opportunity for

the counselor to do things right and well, so that

positive feedback follows.

•	 When observing a session, you gain a wealth of

information about the counselor. Use this information wisely, and provide gradual feedback, not a

litany of judgments and directives. Ask the salient

question, “What is the most important issue here

for us to address in supervision?” 

•	 A supervisee might claim client resistance to

direct observation, saying, “It will make the client

nervous. The client does not want to be taped.”

However, “client resistance” is more likely to be

reported when the counselor is anxious about

being taped. It is important for you to gently and

respectfully address the supervisee’s resistance

while maintaining the position that direct observation is an integral component of his or her

supervision.

•	 Given the nature of the issues in drug and alcohol counseling, you and your supervisee need to

be sensitive to increased client anxiety about

direct observation because of the client’s fears

about job or legal repercussions, legal actions,

criminal behaviors, violence and abuse situations, and the like.

•	 Ideally, the supervisee should know at the outset

of employment that observation and/or taping

will be required as part of informed consent to

supervision.

In instances where there is overwhelming anxiety

regarding observation, you should pace the observation to reduce the anxiety, giving the counselor adequate time for preparation. Often enough, counselors

will feel more comfortable with observation equipment (such as a video camera or recording device)

rather than direct observation with the supervisor in

the room.

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The choice of observation methods in a particular situation will depend on the need for an accurate sense

of counseling, the availability of equipment, the context in which the supervision is provided, and the

counselor’s and your skill levels. A key factor in the

choice of methods might be the resistance of the counselor to being observed. For some supervisors, direct

observation also puts the supervisor’s skills on the

line too, as they might be required to demonstrate or

model their clinical competencies. 

Recorded Observation 

Audiotaped supervision has traditionally been a primary medium for supervisors and remains a vital

resource for therapy models such as motivational

interviewing. On the other hand, videotape supervision (VTS) is the primary method of direct observation in both the marriage and family therapy and

social work fields (Munson, 1993; Nichols, Nichols, &

Hardy, 1990). Video cameras are increasingly commonplace in professional settings. VTS is easy, accessible, and inexpensive. However, it is also a complex,

powerful and dynamic tool, and one that can be challenging, threatening, anxiety­provoking, and humbling. Several issues related to VTS are unique to the

substance abuse field:

•	 Many substance abuse counselors “grew up” in the

field without taping and may be resistant to the

medium;

•	 Many agencies operate on limited budgets and

administrators may see the expensive equipment

as prohibitive and unnecessary; and

•	 Many substance abuse supervisors have not been

trained in the use of videotape equipment or in VTS.

Yet, VTS offers nearly unlimited potential for creative

use in staff development. To that end, you need training in how to use VTS effectively. The following are

guidelines for VTS:

•	 Clients must sign releases before taping. Most programs have a release form that the client signs on

admission (see Tool 19 in Part 2, chapter 2). The

supervisee informs the client that videotaping will

occur and reminds the client about the signed

release form. The release should specify that the

taping will be done exclusively for training purposes and will be reviewed only by the counselor, the

supervisor, and other supervisees in group supervision. Permission will most likely be granted if

the request is made in a sensitive and appropriate

manner. It is critical to note that even if permission is initially given by the client, this permission

can be withdrawn. You cannot force compliance.

•	 The use and rationale for taping needs to be clearly explained to clients. This will forestall a client’s

questioning as to why a particular session is being

taped.

•	 Risk­management considerations in today’s litigious climate necessitate that tapes be erased

after the supervision session. Tapes can be admissible as evidence in court as part of the clinical

record. Since all tapes should be erased after

supervision, this must be stated in agency policies.

If there are exceptions, those need to be described.

•	 Too often, supervisors watch long, uninterrupted

segments of tape with little direction or purpose.

To avoid this, you may want to ask your supervisee to cue the tape to the segment he or she

wishes to address in supervision, focusing on the

goals established in the IDP. Having said this, listening only to segments selected by the counselor

can create some of the same disadvantages as selfreport: the counselor chooses selectively, even if

not consciously. The supervisor may occasionally

choose to watch entire sessions. 

•	 You need to evaluate session flow, pacing, and

how counselors begin and end sessions. 

Some clients may not be comfortable being videotaped

but may be more comfortable with audio taping.

Videotaping is not permitted in most prison settings

and EAP services. Videotaping may not be advisable

when treating patients with some diagnoses, such as

paranoia or some schizophrenic illnesses. In such

cases, either live observation or less intrusive measures, such as audio taping, may be preferred. 

Live Observation

With live observation you actually sit in on a counseling session with the supervisee and observe the session first hand. The client will need to provide

informed consent before being observed. Although

one­way mirrors are not readily available at most

agencies, they are an alternative to actually sitting in

on the session. A videotape may also be used either

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Clinical Supervision and Professional Development

             

           

           

           

         

               

               

	              

	 

	 

	 

	 

	 

	 

	 

	 

	 

 

	 

 

 

 

 

 

 

	 

	 

	 

	 

	 

from behind the one­way mirror (with someone else

operating the videotaping equipment) or physically

located in the counseling room, with the supervisor

sitting in the session. This combination of mirror,

videotaping, and live observation may be the best of

all worlds, allowing for unobtrusive observation of a

session, immediate feedback to the supervisee, modeling by the supervisor (if appropriate), and a record of

the session for subsequent review in supervision. Live

supervision may involve some intervention by the

supervisor during the session.

Live observation is effective for the following reasons:

•	 It allows you to get a true picture of the counselor

in action.

•	 It gives you an opportunity to model techniques

during an actual session, thus serving as a role

model for both the counselor and the client.

•	 Should a session become countertherapeutic, you

can intervene for the well­being of the client.

•	 Counselors often say they feel supported when a

supervisor joins the session, and clients periodically say, “This is great! I got two for the price of

one.” 

•	 It allows for specific and focused feedback.

•	 It is more efficient for understanding the counseling process.

•	 It helps connect the IDP to supervision.

To maximize the effectiveness of live observation,

supervisors must stay primarily in an observer role

so as to not usurp the leadership or undercut the

credibility and authority of the counselor. 

Live observation has some disadvantages:

•	 It is time consuming.

•	 It can be intrusive and alter the dynamics of the

counseling session.

•	 It can be anxiety­provoking for all involved.

Some mandated clients may be particularly sensitive

to live observation. This becomes essentially a clinical

issue to be addressed by the counselor with the client.

Where is this anxiety coming from, how does it relate

to other anxieties and concerns, and how can it best

be addressed in counseling? 

Supervisors differ on where they should sit in a live

observation session. Some suggest that the supervisor

sit so as to not interrupt or be involved in the session.

Others suggest that the supervisor sit in a position

that allows for inclusion in the counseling process.

Here are some guidelines for conducting live

observation:

•	 The counselor should always begin with informed

consent to remind the client about confidentiality.

Periodically, the counselor should begin the session with a statement of confidentiality, reiterating the limits of confidentiality and the duty to

warn, to ensure that the client is reminded of

what is reportable by the supervisor and/or

counselor.

•	 While sitting outside the group (or an individual

session between counselor and client) may undermine the group process, it is a method selected by

some. Position yourself in a way that doesn’t interrupt the counseling process. Sitting outside the

group undermines the human connection between

you, the counselor, and the client(s) and makes it

more awkward for you to make a comment, if you

have not been part of the process until then. For

individual or family sessions, it is also recommended that the supervisor sit beside the counselor to fully observe what is occurring in the

counseling session.

•	 The client should be informed about the process of

supervision and the supervisor’s role and goals,

essentially that the supervisor is there to observe

the counselor’s skills and not necessarily the

client.

•	 As preparation, the supervisor and supervisee

should briefly discuss the background of the session, the salient issues the supervisee wishes to

focus on, and the plans for the session. The role of

the supervisor should be clearly stated and agreed

on before the session. 

•	 You and the counselor may create criteria for

observation, so that specific feedback is provided

for specific areas of the session.

•	 Your comments during the session should be limited to lessen the risk of disrupting the flow or taking control of the session. Intervene only to protect

the welfare of the client (should something

adverse occur in the session) or if a moment critical to client welfare arises. In deciding to inter23
Part 1, Chapter 1

	 

 

 

vene or not, consider these questions: What are

the consequences if I don’t intervene? What is the

probability that the supervisee will make the

intervention on his or her own or that my comments will be successful? Will I create an undue

dependence on the part of clients or supervisee?

•	 Provide feedback to the counselor as soon as possible after the session. Ideally, the supervisor and

supervisee(s) should meet privately immediately

afterward, outlining the key points for discussion

and the agenda for the next supervision session,

based on the observation. Specific feedback is

essential; “You did a fine job” is not sufficient.

Instead, the supervisor might respond by saying,

“I particularly liked your comment about . . .” or

“What I observed about your behavior was . . .” or

“Keep doing more of . . . .”

Practical Issues in Clinical

Supervision

Distinguishing Between

Supervision and Therapy

In facilitating professional development, one of the

critical issues is understanding and differentiating

between counseling the counselor and providing

supervision. In ensuring quality client care and facilitating professional counselor development, the

process of clinical supervision sometimes encroaches

on personal issues. The dividing line between therapy

and supervision is how the supervisee’s personal

issues and problems affect their work. The goal of

clinical supervision must always be to assist counselors in becoming better clinicians, not seeking to

resolve their personal issues. Some of the major differences between supervision and counseling are

summarized in figure 6.

Figure 6. Differences Between Supervision and Counseling

Clinical Supervision Administrative

Supervision Counseling

Purpose • Improved client care 

• Improved job performance

• Ensure compliance with

agency and regulatory

body's policies and procedures

• Personal growth

• Behavior changes

• Better self­understanding

Outcome • Enhanced proficiency in

knowledge, skills, and

attitudes essential to

effective job performance

• Consistent use of

approved formats, policies, and procedures

• Open­ended, based on

client needs

Timeframe • Short­term and ongoing • Short­term and ongoing • Based on client needs

Agenda • Based on agency mission

and counselor needs

• Based on agency needs • Based on client needs

Basic Process • Teaching/learning specific skills, evaluating job

performance, negotiating learning objectives 

• Clarifying agency expectations, policies and procedures, ensuring compliance• Behavioral, cognitive,

and affective process

including listening,

exploring, teaching

Source: Adapted from Dixon, 2004

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The boundary between counseling and clinical supervision may not always be clearly marked, for it is necessary, at times, to explore supervisees’ limitations as

they deliver services to their clients. Address counselors’ personal issues only in so far as they create

barriers or affect their performance. When personal

issues emerge, the key question you should ask the

supervisee is how does this affect the delivery of quality client care? What is the impact of this issue on the

client? What resources are you using to resolve this

issue outside of the counseling dyad? When personal

issues emerge that might interfere with quality care,

your role may be to transfer the case to a different

counselor. Most important, you should make a strong

case that the supervisee should seek outside counseling or therapy. 

Problems related to countertransference (projecting

unresolved personal issues onto a client or supervisee) often make for difficult therapeutic relationships. The following are signs of countertransference

to look for: 

•	 A feeling of loathing, anxiety, or dread at the

prospect of seeing a specific client or supervisee.

•	 Unexplained anger or rage at a particular client.

•	 Distaste for a particular client.

•	 Mistakes in scheduling clients, missed appointments.

•	 Forgetting client’s name, history.

•	 Drowsiness during a session or sessions ending

abruptly.

•	 Billing mistakes.

•	 Excessive socializing.

When countertransferential issues between counselor

and client arise, some of the important questions you,

as a supervisor, might explore with the counselor

include:

•	 How is this client affecting you? What feelings

does this client bring out in you? What is your

behavior toward the client in response to these

feelings? What is it about the substance abuse

behavior of this client that brings out a response

in you?

•	 What is happening now in your life, but more particularly between you and the client that might be

contributing to these feelings, and how does this

affect your counseling?

Clinical Supervision and Professional Development

•	 In what ways can you address these issues in your

counseling?

•	 What strategies and coping skills can assist you in

your work with this client? 

Transference and countertransference also occur in

the relationship between supervisee and supervisor.

Examples of supervisee transference include: 

•	 The supervisee’s idealization of the supervisor.

•	 Distorted reactions to the supervisor based on the

supervisee’s reaction to the power dynamics of the

relationship.

•	 The supervisee’s need for acceptance by or

approval from an authority figure.

•	 The supervisee’s reaction to the supervisor’s establishing professional and social boundaries with the

supervisee. 

Supervisor countertransference with supervisees is

another issue that needs to be considered. Categories

of supervisor countertransference include:

•	 The need for approval and acceptance as a knowledgeable and competent supervisor.

•	 Unresolved personal conflicts of the supervisor

activated by the supervisory relationship.

•	 Reactions to individual supervisees, such as dislike or even disdain, whether the negative

response is “legitimate” or not. In a similar vein,

aggrandizing and idealizing some supervisees

(again, whether or not warranted) in comparison

to other supervisees.

•	 Sexual or romantic attraction to certain supervisees.

•	 Cultural countertransference, such as catering to

or withdrawing from individuals of a specific cultural background in a way that hinders the professional development of the counselor. 

To understand these countertransference reactions

means recognizing clues (such as dislike of a supervisee or romantic attraction), doing careful self­examination, personal counseling, and receiving supervision of your supervision. In some cases, it may be necessary for you to request a transfer of supervisees

with whom you are experiencing countertransference,

if that countertransference hinders the counselor’s

professional development.

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Finally, counselors will be more open to addressing

difficulties such as countertransference and compassion fatigue with you if you communicate understanding and awareness that these experiences are a normal part of being a counselor. Counselors should be

rewarded in performance evaluations for raising

these issues in supervision and demonstrating a willingness to work on them as part of their professional

development.

Balancing Clinical and

Administrative Functions

In the typical substance abuse treatment agency, the

clinical supervisor may also be the administrative

supervisor, responsible for overseeing managerial

functions of the organization. Many organizations

cannot afford to hire two individuals for these tasks.

Hence, it is essential that you are aware of what role

you are playing and how to exercise the authority

given you by the administration. Texts on supervision

sometimes overlook the supervisor’s administrative

tasks, but supervisors structure staff work; evaluate

personnel for pay and promotions; define the scope of

clinical competence; perform tasks involving planning, organizing, coordinating, and delegating work;

select, hire, and fire personnel; and manage the

organization. Clinical supervisors are often responsible for overseeing the quality assurance and improvement aspects of the agency and may also carry a caseload. For most of you, juggling administrative and

clinical functions is a significant balancing act. Tips

for juggling these functions include:

•	 Try to be clear about the “hat you are wearing.”

Are you speaking from an administrative or clinical perspective? 

•	 Be aware of your own biases and values that may

be affecting your administrative opinions.

•	 Delegate the administrative functions that you

need not necessarily perform, such as human

resources, financial, or legal functions.

•	 Get input from others to be sure of your objectivity

and your perspective.

There may be some inherent problems with performing both functions, such as dual relationships.

Counselors may be cautious about acknowledging difficulties they face in counseling because these may

affect their performance evaluation or salary raises.

On the other hand, having separate clinical and

administrative supervisors can lead to inconsistent

messages about priorities, and the clinical supervisor is not in the chain of command for disciplinary

purposes.

Finding the Time To Do Clinical

Supervision

Having read this far, you may be wondering, “Where

do I find the time to conduct clinical supervision as

described here? How can I do direct observation of

counselors within my limited time schedule?” Or, 

“I work in an underfunded program with substance

abuse clients. I have way too many tasks to also

observe staff in counseling.” 

One suggestion is to begin an implementation process

that involves adding components of a supervision

model one at a time. For example, scheduling supervisory meetings with each counselor is a beginning

step. It is important to meet with each counselor on a

regular, scheduled basis to develop learning plans

and review professional development. Observations of

counselors in their work might be added next.

Another component might involve group supervision.

In group supervision, time can be maximized by

teaching and training counselors who have common

skill development needs.

As you develop a positive relationship with supervisees based on cooperation and collaboration, the

anxiety associated with observation will decrease.

Counselors frequently enjoy the feedback and support

so much that they request observation of their work.

Observation can be brief. Rather than sitting in on a

full hour of group, spend 20 minutes in the observation and an additional 20 providing feedback to the

counselor.

Your choice of modality (individual, group, peer, etc.)

is influenced by several factors: supervisees’ learning

goals, their experience and developmental levels,

their learning styles, your goals for supervisees, your

theoretical orientation, and your own learning goals

for the supervisory process. To select a modality of

supervision (within your time constraints and those

of your supervisee), first pinpoint the immediate function of supervision, as different modalities fit different functions. For example, a supervisor might wish

to conduct group supervision when the team is intact

and functioning well, and individual supervision

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Clinical Supervision and Professional Development

         

           

           

             

         

             

             

       

             

             

       

           

       

         

       

     

           

         

             

           

         

               

     

                 

               

               

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

	 

when specific skill development or countertransferential issues need additional attention. Given the variety of treatment environments in substance abuse

treatment (e.g., therapeutic communities, intensive

outpatient services, transitional living settings, correctional facilities) and varying time constraints on

supervisors, several alternatives to structure supervision are available. 

Peer supervision is not hierarchical and does not

include a formal evaluation procedure, but offers a

means of accountability for counselors that they

might not have in other forms of supervision. Peer

supervision may be particularly significant among

well­trained, highly educated, and competent counselors. Peer supervision is a growing medium, given

the clinical supervisors’ duties. Although peer supervision has received limited attention in literature, the

Consensus Panel believes it is a particularly effective

method, especially for small group practices and

agencies with limited funding for supervision. Peer

supervision groups can evolve from supervisor­led

groups or individual sessions to peer groups or can

begin as peer supervision. For peer supervision

groups offered within an agency, there may be some

history to overcome among the group members, such

as political entanglements, competitiveness, or personality concerns. (Bernard and Goodyear [2004] has

an extensive review of the process and the advantages and disadvantages of peer supervision.) 

Triadic supervision is a tutorial and mentoring relationship among three counselors. This model of

supervision involves three counselors who, on a

rotating basis, assume the roles of the supervisee,

the commentator, and the supervision session facilitator. Spice and Spice (1976) describe peer supervision with three supervisees getting together. In current counseling literature, triadic supervision

involves two counselors with one supervisor. There is

very little empirical or conceptual literature on this

arrangement.

Individual supervision, where a supervisor works

with the supervisee in a one­to­one relationship, is

considered the cornerstone of professional skill

development. Individual supervision is the most

labor­intensive and time­consuming method for

supervision. Credentialing requirements in a particular discipline or graduate studies may mandate

individual supervision with a supervisor from the

same discipline.

Intensive supervision with selected counselors is helpful in working with a difficult client (such as one with

a history of violence), a client using substances unfamiliar to the counselor, or a highly resistant client.

Because of a variety of factors (credentialing requirements, skill deficits of some counselors, the need for

close clinical supervision), you may opt to focus, for

concentrated periods of time, on the needs of one or

two counselors as others participate in peer supervision. Although this is not necessarily a long­term

solution to the time constraints of a supervisor, intensive supervision provides an opportunity to address

specific staffing needs while still providing a “reasonable effort to supervise” all personnel.

Group clinical supervision is a frequently used and

efficient format for supervision, team building, and

staff growth. One supervisor assists counselor development in a group of supervisee peers. The recommended group size is four to six persons to allow for

frequent case presentations by each group member.

With this number of counselors, each person can

present a case every other month—an ideal situation,

especially when combined with individual and/or peer

supervision. The benefits of group supervision are

that it is cost­effective, members can test their perceptions through peer validation, learning is

enhanced by the diversity of the group, it creates a

working alliance and improves teamwork, and it provides a microcosm of group process for participants.

Group supervision gives counselors a sense of commonality with others in the same situation. Because

the formats and goals differ, it is helpful to think

through why you are using a particular format.

(Examples of group formats with different goals can

be found in Borders and Brown, 2005, and Bernard &

Goodyear, 2004.)

Given the realities of the substance abuse treatment

field (limited funding, priorities competing for time,

counselors and supervisors without advanced academic training, and clients with pressing needs in a

brief­treatment environment), the plan described

below may be a useful structure for supervision. It is

based on a scenario where a supervisor oversees one

to five counselors. This plan is based on several

principles:

•	 All counselors, regardless of years of experience or

academic training, will receive at least 1 hour of

supervision for every 20 to 40 hours of clinical

practice.

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•	 Direct observation is the backbone of a solid clinical supervision model. 

•	 Group supervision is a viable means of engaging

all staff in dialog, sharing ideas, and promoting

team cohesion. 

With the formula diagramed below, each counselor

receives a minimum of 1 hour of group clinical supervision per week. Each week you will have 1 hour of

observation, 1 hour of individual supervision with one

of your supervisees, and 1 hour of group supervision

with five supervisees. Each week, one counselor will

be observed in an actual counseling session, followed

by an individual supervision session with you. If the

session is videotaped, the supervisee can be asked to

cue the tape to the segment of the session he or she

wishes to discuss with you. Afterwards, the observed

counselor presents this session in group clinical

supervision.

When it is a counselor’s week to be observed or taped

and meet for individual supervision, he or she will

receive 3 hours of supervision: 1 hour of direct observation, 1 hour of individual/one­on­one supervision,

and 1 hour of group supervision when he or she presents a case to the group. Over the course of months,

with vacation, holiday, and sick time, it should average out to approximately 1 hour of supervision per

counselor per week. Figure 7 shows this schedule.

When you are working with a counselor who needs

special attention or who is functioning under specific

requirements for training or credentialing, 1 additional hour per week can be allocated for this counselor,

increasing the total hours for clinical supervision to 4,

still a manageable amount of time. 

Documenting Clinical Supervision

Correct documentation and recordkeeping are essential aspects of supervision. Mechanisms must be in

place to demonstrate the accountability of your role.

(See Tools 10–12 in Part 2, chapter 2.) These systems

should document: 

•	 Informal and formal evaluation procedures.

•	 Frequency of supervision, issues discussed, and

the content and outcome of sessions.

•	 Due process rights of supervisees (such as the

right to confidentiality and privacy, to informed

consent).

•	 Risk management issues (how to handle

crises, duty­to­warn situations, breaches of

confidentiality).

One comprehensive documentation system is Falvey’s

(2002a) Focused Risk Management Supervision

System (FoRMSS), which provides templates to

record emergency contact information, supervisee

profiles, a logging sheet for supervision, an initial

case review, supervision records, and a client termination form. 

Supervisory documents and notes are open to management, administration, and human resources (HR)

personnel for performance appraisal and merit pay

increases and are admissible in court proceedings.

Supervision notes, especially those related to work

Figure 7. Sample Clinical Supervision Schedule

Counselor Week 1 Week 2 Week 3 Week 4 Week 5

A

1 hour direct observation

1 hour individual supervision

1 hour group supervision of A’s case

(3 hours)

1 hour group 1 hour group 1 hour group 1 hour group

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

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Clinical Supervision and Professional Development

	 

	 

	 

	 

	 

	 

	 

	 

	 

	 

	 

	 

	 

	 

	 

	 

	 

	 

with clients, are kept separately and are intended for

the supervisor’s use in helping the counselor improve

clinical skills and monitor client care. It is imperative

to maintain accurate and complete notes on the

supervision. However, as discussed above, documentation procedures for formative versus summative

evaluation of staff may vary. Typically, HR accesses

summative evaluations, and supervisory notes are

maintained as formative evaluations. 

An example of a formative note by a supervisor might

be “The counselor responsibly discussed countertransferential issues occurring with a particular client and

was willing to take supervisory direction,” or “We

worked out an action plan, and I will follow this

closely.” This wording avoids concerns by the supervisor and supervisee as to the confidentiality of supervisory notes. From a legal perspective, the supervisor

needs to be specific about what was agreed on and a

timeframe for following up.

