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Handbook of Counselling Processes, Practice,…

Handbook of Counselling Processes, Practice, and Supervision: A Guide to…

by Ankwasiize Evarist

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Table of Contents
Introduction 6
Conceptualization of Supervision in Counselling Practice: 10
Counselling supervision techniques and models: 8
Professional Development in counselling supervision 23
Qualities of an effective Counsellor and supervisor 33
Qualities and characteristics of a client 78
Conclusion 79
Introduction 80
Conclusion 61
Introduction 62
Discussions of the implication of supervision on counselling professional development 62
Effectiveness of Case Supervision 62
Environmental determinisms in supervision 66
Conclusions 71
Recommendations 72
Suggested Areas for Further Research 74
General Conclusions 74
Introduction 75
Theoretical comprehension in counselling supervision 75
Professional Counselling Practice 109
Conclusion 113
Introduction 114
Mentoring 114
Coaching 116
Consultations 117
Conclusion 119
Introduction 120
Definitions of counselling 120
Importance of personal counselling 121
The Position of Different Theoretical Approaches on the Issue of Personal Therapy during Training 123
Application personal counselling to the supervisees’ development 126
Inhibiting Factors to Enter Personal Therapy for Trainees and Professionals 127
Counselling ethics to be aware of as one approaches personal counselling. 128
A Case of Personal Counselling in Entebbe- Uganda 128
Conclusion 134
Psychosocial Methodologies 136
Carkhuff’s Model of Counselling Process as Modified by J.M.Fuster 140
The Relating-Understanding-Changing (RUC) Counselling And Helping Process Model By Nelson-Jones 142
The Skilled-Helper Model: A Problem Management and Opportunity-Development Approach to Helping by Gerald Egan (2002:21) 144
Counselling Process by Ankwasiize 149
Conclusion 149
Introduction 151
Values inform principles. 151
Good quality of care 156
Misconduct 165
Treatment Planning For Individual Clients 166
Seligman (1996, 1998) Model of Treatment Plan in Counselling Process. 167
Six Category Interventions 168
Conclusion 170
Predicting a Satisfying Marriage 171
Premarital questionnaire 174
Identification and an Analysis of Family Systems Therapies 185
Eight Lenses of Family Systems Therapy 198
Unique family developmental stages 198
Family Life Cycle according to Carter and McGoldrick(1980) 200
The Family Life Cycle according Santrock, (1999) 201
The Marriage Checkup Questionnaire 203
Characteristics of a Dysfunctional Family 224
Family Techniques 225
Conclusion 228
Introduction 229
Substance abuse (Drug addiction) 229
Types of dependency on drugs 229
Factors that cause drug dependency 230
Stages of Drug Abuse 232
Developmental Stages in Alcoholism 233
Treatment for Drug Addict 234
Stages of the motivational interviewing process and the role of the counsellor at each stage 234
Factors that make the youth more vulnerable to abuse of drugs/substance. 235
Signs that could be indication that an adolescent may be abusing substance 235
Treatment Approaches and After Care Program 236
Twelve steps program 237
Promises 238
A Journey to New Recovery Self Quiz 238
Factors to consider in the choice of institutional treatment programs 239
Addiction and family therapy 239
Exercises 256
Introduction 257
Types of the Groups 257
Group (Goals) 257
Group Formation 257
Specific attitudes and behaviours that help a group leader 264
Specific attitudes and behaviours that hinder a group leader. 265
Group Therapies entail 266
Group Rules 267
Transcendence in Transactional Analysis during the Group Process 268
Role Functions in a Group 270
Group Leader’s Behaviour 273
Growth group process in counselling practices: A case of Uganda 274
Conclusion 280
Introduction 281
Types of Counselling in HIV/AIDS 282
Guidance for HIV counselling 284
HIV Pre-Test Counselling In A Group Setting 287
Giving Information about HIV/AIDS 291
Conducting HIV Post-Test Counselling 298

Introduction 308
What is stress? 309
Types of Stress 309
Sources of Stress in an Organization 310
Symptoms of stress 311
Proper stress coping mechanisms 313
Conflict 316
Ten Steps to Resolving Conflict 316
Causes of trauma 318
Signs and symptoms of trauma 319
Trauma recovery process: 321
Stages of child and adolescent Growth and Development 334
Five Perspectives of Human Development 334
Specific Protective Factors Associated with Successful Development 338
Bonding and Attachment 339
Determining attachment status: 340
Parenting theories 341
Child and adolescent therapies 344
Causes of suicidal tendencies 346
Symptoms 346
Management of suicide 347
Anger and Belief systems 348
Self Control Techniques to Anger 349
Anger and Hostility 351
How to Deal With Anger in One’s Self. 353
Anger Management Counselling 354
References 355
Addendum 1. Supervision Contract 375
Addendum 2. Group Supervision Contract 376
Addendum 3. Follow-Up Supervision Review Form 377
Addendum 4 Supervision Form 378
Addendum 5 Future Session Planning 379


In Uganda as it is to the rest of world, counselling supervision has become a necessity in the training of counsellors and continuous professional development of counsellors. To become an effective counsellor/professional practitioner does not necessarily mean to become an effective and competent supervisor (Bartlett, 1983; Holloway & Hosford, 1983; Leddick & Bernard, 1980). Specialized training in supervision is desirable and necessary as supervision is a distinct intervention that is different from counselling or clinical work, and supervisors have specific roles and goals and the ability to create a safe learning environment in which they can convey their counselling/clinical knowledge and skills in such ways that they can promote effectiveness and the professional identity of supervisees (Hess, 1986,1987; Loganbill, Hardy, & Delworth, 1982; Stoltenberg, 1981; Stoltenberg & Delworth, 1987- (International Society of Counselling and Clinical Supervisors (ISOCCS): Competency Standards, 2014).

The first part of this chapter illustrates about the concept of supervision, meaning, importance, forms, ethics and the process. The second part of the chapter gives how one can develop into a professional.

Definitions of Supervision
American Counselling Association: CODE OF ETHICS (2005) SECTION F and Uganda Counselling Association (UCA. 2004) No. D, designate that supervision is a requirement for one to be a professional counsellor.
Hess (1990) defined supervision as a quintessential interpersonal interaction with the general goal that one person (supervisor) meets another (supervisee) in order to make the latter more effective in helping people. Sitenda (2008), during the UCA 5th Conference for counsellors in Uganda at Hotel Africana Kampala called supervision a working alliance between supervisor and the counsellor in which the counsellor offers a relevant recordings of his/her work, reflect on it, receive feedback, and where appropriate offer guidance.
Some counsellors also use group supervision, in which several therapists confer on each other’s work, although ordinarily it is used in addition to individual supervision, rather than as a replacement. ("http://counsellingresource.com/supervision/index.html" surfed on 23 May 2009).
Hough (2006:291) Supervision refers to the practice of giving support, guidance and feedback to counsellors who work with clients. Supervision is in fact mandatory for all counsellors and trainees. Supervision is not a new idea for it has been in existence for very long time; Freud Sigmund the father of modern psychology and his followers supported one another in similar way.
Supervision is defined as a distinct intervention that is provided by a senior member of a profession to a junior member or members of that same profession (supervisees). This relationship is evaluative, extends over time, and has the simultaneous purposes of enhancing the professional functioning of the junior members, monitoring the quality of professional services offered to the clients he/she/they see(s) and, serving as a gatekeeper for those who are to enter the particular profession (Bernard & Goodyear, 1992:4). Matovu (2009) defined supervision as overseeing work for the purpose of keeping