Structuring the Initial Supervision

Sessions

As discussed earlier, your first tasks in clinical supervision are to establish a behavioral contract, get to

know your supervisees, and outline the requirements

of supervision. Before the initial session, you should

send a supportive letter to the supervisee expressing

the agency’s desire to provide him or her with a quality clinical supervision experience. You might request

that the counselor give some thought to what he or

she would like to accomplish in supervision, what

skills to work on, and which core functions used in

the addiction counselor certification process he or she

feels most comfortable performing. 

In the first few sessions, helpful practices include:

•	 Briefly describe your role as both administrative

and clinical supervisor (if appropriate) and discuss

these distinctions with the counselor.

•	 Briefly describe your model of counseling and

learn about the counselor’s frameworks and models for her or his counseling practice. For beginning counselors this may mean helping them

define their model. 

•	 Describe your model of supervision.

•	 State that disclosure of one’s supervisory training,

experience, and model is an ethical duty of clinical

supervisors.

•	 Discuss methods of supervision, the techniques to

be used, and the resources available to the supervisee (e.g., agency inservice seminar, community

workshops, professional association memberships,

and professional development funds or training

opportunities).

•	 Explore the counselor’s goals for supervision and

his or her particular interests (and perhaps some

fears) in clinical supervision.

•	 Explain the differences between supervision and

therapy, establishing clear boundaries in this 

relationship.

•	 Work to establish a climate of cooperation, collaboration, trust, and safety.

•	 Create an opportunity for rating the counselor’s

knowledge and skills based on the competencies in

TAP 21 (CSAT, 2007).

•	 Explain the methods by which formative and summative evaluations will occur.

•	 Discuss the legal and ethical expectations and

responsibilities of supervision.

•	 Take time to decrease the anxiety associated with

being supervised and build a positive working

relationship.

It is important to determine the knowledge and skills,

learning style, and conceptual skills of your supervisees, along with their suitability for the work setting, motivation, self­awareness, and ability to function autonomously. A basic IDP for each supervisee

should emerge from the initial supervision sessions.

You and your supervisee need to assess the learning

environment of supervision by determining:

•	 Is there sufficient challenge to keep the supervisee

motivated?

•	 Are the theoretical differences between you and

the supervisee manageable?

•	 Are there limitations in the supervisee’s knowledge and skills, personal development, self­efficacy, self­esteem, and investment in the job that

would limit the gains from supervision?

•	 Does the supervisee possess the affective qualities

(empathy, respect, genuineness, concreteness,

warmth) needed for the counseling profession?

•	 Are the goals, means of supervision, evaluation

criteria, and feedback process clearly understood

by the supervisee?

•	 Does the supervisory environment encourage and

allow risk taking?

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Methods and Techniques

of Clinical Supervision

A number of methods and techniques are available

for clinical supervision, regardless of the modality

used. Methods include (as discussed previously) case

consultation, written activities such as verbatims and

process recordings, audio and videotaping, and live

observation. Techniques include modeling, skill

demonstrations, and role playing. (See descriptions of

these and other methods and techniques in Bernard

& Goodyear, 2004; Borders & Brown, 2005; Campbell,

2000; and Powell & Brodsky, 2004.) Figure 8 outlines

some of the methods and techniques of supervision,

as well as the advantages and disadvantages of each

method.

The context in which supervision is provided affects

how it is carried out. A critical issue is how to manage your supervisory workload and make a reasonable effort to supervise. The contextual issues that

shape the techniques and methods of supervision

include:

•	 The allocation of time for supervision. If the 20:1

rule of client hours to supervision time is followed,

you will want to allocate sufficient time for supervision each week so that it is a high priority, regularly scheduled activity.

•	 The unique conditions, limitations, and requirements of the agency. Some organizations may lack

the physical facilities or hardware to use videotaping or to observe sessions. Some organizations

may be limited by confidentiality requirements,

Figure 8. Methods and Techniques in Clinical Supervision

Description Advantages Disadvantages

Verbal Reports Verbal reports of clinical 

situations 

Group discussion of clinical

situations

• Informal

• Time efficient

• Often spontaneous in

response to clinical situation

• Can hear counselor’s report,

what he or she includes, thus

learn of the counselor’s

awareness and perspective,

what he or she wishes to

report, contrasted with supervisory observations 

• Sessions seen through eyes

of beholder

• Nonverbal cues missed

• Can drift into case management, hence it is important

to focus on the clinical

nature of chart reviews,

reports, etc., linking to the

treatment plan and EBPs

Verbatim Reports Process recordings 

Verbatim written record of a

session or part of session

Declining method in the

behavioral health field

• Helps track coordination and

use of treatment plan with

ongoing session

• Enhances conceptualization

and writing skills

• Enhances recall and reflection

skills

• Provides written documentation of sessions

• Nonverbal cues missed

• Self­report bias

• Can be very tedious to write

and to read

Written/File

Review

Review of the progress

notes, charts, documentation

• An important task of a supervisor to ensure compliance

with accreditation standards

for documentation

• Provides a method of quality

control

• Ensures consistency of records

and files

• Time consuming

• Notes often miss the overall

quality and essence of the

session

• Can drift into case management rather than clinical

skills development

30
Clinical Supervision and Professional Development

Figure 8. Methods and Techniques in Clinical Supervision (continued)

Description Advantages Disadvantages

Case

Consultation/

Case

Management

Discussion of cases 

Brief case reviews

• Helps organize information,

conceptualize problems, and

decide on clinical interventions

• Examines issues (e.g., cross­cultural issues), integrates theory

and technique, and promotes

greater self­awareness

• An essential component of

treatment planning

• The validity of self­report is

dependent on counselor

developmental level and the

supervisor’s insightfulness

• Does not reflect broad range

of clinical skills of the counselor 

Direct

Observation

The supervisor watches the

session and may provide

periodic but limited comments and/or suggestions

to the clinician

• Allows teaching of basic skills

while protecting quality of care

• Counselor can see and experience positive change in session

direction in the moment

• Allows supervisor to intervene

when needed to protect the

welfare of the client, if the session is not effective or is

destructive to the client

• May create anxiety

• Requires supervisor caution in

intervening so as to not take

over the session or to create

undue dependence for the

counselor or client

• Can be seen as intrusive to

the clinical process

• Time consuming

Audiotaping Audiotaping and review of

a counseling session

• Technically easy and inexpensive

• Can explore general rapport,

pace, and interventions

• Examines important relationship issues

• Unobtrusive medium

• Can be listened to in clinical or

team meetings

• Counselor may feel anxious

• Misses nonverbal cues

• Poor sound quality often

occurs due to limits of technology

Videotaping  Videotaping and review of

a counseling session

• A rich medium to review verbal

and nonverbal information

• Provides documentation of clinical skills

• Can be viewed by the treatment team during group clinical supervision session

• Uses time efficiently

• Can be used in conjunction

with direct observation

• Can be used to suggest different interventions

• Allows for review of content,

affective and cognitive aspects,

process relationship issues in

the present

• Can be seen as intrusive to

the clinical process

• Counselor may feel anxious

and self­conscious, although

this subsides with experience

• Technically more complicated

• Requires training before

using

• Can become part of the clinical record and can be subpoenaed (should be

destroyed after review)

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Part 1, Chapter 1

Figure 8. Methods and Techniques in Clinical Supervision (continued)

Description Advantages Disadvantages

Webcam Internet supervision, synchronistic and asynchronistic

Teleconferencing

• Can be accessed from any computer

• Especially useful for remote

and satellite facilities and locations

• Uses time efficiently

• Modest installation and operation costs

• Can be stored or downloaded

on a variety of media, watched

in any office, then erased

• Concerns about anonymity

and confidentiality

• Can be viewed as invasive to

the clinical process

• May increase client or counselor anxiety or self­consciousness

• Technically more complicated

• Requires assurance that

downloads will be erased and

unavailable to unauthorized

staff

Cofacilitation

and Modeling

Supervisor and counselor

jointly run a counseling

session

Supervisor demonstrates a

specific technique while

the counselor observes

This may be followed by

roleplay with the counselor practicing the skill

with time to process learning and application

• Allows the supervisor to model

techniques while observing the

counselor

• Can be useful to the client

(“two counselors for the price

of one”)

• Supervisor must demonstrate

proficiency in the skill and help

the counselor incrementally

integrate the learning

• Counselor sees how the supervisor might respond

• Supervisor incrementally shapes

the counselor’s skill acquisition

and monitors skill mastery

• Allows supervisor to aid counselor with difficult clients

• Supervisor must demonstrate

proficiency in the skill and

help the counselor incrementally integrate the learning

• The client may perceive counselor as less skilled than the

supervisor

• Time consuming

Role Playing Role play a clinical situation

• Enlivens the learning process 

• Provides the supervisor with

direct observation of skills 

• Helps counselor gain a different perspective 

• Creates a safe environment for

the counselor to try new skills

• Counselor can be anxious

• Supervisor must be mindful

of not overwhelming the

counselor with information

Source: Adapted from Mattel, 2007.

such as working within a criminal justice system

where taping may be prohibited.

• Clinical and management responsibilities of a

supervisor. Supervisors have varied responsibilities, including administrative tasks, limiting the

amount of time available for clinical supervision.

• The number of supervisees reporting to a supervisor. It is difficult to provide the scope of supervision 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. 

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Clinical Supervision and Professional Development

         

         

         

   

	 

	 

	 

	 

	 

 

	 

	 

	 

	 

	 

	 

	 

	 

	 

Administrative

Supervision 

As noted above, clinical and administrative supervision overlap in the real world. Most clinical supervisors also have administrative responsibilities, including team building, time management, addressing

agency policies and procedures, recordkeeping,

human resources management (hiring, firing, disciplining), performance appraisal, meeting management, oversight of accreditation, maintenance of legal

and ethical standards, compliance with State and

Federal regulations, communications, overseeing staff

cultural competence issues, quality control and

improvement, budgetary and financial issues, problem solving, and documentation. Keeping up with

these duties is not an easy task! 

This TIP addresses two of the most frequently voiced

concerns of supervisors: documentation and time

management. Supervisors say, “We are drowning in

paperwork. I don’t have the time to adequately document my supervision as well,” and “How do I manage

my time so I can provide quality clinical supervision?” 

Documentation for Administrative

Purposes

One of the most important administrative tasks of a

supervisor is that of documentation and recordkeeping, especially of clinical supervision sessions.

Unquestionably, documentation is a crucial risk­management tool. Supervisory documentation can help

promote the growth and professional development of

the counselor (Munson, 1993). However, adequate

documentation is not a high priority in some organizations. For example, when disciplinary action is

needed with an employee, your organization’s attorney or human resources department will ask for the

paper trail, or documentation of prior performance

issues. If appropriate documentation to justify disciplinary action is missing from the employee’s record,

it may prove more difficult to conduct the appropriate

disciplinary action (See Falvey, 2002; Powell &

Brodsky, 2004.)

Documentation is no longer an option for supervisors.

It is a critical link between work performance and

service delivery. You have a legal and ethical requirement to evaluate and document counselor performance. A complete record is a useful and necessary

part of supervision. Records of supervision sessions

should include: 

•	 The supervisor–supervisee contract, signed by

both parties.

•	 A brief summary of the supervisee’s experience,

training, and learning needs.

•	 The current IDP.

•	 A summary of all performance evaluations.

•	 Notations of all supervision sessions, including

cases discussed and significant decisions made.

•	 Notation of cancelled or missed supervision

sessions.

•	 Progressive discipline steps taken.

•	 Significant problems encountered in supervision

and how they were resolved.

•	 Supervisor’s clinical recommendations provided to

supervisees.

•	 Relevant case notes and impressions.

The following should not be included in a supervision

record:

•	 Disparaging remarks about staff or clients.

•	 Extraneous or sensitive supervisee information.

•	 Alterations in the record after the fact or premature destruction of supervision records.

•	 Illegible information and nonstandard

abbreviations.

Several authors have proposed a standardized format

for documentation of supervision, including Falvey

(2002b), Glenn and Serovich (1994), and Williams

(1994).

Time Management

By some estimates, people waste about two hours

every day doing tasks that are not of high priority. In

your busy job, you may find yourself at the end of the

week with unfinished tasks or matters that have not

been tended to. Your choices? Stop performing some

tasks (often training or supervision) or take work

home and work longer days. In the long run, neither

of these choices is healthy or effective for your organization. Yet, being successful does not make you manage your time well. Managing your time well makes

you successful. Ask yourself these questions about

your priorities:

33
	 

	 

	 

	 

	 

	 

	 

	 

	 

	 

	 

	 

	 

	 

	 

	 

	 

34 Clinical Supervision and Professional Development	 	 Part 1, Chapter 1

•	 Why am I doing this? What is the goal of this

activity?

•	 How can I best accomplish this task in the least

amount of time?

•	 What will happen if I choose not to do this?

It is wise to develop systems for managing timewasters such as endless meetings held without notes

or minutes, playing telephone or email tag, junk mail,

and so on. Effective supervisors find their times in

the day when they are most productive. Time management is essential if you are to set time aside and

dedicate it to supervisory tasks. 

Resources 

The following are resources for supervision:

•	 Code of Ethics from the Association of Addictions

Professionals (NAADAC; http://naadac.org).

•	 International Certification & Reciprocity

Consortium’s Code of Ethics (http://internationalcredentialing.org/).

•	 Codes of ethics from professional groups such as

the American Association for Marriage and Family

Therapy (http://www.aamft.org), the American

Counseling Association

(http://www.counseling.org), the Association for

Counselor Education and Supervision

(http://www.acesonline.net), the American

Psychological Association (http://www.apa.org), the

National Association of Social Workers

(http://www.socialworkers.org), and the National

Board for Certified Counselors (NBCC;

http://www.nbcc.org).

•	 ACES Standards for Counseling Supervisors;

ACES Ethical Guidelines for Counseling

Supervisors

(http://www.acesonline.net/members/supervision/);

and NBCC Standards for the Ethical Practice of

Clinical Supervision.

TAP 21­A provides detailed appendices of suggested

reading and other resources (CSAT, 2007).

Additionally, Part 3 of this document provides a literature review and bibliographies (available online only

at http://store.samhsa.gov). The following are examples of online classroom training programs in clinical

supervision in the substance abuse field: 

•	 http://www.attcnetwork.org/regcenters/

index_midatlantic.asp, Clinical Supervision for

Substance Abuse Treatment Practitioners Series.

•	 http://www.attcnetwork.org/regcenters/

index_midatlantic.asp, Motivational Interviewing

Assessment: Supervisory Tools for Enhancing

Proficiency.

•	 http://www.attcnetwork.org/regcenters/

index_northeast.asp, Clinical Supervision to

Support the Implementation, Fidelity and

Sustaining Evidence­Based Practices.

•	 http://www.attcnetwork.org/regcenters/

index_northwestfrontier.asp, Clinical Supervision,

Part 2: What Happens in Good Supervision.

Other training programs are given in professional

graduate schools, such as New York University

School of Social Work; Smith College School for Social

Work; University of Nevada, Reno, Human and

Community Sciences; and Portland State University

Graduate School of Education.

For information about tools to measure counselor

competencies and supervisor self­assessment tools,

along with samples, see the following:

•	 David J. Powell and Archie Brodsky, Clinical

Supervision in Alcohol and Drug Abuse

Counseling, 2004.

•	 L. DiAnne Borders and Lori L. Brown, The New

Handbook of Counseling Supervision, 2005

•	 Jane M. Campbell, Becoming an Effective

Supervisor, 2000.

•	 Janet Elizabeth Falvey, Managing Clinical

Supervision: Ethical Practice and Legal Risk

Management, 2002.

•	 Carol A. Falender and Edward P. Shafranske,

Clinical Supervision: A Competency­Based

Approach, 2004.

•	 Cal D. Stoltenberg, Brian McNeill, and Ursula

Delworth, IDM Supervision: An Integrated

Developmental Model for Supervising Counselors

and Therapists, 1998.
 

 

Chapter 2 

Introduction 

In this chapter, through vignettes, you will meet eight clinical supervisors with a variety of skill levels, a number 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 individuals 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. 

“How­to” 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 provides insights into the counselor’s relationships with clients and suggests possible approaches. The notes provide 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. 

“How­to” 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 “how­tos” will apply in every situation, 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 experience and training who are true master supervisors. The Consensus Panel has made significant efforts to present realistic scenes in supervision using clinical approaches that include motivational interviewing (MI), cognitive–behavioral therapy (CBT), supportive psychotherapy, crisis intervention methods, and a variety of supervisory 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 demonstrated. 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 clinical staff, including establishing a consistent model of direct observation. The vignette begins with the supervisor describing to staff how he will implement a new method of supervision. 

Clinical Supervision and Professional Development 35
                                              

Background 

Walt has been assigned to redesign the supervision program for a community­based 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 full­time­equivalent counseling positions, has a

broad range of professional training and experience, from entry­level 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 experience. 

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 training 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 development. 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?

Part 1, Chapter 2 3636
Clinical Supervision and Professional Development

                                 

	 

	 

	 

	 

 

[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 experienced supervisor would be less confrontive and authoritarian and would adopt a

more consultative posture. He would be direct but not necessarily confrontational. 

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 experiences 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 evidence­based practices within an organization

3.	 Professional and workforce development: enhancing staff retention, improving 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 determine 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

37
Part 1, Chapter 2

need more training but I have concerns about being videotaped or observed. I’m going to make mistakes. I’ll be selfconscious 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 counselor’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 counselor through methods for presenting the direct observation methods to the

client.

WALT: I can sure understand your sense of feeling self­conscious 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 one­way 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 “how­tos” of live observation and videotaping, including the concept of saliency, bringing to

supervision the one issue the counselor wishes to address. Walt presents a step­by­step process to begin doing

direct observation.]

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Clinical Supervision and Professional Development

How To Implement Direct Observation or Videotaping

1.	 Obtain written and verbal agreement from the clients and all concerned parties 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 observation, 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 cost­effectiveness 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 cost­effective 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. 

39
Part 1, Chapter 2

[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 session, 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. 

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Clinical Supervision and Professional Development

	 

	 

	 

	 

 

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 vulnerability 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 statement, 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 disciplinary 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 videotape 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 recovery, 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. 

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[Laughter.] 

[In the discussion that follows, Walt acknowledges Al’s concerns, and Al, Carrie, and Walt talk about those concerns. 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 identify 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 supervision. 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 disadvantages:

1.	 The strengths and success of peer group supervision depend on the composition of the group, the individual members’ strengths, and the clarity of the

peer group contract. Members must agree on the time, location, and frequency of meetings, as well as the organizational structure and goals of the meetings and limits of confidentiality. In these dimensions, peer supervision differs from occasional and unplanned peer consultation, a more informal

process.

2.	 Peer group supervision decreases professional isolation, increases professional 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.

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3.	 Vague, ambiguous, or ambivalent goals and structure often lead to difficulties in peer supervision. As with individual or clinical supervision, an interpersonal atmosphere of reasonable safety (including respect, warmth, honesty, and a collaborative openness) are critical. 

4.	 Effectiveness and supervisee enjoyment diminish when competitiveness, criticism, 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 suggestions. 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 roleplays 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 verify 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 person of greater experience instructs, guides, advises, provides feedback, and

coaches someone of lesser experience. 

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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 co­occurring 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 entry­level 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 part­time 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 community­based 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 well­established 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.] 

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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 licensure 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 co­led 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 well­being of the clients. 

Master Supervisor Note: Notice how Bill is laying the foundation and rationale 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 experienced 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.

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Part 1, Chapter 2

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 psychoeducation. 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 in­house and in workshops around

the State. We encourage and support any efforts you might make toward professional development, such as getting 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 supervision 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 handled 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. 

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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 self­awareness of these feelings is critical 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 private 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 feelings 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 previous 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 development, 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 side­by­side

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 driven by alternating anxiety and self­confidence and who feels the need to be independent, even though she might not as yet be able to act independently. Finally,

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Level 3 supervisors have balanced their levels of self­awareness, motivation, and

autonomy. For further descriptive information on levels of counselors and supervisors, 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 supervisee, and counselors should understand why an IDP is important for the supervisory 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 something 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. 

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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 presenter’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 session 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 open­door 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 agenda, 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 transition 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?

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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 noncompliance 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 observation 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 negatively affect the relationship. A supervision of supervision issue might be to

explore what was happening for Bill and his possible ambivalence about Jan.

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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 clinicians, with the goal of protecting the welfare of the client. The vignette begins with a discussion about a potential 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 10­week 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 occasions. 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 12­Step 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.

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STAN: And that’s a barbecue you might be attending?

ELOISE: Yeah. I’m fairly active with all my 12­Step friends and sponsees. 

STAN: I would like to raise a concern I have about your relationship with Alicia. You take great pride in working 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 relationship 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 defensive 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 identify 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 clinical 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.”

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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 12­Step meetings. So what are you saying?

Master Supervisor Note: There is a difference between a dual quality to a relationship 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 manipulation or inappropriate self­disclosure. 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 decisions 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 relationships. 

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 perspective, 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.

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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 wake­up

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 others, 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 cultural 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 cultural variables while continuing to make sound ethical decisions. 

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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 12­Step 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 ethical decisionmaking:

1.	 Recognize the ethical issues by asking whether there is potentially something 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 produce 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? 

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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 context 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 counseling 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. 

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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, self­advocacy, nonmalfeasance? 

3.	 How would a person discern his or her intentions? How do you keep yourself

from self­deception 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.] 

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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 perceived, 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 Evidence­Based Practice

Overview

This vignette portrays supervision of two counselors at different levels of experience and orientation to implement an evidence­based practice (EBP) into their clinical work. Both counselors have reservations about adapting 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 mid­sized 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 funding. Therefore, the ED has directed the three clinical supervisors to begin the implementation of MI as a primary treatment method for treatment staff, first on a pilot basis then agency­wide. Gloria, one of the supervisiors, 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.

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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

science­based 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 something 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 naturally: active listening, respect for others’ views, an appreciation of the role of resistance, good goal setting practices, 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 experienced resistance to change in supervision.

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5.	 Consider using self­disclosure 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 concerns 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 self­involving

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 12­Step facilitation guy.

That works for me and for my clients. I don’t see changing horses in the middle of the stream to achieve political correctness.

GLORIA: Your 12­Step approach works for you, and we heartily endorse it, too. 12­Step facilitation is an essential 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 ever­evolving 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 middle, 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 matters, 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 lev6060
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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, 12­Step facilitation. In your experience, what works with Latino men? 

JAIME: I’d agree with Larry, 12­Steps, 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 12­Step 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 well­being 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 12­Step 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 people. I know 12­Step works, and I have to be convinced that this doesn’t interfere with having a strong relationship 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 science­based 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 curious 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 12­Step. 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 12­Step

work? What do you think?

LARRY: If an approach builds the relationship with the client, I’m all for it. I know that 12­Step 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 12­Step 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

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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 polarizing 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 struggle is a sign of staff ambivalence to change. Resistance and ambivalence are normal in any situation involving change. A master supervisor works with the

resistance, using its energy to promote change, not taking it “head­on.”

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 supervisee to do something you’re not willing to do first.” A second rule is that “leaders 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 supervisors 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, having the title “supervisor” does not necessarily make a person a leader. To earn

respect, the supervisor should display qualities of honesty, responsibility, fairness, and understanding. In this vignette, Gloria provides direction and leadership 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. 

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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 smoke­free 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 year­long 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 12­Step 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 concerned about our funding, of course. But, client welfare always comes first. No, we would not be doing this simply 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 clinical supervision sessions (individually and in group) to MI practices, to use videotapes and role plays to continue

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our learning and practice our skills. We can phase in MI over time. I’m committed to supporting you in whatever 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 session 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 Spanish­speaking Al­Anon. 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

co­occurring disorders. 

While she is friendly and outgoing with others, her natural response to stress is to withdraw and isolate herself, 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 appointments. 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

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home. Melissa was uncomfortable agreeing to this but also was uncomfortable not responding to Juanita’s distress. 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 work­related 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–work­related) life

problems that affect the work environment. 

4.	 To illustrate how to monitor and maintain adequate clinical performance when an employee is facing difficult 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 apologize 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 work­related problems. The key question you need to return

to is “How is this personal issue affecting your job performance?” This prevents you from becoming the counselor’s counselor and turning supervision

into therapy.

2.	 You can clarify the boundaries of what constitutes acceptable job performance, as some counselors may be uncertain where the boundaries lie. 

3.	 You should continually focus on approaches to improve job performance, providing useful suggestions and recommendations for improvement. It is also

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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 valuable 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 personal 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 counseling and supervision may be contingent on the supervisor’s theoretical orientation, 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 development, self­exploration, becoming a better person.1. The goal is to make the counselor a

better counselor.

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

and manifestations of cognitions, affects,

and behaviors associated with life issues

and how these issues can be resolved.

3. The focus is on how issues may affect

client care, the conceptualization of the

client problems and counseling process,

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 relationship with clients?”

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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 reconnect 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 illustrate 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 counter­transference 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.

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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 co­occurring disorders, some specific points about counseling 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 re­introduces 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 counselor’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 Al­Anon 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 helpful 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.

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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 performance 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 supervision 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 outpatient counselors, supervised by Gene, who left the agency last month to take another position. Kate has a master’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.

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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 consideration 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

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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, command­andcontrol model to a networked, team­based approach that values participative

leadership and staff empowerment, bottom­up management, team input, and collaboration. 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 well­being 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 administrators 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 communication. 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 promotions. 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. 

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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 self­reflection 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?

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[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 successor from within the agency. Mentorship is an urgently needed process in the substance abuse field as a significant 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 clinical 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 retirement. Margie’s goals in this session are to begin to define Betty’s learning needs, to establish a mentoring relationship, 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.

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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 relationship.

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 excellent, 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 working 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 paper­pusher, 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 something over to the next generation of people to follow you. You’re having a great impact now on your clients. As

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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 concerns, and observes a more experienced professional in a safe learning environment. Through reflection and collaboration, the mentee can become more selfconfident and competent in his or her integration and application of the knowledge 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 experienced and more experienced people in various settings, addressing practical,

hands­on work experience to enhance the knowledge, skills, attitudes, and competencies 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, self­study 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.

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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 intimidating, 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 better 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. 

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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 leadership 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 children 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 leadership, 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 management interests, values, and skills, participants attend a 5­day 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://kentuckyoar.net/about_us.htm). A 3­day 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://academicdepartments.musc.edu/psychiatry/education/res_fell/

addict/addict.htm). Participants meet in six 3­day sessions during the year.

North Carolina Addiction Fellows Program (http://www.fellowshiphall.com/training.php). Twenty participants meet

to create a group of leaders for the field in North Carolina.

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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 maintain 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 30­hour class on clinical supervision and is seeking her certification 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 20­to­1 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 indepth clinical supervision, Ella needs the support and endorsement from Jonathan of the new supervision system. Given his emphasis on billable hours and reducing nonreimbursable activities, Ella knows that introducing these changes in the agency will not be easy, but she comes to Jonathan with her plan for supervision, asking 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 supervisory 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.

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Third, I know our organizational development plan calls for us to expand services in the near future. We need

to attract high­quality 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 self­care 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 administrators: concerns about liability, credentialing of personnel as mandated by the

State, staffing needs and turnover, and billable hours. When presenting a proposal 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 results­oriented 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 sensitive 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 supervision, it will feel like we’re constantly putting our fingers in the dike. 

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Master Supervisor Note: When conceptualizing, justifying, and implementing

a new comprehensive supervision program each level of staff—agency administration, 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 benchmarks 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.] 

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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 terminology. So what are you proposing we do? 

ELLA: I need your endorsement and support for a system of supervision involving direct observation of counseling 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 management 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 long­term 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, long­term 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 supervision and make noticeable improvements in their skills.

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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 commercial 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 person. 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 hour­long 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 number of hours of training to be certified as clinical supervisors. Simply because

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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 supervisors 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 supervisor 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 cameras. 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 providing 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 all­staff 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 low­cost media. Fifth, we will provide an in­service 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 observation. 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. 

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Master Supervisor Note: Again, it is important to be prepared for this presentation with a clear statement of funding requirements, training needs, mechanisms 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 roll­out, 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 development and a means to implement evidence­based practices, address risk­management issues and vicarious liability, create consistency within the agency, minimize reactivity, address accreditation issues, and support counselor 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 cost­effective way of conducting the staff and supervisor training? I’d like to see a 3­, 6­,

and 12­month implementation and financial plan for this. Can you provide projections as to potential cost offsets 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. 

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Clinical Supervision and 

Professional Development 

of the Substance 

Abuse Counselor 

Part 2: 

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PART

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Clinical Supervision and Professional Development

Chapter 1 

Clinical supervision should be an essential part of all

substance abuse treatment programs. Every counselor, regardless of skill level and experience, needs

and has a right to supervision. In addition, supervisors need and have a right to their own clinical supervision.  For more on the essential nature of clinical

supervision, see Appendix B, New York State Office of

Alcoholism and Substance Abuse Services Clinical

Supervision Statement. Unfortunately, many agencies

place a higher priority on administrative tasks (such

as case recordkeeping and crisis management), than

on clinical supervision. This guide for administrators

will assist in developing a rationale for and designing

a clinical supervision system for your substance abuse

treatment organization. Part 2 provides strategies and

tools for implementing effective supervision along

with advice on allocating resources for best results.

Benefits and Rationale

A successful clinical supervision program begins with

the support of administrators. You communicate the

value, benefits, and integral role of clinical supervision in quality care, staff morale and retention, and

overall professional development within the context of

the organization’s mission, values, philosophy of care,

and overall goals and objectives. Being able to discuss

specific benefits of clinical supervision will increase

the likelihood of internal support, enhance your organization’s ability to deliver quality supervision, and

add marketability for funding opportunities.

Administrative Benefits 

Clinical supervision enables organizations to measure

the quality of services. It ensures that employees follow agency policies and procedures and comply with

regulatory accreditation standards while promoting

the mission, values, and goals of the organization.

Supervision provides administrators with tools to

evaluate job performance, maintain communication

between administrators and counselors, facilitate conflict resolution, and hold personnel accountable for

quality job performance. Clinical supervision is a

risk­management tool that increases an organization’s ability to respond to risk, thereby reducing

overall liability. It also addresses human resource

issues, including staff satisfaction and retention of

personnel. Finally, supervision provides marketing

benefits by improving the overall reputation of the

agency in the community and among other service

providers.

Clinical Services Benefits 

The goal of clinical supervision is to continuously

improve quality client care. Supervision by trained

and qualified supervisors helps staff understand and

respond more effectively to all types of clinical situations and prevent clinical crises from escalating. It

specifically addresses assessment, case conceptualization, treatment strategies, and discharge planning. Supervision aids in addressing the unique

needs of each client. It provides a mechanism to

ensure that clinical directives are followed and facilitates the implementation and improvement of evidence­based practices (EBPs). “Quality supervision

will become a major factor in determining the degree

to which EBPs are adopted in community settings”

(CSAT, 2007, p. 12). Clinical supervision also

enhances the cultural competence of an organization

by consistently maintaining a multicultural perspective. “Supervision encourages supervisees to examine their views regarding culture, race, values, religion, gender, sexual orientation, and potential biases” (CSAT, 2007, p. 27).

CSAT’s Technical Assistance Publication (TAP) 21­A,

Competencies for Substance Abuse Treatment Clinical

Supervisors, defines supervision as a “social influence

process that occurs over time in which the supervisor

participates with supervisees to ensure quality care.

Effective supervisors observe, mentor, coach, evaluate, inspire, and create an atmosphere that promotes

self­motivation, learning, and professional development” (CSAT, 2007, p. 3). Also, supervision can

improve client outcomes (Carroll, Ball, Nich, Martino,

Frankforter, Farentinos, et al., 2006). Finally, supervision increases staff members’ sensitivity and

responsiveness to diversity issues among staff, with

clients, and between staff and clients.

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Professional Development

Benefits

Quality clinical supervision has been shown to

increase staff retention through professional skills

development and increased competency (Bernard &

Goodyear, 2004). Supervision provides the forum for

expanding current clinical practices, intellectual stimulation, emotional support, and improvement in critical thinking (see CSAT, 2007). Supervision is part of

an organization’s career ladder, as it supports staff in

obtaining and maintaining professional credentials. It

also provides information and guidance about key

contextual factors that may influence their work performance such as culture, lifestyles, and beliefs.

Workforce Development Benefits

Supervision by trained and qualified supervisors is

an essential tool in the recruitment and retention of

personnel, as counselors often rate training and

development as critical factors in their selection of

employment. In addition, supervision has been

shown to improve staff morale and motivation by

making staff feel valued and appreciated (Bernard

& Goodyear, 2004). It also assists in promoting

counselor wellness, and promotes the overall development of the substance abuse treatment field by

upgrading the credentials, knowledge, skills, and

attitudes of personnel.

Program Evaluation and Research

Benefits 

Implementation of program evaluation and/or

research is often misunderstood by counselors and

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,

connecting it to client outcomes, and communicating achievements and challenges to the evaluators.

Clinical supervision can also provide the mechanism for data gathering and information retrieval

in support of the new projects and programmatic

innovations.

Key Issues for

Administrators in Clinical

Supervision

Administrative and Clinical Tasks

of Supervisors

Supervisors wear many hats. In most organizations,

the administrative and clinical supervisor is the same

person (see also the section that follows,

Administrative and Clinical Supervision, p. 89). Most

clinical supervisors still carry a client caseload (albeit

reduced somewhat from that of a line counselor), perform administrative duties, write grant proposals,

serve as project managers, and supervise the clinical

performance of counselors. Each role involves different expectations and goals. It is important for administrators to be aware of each of these roles and for

supervisors to be prepared to perform effectively in

administrative, organizational, and clinical roles. 

Kadushin (1976) outlines multiple administrative

tasks for a clinical supervisor: staff recruitment and

selection; orientation and placement of employees;

work planning and assignments; monitoring, coordinating, reviewing, and evaluating work; staff communication both up and down the chain of command;

advocating for client and clinician needs; acting as a

buffer between administrators and counselors; and

acting as a change agent and community liaison.

Munson states, “As part of their administrative

responsibilities, supervisors are often required to

manage program transitions and modifications.

Departments and programs can be altered, restructured and merged” (1979, p. 72).

Assessing Organizational

Structure and Readiness for

Clinical Supervision 

In implementing a clinical supervision program, an

important first step will be to evaluate the agency’s

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

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Clinical Supervision and Professional Development

process of assessing and adopting EBPs. You need to

assess the following:

•	 How decisions are made within the organization

(centralized versus decentralized, vertical or

horizontal).

•	 How authority is defined and handled (top down,

bottom up, through the chain of command, or ad

hoc).

•	 How power is defined and handled (reward, coercion, legitimate power through status, prestige,

titles, expert power through skills and experience,

or referent power through respect for an individual—or all of the above).

•	 How information is communicated (structured/formal/informal, on a need­to­know basis, bidirectional feedback and communication). 

•	 How the organizational structure influences supervisory relationships, process, and outcome. 

•	 The overall cultural proficiency of the organization.

The following organizational issues should be considered by an agency before a clinical supervision system

is implemented:

•	 Organizational context. How consistently do staff

adhere to agency philosophy and culture? To what

extent will clinical supervisors teach and support

this philosophy? 

•	 Clinical competence. What specific knowledge,

skills, and attitudes are expected of substance

abuse counselors? What is each counselor’s baseline competence and learning style? What is the

level of cultural competence of staff?

•	 Motivation. How should the staff’s motivation and

morale be characterized?

•	 Supervisory relationships. What is the nature of

relationships between administrators and frontline workers? How healthy or unhealthy are those

relationships?

•	 Environmental variables. To what extent do

administrators expect supervisors to proactively

teach ethical and professional values? Do staff

have a common set of goals? How does the organization promote professional development? How is

progress toward those goals monitored and supported? What is the cultural, racial, religious, gender, and sexual orientation mix of the clients

served by the organization?

•	 Methods and techniques. How familiar is the

organization with individual, group, and peer

supervision? How familiar is the organization with

case progress note review, case consultation methods, direct observation, live supervision, audio­ or

videotaping, and role playing?

Assessing an organization’s readiness for a clinical

supervision system may also include such questions

as: “What stage of readiness for implementing a clinical supervision system are the board of directors,

other administrative staff and clinical supervisory

staff (if any), direct care staff, and support personnel?

What are some of the organizational, administrative,

and clinical barriers to implementing a clinical supervision system?” Potential barriers include lack of

familiarity with supervision methods and techniques,

the need for further training of supervisors, and lack

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

administrator like to see happen and who should be

part of the process for implementing clinical supervision? (See Tools 1 and 2 in chapter 2.)

Administrative and

Clinical Supervision

This section is a comprehensive look at the issues facing supervisors in their dual roles. In the substance

abuse treatment field, one of the major challenges

facing supervision is the reality that most supervisors

perform both administrative and clinical supervisory

functions. The numerous conflicts and ambiguity that

result from these roles can pose serious problems for

administrators, supervisors, and supervisees.

Determining the distinction between the roles of clinical and administrative supervision can be difficult

because there are no uniform definitions of these

functions. Most writing on administrative supervision

is in the context of the evaluative and record­keeping

functions of a supervisor. 

To the extent possible, administrative supervision

should be distinguished from clinical supervision.

Bradley and Ladany (2001) state that administrative

supervisors “help the supervisee function effectively

as a part of the organization,” with an emphasis on

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“organizational accountability, case records, referrals,

and performance evaluations” (p. 5). In contrast, clinical supervisors focus on the services received by the

client, including the therapeutic relationship, assessment, interventions, and client welfare. While these

tasks may be seen as substantially different, many

are complementary. Therefore, you and the supervisors need to be mindful of the different roles and of

the inherent ethical, relational, and role conflict

issues. Best supervision practices will work to keep

the dual roles as clear as possible.

Legal and Ethical Issues

for Administrators

You play a vital role in clarifying legal and ethical

issues for your organization, especially for clinical

supervisors and counseling personnel. You are invaluable in providing information and support for supervisors and staff.

You and your supervisors need to define and document (in writing) the legal and ethical standards for

the agency. You can draw from the staff’s professional

codes of ethics as well as accepted best practices. All

personnel should be consistently and continually

trained in the agency’s legal and ethical standards, as

well as in changing case law and legislation affecting

clinical practice. You need to reinforce your support

for supervisors who face situations where legal and

ethical issues may arise. You should help supervisors

develop a process for ethical decisionmaking as supervisors as well as a process for teaching ethical decisionmaking to counselors. 

Among the key issues for you and your supervisors

are the following:

•	 Direct and vicarious liability. Important factors

affecting liability include the supervisor’s power of

control; the counselor’s duty to perform a clinical

service; the time, place, and purpose of the service;

the motivation for responding the way the counselor responded; and the supervisor’s expectations

for action. Critical legal questions for administrators are: Did you make a reasonable effort to

supervise? Was there any dereliction of duty? Did

treatment create any harm, wrongdoing, or damage to the client, the organization, or the community? Did you and the supervisor give appropriate

advice concerning the counselor’s actions? Were

tasks assigned to staff that were outside their

scope of competence? 

Confidentiality. Has the organization adhered to all

laws of confidentiality (i.e., the Health Insurance

Privacy and Portability Act [HIPAA], 42 CFR, Part

2)? To what extent has the organization balanced the

counselor’s and client’s right to privacy and performance review? Has the organization adhered to its duty

to warn, to report, and to protect? 

•	 Informed consent and due process. This requires

that supervisees and clients be fully informed as

to the approach and procedures of the agency’s

actions (see Tools 4 and 19). Have the clients and

counselors been informed about treatment

parameters and supervision requirements? Have

all required forms and documents been read and

signed by all relevant parties? Is there a fair

process that encourages conflict resolution and

ensures the person a process of appeals?

•	 Supervisor and counselor scope of competence.

Are supervisors and counselors operating within

their scope of practice and competence? Are

supervisors and counselors meeting minimal

standards of competence regarding cultural and

contextual awareness, knowledge, and skills? Are

they effectively working within the wider client

systems and networking appropriately with wider

community services and institutions?

•	 Dual relationships. A dual relationship exists

when a supervisor and supervisee or counselor

and client have an additional relationship outside

the primary professional relationship. Guidelines

for supervisory relationships prohibit supervising

current or former clients (a difficult issue in the

substance abuse field where it is not uncommon

for an agency to hire and supervise former clients

in recovery). Do any supervisors have current or

former romantic or sexual partners, business

associates, family members, or friends among

their supervisees? Is the distinction clear

between the teaching and supervisory roles when

students are being supervised? Are supervisors

mindful of crossing over from the supervisory

relationship to social activities with supervisees

that may impair objectivity? Do supervisors avoid

excessive self­disclosure in supervision and avoid

comments or actions that might be interpreted as

sexual? Do you and your supervisors respect and

recognize professional boundaries in all aspects of

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Clinical Supervision and Professional Development

your relationships? When in doubt, do you

consult with colleagues?

You should provide comprehensive legal and ethical

orientation to all employees, review codes of ethics at

the time of hire, and require employees to sign a

statement that they will abide by these codes. You

will want to review agency adherence to these codes

periodically under the umbrella of a quality assurance or compliance program. Clinical supervisors

should be proactive and provide documentation that

describe and conceptualize client problems addressing

potential legal and ethical dilemmas, document all

clinical directives given, and offer counselors a written summary of recommendations. Finally, you

should review liability insurance coverage and suggest that supervisors and counselors maintain their

own personal professional liability and malpractice

insurance. 

For further legal and ethical issues, the reader is

referred to the forms in this section. 

Diversity and Cultural

Competence 

An important responsibility for supervisors is to continually improve their cultural competence in order to

teach and support staff. Cultural competence is gained

through education and training, supervised clinical

work, and ongoing exposure to the population being

served. All potential supervisors should be required to

receive training in cultural competence. It is the supervisor’s responsibility to initiate discussions of differences in race, ethnicity, gender, religion, socioeconomic

status, sexual orientation, or disability regarding both

clinical work with clients and supervisory and team

relationships. This promotes the acceptance of diversity and cultural issues as appropriate topics of discussion and allows the supervisor the opportunity to

model culturally competent behaviors.

To appreciate the importance of cultural competence,

counselors must first recognize “the power of their

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

variables affect their interactions with clients.

Administrators should be watchful for problems that

can arise in the supervisory relationship when supervisors are of a different race, culture, or ethnicity

than their supervisees. Fong and Lease (1997) have

identified four areas that might present challenges:

1.	 Unintentional racism. Well­intentioned supervisors who are unaware of how their racial identity

affects their relationships with supervisees may

avoid talking about race or culture. 

2.	 Power dynamics. The power differential in the

supervisory relationship may be exaggerated in

dyads where the supervisor is part of the dominant group and the supervisee is a member of a

minority group.

3.	 Trust and vulnerability. Supervisees who are in a

vulnerable position are, at the same time, encouraged to trust their supervisors, when they may

have little reason to do so.

4.	 Communication issues. Differing communication

styles among cultural groups can result in misunderstandings.

An excellent exercise for you and your supervisors is

to evaluate how supervisors measure up to multicultural supervision competencies. Bradley and Ladany

(2001) list the following in what they term the “supervisor­focused personal development” domain:

•	 “Supervisors actively explore and challenge their

own biases, values, and worldview and how these

relate to conducting supervision;

•	 Supervisors actively explore and challenge their

attitudes and biases toward diverse supervisees;

•	 Supervisors are knowledgeable about their own

cultural background and its influence on their attitudes, values, and behaviors;.

•	 Supervisors possess knowledge about the background, experiences, worldview, and history of culturally diverse groups; and

•	 Supervisors are knowledgeable about alternative

helping approaches other than those based in a

North American and Northern European context”

(pp. 80–81).

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Developing a Model for

Clinical Supervision

An organization must develop a model for clinical

supervision that best fits its needs. What are its

underlying needs, goals, and objectives? What models are available to assist in reaching your organizational goals? The model should be selected in light of

the organization’s mission, philosophy of treatment,

and orientation. You need to assess the organization’s readiness for implementing a supervision system and barriers that might impede the process.

What are the organization’s capacities for implementation? Once implemented, how will the program’s

quality be evaluated? How will continuous quality

improvement strategies be incorporated into the

supervision model? And if the program is successful,

how will it be sustained?

An effective model for clinical supervision will keep

the target clear: ensuring that the client receives better treatment as a result of the clinical supervision

system. In addition: 

•	 It will begin with the supervisors’ unique management or leadership style, their levels of proficiency

in supervision, the organization’s philosophy about

clinical supervision, and the specialized client

needs for clinical services.

•	 It will improve counselor competence, make work

more manageable, encourage staff to stretch

beyond their current capabilities, build mastery

and growth, and meet the needs of the client,

counselor, agency, and credentialing bodies. 

•	 It will encourage supervisees to grow professionally in their understanding of culture, race, religion,

gender, and sexual orientation as these issues are

present clinically. 

Implementing a Clinical

Supervision Program

TAP 21­A (CSAT, 2007) describes the importance of

using a clearly articulated process for implementing a

new model of clinical supervision in both State and

local agency settings as follows: “If agencies are to

improve their supervisory practices by adding activities identified as clinical supervision competencies, a

set of guidelines is needed to support the development of an implementation plan” (p. 7). To ensure a

smooth transition to the new supervision program, an

agency will need to perform the following tasks:

[d]efining or clarifying the rationale, purpose and

methods for delivering clinical supervision; [e]nsuring

that agency management fully understands and supports the changes that need to be made; [p]roviding

training and support in supervisory knowledge and

skill development; and [o]rienting clinicians to the

new supervision rationale and procedures” (p. 7).

These tasks are part of an implementation process

whereby the changes are introduced over a limited

period of time that allows for procedures to be developed and tested and clinicians to provide feedback

and adjust to the supervisory process. “The broad

goal is to create a continuous learning culture within

the agency that encourages professional development,

service improvement, and a quality of care that maximizes benefits to the agency’s clients” (p. 8).

More detailed guidelines for implementing and phasing a clinical supervision system into existing

processes include:

1.	 You need to be clear as to the organization’s goals

of supervision, viewing supervision as a way of

supporting and reaching the agency’s mission. 

2.	 You should be familiar with the skills and competencies outlined in TAP 21­A (CSAT, 2007) and

other experience and/or credentialing requirements. The competence of the designated supervisors is central to the successful design and implementation of the program. In some cases, agencies will need to invest in additional training for

potential clinical supervisors. Ask yourself the following about your supervisors:

•	 Has the supervisor had formal training and is

he or she credentialed in counseling, substance abuse, and clinical supervision? 

•	 At what level of supervision proficiency are

the clinical supervisors?

•	 Has the supervisor received supervision of his

or her clinical skills?

•	 What is the supervisor’s relationship with

staff?

•	 What is his or her level of cultural proficiency

and ability to work with culturally diverse

clients?

3.	 It is essential that a clear statement of support

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tion, counselors, and support staff. This statement should provide a rationale (see p. 95) for

implementing clinical supervision. The importance of this step cannot be overemphasized. 

4.	 The next step in implementing a clinical supervision system is to create a Change Team from

within your organization to spearhead the effort.

Selecting the appropriate agency representatives

to be the link between you and the supervision

system will ensure internal communication and

support. The Team should comprise individuals

committed to quality care and the supervision

process. They need to be somewhat familiar with

the process of supervision and have a clinical

background. Supervisors need to have a thorough

understanding of the agency’s model and techniques of supervision. The Change Team leader

will ensure participation and followup with the

organization’s clinical supervisors. Planning specific steps to ensure sustainability of the system

is integral to long­term success.

5.	 You, the Change Team, and clinical supervisors

should read and understand the importance of

the standards outlined in TAPs 21 (CSAT, 2006)

and 21­A (CSAT, 2007). Each counselor should

have a copy of TAP 21 (Addiction Counseling

Competencies—The Knowledge, Skills, and

Attitudes of Professional Practice [CSAT, 2006]).

It is important for clinical supervisors to meet

with the Change Team to discuss the skills and

competencies in TAP 21­A, and to identify both

the organization’s strengths and areas needing

improvement. The Team should draft formal policies and procedures to articulate expectations and

guidelines.

6.	 An all­staff meeting should feature the organization’s view of clinical supervision and how it will

implement the supervision system. The formal

policy and procedure should be distributed and

discussed. All clinical staff involved in the system

should attend this briefing, presented by the

Change Team leader and key clinical supervisors. 

7.	 Provide necessary training, time, and funding for

supervisors. Because the training requirement for

credentialing as clinical supervisors is typically

participation in a 30­hour class on supervision,

you need to ensure that all supervisors receive

training before proceeding to comprehensive

implementation. 

8.	 If the organization is sizable or the clinical staff is

large, it is sometimes helpful to initiate a pilot

supervision system in selected units of the organization. This is an issue that can be addressed by

the Change Team. If organizational staff are particularly resistant to implementing the supervision program, it may be helpful to demonstrate

the efficacy of a quality supervision program via a

pilot program.

9.	 Supervisors should prioritize discussing the

supervisory agreement or contract with each

supervisee and invest time to determine the

training needs and goals for each counselor. This

is the beginning of an Individual Development

Plan (IDP), outlining the counselor’s knowledge,

skills, attitudes, and cultural competence. It is

essential that the supervisor observe the counselor in action before rating her or his abilities.

Rating scales provide the baseline from which to

begin supervision. Both supervisors and counselors should develop and complete rating scales

and IDPs. Dialog on areas of agreement and disagreement at the outset form a vital part of the

supervision process. This discussion also provides

the supervisor with an opportunity to praise staff

members for their strengths. 

10. Supervisors should schedule formal, frequent, and

regular individual supervisory sessions. These

sessions, similar to individual sessions with

clients, need to be respected and protected from

unnecessary interruptions or distractions. The

supervisory sessions should be documented and

follow the prescribed focus outlined in the IDP.

11. To begin direct observation, design an implementation strategy (assuming the organization has

recognized the value of direct observation; see

Part 1, chapter 1), and establish a weekly rotation schedule for the observation of each counselor over the next 3 months. Initially, the clinical

supervisor can provide direct observation feedback to counselors individually and then move

toward a group supervision model whenever practical and possible to promote team building and

efficiency. To help with sustainability, the supervisor should discuss supervision at every opportunity. Staff needs to see that supervision will be

conducted on a regular basis, and that frequency

will be determined by the agency’s needs and

those of the individual counselor and team. 

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12. Provide feedback and review the IDP. Through

the observation, the supervisor and counselor can

discuss the strengths and challenges of the counselor’s performance. The developing IDP should

outline in detail the areas for improvement and

how these changes will be further observed and

monitored. Learning goals evolve as continued

observation leads to further suggestions for

improving performance. 

13. Supervisors should document their direct observation using various forms that exist for this purpose. The documentation should include times of

meetings and observation, a brief statement of

the content of the clinical session observed,

review procedures (audio or video tape), feedback

provided, and mentoring and teaching offered. 

14. Incentive plans can be developed to encourage

counselors to become seriously involved in their

professional development. 

15. Create a sustainable treatment team. Over time,

some staff will leave and others will join the

team. It is important for you and your supervisors

to work with the team to create an atmosphere of

learning that supports the agency’s commitment

to clinical supervision. This means including the

clinical supervision policy and procedures in the

orientation of new staff. It definitely means that

the team will continue to meet for supervision on

a regular basis. 

16. Develop a system of supervision of clinical supervisors, particularly for those who are new to their

role. Supervisors need to continually build and

improve their supervisory skills as well as have a

forum to discuss staff challenges. Some agencies

have created supervisory peer groups where the

supervisors present and receive feedback on their

supervision, other agencies hire a consultant to

provide supervision, while some regional coalitions have established monthly forums. 

Some of the primary elements in a supervision of

supervisors system include:

•	 Direct observation. This may best be done by

periodically (e.g., once a calendar quarter)

videotaping a supervision session and having

the supervisor’s supervisor review the videotape. They then discuss what occurred during

the supervision, with the supervisor’s supervisor providing feedback and recommendations.

•	 Competencies. It is important that the supervisors of supervisors be Level 3 counselors and

preferably Level 3 supervisors (see Figures 5

and 6 in Part 1, chapter 1). They need to be

certified clinical supervisors and to have had

supervision as supervisors themselves so they

have experience with this type of supervision.

Administrators should give them the responsibility and authority to perform this task and

to require that tapes be provided for review in

a timely fashion. Supervisors should develop

the competencies sufficient to attain their credentials as a certified clinical supervisor. 

•	 Record­keeping system. A logging system

should maintain records on the initial counselor–supervisor sessions and the supervision

of supervisors sessions.

•	 Recruiting personnel. If your agency does not

have an internal person to provide the supervisor’s supervision, it is recommended that

you contract for such services with external

sources. Over time, the external supervisor

should train an internal person to assume

this role.

Phasing in a Clinical Supervision

System

The steps below have been found to be helpful in

phasing in clinical supervision systems in an orderly

manner. Although the list is provided sequentially,

the needs of an agency will determine the timeframe

and selection of objectives.

Phase I: Organization and Creation of a

Structure

•	 Assess and describe the agency culture (including

assets and deficits), selecting assets to build on

and/or deficits for remediation regarding clinical

supervision.

•	 Assess the facility’s policies and procedures to

determine the feasibility and practicality of a clinical supervision system (i.e., presence of clinical

supervisory staff, availability of direct observation

technology, etc.).

•	 Examine job descriptions to determine staff scope

of practice and competence. 

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• Reach consensus among the Change Team about

the definition of clinical supervision and its key

components for that agency.

• Publicize this consensus statement to all personnel, introducing staff to the new supervisory model

and clearly communicating expectations for the

delivery and outcomes of clinical supervision

before program implementation.

• With all personnel, discuss and introduce clinical

supervision policies and procedures.

• Review the organization’s cultural competence as

it relates to the client populations served.

• Develop documentation and accountability systems.

Phase II: Implementation

• Implement a supervisory contract, including

informed consent, with all staff to improve the

supervisory working alliance.

• Assess the quality of the supervisory relationship

and devise interventions to strengthen the learning alliance.

• Conduct counselor assessments to establish competency baselines.

• Design initial supervisory goals and measurable

objectives for each counselor.

• Use strengths­based approaches where appropriate and possible in clinical supervision, supporting

counselors’ positive actions with clients.

• Develop a system of supervision of supervision.

Some programs use the same taping and monitoring systems for supervisors that are used between

counselors and clients, with supervisors expected

to videotape their supervision sessions at least

once a month, and receive supervision of their

supervision by the team of supervisors and/or

their supervisor.

Phase III: Establishing a Training Plan and

Learning Goals

• Complete a written IDP for each counselor.

• Provide focused, on­the­job training.

• Identify clinical supervision quality indicators to

monitor the quality assurance program for the

agency.

• Periodically review job descriptions and evaluation

procedures to ensure that counselor competencies

are sound. Review the counselor’s ability to perform

the TAP 21 competencies, the activities and functions

performed by a substance abuse counselor that form

the basis of the standards required in many States

for credentialing. Also see the Northwest Frontier

Addiction Technology Transfer Center Performance

Rubric at http://www.attcnetwork.org/documents/

Final.CS.Rubrics.Assessment.pdf. 

Phase IV: Improving Performance

Proficiency in the Addiction Counseling Competencies

(CSAT, 2006) and the International Certification and

Reciprocity Consortiums 12 Core Functions should be

the subject of continuous assessment and professional

development during clinical supervision. Additional

specific performance concerns include:

• Continually align the clinical supervision goals to

the agency’s mission, values, and approach;

• Create risk management policies and practices

and monitor adherence;

• Address the cultural competence of personnel in

supervision;

• Consistently address a deepening of counselor

knowledge, skills, and attitudes about legal and

ethical issues;

• Use formative and summative evaluation and

feedback procedures to inform the clinical supervision process;

• Develop quality improvement plans for the agency,

including clinical supervisory procedures;

• Overtly address and encourage counselor and staff

wellness programs;

• Invest in counselor and staff training; and

• Foster your staff from within, continually seeking

individuals with the potential to become tomorrow’s supervisors.

Documentation and Record

Keeping

Overseeing documentation and record keeping is an

essential administrative task, as maintaining a

supervisory record has multiple purposes for administrators, supervisors, and counselors. One of the primary purposes of documentation is to serve as the

legal record for the delivery of supervision: a reasonable effort was made to supervise. The supervisory
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record is also important in developing a thoughtful

plan for both quality client care and professional

development. The supervisory record serves to:

•	 Improve client care.

•	 Model good record­keeping procedures for personnel.

•	 Afford and enhance ethical and legal protection.

•	 Provide a reliable source of data in evaluating the

competencies of counselors.

•	 Provide information concerning staff ability to

assess and treat clients.

•	 Reflect staff understanding of the dynamics of

behavior and the nature and extent of the problems treated.

•	 Assess staff cultural competence and proficiency. 

•	 Provide information about the clinical supervisor’s

ability to assess counselor competencies and the

nature of the clinical supervisory relationship.

•	 Provide information about the clinical supervisor’s

clinical and supervisory competence.

A good clinical supervision record should include the

following elements:

•	 Requirements for counselor credentialing (certification/licensure) and the extent to which each

counselor meets those requirements.

•	 The counselor’s regularly updated resume and a

brief summary of his or her background and clinical expertise.

•	 A copy of the informed consent document, signed

by the supervisor and the supervisee.

•	 A copy of the clinical supervision contract, signed

by the supervisor and the supervisee.

•	 The IDP, updated minimally twice a year and

preferably every 3 months.

•	 A copy of the formative and summative evaluations the supervisor has given to the supervisee

and all relevant updates to these evaluations.

•	 A log of clinical supervision sessions, dates, times;

a brief summary of key issues discussed; recommendations given by the supervisor and actions

taken by the counselor; documentation of cancelled

or missed sessions by either the supervisor or

supervisee; and actions taken by the supervisor

when supervision sessions are missed.

•	 A brief summary of each supervision session,

including specific examples that support learning

goals and objectives.

•	 A risk management review summary, including

concerns about confidentiality, duty to warn situations, crises, and the recommendations of the

supervisor concerning these situations.

The entire documentation record can be brief and in

summary form. (See Tools 10–12 in Part 2, chapter 2,

including checklists and summary statements to

reduce the volume of work for the supervisor.)

Evaluation

Although training in how to conduct productive and

constructive evaluations of personnel is rare, evaluation of personnel is a critical administrative task of

supervisors and administrators. The goals of evaluation include, but are not limited to, reviewing job performance; assessing progress toward professional

development goals; eliciting future learning goals;

assessing fitness for duty and scope of competence;

and providing feedback to staff on adherence to

agency policies, procedures, and values. 

There are a number of issues that shape the feedback

process, including:

•	 How does the agency define a “good” counselor?

What knowledge, skills, and attitudes are critical?

What level of cultural competence is needed?

•	 How does a supervisor measure general affective

qualities, such as counselor’s empathy, respect,

genuineness, concreteness for clients?

•	 What standardized tools will be used to support

the evaluation? There are few evaluation instruments with psychometric validity or reliability. 

The IDP can be the basis for evaluation. Each counselor should have a development plan that takes into

consideration her or his counseling developmental

level (see Stoltenberg, McNeill, & Delworth, 1998),

learning needs and styles, job requirements, client

needs, and the agency’s overall goals and objectives.

A sample IDP is provided in chapter 2 (Tool 15).

How do administrators and supervisors evaluate personnel and assess job performance? There are two

forms of evaluation: formative and summative.

Formative evaluation focuses on progress, is regularly

provided, and gives feedback to the employee regarding his or her attainment of the knowledge, skills,

and attitudes necessary to the job. It addresses the

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question, “Are you going in the right direction?” The

quality of the supervisory relationship determines the

success of the formative evaluation process.

Summative evaluation is a formal process that rates

employees’ overall ability to do their job and their fitness for duty. It answers the question, “Does the

employee measure up?” In substance abuse counseling, summative evaluation takes into account many

variables: the range and number of clients seen, the

issues and problems addressed by the counselor, the

general themes in training and supervision, skill

development, self­awareness, how learning goals have

been translated into practice, and the employee’s

strengths, expertise, limitations, and areas for future

development. Summative evaluation also addresses

the nature of the supervisory relationship and goals

for future training. 

The best evaluations occur when there is open

exchange of information and ideas between the

supervisor and counselor, where specific examples

are gleaned from the ongoing supervisory documentation, and expectations are again reviewed and

agreed upon. Some organizations have moved to

360­degree assessments, with input from many layers of the organization. Tool 13 in chapter 2 is a

counselor evaluation of a supervisor. The quality

and quantity of feedback from a supervisor is an

important part of supervision, according to supervisees (Bernard & Goodyear, 2004). Formalized feedback and evaluation is designed to review the ongoing, frequent feedback provided over time in a

supervisory system (see Tool 14).

Conducting an evaluation involves exercising authority and power. When supervisors evaluate counselors,

they are also evaluating themselves and their effectiveness as supervisors with particular supervisees.

The evaluation process brings up many emotions for

both parties. In providing feedback, supervisors

should: 

Provide positive, as well as constructive, feedback:

•	 Differentiate between data­based and qualitative

judgments about job performance.

•	 State observations clearly and directly.

•	 Prioritize key areas for review rather than flood

the counselor with an all­inclusive review.

Supervisees prefer:

•	 Clear explanations.

•	 Written feedback whenever possible.

•	 Feedback matched to their counseling development level.

•	 Encouragement, support, and opportunities for

self­evaluation.

•	 Specific suggestions for change.

Feedback should be:

•	 Frequent.

•	 As objective as possible. 

•	 Consistent. 

•	 Credible. 

•	 Balanced. 

•	 Specific, measurable, attainable, realistic, and

timely: SMART. 

•	 Reduced to a few main points.

Supporting Clinical Supervisors in

Their Jobs

Being a supervisor in any setting is a difficult job.

The supervisor represents the concerns of administrators, counselors, and clients. Supervisors advocate on

behalf of those above and below them in the organization chart. Hence, it is imperative that you provide

support for the clinical supervisor in the agency and

in the job. 

To show support for clinical supervision, review the

organization’s receptivity to supervision: Is its climate for change, tolerance, and commitment conducive to efficient implementation of a clinical supervision system? Also, assess the magnitude of the proposed supervision system and the critical factors

needed for success. “The agency structure and the

supervisory program within it define the parameters

of the supervisory relationship. Decision­making

processes, autonomy within units, communication

norms, and evaluative structures are all relevant to

the supervisory function” (Holloway, 1995, p. 98).

To assess the organization’s receptivity to supervision, you should address the following issues:

1.	 To what degree does the organization value

accountability and have clear expectations of its

personnel?
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2.	 How is supervision tied to an employee’s ongoing

performance improvement plan or performance

incentive program?

3.	 To what extent does the organization have efficient and effective systems in place to manage

day­to­day operations?

4.	 To what extent does the organization view itself

as a learning environment, encouraging inquisitiveness, creativity, innovation, and professional

development?

5.	 To what extent does the organization value

upward and downward communication and relationships by creating opportunities for staff to be

heard? Does the organization understand that the

learning alliance and relationship is key to successful supervision?

6.	 In what ways is the organization a dynamic,

growing organism that values everyone’s

contribution?

7.	 To what extent does the organization “provide

diversity training and other experiences that

empower [a counselor] to become an advocate for

the organization’s target population and an agent

of organizational change” ? (CSAT, 2007, p. 31)

8.	 How does the organization view teamwork, and

what structures are in place to support the teambuilding process?

9.	 How do lines of authority and communication

operate in the organization? How do formal and

informal decisionmaking processes that influence

the supervisors’ functions work? 

10. To what extent do administrators know about and

understand the process and practices of clinical

supervision? What training do they need in this

regard? 

11. What is the common ground in understanding the

relationship between the administrative and clinical functions of the supervisor? 

12. If the organization does not have trained and

motivated clinical supervisors, what is your plan

for recruiting new supervisors and/or training

current supervisors who will be able to take on

this new responsibility?

13. Are the job descriptions and roles clear, current,

and accurate for all personnel? 

14. How much supervision of their supervision will

the supervisors receive from administrators or

other consultants?

You support clinical supervision when you help

supervisors build an organizational climate in which

they can do quality work. This entails the following

factors:

1.	 Allocating time for clinical supervision. Since

supervision is not (in most cases) a revenue­generating activity, administrators may tend to minimize the importance of quality clinical supervision and fail to provide the needed time to “make

a reasonable effort to supervise.” A matrix presented in Part 1, chapter 1 gives guidelines to

supervisors for organizing their time and providing quality supervision. 

2.	 Making clinical supervision an agency priority.

You can support the clinical supervisor with a

clear statement of the importance of supervision

and provide the resources needed to perform this

function. This might include the acquisition of

taping equipment, provision of one­way mirrors,

etc. Staff need to hear unequivocally that supervision is a necessity and a requirement for all personnel, regardless of years of experience, academic background, skill and counselor developmental

levels, and status within the organization.

Supervisors also need supervision. 

3.	 Supporting creative methods for supervision. As

this TIP advocates for direct methods of supervision through one­way mirrors, video/audio taping,

and live observation, you can state clearly that

“at our agency we observe.” Other methods for

clinical supervision might include group or peer

supervision models (see Part 1, chapter 1).

4.	 Building and supporting a record­keeping process

for clinical supervision. This entails providing

time and tools for the documentation related to

clinical supervisory and administrative functions.

Supervisory notes need to be integrated with clinical notes and human resource files. One good

documentation system is the Focused Risk

Management Supervision System (FoRMSS;

Falvey, Caldwell, & Cohen, 2002). Assisting in

organizing the supervisory process by investing in

activities that will increase productivity over

time, setting and adhering to priorities, and

increasing coping skills repertoire to manage multiple tasks through cross­training and team building. You also need to periodically review job

descriptions, personnel strengths and aptitudes,

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Clinical Supervision and Professional Development

loads accordingly. You should periodically review

the purpose and function of every meeting and

seek to streamline meeting times for economy and

efficiency.

5.	 Assisting supervisors in implementing agency priorities, such as the adaptation of EBPs to fit the

agency’s goals and objectives. Hence, if an organization is implementing an EBP, it is imperative

that supervisors also be trained in how to supervise that practice, perhaps even before counselors

are trained. 

6.	 Assisting supervisors in other personnel functions, such as working with impaired professionals and providing an employee assistance program (EAP) as a resource to supervisors and

supervisees. You and your supervisors need to

work together when staff are involved in ethical

or legal issues that might impair the organization’s function and credibility, and the supervisor

needs to keep the administrator informed of all

actions taken throughout the process.

7.	 Supporting supervisors in developing cultural

competence within the organization. This entails

hiring culturally competent clinical supervisors

and staff and providing personnel training on cultural issues. It also requires supporting supervisors in developing and improving cultural competence in counselors. 

Professional Development

of Supervisors

You both support clinical supervisors in their function and monitor their professional development and

performance by:

•	 Building a system to monitor, evaluate, and provide feedback to clinical supervisors. Supervision

of one’s supervision is lacking in many organizations. Every clinical supervisor is entitled to and

needs to have some form of supervision of their

supervision, either live or online.

•	 Creating IDPs with all supervisors. Even as every

client needs a treatment plan and every staff

member needs an IDP, every clinical supervisor

also needs an IDP. Supervisors’ IDPs are jointly

developed and monitored by the clinical supervisor

and his or her supervisor.

•	 Helping supervisors develop a professional identity as a supervisor. This entails encouraging the

supervisor to be credentialed as a clinical supervisor. They should also receive ongoing training

required for recertification.

•	 Providing time for them to work with a mentor

(either someone within the organization or an outside consultant). 

•	 Requiring an annual minimum number of clinical

supervision training hours.

•	 Offering time and resources for supervisors to participate in State or local support groups for supervisors.

•	 Providing job performance evaluations on a regular and timely basis.

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Chapter 2 

Introduction 

Your clinical supervision system needs to match the unique issues and contextual factors of your agency, and

your agency needs to have a clear vision of what it wishes to accomplish with its clinical supervision system

and actively determine and understand the processes by which it will get there. The tools presented in this

chapter are designed to make the tasks associated with implementing a clinical supervision system easier. You

will want to take advantage of the experience of well­established supervision programs and adapt the tools that

have worked for them to suit the specific needs of your program.

The resources presented in this chapter are organized to be parallel to Part 2, chapter 1. These tools should be

considered as prototypes and, in some cases, might even be used as is, provided they fit the context of your

organization. These tools can be used by both clinical supervisors and administrators as part of a comprehensive clinical supervision system. 

The Change Book: A Blueprint for Technology Transfer (Addiction Technology Transfer Center [ATTC] National

Office, 2004) provides the basis for the organizational change process presented here. You may wish to consult

with colleagues who have implemented a clinical supervision system for their organizations, especially if the

agency is similar to yours. Managing organizational change is very similar to working with a client in a clinical

setting. Your understanding of the recovery process and of the counselor’s personal qualities and skills that

facilitate recovery are invaluable resources as you apply the tools presented in this chapter. 

Assessing Organizational Readiness

You will need to determine the state of readiness of your organization and its personnel to implement a clinical

supervision system. This assessment should include agency contextual variables, competence of supervisory

staff, clinical competence of counseling staff and organizational integrity, motivation of personnel, the nature of

your relationships with staff, environmental variables (such as current or recent organizational changes, financial issues, accreditation, and legislative mandates), and the best methods and techniques to be used (see Tool

1). Tool 2 will help in assessing organizational readiness to change and identifying and prioritizing barriers to

change. Just as a clinician might assess a client’s stage of readiness to change, these principles can be applied

to implementing a clinical supervision system or other types of organizational change. Tool 3 will help you

reach agreement with staff on the goals of supervision.

101
Conditions Not at All

1

A Little

2

Possibly

3

Very Likely

4

Definitely

5

Staff have a common set of goals. A goal of the organization is

that clinical supervision is valued and should be provided.

Administrators model a norm of collegiality. Although a supervisee's performance evaluation implies a hierarchy, the organization demonstrates an openness ensuring that each person

will be respected and treated as a valuable member of the

team.

The organization promotes professional development.

Continuous education and professional growth are promoted

for supervisors as well as counselors.

Progress toward goals is monitored actively and does not wait

for outcome evaluation. Ongoing monitoring is valued.

Obstacles are identified and handled as an organizational challenge, instead of allowing a situation to deteriorate and be

judged as demonstrating a lack of competence of particular

staff members. 

Support for clinical supervision is appropriately generous.

Allotment of time and resources is critical.

______________________________________________________________________________________

Tool 1. Initial Organizational Assessment

Organizational Context

Priority Focus

Secondary Focus __________________________________________________________________________________ 

Source: Based on Bernard & Goodyear, 1998; Adapted from Porter & Gallon, 2006.

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______________________________ ______________________________

______________________________ ______________________________

______________________________ ______________________________

______________________________ ______________________________

Clinical Supervision and Professional Development 103

Tool 2. Organizational Stage of Readiness To Change

Implementing a Clinical Supervision Program in Your Agency

Stages of Change

Precontemplation

Contemplation

Preparation

Action

Maintenance

Unaware of issue

Considering the issue

Designing a plan of action

Implementing the action plan

Maintaining the change

Stage of Readiness Incentives to Change Obstacles to Change Resources for Change

Board of Directors

Administration

Supervisors

Direct Care Staff

Support Staff

Primary Group—Focus of Change Expected Outcome and Timeframe

Secondary Group—Focus of Change Expected Outcome and Timeframe
_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

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104 Part 2, Chapter 2

This part of Tool 2 is designed for use by administrators and supervisors to identify the current barriers in the

organization to implementing a comprehensive supervision system. Administrators and supervisors should fill

this out separately, and then discuss answers in an executive team meeting.

Tool 2. Organizational Stage of Readiness To Change

Implementing a Clinical Supervision Program in Your Agency

Current Barriers to Change

Organizational Administrative Clinical Other

List the most important barriers to address within the next 3 months.

What would you like to have happen?

Who do you need to help participate in the change?

Source: Adapted from Porter & Gallon, 2006.
Clinical Supervision and Professional Development 105

Tool 3. Goals for Supervision

Organizational Context

How does the organization support counselors and supervisors in achieving the organization’s mission statement? What

steps are needed to gain consensus between administration and direct service personnel to achieve the mission statement? What are the specific steps we can take as administrators to achieve this goal of consensus regarding the philosophy of the organization and its relationship to clinical work?

GOAL: _______________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

Cultural Competence

What cultural and contextual factors are unique to this agency? What factors need to be addressed in clinical supervision?

GOAL: _______________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

Clinical Competence

What specific knowledge, skills, and attitudes do we expect from our counselors? How do we acknowledge and address

the individual counselor’s baseline competence and learning style?

GOAL: _______________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

Motivation

How can we ensure that the clinical supervisor will help motivate counselors to participate in clinical supervision and

perform clinical tasks?

GOAL: _______________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

Supervisory Relationship

How can we support and validate the supervisory relationship both informally and formally?

Do we believe that the supervisory relationship is an important variable in the supervisory process? How can we support

and validate the supervisory relationship both informally and formally?

GOAL: _______________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

Ethics and Professional Values

How much do we expect that clinical supervisors will proactively teach ethics and professional values?

GOAL: _______________________________________________________________________________________________

______________________________________________________________________________________________________

______________________________________________________________________________________________________

Source: Adapted from Mattel, 2007

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106 Part 2, Chapter 2

Legal and Ethical Issues of Supervision

Legal and ethical considerations should be paramount as you implement a supervision system. The goal is to

know how to operate within the boundaries of legal and ethical codes and regulations for the protection of all

parties, including the agency, administration, staff, and clients. Legal and ethical issues of supervision include

direct and vicarious liability, confidentiality, informed consent and due process, supervisor and supervisee scope

of competence and practice, and dual relationships (see discussion of these issues in Part 2, chapter 1). 

The Association for Counselor Education and Supervision (ACES) has standards for counseling supervisors 

that can serve as guidelines for the substance abuse field (available online at 

http://www.acesonline.net/members/supervision/). ACES also has ethical guidelines for supervisors that address

issues such as protecting client welfare and rights, supervisory roles, and program administration roles. The

National Board for Certified Counselors, Inc., has a Code of Ethics pertaining to the practice of professional

counseling and clinical supervision. This code, like the ACES code, is reproduced in TAP 21­A (Competencies for

Substance Abuse Treatment Clinical Supervisors [CSAT, 2007]). Other professions also have similar guidelines,

such as the Association of State and Provincial Psychology Boards (reprinted in Falvey, 2002b), the National

Association of Social Workers (NASW, Guidelines for Clinical Social Work Supervision, 1994), and the

American Association for Marriage and Family Therapy (AAMFT Supervisor Designation: Standards and

Responsibilities Handbook, 1999).

Informed consent is important for several reasons: (1) clients are entitled to know and agree to what processes

support quality treatment, who will be reviewing information about them, and how this information will be

used; (2) counselors are entitled to know how their work will be evaluated, the process of the supervision, and

how this information will be used to support both quality care and their professional development; and (3) the

administration is entitled to know that supervisory processes are articulated to support quality care and

address legal and ethical standards. 

Tool 4 is one of a number of sample informed consent for supervision forms that are available. 

Tool 4. Informed Consent Template

The consent should include:

The purpose of supervision: the structure and mutual understanding of supervision

• Goals of supervision

• How goals will be evaluated and the specific timeframes

• Specific expectations of the supervisor and the supervisee

• Integration of theoretical models

Professional disclosure: information about the supervisor that includes credentials and qualifications and

approach to supervision

• Educational background

• Training experiences

• Theoretical orientation

• Clinical competence with various issues, models, techniques, populations

• Sense of mission or purpose in the field

• Educational plans and professional goals

Supervision process: methods and format of supervision 

• Individual, group, peer, dyadic

• Method of direct observation

• Permission to record sessions on audio­ or videotape

Due Process: includes written procedures to be followed when a grievance or complaint has been made against the

administration, the supervisor, or the counselor. It ensures that all sides are heard and that the complaint and response

to the complaint receive due consideration. In this case, informed consent means that all parties are aware of the

process for lodging a complaint.
                               

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Clinical Supervision and Professional Development 107

Tool 4. Informed Consent Template (continued)

Ethical and legal issues: policies, regulations, and laws regarding supervisory and therapeutic relationships

• Number of supervisees for which the supervisor will be responsible

• Emergency and back­up procedures (e.g., supervisor accessibility)

• Ethical codes of conduct

• Process for discussing ethical dilemmas

• Confidentiality regarding information discussed in supervision

• Confidentiality issues when more than one supervisee is involved

• Dual roles and relationships

• Process for addressing supervisee issues (e.g., burnout, countertransference)

Statement of agreement 

Signed acknowledgement by all parties that they understand and agree to comply with the contract

Source: Adapted from Falvey, 2007. 

Selection and Competencies of Supervisors

When hiring or appointing a person as a clinical supervisor, you will need to understand the scope of practice

and competence of a supervisor. Consult TAP 21­A (CSAT, 2007) and the International Certification and

Reciprocity Consortium [IC&RC] Role Delineation Study for Clinical Supervisors (2000).

Administrators can use checklists such as Tool 5 to determine the competencies of a potential clinical supervisor.

Tool 5. Checklist for Supervisor Competencies

Competencies Poor Below

Average Average AboveAverage Excellent

Knowledge

Has knowledge of theory and intervention strategies

Has knowledge of screening, assessment, and diagnostic standards

Understands cultural and ethnic issues

Has knowledge of resources in the community

Has knowledge of current ethical guidelines and legal issues

Practice

Demonstrates mastery of intervention techniques

Is timely and thorough in documentation

Is able to develop rapport

Is able to conceptualize problems

Can respond to multicultural issues

Is able to formulate treatment goals
                             

                             

                                   

                                   

                               

                           

                               

                                       

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108 Part 2, Chapter 2

Tool 5. Checklist for Supervisor Competencies (continued)

Competencies Poor Below

Average Average Above

Average Excellent

Personal

Demonstrates ethical behavior

Demonstrates use of good judgment and counseling skills

Is interpersonally competent

Is able to identify own strengths and weaknesses

Is able to accept and learn from feedback

Is an asset to the profession

Source: Adapted from Campbell, 2000. Permission pending.

Other sources to consult on the same topic include: 

•	 Bernard and Goodyear, 2004: Evaluation Questionnaires and Scales (pp. 316–339).

•	 Falvey, 2004b: Ethical Mandates for Professional Competence, Standards for Clinical Supervisor

Competence (pp. 25, 28). 

•	 Powell and Brodsky, 2004: ACES Supervision Interest Network, Competencies of Supervisors (pp. 327–332).

•	 Campbell, 2000 (pp. 257–285). 

Substance Abuse Policy

As an administrator, you have ultimate responsibility for enforcing policies and procedures for maintaining a safe

workplace. Under provisions of the Drug­Free Workplace Act of 1988, all agencies receiving Federal and/or State

funds are required to have a substance abuse policy. This policy should state how the organization maintains a safe

workplace so as to provide the highest quality service to its clients. The procedures should address how the agency

will deal with issues related to alcohol and drugs in the workplace, fitness­for­duty concerns, testing of employees,

drug­related convictions, searches, and violations of policies. Tool 6 is a sample substance abuse policy. Other

administrative issues can be addressed, such as gambling and tobacco in the workplace, pornography in the workplace, and abuse of Internet access and use in the workplace. Tool 6 is an example of a substance abuse policy.

Tool 6. Sample Policy on Substance Abuse

This organization is committed to maintaining a safe workplace and to providing high­quality service to its clients.

Successful attainment of these goals depends on the establishment and maintenance of a workplace that is free from

the adverse effects of drug use and alcohol abuse. 

Alcohol

1. The use, possession, or being under the influence of alcohol while on duty or on the premises is strictly forbidden.

This prohibition precludes an employee from consuming alcohol at meal times during work hours, even off premises.

2. Employees are prohibited from working with the smell of alcohol on their breath, regardless of when or where alcohol was consumed.

Drugs

1. The use, possession, being under the influence of, manufacture, sale, dispensation, or distribution of illegal or unauthorized drugs or drug paraphernalia while on duty or on the premises is forbidden.

2. An employee’s involvement with illegal or unauthorized drugs off duty and/or off premises may result in discipline,

up to and including discharge, where such involvement may have an adverse effect on the organization’s reputation.
PART

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Tool 6. Sample Policy on Substance Abuse

Clinical Supervision and Professional Development 109

3. Employees who are taking prescribed medications must keep them in a secure location, completely inaccessible to

anyone but themselves, while on the premises. It is expected that employees will follow all safety precautions associated with consumption of that drug (i.e., regarding operating machinery or driving vehicles).

Fitness for Duty

1. Employees are required to be fit for duty.

2. An employee is unfit for duty if, while on duty or on the premises, he or she is under the influence of or affected by

illegal or unauthorized alcohol and/or has an impermissible level of illegal or legally prescribed drugs or alcohol in his

or her system and/or is affected to a degree that the employee cannot perform work because of the legally prescribed drugs.

3. Unfitness for duty can be determined through a variety of means, separately or in conjunction with each other,

depending on the circumstances, such as direct observation and/or drug and/or alcohol testing.

4. An employee will be terminated if he or she is unfit for duty because of drugs and/or alcohol.

Testing of Employees

1. Reasonable Suspicion. An employee may be required to submit to drug and/or alcohol testing whenever there is reason to believe because of physical, behavioral, or performance indicators, that the employee is under the influence of

or is affected by illegal or legally prescribed drugs and/or alcohol while on duty or on the premises.

2. Post­Accident. An employee may be tested for drugs and/or alcohol after any accident that could have been caused

by human error or carelessness. An accident is defined as an event resulting in medical treatment by a professional or

property damage in excess of $500.

3. Medication Control. If prescribed medication or controlled substances dispensed by the organization disappear or

cannot otherwise be accounted for, all employees who may have had access to such medication or substances will be

tested for illegal drugs.

4. Positive Test Result. An employee who tests positive for an illegal drug or unauthorized or illegally obtained legal

drug and/or alcohol is unfit for duty and may be disciplined.

Drug­Related Convictions

An employee who is convicted of a drug­related offense occurring in or out of the workplace is in violation of this

policy. A conviction includes a guilty plea, a plea of nolo contendere, or any court­supervised program or courtimposed sentence.

Searches

The organization reserves the right to search an employee, his or her possessions, work area, or vehicle while on the

premises to determine if illegal drugs or alcohol are present.

Failure to Cooperate

An employee who refuses to provide a specimen at the date and time requested, who refuses to provide written consent

to testing, who provides a false or tampered specimen, or refuses to consent to a search of his or her person, possessions, work area, or vehicle may be discharged.

Supervision Guidelines

Supervision guidelines describe the organization’s commitment to clinical supervision, working terms, principles of supervision at that organization, and required documentation of clinical sessions and clinical supervision. The guidelines should clearly state the frequency of supervision, ongoing feedback procedures, and commitment to ongoing professional development. Tool 7 is an example of such a document.
PART

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An individualized approach based on the learning needs and style of the supervisee.

Frequency and length of supervisory meetings.

110 Part 2, Chapter 2

Tool 7. Clinical Supervision Policy and Procedure

Underlying Principles

Clinical supervision is a powerful tool for managing and ensuring continuous improvement in service delivery. Clinical

supervision is comprised of balancing four distinct functions: administrative, evaluative, supportive, and clinical.

Fundamental structures include a positive working relationship, client­centered approach, commitment to professional

development, and accountability. The following principles ensure high­quality clinical supervision:

• A safe, trusting working relationship that promotes a learning alliance.

• A counselor­centered program with a culturally and contextually responsive focus.

• Active promotion of professional growth and development. 

• Shared clinical responsibility ensuring that the client’s treatment goals are addressed.

• A rigorous process that ensures ethical and legal responsibility.

•

• Congruence with the values and philosophy of the agency.

Terms

A healthy working relationship is built on shared vision and goals, clear expectations, and the belief in the good

intentions of staff members. It demonstrates reciprocal communication where all parties provide comprehensive, timely

information that is respectful. Each person is responsible for providing relevant information critical to his or her job

function and the mission of the agency. The working relationship recognizes the importance of the chain of command

throughout all agency levels. The agency expects that this chain of command supports structure, appropriate boundaries,

and decisionmaking at all levels. The chain of command is followed to ensure effective and efficient communication.

Trust is central to the working relationship. This is manifested in several ways: (1) people are accountable to their work

and job responsibilities, (2) confidentiality is maintained, (3) decisions are respected, and (4) misunderstandings are pursued to clarify miscommunication, seek to understand the other person, air emotions, and reach resolution. 

The learning alliance is based on the belief that the supervisee has specific learning needs and styles that must be

attended to in supervision. The relationship between supervisor and supervisee is best formulated and maintained when

this frame of reference is predominant. Supervisees participate in a mutual assessment based on a combination of direct

and indirect observations.

Guidelines for Clinical Supervision

The principles of clinical supervision are made explicit by a clear contract of expectations, ongoing review and feedback,

and a commitment to professional development.

Clear contract of expectations

It is critical that both the supervisor and supervisee share their expectations about the process, method, and content of

clinical supervision. This can advance the development and maintenance of a trusting, safe relationship. The following

information should be discussed early in the working relationship:

• Models of supervision and treatment.

• Supervision methods and content.

•

• Ethical, legal, and regulatory guidelines.

• Access to supervision in emergencies.

• Alternative sources of supervision when the primary supervisor is unavailable.

The supervisee will be provided with a job description that outlines essential duties and performance indicators.

Additionally, each supervisee will receive an assessment of core counseling skills based on the TAP 21 competencies and

other appropriate standards.

Documentation

Supervisory sessions are recorded as notes that indicate the focus of the session, the issues discussed, solutions suggested, and agreed upon actions. Supervisors will maintain a folder for each of their supervisees. The folder will contain the

IDP, clinical supervision summaries, and personnel actions (e.g., memos, commendations, other issues). Supervisees are

allowed full access to the folders.
PART

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Tool 7. Clinical Supervision Policy and Procedure (continued)

Clinical Supervision and Professional Development 111

Clinical supervision frequency

Each supervisee will receive 4 hours of supervision monthly. A combination of individual and group supervision may be

used. Supervisors are to ensure that a minimum of 50 percent of this time is devoted to clinical, as opposed to administrative, supervision.

Ongoing review and feedback

The supervisee will be given an annual performance evaluation that reviews both job expectations and the clinical skills

learning plan. Written records of the supervisee will be reviewed on a regular basis. Supervisees will be given specific

written feedback regarding their strengths and areas for improvement. The supervision system operates through direct

observation of clinical work. This ensures that direct, focused feedback will be provided, increases the degree of trust

and safety, and provides an accurate evaluation of skills development progress. Observations will be pre­arranged and

take the form of sitting in on a session, co­facilitating, or videotaping. The supervisee will present a case at a minimum

of once per month.

Commitment to ongoing professional development

The supervisee’s learning plan should document goals, objectives, and methods to promote professional development.

The plan should be completed within the first 6 months of employment and updated annually. Ongoing supervision

should focus on achieving the identified goals. The agency supports supervisees’ participation in training to achieve their

professional development goals.

Source: Adapted from unpublished Basics, Inc. materials

The Supervision Contract

A supervision contract protects the rights of the agency, the supervisor, and supervisee. A written contract

between supervisor and supervisee, stating the purpose, goals, and objectives of supervision is important. Tool

8 is a template for supervision contracts. In addition to the contract, for the purposes of informed consent, it is

useful to have a supervision consent form signed by both the supervisor and supervisee, indicating the supervisee’s awareness and agreement to be supervised (see Tool 4). 

Tool 8. Supervision Contract Template

This document serves as a description of the supervision provided by (supervisor name, credentials, title) to (supervisee,

credentials, title).

Primary Purpose, Goals, and Objectives

• Monitor and ensure client welfare

• Facilitate professional development 

• Evaluate job performance

Provision

• (Frequency) of individual supervision at (day and time)

• (Supervision model and case review format) will be used 

• Clients of the counselor will give informed consent for supervision of their case

• Counselor will have a minimum of (amount) of supervision for every (number) of client contact hours

• All client cases will be reviewed on a rotating basis based on need

Documentation

• (Form name) will be used to document the content and progress of the supervision

• Informal feedback will be provided at the end of each session

• Written formal evaluation will be provided (frequency)

• Supervision notes will be shared (at the supervisor’s discretion or at request of counselor)
PART

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Tool 8. Supervision Contract Template (continued)

___________

___________

112 Part 2, Chapter 2

Duties and Responsibilities

The supervisor at a minimum will:

• Review all psychosocial histories, progress notes, treatment plans, and discharge plans.

• Question the counselor to justify approach and techniques used.

• Present and model appropriate clinical interventions.

• Intervene directly if client welfare is at risk.

• Ensure that ethical guidelines and legal statutes are upheld.

• Monitor proficiencies in working with community resources and networking with community agencies.

The counselor at a minimum will:

• Uphold all ethical guidelines and legal statutes.

• Be prepared to discuss all client cases.

• Discuss approaches and techniques used and any boundary issues or violations that occur.

• Consult supervisor or designee in emergencies.

• Implement supervisor directives.

• Adhere to all agency policies and procedures.

Procedural Consideration

• The Individual Development Plan’s goals and objectives will be discussed and amended if necessary.

• The quality of the supervisory relationship will be discussed and conflicts resolved.

• If conflicts cannot be resolved, (name) will be consulted.

• In the event of an emergency, the counselor is to contact the supervisor. If unavailable, contact (alternate’s name,

title, and other relevant back­up information).

• Crises or emergency consultations will be documented.

• Due process procedures (as explained in the agency’s policy and procedure handbook) have been reviewed and will

be discussed as needed.

Supervisor’s Scope of Competence

• Title/date of credentials/licensure.

• Formal supervisory training and credentials.

• Years providing supervision.

• Current supervisory responsibilities.

This agreement is subject to revision at any time on request of either person. Revision will be made only with consent of

the counselor and approval of the supervisor. We agree to uphold the directives outlined in this agreement to the best

of our ability and to conduct our professional behavior according to the ethical principles and codes of conduct of our

professional associations.

Supervisor_____________________________________ Title__________________________ Date

Supervisee_____________________________________ Title__________________________ Date

This agreement is in effect from (current date) to (annual date of review or termination)

Source: Mattel, 2007

Another sample supervision contract form can be found in Campbell (2000), p. 285.
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Clinical Supervision and Professional Development 113

The Initial Supervision Sessions 

An initial supervision sessions checklist documents the topics to be covered in initial sessions by the supervisor

and supervisee. The goal is that as part of establishing the supervisory relationship, the supervisor and supervisee should discuss the basic issues in substance abuse counseling and in supervision. For new supervisors

and for administrators to monitor the implementation of supervision, a checklist, such as Tool 9, can ensure

that the important issues are discussed. The example below can aid in setting a preliminary structure for

supervision, clarifying goals and expectations, and incorporating feedback so as to promote a sense of openness,

trust, and safety. It is understood that not all of these topics can be covered in the first few sessions, but these

topics are important considerations in initiating clinical supervision.

Documentation and Recordkeeping

Documentation is unquestionably a crucial risk­management tool for clinical supervisors and is no longer

optional in supervision. Legal precedents suggest that organizations are both ethically and legally responsible

for quality control of their work, and the supervision evaluation, documentation, and record­keeping systems

are a useful and necessary part of that professional accountability. However, in contrast with the myriad clinical forms and documentation required, there is a paucity of tools for documentation in supervision. Most organizations rely on the personal style and records of individual supervisors, and do not have an organization­wide

standardized system of record keeping for supervision. Documenting supervision should not be burdensome, but

it should be systematic and careful. Key components of what should be documented and how it should be documented are provided in the following paragraphs.

A record of supervision sessions needs to be maintained that documents: when supervision was conducted, what

was discussed, what recommendations were provided by the supervisor, and what actions resulted. A supervisor should maintain a separate file on each counselor supervised, including:

•	 Caseloads. 

•	 Notes on particular cases. 

•	 Supervisory recommendations and impressions.

•	 The supervision contract. 

•	 A brief summary of the supervisee’s experience, training, learning needs, and learning styles.

•	 The individual development plan. 

•	 A summary of all performance evaluations.

•	 Notations of supervision sessions, particularly concerning duty­to­warn situations, cases discussed, and significant decisions made. 

•	 Notations of canceled or missed supervision sessions. 

•	 Significant issues encountered in supervision and how they were resolved. 

By far, the most comprehensive documentation system for clinical supervisors is Falvey’s FoRMSS system

(2002a), which includes emergency contact information, supervisee profiles, a log sheet for supervision, an initial case overview, a supervision record, and a termination summary that records the circumstances of client

termination, client status at termination, and any followup or referrals needed. The FoRMSS system alerts

supervisors to potential clinical, ethical, or legal risks associated with cases. 

Records of supervision must be retained for the period required by the State and pertinent accreditation bodies.

The American Psychological Association’s guidelines (2007) recommend retaining clinical and supervisory

records for at least 7 years after the last services were delivered. Organization policy may differ from this.

Administrators should check with local and State statutes regarding record­keeping requirements. It is prudent

for an organization and supervisor to retain supervision records for at least as long as required by the State

and accreditation bodies.
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114 Part 2, Chapter 2

Tool 9. Initial Supervision Sessions Checklist

Education, Training, and Clinical Experience

_____  Educational background

_____  Training experience

_____  Setting(s), number of years

_____  Theoretical orientation

_____  Clinical competence with various issues, models, techniques, populations, presenting problems, treatment 

modalities

_____  Sense of mission and purpose in the field

_____  Educational plans and professional goals of the supervisee

_____  Training and awareness of cultural and contextual issues in counseling

_____  Training and awareness of community networking in counseling

Philosophy of Supervision

_____  Philosophy of therapy and change

_____  Purpose of supervision

Previous Supervision Experiences

_____  Previous supervision experiences (e.g., format, setting)

_____  Strengths and weaknesses as counselor and as supervisee

_____  Supervisee’s competence with stages of counseling process

_____  Supervisee’s level of development in terms of case planning, notes, collateral support, and networking

_____  Supervisory competence with various issues, models, techniques, populations, therapy groups, and modalities

_____  Methods for managing supervisor­supervisee differences

Supervision Goals

_____  Goals (personal and professional)

_____  Process of goal evaluation and timeframe

_____  Requirements for which supervisee is seeking supervision (e.g., licensure, professional certification)

_____  Requirements to be met by supervision (e.g., total hours, individual or group supervision)

Supervision Style and Techniques

_____  Specific expectations the supervisee or supervisor has of the parties involved (e.g., roles, hierarchy)

_____  Type of supervision that would facilitate clinical growth of the supervisee

_____  Preferred supervision style (didactic, experiential, collegial)

_____  Parallels between therapy and supervision models

_____  Supervision focus (e.g., counselor’s development, cases)

_____  Manner of case review (e.g., crisis management, in­depth focus)

_____  Method (e.g., audio­ or videotaping, direct observation)

Theoretical Orientation

_____  Models and specific theories in which supervisee and supervisor have been trained, practice, and or conduct

supervision

_____  Extent to which these models have been used clinically

_____  Populations, presenting problems, and/or family forms with which the models have been most effective

_____  Interest in learning new approaches
PART

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Tool 9. Initial Supervision Sessions Checklist (continued)

_________________________________________________________________________________________________________________

________________________________________________________________________________________________________________

___________________________________________________________________________________________________________

______________________

Clinical Supervision and Professional Development 115

Legal and Ethical Considerations

_____  Ultimate responsibility for clients discussed in supervision in different contexts (e.g., licensed vs. unlicensed counselor, private practice vs. public agency)

_____  Number of cases for which the supervisor will be responsible

_____ Emergency and back­up procedures

_____  Awareness of professional ethical codes

_____  Confidentiality regarding the information discussed in supervision

_____  Confidentiality issues when more than one supervisee is involved

_____  Specific issues in situations where dual relationships exist (e.g., former client)

_____  Process for addressing supervisee issues (e.g., burnout, countertransference)

Other

What do we need to know about each other that we have not already discussed?

Source: Adapted from Falvey, 2002b. Permission pending.

Tools 10–12 are sample documentation forms. (See also Campbell, 2000.)

Tool 10. Supervision Note Sample

Professional Development Plan Current Focus

Goal/TAP Competencies Objective Date of Expected Completion

Supervision Content

Issue Discussion Recommendation/ Action Followup

Progress on Professional Development Plan Objectives

Other

Supervisor__________________________________ Counselor________________________________ Date

Source: Porter and Gallon, 2006.
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_____________________________________ :____________________________________________

_________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________

_________________________________________________

_______________________________________________________

116 Part 2, Chapter 2

Tool 11. Current Risk­Management Review

Case: Date:

ISSUES

~ Informed Consent ~ Supervisee Expertise

~ Parental Consent ~ Supervisor Expertise

~ Confidentiality ~ Institutional Conflict

~ Recordkeeping ~ Dual Relationship

~ Records Security ~ Sexual Misconduct

~ Child Abuse/Neglect  ~ Releases Needed

~ Risk of Significant Harm ~ Voluntary/Involuntary Hospitalization

~ Duty to Warn ~ Utilization Review Discharge/Termination

~ Medical Exam Needed

Discussion:

Recommendation:

Action:

Signature__________________________________________________Date

Title

Source: Based on Falvey, 2002b.
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Clinical Supervision and Professional Development 117

Tool 12. Supervisory Interview Observations

STATEMENTS/BEHAVIORS STATEMENTS/BEHAVIORS COMMENTS

Step 1 

SET AGENDA 

Decrease anxiety

Involve counselor

Step 2 

GIVE FEEDBACK 

Empower

Individualize

Step 3 

TEACH and NEGOTIATE 

Share agenda

Clarify knowledge, skills, attitude

Identify learning steps 

Agree upon methods of learning 

Step 4 

SECURE COMMITMENT 

Clarify expectations

Clarify responsibility

Create mutual accountability

LOOK FOR OBSERVATIONS, BEHAVIORS, NOTES

SUMMARY OBSERVATIONS

Interview structure followed?

Time managed effectively?

Established nurturing and supportive environment?

Stayed on course?

Resistance? Power struggle?

Agreement secured?

Followup plan created?

NOTES:

Source: Based on Porter & Gallon, 2006.
PART

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Rating

118 Part 2, Chapter 2

Evaluation of Counselors and Supervisors

Evaluation of counselors and supervisors is both formative (ongoing and evolving over time) and summative

(periodic and formal). Nowhere else in supervision does the power differential between the supervisor and

supervisee become more evident than in the evaluation process. Feedback and evaluation are necessary and

important in an organization’s risk­management procedures. Agencies need a formal procedure and criteria for

staff evaluation. When supervisors conduct supervisee evaluations, counselors need to understand there is a

level of subjectivity in the process. There is no psychometrically valid tool to assess counselor competence. An

element of the supervisor’s judgment is always involved.

Most evaluation guidelines and tools identify general areas of competence to assess—knowledge, skills, and

attitudes—but specific criteria for making an evaluation are left to the individual supervisor and the organization. It is important that the evaluation of staff be closely linked to job descriptions, the supervision contract,

and the specific needs of the agency. Levels of competence and fitness for duty should be established by the

individual organization, with consideration given to the credentialing and accreditation requirements of the

agency. Supervisee triads also offer another option to assist in the evaluation process. A grievance and appeals

process should be defined. Finally, supervisors need to be reminded that they are the gatekeepers for the

agency, providing feedback, remediation as needed, and dismissal of personnel if indicated.

Tools 13 and 14 aid the supervisee in evaluating the supervisor and the supervisor in assessing the counselor.

Tool 13. Counselor Evaluation of the Supervisor

This evaluation form gives the supervisor valuable feedback while it gives the counselor a sense of responsibility and

involvement in the design and development of supervision.

Use a 7­point rating scale where:

1 = strongly disagree

4 = neither agree nor disagree

7 = strongly agree

1. Provides useful feedback regarding counselor behavior

2. Promotes an easy, relaxed feeling in supervision

3. Makes supervision a constructive learning process

4. Provides specific help in areas needing work

5. Addresses issues relevant to current clinical conditions

6. Focuses on alternative counseling strategies to be used with clients 

7. Focuses on counseling behavior

8. Encourages the use of alternative counseling skills

9. Structures supervision appropriately

10. Emphasizes the development of strengths and capabilities

11. Brainstorms solutions, responses, and techniques that would be helpful in future counseling situations

12. Involves the counselor in the supervision process

13. Helps the supervisee feel accepted and respected as a person

14. Appropriately deals with affect and behavior 

15. Motivates the counselor to assess counseling behavior
PART

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Tool 13. Counselor Evaluation of the Supervisor (continued)

This evaluation form gives the supervisor valuable feedback while it gives the counselor a sense of responsibility and

involvement in the design and development of supervision.

Use a 7­point rating scale where:

1 = strongly disagree

4 = neither agree nor disagree

7 = strongly agree

Rating

Clinical Supervision and Professional Development 119

16. Conveys a sense of competence

17. Helps to use tests constructively in counseling

18. Appropriately addresses interpersonal dynamics between self and counselor

19. Can accept feedback from counselor

20. Helps reduce defensiveness in supervision

21. Encourages expression of opinions, questions, and concerns about counseling

22. Prepares the counselor adequately for the next counseling session

23. Helps clarify counseling objectives

24. Provides an opportunity to discuss adequately the major difficulties the counselor is facing with clients

25. Encourages client conceptualization in new ways

26. Motivates and encourages the counselor

27. Challenges the counselor to perceive accurately the thoughts, feelings, and goals of the client

28. Gives the counselor the chance to discuss personal issues as they relate to counseling

29. Is flexible enough to encourage spontaneity and creativity

30. Focuses on the implications and consequences of specific counseling behaviors

31. Provides suggestions for developing counseling skills

32. Encourages the use of new and different techniques

33. Helps define and achieve specific, concrete goals

34. Gives useful feedback

35. Helps organize relevant case data in planning goals and strategies with clients

36. Helps develop skills in critiquing and gaining insight from counseling tapes

37. Allows and encourages self­evaluation

38. Explains the criteria for evaluation clearly and in behavioral terms

39. Applies criteria fairly in evaluating counseling performance

40. Addresses cultural issues of supervisee in a helpful manner.

41. Discusses cultural and contextual issues of the client, family, and wider systems that open up new

resources and avenues for support.

Source: Adapted from Powell and Brodsky, 2004.
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120 Part 2, Chapter 2

Tool 14. Counselor Competency Assessment

Based on TAP 21, Addiction Counseling Competencies: 

The Knowledge, Skills, and Attitudes of Professional Practice (CSAT, 2006) 

Competency Area Needs

Improvement

Able to Perform

Skill Proficient ConsistentMastery

Understand Substance Use

Disorders

• Models and theories

• Recognize complex context

of substance abuse

Treatment Knowledge

• Philosophies

• Practices

• Outcomes

Application to Practice

• DSM­IV­TR

• Repertoire of helping

strategies

• Familiar with medical and

pharmacological resources

Diversity and Cultural

Competence

• Understand diversity

• Use client resources

• Select appropriate strategies

Clinical Evaluation

• Screening

• Assessment

Assess Co­Occurring

Disorders

• Symptomatology

• Course of treatment

Treatment Planning

• Based on assessment

• Individualized

• Ensure mutuality

• Reassessment

• Team participation

Referral and Followup

• Evaluate referrals

• Ongoing contact

• Evaluate outcome

Case Management
PART

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Clinical Supervision and Professional Development 121

Tool 14. Counselor Competency Assessment (continued)

Based on TAP 21, Addiction Counseling Competencies: 

The Knowledge, Skills, and Attitudes of Professional Practice (CSAT, 2006) 

Competency Area Needs

Improvement

Able to Perform

Skill Proficient ConsistentMastery

Group Counseling

• Group theory

• Describe, select, and use

appropriate strategies

• Understand and work with

process and content

• Facilitate group growth

Family, Couples Counseling

• Theory and models

• Understand characteristics

and dynamics

• Describe, select, and use

appropriate strategies

Individual Counseling

• Theory of individual 

counseling

• Describe, select, and use

appropriate strategies

• Understand functions and

techniques of individual

counseling

Client, Family, and

Community Education

• Culturally relevant

• Provide current information

• Teach life skills

Documentation

• Knowledge of regulations

• Prepare accurate, concise

notes

• Write comprehensive, clear

psychosocial narrative

• Record client progress in

relation to treatment goals

• Discharge summaries

Professional and Ethical

Responsibilities

• Adhere to code of ethics

• Apply to practice

• Participate in supervision

• Participate in performance

evaluations

• Ongoing professional 

education

Source: Porter & Gallon, 2006.
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 _______________________________________________________________________

 ______________________________________________________________________________________________

______________________

5

Master

4

Skilled

3

Competent

2

Developing

1

Understands

____________________________________________________

_________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________

_________________________________________________________

_________________________________________________________________________________________________________________

122 Part 2, Chapter 2

Other useful resources are:

•	 Bernard and Goodyear, 2004: Supervision Instruments (pp. 317–326).

•	 Campbell, 2000: Generic Rating Sheet and Evaluation Form, Supervisee’s Basic Skills and Techniques 

(p. 263); Sample Generic Supervisee Evaluation Form (p. 275).

•	 Powell and Brodsky, 2004: Evaluation of the Counselor, adapted from Stoltenberg and Delworth, 1987 

(p. 351).

•	 Powell and Brodsky, 2004: Counselor Assessment Forms (p. 373–379).

•	 Northwest Frontier Addiction Technology Transfer Center Performance Rubric available online at

http://www.attcnetwork.org/documents/Final.CS.Rubrics.Assessment.pdf.

Individual Development Plan

After the supervisor and counselor have agreed on goals, they should formulate an individual development plan

(IDP) or professional development plan. It should address the expectations for supervision, the counselor’s experience and readiness for the position, procedures to be used to observe and assess the counselor’s competencies,

and the counselor’s professional development goals. Some IDP formats follow the 12 Core Functions taking into

account the stage of development of the counselor. Other formats might use the competencies in TAP 21. Tool

15 outlines the generic knowledge, skills, and attitudes to be addressed as part of one’s professional development plan. Whatever format is adopted, the IDP should provide the counselor with a road map for learning

goals.

Tool 15. Professional Development Plan

Staff_____________________________________ Position ___________________________________ Date

Practice Dimension:

Competency number and page from TAP 21:

Present level of competence from TAP 21 Rating Form:

1 = Understands

2 = Developing

3 = Competent

4 = Skilled

5 = Master

Comprehends the tasks and functions of counseling

Applies knowledge and skills inconsistently

Consistent performance in routine situations

Effective counselor in most situations

Skillful in complex counseling situations

Describe the counselor’s strengths and challenges for this rating:

Expected level of competency to be achieved with this learning plan:

1

Understands

2

Developing

3

Competent

4

Skilled

5

Master

Describe the goal for this learning plan in observable terms:
PART

2

Tool 15. Professional Development Plan (continued)

_______________________________________________________________________________________________________

_________________________________________________________________________________________________________________

 ____________________________________________________________________________________________________________

_________________________________________________________________________________________________________________

 ________________________________________________________________________________________________________

_________________________________________________________________________________________________________________

____________________________________________________________

_________________________________________________________________________________________________________________

______________________________________

_____________________________________________

 ________________________________

 ________________________________

 ______________________________________

________________________________

Clinical Supervision and Professional Development 123

List the Knowledge, Skills, and Attitudes relevant to achieving the target competency.

Knowledge

Skills

Attitudes

State the performance goal in specific behavioral terms:

What activities will the counselor complete in order to achieve the stated goal?

How will progress be evaluated? How will proficiency be demonstrated?

Supervisor Signature ________________________________________________________ Date

Counselor Signature ________________________________________________________ Date

UPDATE

Date of “re­observation”

Demonstration of knowledge and skills successful? _________ Yes    _________ No

If “No,” demonstration needs the following correction and followup demonstration rescheduled:

Supervisor Signature ________________________________________________________ Date

Counselor Signature ________________________________________________________ Date ________________________________

Source: Adapted from Porter & Gallon, 2006.

Outline for Case Presentations

Counselors often need to be taught how to present cases in supervision. The counselor needs to think about the

goals he or she would like to achieve for the client and his or her particular concerns about the case. It is possible to use the case presentation format for a variety of purposes: to explore the client’s clinical needs, to aid in

case conceptualization, to process relational issues in counseling (transference and countertransference), to

identify and plan how to use specific clinical strategies, and to promote self­awareness for the counselor. In the

beginning, the supervisor should structure the case presentation procedures to ensure consistency and conformity to agency guidelines. Tool 16 can be adapted to the particular theoretical model of the agency and the specific needs of the supervisee and organization. 
PART

2

_______________________________________________________________________________________________

____________________________________________________________________________________________________________

______________________________________________________________________________________________

_____________________________________________________________________________________

_________________________________________________________________________________________________________________

_____________________________________

_________________________________________________________________________________________________________________

______________________________________________________

_________________________________________________________________________________________________________________

____________________________________________________________

_________________________________________________________________________________________________________________

___________________________________________________________________________________________

_________________________________________________________________________________________________________________

________________________________

_________________________________________________________________________________________________________________

124 Part 2, Chapter 2

Tool 16. Sample Case Consultation Format

Name of presenter:

Date:

Identifying data about the client (age, marital status, number of marriages, number and ages of children, occupation,

employment status)

Presenting problem:

Short summary of the session:

Important history or environmental factors (especially cultural or diversity issues):

Tentative assessment or problem conceptualization (diagnosis):

Plan of action and goals for treatment (treatment plan):

Intervention strategies:

Concerns or problems surrounding this case (e.g., ethical concerns, relationship issues):

Source: Adapted from Campbell, 2000.

Audio­ and Videotaping

To ensure competence, the agency should provide instruction on audio­ and videotaping to all staff. Instruction

should include the overall purpose of taping, how to inform the client about the taping procedure, how to use

the recording equipment, the placement of taping devices, how to ensure client confidentiality and obtain

signed releases, how to begin the actual session while recording, and how to process the tapes after recording.

Tool 17 provides helpful hints for successful audio­ and/or videotaping.

Tool 17. Instructions for Audio and Videotaping

1.  Use quality equipment. Check the sound quality, volume, and clarity. It is best to use equipment with separate clipon microphones unless you are in a sound studio with a boom microphone. Clip­on microphones are inexpensive and

easy to obtain.

2. Buy good quality tapes. It is not necessary to buy top­of­the­line tapes, but avoid the cheapest. Better tapes give

better sound and picture and can be reused.

3. Placement of equipment matters. Use a tripod for the video camera. Check the angle of camera, seating, volume,

and the stability of the picture.
PART

2

Tool 17. Instructions for Audio and Videotaping (continued)

Clinical Supervision and Professional Development 125

4. Check the background sound and volume. Choose a quiet, private place to do this, both to protect confidentiality

and to improve recording quality. Do not use an open space, an office with windows facing the street, or a place subject to interruption. Loud air­conditioning fans, ringing phones and pagers, street noise, and office conversations all

disrupt the quality of taping.

5. Know how to use the equipment. Conduct a dry run. Be sure to check the placement of chairs, video camera

angles, and picture quality before you begin. If the supervisee is especially anxious or unfamiliar with the equipment,

have him or her make a practice tape. Be sure those in the picture are the persons agreed on by the supervisor and

supervisee.

6. Protect the confidentiality of the supervisee and the client. Choose a private, controlled space for taping. Keep

the tapes in a locked cabinet and don’t include identifying data on the outside of the tape. When finished with

supervision, erase the tape completely before reusing; do not just tape over the previous session.

7. Process with the supervisee any anxiety or concern generated by taping. Three areas of potential anxiety are

the technical aspects (equipment and room availability), concern for the client (confidentiality), and the effect of taping on the session (critical evaluation of performance by the supervisor).

8. Explain taping, its goals, and its purpose to the client at least one session before proceeding. Review with the client

any concerns about confidentiality. Remember that the more comfortable and enthusiastic the supervisor and the

supervisee are with the value of taping, the more comfortable the client will be. Sometimes just reassuring the client

that the tape can be turned off at any point if the client is uncomfortable increases a sense of control and reduces

anxiety. Usually after the first few minutes of taping, both the client and counselor forget its presence, and this

option is rarely used. If the client appears resistant, a decision should be made as to the appropriateness of using this

particular method of supervision in this situation.

9. Get a written release from the client. Be sure the release includes a description of the purpose of the tape, limits

of confidentiality, identities of those viewing the tape, and assurance of erasure of the tape afterward. If the tape is

to be used in group supervision or a staffing seminar, the client should be informed of that fact.

10. Before beginning the actual session, check the equipment by making a short practice tape covering background

material on the client. Then, rewind the tape and play it to check sound, volume, camera angle, and picture. When

satisfied, begin the actual session.

Source: Adapted from Campbell, 2000.
PART

2

	 

	 

	 

	 

	 

	 

	 

	 

	 

	 

	 

	 

	 

 ______________________________

 _______________________________

126 Part 2, Chapter 2

Further, it is essential that an organization provide documentation to protect the confidentiality of information

and to preserve patients’ rights. This is especially important if direct observation of clinical sessions is to occur

using audio or videotaping. Tool 18 explains the benefits and procedures of taping and can be read by the counselor to the client. The consent form, Tool 19, should be signed and dated prior to taping. 

Tool 18. Confidentiality and Audio­ or Videotaping

Video recording of clinical processes will be conducted with the client’s written, informed consent for each taping.

Clients understand that no taping will occur without their consent. A process already in place will ensure the security

and destruction of DVDs or erasure of VHS tapes.

The purpose of videotaping is to improve counselors’ clinical skills through supervision and teaching.

Counselor benefits of videotaping include:

•	 Improving therapeutic skills.

•	 Improving treatment team cohesion.

•	 Improving assessment, treatment planning, and delivery of services.

•	 Improving clinical supervision.

Procedure:

The client’s counselor will explain and fully disclose the reason, policy, and procedure for videotaping the client. Both

will sign a specific videotaping release form. The counselor should also explain that refusal to be taped will not affect

the client’s treatment at the agency.

1.	 The client must be 18 years old to sign the consent. Those under 18 must have a parent’s signature in addition to

their own.

2.	 Respecting the client’s concerns is always the priority. Should any client or family member show or verbalize concerns

about taping, those concerns need to be addressed. 

3.	 All taping devices will be fully visible to clients and staff while in use.

4.	 A video camera will be set up on a tripod, consistent with safety standards and in full view of each client. Clients will

be notified when the camcorder is on or off. 

5.	 The tape will be labeled when the session is completed, and no copies will be made.

6.	 Clinical review for supervision or training: The treatment team will review the tape and assess clinical skills for the

purpose of improving clinical techniques.

7.	 The tape will be turned over to the Medical Records Department (if available) for sign out.

8.	 Tapes and DVDs will be stored in a locked drawer in the Medical Records Department. Within 2 weeks of taping,

tapes will be erased and DVDs destroyed in the presence of two clinical staff members who attest to this destruction

on a form to be kept for 3 years.

9.	 Tapes and DVDs may not be taken off premises.

Tool 19. Audio or Video Recording Consent 

I , ________________________________, consent to be recorded or filmed for supervision purposes. I also agree to allow

the clinical staff to review the film as a resource to facilitate staff development for the enhancement of clinical procedures. I understand that any film in which I am a participant will be erased within 2 weeks of the date of filming. I

understand that no copies will be made of such film.

Patient Signature ____________________________________________________________ Date

Witness Signature ___________________________________________________________ Date
 

 

 

 

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drugs field: An imperative or an option? Drug and Alcohol Review, 26, 241–249.

Shoptaw, S., Stein, J., & Rawson, R. (2000). Burnout in substance abuse counselors: Impact of

environment, attitudes, and clients with HIV. Journal of Substance Abuse Treatment, 19,

117–126.

Skovholt, T. M., & Ronnestad, M. H. (1992). The Evolving Professional Self: Stages and

Theories in Therapist and Counselor Development. New York: Wiley.

Spice, C. G., Jr. & Spice, W. H. (1976). A triadic method of supervision in the training counselors and counseling supervisors. Counselor Education and Supervision, 15, 251–258

Stoltenberg, C. D. & Delworth, U. (1987). Supervising Counselors and Therapists: A

Developmental Approach. San Francisco: Jossey­Bass.

Stoltenberg, C. D., McNeill, B., & Delworth, U. (1998). IDM Supervision: An Integrated

Developmental Model for Supervising Counselors and Therapists. (1st ed.) San Francisco:

Jossey­Bass Publishers.

Swenson, L. C. (1997). Psychology and Law for the Helping Professions (2nd ed.). Pacific Grove,

CA: Brooks/Cole Pub. Co.

Tromski­Klingshirn, D. (2006). Should the clinical supervisor be the administrative supervisor?

The ethics versus the reality, The Clinical Supervisor, 25, 53–67.

U.S. Department of Health and Human Services (2003). Developing Cultural Competence in

Disaster Mental Health Programs: Guiding Principles and Recommendations. (Rep. No.

HHS Pub. No. SMA 3828). Rockville, MD: Center for Mental Health Services, Substance

Abuse and Mental Health Services Administration.

Clinical Supervision and Professional Development 133
 

White, W. L. & Popovits, R. M. (2001). Critical incidents: Ethical Issues in the Prevention and

Treatment of Addiction. (2nd ed.). Bloomington, IL: Chestnut Health Systems.

Williams, L. (1994). A tool for training supervisors: Using the supervision feedback form (SFF).

Journal of Marital and Family Therapy, 20, 311–315.

134 Bibliography
                     

                     

                     

                           

                   

                     

                   

                             

                       

         

 

 

 

 

 

 

 

 

 

 

Appendix B: New York State 

Office of Alcoholism and

Substance Abuse Services

Clinical Supervision Vision

Statement

To position clinical supervision, within the system of prevention, treatment, and recoveryoriented services, as integral to a continuous learning culture that encourages professional

development, service improvement, and quality of care, maximizing benefits to the client.

Clinical supervision is defined as “a social influence process that occurs over time in which the

supervisor participates with the supervisees to ensure quality clinical care. Effective supervisors

observe, mentor, coach, evaluate, inspire, and create an atmosphere that promotes self­motivation,

learning, and professional development. They build teams, create cohesion, resolve conflict, and

shape agency culture, while attending to ethical and diversity issues in all aspects of the process.

Such supervision is key to both quality improvement and the successful implementation of consensus and evidence­based practices” (TAP 21A).

Highlights

ü Clinical supervision is a valuable and necessary strategy to ensure continuous staff

and program development.

ü The supervisory relationship must be supportive and culturally competent, provide

direct oversight, and prioritize skill development and counselor wellness.

ü Clinical supervision is a formal process that is provided frequently and employs direct

observation techniques.

ü Clinical supervisors are specifically trained and invest in continuing professional

development.

ü Fully integrated clinical supervision is expected to result in improved staff retention,

counselor skills, and clinical outcomes.

Clinical Supervision and Professional Development 135
                           

                     

                   

                 

               

                           

                     

                         

                   

                     

                         

                               

                       

                 

                   

               

             

               

                   

             

                       

                             

                 

                     

               

                     

                     

                       

                     

                       

                       

                           

                     

                 

                       

                   

                     

                 

                   

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The integration of clinical supervision is both a short­term and long­term strategy for ongoing quality improvement and increased successful client outcomes. The proficiency and integrity of the

workforce, and subsequently the caliber of services, are strengthened through gatekeeping functions, direct oversight, teaching, training, infusion of diversity­cultural competence and sensitivity,

and the morale­boosting benefits inherent in quality clinical supervision.

Research and expert consensus links clinical supervision with a wide variety of actual and potential outcomes, including improved quality of services to clients, professional development of staff,

better adherence to codes of ethical conduct, increased staff retention, improved morale and wellness, fidelity to evidenced­based practices, improved regulatory compliance and risk management,

and enhanced perception of recovery­oriented systems of care by consumers, professionals, and the

community. Though more empirical work is needed, there is enough reliable evidence to indicate

that clinical supervision is a highly efficient practice key to the growth and future of the field

Skilled clinical supervisors help staff gain advanced competency through both formal training and

education supported by ongoing feedback and guidance throughout their professional career.

Values inherent in clinical supervision are articulated in the acronym ASPECT:

Accountability – upholding the promise to deliver quality services.

Stewardship – mindful use of all available resources.

Professionalism – consistent and ethical role modeling and application.

Excellence – the relentless pursuit to provide the best quality care.

Continuous Learning – steadfast commitment to ongoing development.

Teamwork – active support of collective wisdom and energy to achieve great results.

The quality of the relationship between the clinical supervisor and supervisee is critical to a positive learning alliance. Clinical supervisors exercise supervisory responsibilities in a culturally

responsive, respectful, fair, and objective manner. They invest in a positive supervisory alliance

and endorse the professional development process of supervisees through well­thought­out, documented, and actively supported learning plans. These more experienced and objective professionals

also help to mitigate the potentially adverse effects of countertransference, compassion fatigue, and

burnout.

Moving the field forward by integrating clinical supervision into all recovery­oriented systems of

care requires increasing the value of clinical supervision amongst policy makers, administrators,

supervisors, and direct­line staff; retooling staffing patterns to support the provision of clinical

supervision as a primary responsibility; and including a clinical supervisor certification. Full integration across the State may require a mechanism to include clinical supervision as a reimbursable service, thereby endorsing the integrity of clinical supervision and staffing needs.

Effective clinical supervisors have available specialized training in clinical supervision inclusive

of formal education and direct supervision to supplement their clinical training. Clinical supervisors are recognized through an established credential that certifies their competency.

Individual and group clinical supervision is offered regularly through acceptable methods including

direct observation. This can be through live face­to­face supervision, audio/video tapes, and/or other

electronic resources. Supervisors use this information to target specific skill enhancement to

improve performance.

136 Appendix B
                               

                         

                   

                         

               

                       

               

                           

           

 

 

 

 

 

 

 

 

 

The clinical supervision hour focuses on the clinical content of the work and how the worker performs as a professional helper. Clinical technique and theory are explored and integrated to

empower the supervisee’s conceptual understanding and application of practical skills.

Resources are available for supervisors to receive their own clinical supervision that coaches them

in their own professional development and supports effective clinical care.

Adopting clinical supervision may require significant change in agency, local, and State operations.

This system­wide investment will yield invaluable gains, including a quality improvement­oriented

approach to monitoring and service delivery that is projected to lead to improved staff retention,

enhanced counselor skills, and better clinical outcomes.

Clinical Supervision and Professional Development 137
Appendix C: Advisory Meeting

Panel

Note: The information given indicates each participant's affiliation as of 2007, when the panel

was convened, and may no longer reflect the individual's current affiliation.

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

FASAM

Director

Center for Substance Abuse Treatment

Substance Abuse and Mental Health Services

Administration

Rockville, Maryland

Mady Chalk, Ph.D.

Director

Division of Services Improvement

Center for Substance Abuse Treatment

Substance Abuse and Mental Health Services

Administration

Rockville, Maryland

Christina Currier

Public Health Analyst 

Practice Improvement Branch 

Division of Services Improvement 

Center for Substance Abuse Treatment

Substance Abuse and Mental Health Services

Administration

Rockville, Maryland

Michael T. Flaherty, Ph.D.

Northeast Addiction Technology Transfer

Center

Institute for Research, Education and

Training in Addictions

Pittsburgh, Pennsylvania

Kevin Hennessy, Ph.D.

Science to Service Coordinator

Substance Abuse and Mental Health Services

Administration/OPPB

Rockville, Maryland

Constance M. Pechura, Ph.D.

Senior Program Officer

Robert Wood Johnson Foundation

Princeton, New Jersey

Richard A. Rawson, Ph.D.

Pacific Southwest Addiction Technology 

Transfer Center

Los Angeles, California

Jack B. Stein, Ph.D.

Acting Deputy Director

Division of Epidemiology, Services, and

Prevention Research

National Institute on Drug Abuse

National Institutes of Health

Bethesda, Maryland

Richard T. Suchinsky, M.D.

Associate Chief for Addictive Disorders

Mental Health and Behavioral Sciences 

Service

U.S. Department of Veteran Affairs

Washington, D.C.

Karl D. White, Ed.D.

Public Health Analyst 

Practice Improvement Branch 

Division of Services Improvement 

Center for Substance Abuse Treatment

Substance Abuse and Mental Health

Services Administration

Rockville, Maryland

Mark Willenbring, M.D.

Director

Division of Treatment and Recovery Research 

National Institute on Alcohol Abuse and

Alcoholism

National Institutes of Health

Bethesda, Maryland

139
Appendix    D: Stakeholders

Meeting Participants

Note: The information given indicates each participant's affiliation during the time the panel was

convened and may no longer reflect the individual's current affiliation.

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

FASAM

Director

Center for Substance Abuse Treatment 

Substance Abuse and Mental Health Services

Administration

Rockville, Maryland

Mirean Coleman, M.S.W., LICSW, CT

Senior Policy Associate 

National Association of Social Workers

(NASW)

Washington, DC

Tom Durham, Ph.D.

Executive Director

The Danya Institute

Silver Spring, Maryland 

Anne M. Herron, M.S.W.

Director, Division of State and Community

Assistance

Center for Substance Abuse Treatment

Substance Abuse and Mental Health Services

Administration

Rockville, Maryland

Ted Judson, M.Ed., ADC2, CCS

Certification and Contracts Officer

Navy Drug and Alcohol Counselor School

San Diego, California

Linda Kaplan

Special Expert

Division of Services Improvement

Center for Substance Abuse Treatment

Substance Abuse and Mental Health  Services

Administration

Rockville, Maryland

Peter J. Martieau

Public Health Analyst

Center for Substance Abuse Prevention

Substance Abuse and Mental Health Services

Administration

Rockville, Maryland

Jack Stein, M.S.W., Ph.D.

Director, Division of Services Improvement

Center for Substance Abuse Treatment

Substance Abuse and Mental Health Services

Administration

Rockville, Maryland

Bill Trefzger

Lead, Communication Services Team

Office of Communication

Substance Abuse and Mental Health Services

Administration

Rockville, Maryland

141
Appendix E: Field Reviewers 

Note that information given indicates each participant's affiliation as of 2008, when the review

was conducted, and may no longer reflect the individual's current affiliation.

L. DiAnne Borders, Ph.D.

Excellence Professor

University of North Carolina at Greensboro

Greensboro, NC

Donny Brock

Treatment Director, Outpatient Division Head

Charleston Center

Charleston, SC

Patricia A Burke, M.S.W., LCSW

Private Practice

West Baldwin, ME

Charlotte M. Chapman

Director of Training

Mid­Atlantic Addiction Technology Transfer

Center

Richmond, VA

Thomas G. Durham, Ph.D. 

Executive Director, The Danya Institute

Silver Spring, MD

Janet E. Falvey, Ph.D., NCC, ACS

Professor

University of New Hampshire

Durham, NH

Steven L. Gallon, Ph.D.

Northwest Frontier Addiction Technology

Transfer Center

Salem, OR

John Hamilton LMFT, LADC

Regional Network of Programs, Inc.

Fairfield, CT

Ted Judson, M.Ed., ADC2, CCS

Assistant Department Head

Navy Drug and Alcohol Counselor School

San Diego, CA

Hunter McQuisition, M.D.

Director, Division of Integrated Psychiatric

Services, Department of Psychiatry

The St. Luke’s–Roosevelt Hospitals

New York, NY 

Thomas A. Peltz, LMHC, CADAC I, CAS

Private Practice

Beverly Farms, MA

Annie Ramniceanu

Clinical Director

Spectrum Youth and Family Services

Burlington, VT

Sandra A. Rigazio­DiGilio, Ph.D.

Professor 

Marriage and Family Therapy Program 

University of Connecticut 

Storrs, CT

John (Jack) M. Schibik, Ph.D., LPC,

LCADC, CCS, CPS

Kairos Counseling, Consulting Coaching

Services

Naples, Florida

Diane Shea, Ph.D.

Adjunct Professor

Holy Family University

Newtown, PA

Ernestine Winfrey

Executive Director

Good News Home for Women

Flemington, NJ

143
Appendix F—

Acknowledgments 

Numerous people contributed to the development of this TIP, including the TIP Consensus

Panel (see page v), the Knowledge Application Program (KAP) Advisory Meeting Panel (see

Appendix C), the SAMHSA Stakeholders Meeting attendees, (see Appendix D), and TIP Field

Reviewers (see Appendix E). 

This publication was produced under KAP, a Joint Venture of The CDM Group, Inc. (CDM),

and JBS International, Inc. (JBS), for the Substance Abuse and Mental Health Services

Administration, Center for Substance Abuse Treatment.

CDM KAP personnel included Rose M. Urban, M.S.W., J.D., LCSW, LCAS, KAP Executive

Deputy Project Director; Susan Kimner, Managing Project Co­Director; Bruce Carruth, Ph.D.,

Expert Content Director; Janet Humphrey, M.A., former Editor; Virgie D. Paul, M.L.S.,

Librarian; Lee Ann Knapp, Quality Assurance Editor. 

145
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Index 

A

AAMFT. See American Association for

Marriage and Family Therapy

ACES. See Association for Counselor

Education and Supervision

Addiction Counseling Competencies, 3

Addiction Technology Transfer Center

The Change Book: A Blueprint for

Technology Transfer, 101

Leadership Institute, 77

Administrative tasks

balancing with supervisory tasks, 5, 26,

33, 78, 88, 89–90

documentation for administrative purposes, 33, 91, 94, 95–96

Administrators

administrative supervision compared with

clinical supervision, 89–90

administrative support for clinical supervision, 81, 92–93

assessing organizational readiness for

clinical supervision, 88–89, 101–105

assessing the competence of supervisors

and counselors, 90, 92

assessing the organization’s receptivity to

supervision, 97–98

Change Teams and, 93

competence of supervisors and counselors

and, 90, 120–121

confidentiality issues, 90–91

developing a model for clinical supervision, 92

direct and vicarious liability and, 90

direct observation and, 93, 94

diversity and cultural competence and, 91

documentation and recordkeeping and, 33,

91, 94, 95–96

dual relationships and, 90–91

ethical issues for, 90–91

feedback and, 94, 96, 97

implementing a clinical supervision program, 92–99

informed consent and, 90

key issues for, 80, 88–89

legal issues for, 90–91

making the case for clinical supervision to

(vignette), 78–84

organizational structure considerations,

89, 97–98

phasing in a clinical supervision system,

94–95

pilot supervision systems and, 93

professional development of supervisors

and, 99

recruiting personnel, 94

scheduling supervisory sessions, 93

substance abuse policy, 108–109

supporting clinical supervisors in their

jobs, 97–99

understanding the differences between

case management and clinical supervision, 81

Advisory Meeting Panel, members, 139

Al. See Walt vignette

Alicia. See Stan vignette

American Association for Marriage and

Family Therapy

ethical and legal guidelines, 106

American Psychological Association

guidelines for retaining records of supervision, 113

Assessing organizational readiness

administrator’s role, 88–89

elements of, 101

identifying current barriers to implementing a supervision system (Tool 2), 104

initial organizational assessment (Tool 1),

102

organizational stage of readiness to

change (Tool 2), 103–104

Association for Counselor Education and

Supervision

standards and ethical guidelines, 106

Association of State and Provincial Psychology

Boards

ethical and legal guidelines, 106

ATTC. See Addiction Technology Transfer

Center

Audiotaped supervision

confidentiality and (Tool 18), 126

147
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

description, advantages, and disadvantages of, 22, 31

instructions for (Tool 17), 124–125

recording consent (Tool 19), 126

B

Beauchamp, T.L.

ethical and legal issue resource, 13

Behavioral contracting in supervision

elements of, 17

Benefits of clinical supervision

improvement of client outcome, 87

professional development, 88, 99

program evaluation and research, 88

responsiveness to diversity, 87

workplace development, 88

Bernard, J.M.

examples of work samples and peer

assessments, 18

qualities of a good model of clinical supervision, 9

Betty. See Margie vignette

Bibliography, 127–134

Bill vignette

defining and building the supervisorsupervisee alliance, 44–51

Blended Model. See Integrated models of

supervision

Boundary issues

ethical and legal considerations, 14–15,

51–58

Bradley, L.J.

administrative supervision/clinical supervision comparison, 89–90

supervisor­focused personal development

domain, 91

Brodsky, A.

ethical and legal issue resource, 13

examples of work samples and peer

assessments, 18

qualities of a good model of clinical supervision, 9

Burnout

helping counselors with, 19–20

C

Caldwell, C.F.

Focused Risk Management Supervision

System, 28, 98

Campbell, J.M.

examples of work samples and peer

assessments, 18

supervision contract, 112

Carrie. See Walt vignette

Case consultation/case management

description, advantages, and disadvantages, 31

understanding the differences between

case management and clinical supervision, 81

Case presentations

outline for, 123–124

sample case consultation format (Tool 16),

124

The Change Book: A Blueprint for Technology

Transfer, 101

Childress, J.F.

ethical and legal issue resource, 13

Clinical supervision. See also Supervision

administrative benefits, 87

administrative supervision comparison,

89–90

advocating for both administrators and

workers and clients, 60

benefits of, 87–88

central principles of, 5–6

definitions, 3, 87

demonstrating the importance of administrative support for, 81

differences between supervision and counseling (figure), 24

goals of, 17, 20, 24, 44, 51, 69, 87

implementing a clinical supervision system, 82–83

making the case for clinical supervision to

administrators (vignette), 78–84

presenting a proposal for, 79, 84

qualities of effective supervisors, 62

rationale for, 3–4, 37, 45, 78, 87

time standard for, 14, 27, 28, 30, 50

Clinical supervisors

competence of, 90, 92, 106

functions of, 4

gatekeeper role, 6, 13

guidelines for new supervisors, 6–8

identifying staff with high potential for

advancement, 77

roles of (figure), 4

supervision of, 5

148 Index
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Coach role of clinical supervisors

description, 4

vignette illustrating, 35–44

Codes of ethics

employees’ signing of statements agreeing

to abide by, 91

resources, 34, 106

reviewing, 91

Cofacilitation and modeling method of 

supervision

description, advantages, and disadvantages of, 32

Cognitive­behavioral therapy. See Treatmentbased supervision models

Cohen, C.R.

Focused Risk Management Supervision

System, 28, 98

Compassion fatigue

communication and, 26

helping counselors with, 19–20

Competence of clinical supervisors

assessing, 90, 92, 106

checklist for supervisor competencies

(Tool 5), 107–108

Competencies for Substance Abuse Treatment

Clinical Supervisors, 3, 87

Competency­based models of supervision

description and key strategies, 8

Confidentiality

audiotaping, 39, 126

criteria for waiving, 15

direct observation, 39

duty­to­warn requirements and, 15, 90

issues for administrators, 90–91, 106

levels of, 15

online counseling and supervision and,

15, 17

State legal and legislative standards for,

15

training counselors in, 15

videotaping, 39, 126

Consensus Panel

central principles of clinical supervision,

5–6

employee assistance program, 20

peer supervision recommendation, 27

Constantine, M.G.

Multicultural Model of supervision, 11

questions supervisors can use with 

supervisees, 13

Consultant role of clinical supervisors, 4

Contextual factors. See Cultural and contextual factors

Counselors. See also Developmental stages of

counselors; Evaluation of counselors and

supervisors

competency assessment (Tool 14),

120–121

counselor evaluation of the supervisor

(Tool 13), 118–119

outline for case presentations, 123–124

Countertransference

between counselor and client, 25, 51–58,

68

signs of, 25

between supervisors and supervisees, 25

Cross, T.L.

stages of becoming culturally competent,

12

Cultural and contextual factors. See also

Diversity and cultural competence 

contextual issues in techniques and methods of supervision, 30, 32, 101

Counselor Development domain and, 11

example of, 54

identifying, 11

importance of culture in supervision, 11

levels of cultural consideration, 12

supervisor self­examination, 12–13, 34

Supervisory Alliance domain, 11

D

Delworth, U.

Integrated Developmental Model of supervision, 8, 9

Developmental model of supervision

description and key strategies, 8

Developmental stages of counselors

cautions and principles, 9–10

counselor developmental model 

(figure), 10

defining and building the supervisory

alliance (vignette), 44–51

managing staff confrontations, 62

mentoring and, 74

working with counselors at different levels of proficiency, 60–61

Developmental stages of supervisors

description, 10–11, 47–48, 94

Index 149 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

supervisor developmental model 

(figure), 11 

Direct liability 

administrators and, 90 

description, 13 

vicarious liability and, 14, 90, 106 

Direct observation 

administrators and, 93, 94 

advantages of, 21, 28, 31 

confidentiality and, 39 

disadvantages of, 31 

effectiveness of, 6 

encouraging acceptance of, 41 

feedback and, 18, 21, 40 

guidelines for, 21 

implementing, 39 

resistance to, 21, 39, 42 

selecting cases for, 21 

vignette on implementing, 35–44 

Disciplinary actions

policies and procedures for dealing with 

unacceptable behavior by counselors, 

20, 41 

Discrimination Model. See Competency­based

models of supervision

Diversity and cultural competence 

addressing personal issues, 65 

administrators’ responsibilities, 91, 98 

assessing, 89 

communication issues, 91 

continuum of cultural competence (figure), 

12 

description, 5, 11–12 

importance of cultural competence, 5, 91 

responsiveness to diversity, 87 

Documentation and recordkeeping 

for administrative purposes, 33, 91, 94, 

95–96 

duty­to­warn situations, 15 

evaluations of counselors, 20, 28, 94, 

96–97 

Focused Risk Management Supervision 

System, 28, 98 

formative and summative evaluations 

and, 29 

importance of, 28 

individual development plans, 17 

initial supervision sessions, 113–117 

purpose of, 95–96 

records of supervisory sessions, 33 

retention period for records of supervision, 113 

systems to be documented, 28 

Drug­Free Workplace Act 

substance abuse policy requirement, 108 

Dual relationships 

between counselors and clients, 14, 51–58, 

106 

description and examples of, 14, 53, 106 

ethical and legal considerations, 14–15, 

51–58, 106 

issues for administrators, 90–91, 106 

between supervisors and supervisees, 14, 

106 

Due process 

description, 106 

documentation of, 28 

Duty­to­warn requirements 

confidentiality and, 15, 90 

E

EAPs. See Employee assistance programs

EBPs. See Evidence­based practices

Ella vignette

making the case for clinical supervision to

administrators, 78–84

Eloise. See Stan vignette

Employee assistance programs

informing supervisors and, 69 

recommendation for, 20 

videotaped supervision and, 22 

Environmental variables in clinical supervision systems 

description, 89 

Ethical and legal issues 

addressing ethical standards (vignette), 

51–58 

for administrators, 90–91 

codes of ethics, 34, 91 

competence of supervisors and counselors, 

90, 92, 106, 120–121 

confidentiality, 15, 17, 90–91, 106 

deciding how to address potential legal or 

ethical violations (figure), 16 

direct versus vicarious liability, 13–14, 90, 

106 

dual relationships and boundary issues, 

14–15, 90–91, 106 

150 Index
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

due process and, 28, 106 

how to ask questions in ethical decisionmaking, 57 

informed consent, 15, 90, 106 

orientation in for all employees, 91 

policies and procedures for dealing with 

unacceptable behavior by counselors, 

20, 110–111 

resources on, 13, 34 

steps to ethical decisionmaking, 55 

supervision note admissibility in court 

proceedings, 28–29 

supervisor ethics, 17 

underlying assumptions, 13 

Evaluation of counselors and supervisors 

client input, 18 

counselor competency assessment (Tool 

14), 120–121

counselor evaluation of the supervisor

(Tool 13), 118–119 

documentation and, 28, 29, 96–97 

feedback issues, 18, 96, 118 

formal procedure for, 118 

formative, 18, 96–97, 118 

general areas of competence to assess, 118 

goals of, 96 

summative, 18, 97, 118 

timely basis for, 99 

Evidence­based practices

implementing an evidence­based practice

(vignette), 58–64 

integrated models of supervision and, 8 

integration with clinical supervision, 5, 6, 

87, 88–89

staff resistance to incorporating, 58–64

treatment­based supervision models 

and, 8 

F

Falvey, J.E. 

ethical and legal issue resource, 13 

Focused Risk Management Supervision 

System, 28, 98, 113 

standardized format for documentation of 

supervision, 33 

Feedback 

administrators and, 94, 96, 97 

direct observation and, 18, 21, 40 

importance of, 118 

live observation and, 24, 40 

Field reviewers, 143 

Focused Risk Management Supervision 

System 

description, 28, 98, 113 

Fong, M.L. 

diversity and cultural competence issues, 

91 

Formative evaluation of counselors 

description, 18, 118 

documentation of, 29 

focus of, 18, 96–97 

FoRMSS. See Focused Risk Management

Supervision System

G

Gatekeeper role of clinical supervisors 

ethical and legal issues and, 13 

importance of, 6 

managing problem staff, 20 

policies and procedures for dealing with 

unacceptable behavior by counselors, 

20, 41 

Glenn, E. 

standardized format for documentation of 

supervision, 33 

Gloria vignette 

implementing an evidence­based practice, 

58–64 

Goals of clinical supervision 

description, 17, 20, 24, 44, 51, 69, 87 

form for identifying (Tool 3), 105 

Goodyear, R.K. 

examples of work samples and peer 

assessments, 18 

qualities of a good model of clinical supervision, 9 

Greene, B. 

ethical and legal issue resource, 13 

Group clinical supervision 

description, 27 

as a means of engaging all staff in dialog, 

sharing ideas, and promoting team 

cohesion, 28 

Gutheil, T.G. 

ethical and legal issue resource, 13 

Index 151 
 

 

 

 

 

 

H

Health Insurance Portability and

Accountability Act

confidentiality and, 15, 90–91

HIPAA. See Health Insurance Portability and

Accountability Act

Holloway, E.

cultural issues in supervision, 12

Systems Model, 11

I

IC&RC. See International Certification and

Reciprocity Consortium

IDM. See Integrated Developmental Model of

supervision

IDPs. See Individual development plans

Implementing a clinical supervision system

administrators and, 92–99 

barriers to (Tool 2), 104 

supervisors and, 82–83 

Indirect observation

drawbacks to, 21

Individual development plans

as a basis for evaluation, 96

beginning discussion of, 44–51

elements of, 17, 122

implementing for each supervisee, 48

initial supervision sessions and, 29

for potential successors, 73

professional development plan (Tool 15),

122–123

for supervisors, 17–18, 99

Individual supervision

description, 27

Informed consent

description, 15, 106

importance of, 106

issues for administrators, 90

levels of, 15

live observation and, 22, 39

observation and/or taping of 

sessions, 21, 39 

supervision contract and, 15 

template for, 106–107 

Initial supervision sessions

checklist (Tool 9), 114–115

current risk management review (Tool

11), 116

documentation and recordkeeping,

113–117

goal of, 113

helpful practices, 29

individual development plans and, 29

learning environment of supervision and,

29

supervision content (Tool 10), 115

supervision note sample (Tool 10), 115

supervisory interview observations (Tool

12), 117

Integrated Developmental Model of supervision

description and key strategies, 8, 9

Integrated models of supervision

description and key strategies, 8

Intensive supervision

description, 27

International Certification and Reciprocity

Consortium

Role Delineation Study for Clinical

Supervisors, 107

J

Jaime. See Gloria vignette

Jan. See Bill vignette

Juanita vignette

maintaining focus on job performance,

64–69

K

Kadushin, A.

administrative tasks for clinical supervisors, 88

Kate vignette

promoting a counselor from within, 69–73

Kevin. See Kate vignette

L

Ladany, N.

administrative supervision/clinical supervision comparison, 89–90

supervisor­focused personal development

domain, 91

Larry. See Gloria vignette

Lease, S.H.

diversity and cultural competence 

issues, 91

Legal issues. See Ethical and legal issues

Liability

direct versus vicarious liability, 13–14, 90

issues for administrators, 90

152 Index
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

issues in supervisory vulnerability, 14 

“reasonable effort to supervise” and, 14 

Live observation 

description, 22 

disadvantages of, 23 

effectiveness of, 23 

feedback and, 24, 40 

guidelines for conducting, 23–24 

helping counselors and clients become 

comfortable with, 38 

intervening during the session, 23–24, 40 

one­way mirrors and, 22–23 

videotaping and, 22–23 

vignette on implementing, 35–44 

M

Maggie. See Kate vignette

Margie vignette

mentoring a successor, 73–77

McNeill, B.

Integrated Developmental Model of supervision, 8, 9 

Melissa. See Juanita vignette 

Mentor/role model role of clinical supervisors 

description, 4, 43, 75 

mentoring a successor (vignette), 73–77 

resources on mentorship, 77 

vignette illustrating, 35–44 

Methods and techniques of clinical supervision 

assessing, 89 

contextual issues, 30, 32, 101 

description, advantages, and disadvantages (figure), 30–32

implementing a new method of supervision (vignette), 35–44

introducing changes in clinical practices,

59–60

Methods of observation 

choice of method, 22 

direct, 6, 20–21, 28, 31, 35–44, 93, 94 

indirect, 21 

live, 22–24, 35–44 

recorded, 22, 35–44, 124–125, 126 

MI. See Motivational interviewing 

Michael E. Townsend Leadership Academy 

description and contact information, 77 

Microtraining. See Competency­based models 

of supervision 

Modalities of supervision 

group clinical supervision, 27 

individual supervision, 27 

intensive supervision, 27 

peer supervision, 27, 42–43, 94 

sample clinical supervision schedule (figure), 28 

triadic supervision, 27 

Models of clinical supervision. See also 

Evidence­based practices 

competency­based, 8 

cultural and diversity factors and, 8–9 

development of, 92 

developmental, 8 

identifying and selecting your model, 9 

integrated, 8 

introducing changes in clinical practices, 

59–60 

qualities of a good model, 9 

time management and, 26 

treatment­based, 8 

Monitoring performance

addressing personal issues that affect job

performance, 65–66 

behavioral contracting, 17 

burnout and compassion fatigue and, 

19–20, 26 

evaluation of counselors, 18, 96–97 

gatekeeping role and, 20 

individual development plan, 17–18 

maintaining focus on job performance 

(vignette), 64–69

Motivational interviewing. See also

Treatment­based supervision models 

implementing (vignette), 58–64 

staff resistance and, 42 

Multicultural Model of supervision 

description, 11 

Munson, C.E. 

administrative tasks for clinical supervisors, 88 

N

NASW. See National Association of Social 

Workers 

National Association of Social Workers 

ethical and legal guidelines, 106 

National Board for Certified Counselors, Inc. 

Code of Ethics, 106 

New supervisors 

building a leadership position, 69–73 

Index 153 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

guidelines for, 6–8 

implementing a new method of supervision and, 37 

promoting a counselor from within 

(vignette), 69–73 

qualities of an effective leadership style, 

71 

things a new supervisor should know, 7–8 

New York State Office of Alcoholism and 

Substance Abuse Services 

Clinical Supervision Vision Statement, 

135–137 

North Carolina Addiction Fellows Program 

description and contact information, 77 

O

Online classroom training programs 

list, 34 

Online counseling and supervision 

confidentiality issues, 15, 17 

P

Peer supervision 

advantages and disadvantages, 42–43 

description, 27 

developing a system for, 94 

Personal problems. See Stress 

Pope, K.S. 

ethical and legal issue resource, 13 

Powell, D.J. 

examples of work samples and peer 

assessments, 18 

qualities of a good model of clinical supervision, 9 

Practical issues 

balancing clinical and administrative 

functions, 26 

countertransference and, 25–26, 51–58, 

68 

distinguishing between supervision and 

therapy, 24–26, 65, 66 

documenting and recordkeeping issues, 

28–29 

finding the time to do clinical supervision, 

26–28

selecting a modality of supervision, 26–27

structuring the initial supervision 

sessions, 29 

transference and, 25, 51–58 

Prison settings 

videotaped supervision and, 22 

Professional development benefits of clinical 

supervision, 88, 99 

Professional development plan (Tool 15), 

122–123 

Program evaluation and research benefits of 

clinical supervision 

description, 88 

Psychodynamic psychotherapy. See 

Treatment­based supervision models 

R

Racism. See Diversity and cultural competence

Rationale for clinical supervision 

description, 3–4, 45, 78, 87 

providing, 37 

Reamer, F.G. 

ethical and legal issue resource, 13 

Reasonable effort to supervise 

importance of, 78 

liability issues, 14 

Recorded observation

audiotaped, 22, 124–126

videotaped, 22, 35–44, 124–126

Recordkeeping. See Documentation and

recordkeeping

Resources 

bibliography, 127–134 

competencies of clinical supervisors, 108 

counselor competency assessment, 122 

ethical and legal issues, 13, 34, 106 

for supervision, 34 

Risk management issues

current risk management review (Tool

11), 116 

documentation, 28, 33 

videotaped supervision and, 22 

Role playing method of supervision 

description, advantages, and disadvantages of, 32 

S

Serovick, J.M. 

standardized format for documentation of 

supervision, 33 

Sexual relationships. See Boundary issues; 

Dual relationships 

154 Index
 

 

 

 

SMART. See Specific, measurable, attainable,

realistic, and timely

Sonne, J.L.

ethical and legal issue resource, 13

South Carolina Addiction Fellows Program

description and contact information, 77

Specific, measurable, attainable, realistic, and

timely competency­based models of supervision and, 8

feedback and, 18

Spice, C. G., Jr.

triadic supervision, 27

Spice, W.H.

triadic supervision, 27

Staff resistant to supervision

working with, 7

Stakeholders meeting participants, 141

Stan vignette

addressing ethical standards, 51–58

Stoltenberg, C.D.

Integrated Developmental Model of supervision, 8, 9

Stress

addressing personal issues that affect job

performance, 65–66

helping counselors with, 19–20, 64–69

Substance abuse policy

sample policy (Tool 6), 108

Summative evaluation of counselors

description, 18, 97, 118

documentation of, 29

Supervision. See also Clinical supervision

definitions of, 3, 87

Supervision contracts

elements of, 50

informed consent and, 15

template (Tool 8), 111–112

uses for, 111

Supervision guidelines

clinical supervision policy and procedure

(Tool 7), 110–111

Supervisor ethics

standards for, 17

Supervisor self­examination

feelings toward counselors, 47, 50

questions for, 12–13, 47

resources, 34

Supervisor­supervisee alliance

countertransference issues, 25

cultural issues, 11, 13

defining and building the alliance

(vignette), 44–51

developing and maintaining a strong and

professional relationship, 73–77

dual relationships and boundary issues,

14–15, 51–58 

importance of, 4 

mentorship and, 74 

power issues, 13, 14, 18, 57, 91 

Systems Model of supervision

description, 11

T

Task­Oriented Model. See Competency­based

models of supervision

Teacher role of clinical supervisors, 4

Techniques of clinical supervision. See

Methods and techniques of clinical supervision

Time management

adding components of a supervision model

one at a time, 26–27

administrative tasks and, 33–34

plan for scheduling supervision, 27–28

questions about one’s priorities, 33–34

Time standard for clinical supervision

20:1 rule of client hours, 14, 27, 28, 30

Training programs

choosing a course on clinical supervision,

43

establishing a training plan and learning

goals, 95

online, 34, 43

Transference

examples of, 25

vignette, 51–58

Treatment­based supervision models

description and key strategies, 8

Triadic supervision

description, 27

V

Verbal reports

description, advantages, and disadvantages, 30

Verbatim reports

description, advantages, and disadvantages, 30

Index 155
Vicarious liability

administrators and, 90

confidentiality and, 15

description, 14

direct liability and, 13–14, 106

examples of negligence, 14

Videotaped supervision

confidentiality and, 39, 126

description, advantages, and disadvantages of, 22, 31

guidelines for, 22

implementing, 39

instructions for (Tool 17), 124–125

live observation and, 22–23

recording consent (Tool 19), 126

resistance to, 22, 42

risk­management issues, 22

vignette on implementing, 35–44

Vignettes

addressing ethical standards, 51–58

defining and building the supervisory

alliance, 44–51

establishing a new approach for clinical

supervision, 35–44

implementing an evidence­based practice,

58–64

maintaining focus on job performance,

64–69

making the case for clinical supervision to

administrators, 78–84

mentoring a successor, 73–77

promoting a counselor from within, 69–73

VTS. See Videotaped supervision

W

Walt vignette

implementing a new method of supervision, 35–44

Webcam method of supervision

description, advantages, and disadvantages of, 32

Williams, L.

standardized format for documentation of

supervision, 33

Work setting

benefits of clinical supervision, 88

problems and resources, 7

Written/file reviews

description, advantages, and disadvantages, 30

156 Index
                             

                           

                         

                                 

SAMHSA TIPs and Publications Based on TIPs

What Is a TIP?

Treatment Improvement Protocols (TIPs) are the products of a systematic and innovative process that brings together clinicians, 

researchers, program managers, policymakers, and other Federal and non­Federal experts to reach consensus on state­of­the­art 

treatment practices. TIPs are developed under the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) 

KnowledgeApplication Program (KAP) to improve the treatment capabilities of the Nation’s alcohol and drug abuse treatment service system. 

What Is a Quick Guide?

A Quick Guide clearly and concisely presents the primary information from a TIP in a pocket­sized booklet. Each Quick Guide is

divided into sections to help readers quickly locate relevant material. Some contain glossaries of terms or lists of resources. Page 

numbers from the original TIP are referenced so providers can refer back to the source document for more information.

What Are KAP Keys?

Also based on TIPs, KAP Keys are handy, durable tools. Keys may include assessment or screening in­struments, checklists, and

summaries of treatment phases. Printed on coated paper, each KAP Keys set is fastened together with a key ring and can be kept

within a treatment provider’s reach and consulted fre­quently. The Keys allow you, the busy clinician or program administrator, to

locate information easily and to use this information to enhance treatment services.

Ordering Information

Publications may be ordered or downloaded for free at http://store.samhsa.gov. To order over the phone, please call 

1­877­SAMHSA­7 (1­877­726­4727) (English and Español).

TIP 1    State Methadone Treatment Guidelines—Replaced by

TIP 43

TIP 2    Pregnant, Substance­Using Women—Replaced by

TIP 51

TIP 3    Screening and Assessment of Alcohol­ and Other

Drug­Abusing Adolescents—Replaced by TIP 31

TIP 4    Guidelines for the Treatment of Alcohol­ and Other

Drug­Abusing Adolescents—Replaced by TIP 32

TIP 5    Improving Treatment for Drug­Exposed Infants

TIP 6    Screening for Infectious Diseases Among Substance

Abusers—Archived

TIP 7    Screening and Assessment for Alcohol and Other

Drug Abuse Among Adults in the Criminal Justice 

System—Replaced by TIP 44 

TIP 8    Intensive Outpatient Treatment for Alcohol and

Other Drug Abuse—Replaced by TIPs 46 and 47

TIP 9    Assessment and Treatment of Patients With

Coexisting Mental Illness and Alcohol and Other

Drug Abuse—Replaced by TIP 42

TIP 10  Assessment and Treatment of Cocaine­ Abusing

Methadone­Maintained Patients—Replaced by TIP 43

TIP 11  Simple Screening Instruments for Outreach for

Alcohol and Other Drug Abuse and Infectious

Diseases—Replaced by TIP 53

TIP 12  Combining Substance Abuse Treatment With

Intermediate Sanctions for Adults in the Criminal

Justice System—Replaced by TIP 44

TIP 13  Role and Current Status of Patient Placement

Criteria in the Treatment of Substance Use

Disorders

             Quick Guide for Clinicians 

                Quick Guide for Administrators 

                KAP Keys for Clinicians

TIP 14  Developing State Outcomes Monitoring Systems for

Alcohol and Other Drug Abuse Treatment

TIP 15  Treatment for HIV­Infected Alcohol and Other Drug

Abusers—Replaced by TIP 37

TIP 16  Alcohol and Other Drug Screening of Hospitalized

Trauma Patients 

             Quick Guide for Clinicians 

                KAP Keys for Clinicians 

TIP 17  Planning for Alcohol and Other Drug Abuse

Treatment for Adults in the Criminal Justice

System—Replaced by TIP 44

TIP 18  The Tuberculosis Epidemic: Legal and Ethical Issues

for Alcohol and Other Drug Abuse Treatment

Providers—Archived

TIP 19  Detoxification From Alcohol and Other Drugs—

Replaced by TIP 45

TIP 20  Matching Treatment to Patient Needs in Opioid

Substitution Therapy—Replaced by TIP 43

TIP 21  Combining Alcohol and Other Drug Abuse

Treatment With Diversion for Juveniles in the

Justice System 

             Quick Guide for Clinicians and Administrators 

157
TIP 22  LAAM in the Treatment of Opiate Addiction—

Replaced by TIP 43

TIP 23  Treatment Drug Courts: Integrating Substance Abuse

Treatment With Legal Case Processing 

             Quick Guide for Administrators 

TIP 24  A Guide to Substance Abuse Services for Primary

Care Clinicians 

             Concise Desk Reference Guide 

                Quick Guide for Clinicians 

                KAP Keys for Clinicians 

TIP 25  Substance Abuse Treatment and Domestic Violence 

             Linking Substance Abuse Treatment and Domestic

Violence Services: A Guide for Treatment Providers 

                Linking Substance Abuse Treatment and Domestic

Violence Services: A Guide for Administrators 

                Quick Guide for Clinicians 

                KAP Keys for Clinicians 

TIP 26  Substance Abuse Among Older Adults 

             Substance Abuse Among Older Adults: A Guide for

Treatment Providers 

                Substance Abuse Among Older Adults: A Guide for

Social Service Providers 

                Substance Abuse Among Older Adults: Physician’s

Guide 

                Quick Guide for Clinicians 

                KAP Keys for Clinicians

TIP 27  Comprehensive Case Management for Substance

Abuse Treatment

             Case Management for Substance Abuse Treatment: A

Guide for Treatment Providers 

                Case Management for Substance Abuse Treatment: A

Guide for Administrators 

             Quick Guide for Clinicians 

                Quick Guide for Administrators 

TIP 28  Naltrexone and Alcoholism Treatment—Replaced by

TIP 49

TIP 29  Substance Use Disorder Treatment for People With

Physical and Cognitive Disabilities

             Quick Guide for Clinicians

                Quick Guide for Administrators 

                KAP Keys for Clinicians 

TIP 30  Continuity of Offender Treatment for Substance Use

Disorders From Institution to Community 

             Quick Guide for Clinicians

                KAP Keys for Clinicians 

TIP 31  Screening and Assessing Adolescents for Substance

Use Disorders

             See companion products for TIP 32.

TIP 32  Treatment of Adolescents With Substance Use

Disorders 

             Quick Guide for Clinicians 

                KAP Keys for Clinicians 

TIP 33  Treatment for Stimulant Use Disorders

             Quick Guide for Clinicians

                KAP Keys for Clinicians 

TIP 34  Brief Interventions and Brief Therapies for Substance

Abuse 

             Quick Guide for Clinicians 

                KAP Keys for Clinicians 

TIP 35  Enhancing Motivation for Change in Substance Abuse

Treatment

             Quick Guide for Clinicians 

                KAP Keys for Clinicians 

TIP 36  Substance Abuse Treatment for Persons With Child

Abuse and Neglect Issues

             Quick Guide for Clinicians 

                KAP Keys for Clinicians

                Helping Yourself Heal: A Recovering Woman’s Guide to

Coping With Childhood Abuse Issues 

                Also available in Spanish

                Helping Yourself Heal: A Recovering Man’s Guide to

Coping With the Effects of Childhood Abuse 

             Also available in Spanish

TIP 37  Substance Abuse Treatment for Persons With

HIV/AIDS

             Quick Guide for Clinicians

                KAP Keys for Clinicians 

                Drugs, Alcohol, and HIV/AIDS: A Consumer Guide 

                Also available in Spanish

                Drugs, Alcohol, and HIV/AIDS: A Consumer Guide for

African Americans

TIP 38  Integrating Substance Abuse Treatment and

Vocational Services

             Quick Guide for Clinicians 

                Quick Guide for Administrators 

                KAP Keys for Clinicians 

TIP 39  Substance Abuse Treatment and Family Therapy

             Quick Guide for Clinicians

                Quick Guide for Administrators

                Family Therapy Can Help: For People in Recovery

From Mental Illness or Addiction

158
TIP 40  Clinical Guidelines for the Use of Buprenorphine in

the Treatment of Opioid Addiction

             Quick Guide for Physicians 

                KAP Keys for Physicians 

TIP 41  Substance Abuse Treatment: Group Therapy

             Quick Guide for Clinicians 

TIP 42  Substance Abuse Treatment for Persons With CoOccurring Disorders

             Quick Guide for Clinicians 

             Quick Guide for Administrators 

                KAP Keys for Clinicians 

TIP 43  Medication­Assisted Treatment for Opioid Addiction

in Opioid Treatment Programs

             Quick Guide for Clinicians 

                KAP Keys for Clinicians 

TIP 44  Substance Abuse Treatment for Adults in the

Criminal Justice System

             Quick Guide for Clinicians

                KAP Keys for Clinicians 

TIP 45  Detoxification and Substance Abuse Treatment

             Quick Guide for Clinicians

                Quick Guide for Administrators

                KAP Keys for Clinicians 

TIP 46  Substance Abuse: Administrative Issues in

Outpatient Treatment

             Quick Guide for Administrators

TIP 47  Substance Abuse: Clinical Issues in Outpatient

Treatment

             Quick Guide for Clinicians 

                KAP Keys for Clinicians 

TIP 48  Managing Depressive Symptoms in Substance Abuse

Clients During Early Recovery

TIP 49  Incorporating Alcohol Pharmacotherapies Into

Medical Practice

             Quick Guide for Counselors 

                Quick Guide for Physicians 

             KAP Keys for Clinicians 

TIP 50  Addressing Suicidal Thoughts and Behaviors in

Substance Abuse Treatment

             Quick Guide for Clinicians 

                Quick Guide for Administrators 

TIP 51  Substance Abuse Treatment: Addressing the Specific

Needs of Women

             Quick Guide for Clinicians

                Quick Guide for Administrators 

TIP 52  Clinical Supervision and Professional Development

of the Substance Abuse Counselor

             Quick Guide for Clinical Supervisors

                Quick Guide for Administrators

TIP 53  Addressing Viral Hepatitis in People With Substance

Use Disorders

             Quick Guide for Clinicians and Administrators

             KAP Keys for Clinicians 

TIP 54  Managing Chronic Pain in Adults With or in

Recovery From Substance Use Disorders

             Quick Guide for Clinicians 

                KAP Keys for Clinicians

                You Can Manage Your Chronic Pain To Live a Good

Life: A Guide for People in Recovery From Mental

Illness or Addiction

TIP 55  Behavioral Health Services for People Who Are

Homeless

TIP 56  Addressing the Specific Behavioral Health Needs of

Men 

TIP 57  Trauma­Informed Care in Behavioral Health

Services 

TIP 58  Addressing Fetal Alcohol Spectrum Disorders

(FASD)

TIP 59  Improving Cultural Competence

159
Clinical Supervision and Professional

Development of 

the Substance Abuse Counselor

This TIP is divided into three parts that are bound and produced separately.

Clinical Supervision and Professional Development of the Substance Abuse Counselor, Part 1, is for clinical supervisors. It presents basic information about clinical supervision in the substance abuse treatment field. It covers the central principles of clinical supervision and guidelines for new supervisors,

including the functions of a clinical supervisor; developmental levels of counselors and clinical supervisors; cultural competence; ethical and legal issues such as direct and vicarious liability, dual relationships and boundary issues, informed consent, confidentiality, and supervisor ethics; monitoring clinical

performance of counselors; and practical issues such as balancing one’s clinical and administrative

duties, finding the time to do clinical supervision, documentation, and structuring clinical supervision

sessions. Chapter 2 of Part 1 presents the “how to” of clinical supervision and 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, and “how­to” descriptions of specific techniques

Clinical Supervision and Professional Development of the Substance Abuse Counselor: An

Implementation Guide for Administrators, Part 2 will help administrators understand the benefits and

rationale behind providing clinical supervision for their programs’ substance abuse counselors. It provides tools for making the tasks associated with implementing a clinical supervision system easier,

including 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; and providing professional development

for clinical supervisors.

Clinical Supervision and Professional Development of the Substance Abuse Counselor: A Review of the

Literature is for clinical supervisors, interested counselors, and administrators. It 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. Part 3 is available only online at http://store.samhsa.gov. 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Substance Abuse and Mental Health Services Administration 

Center for Substance Abuse Treatment 

HHS Publication No. (SMA) 14­4435

First Printed 2009

Revised 2014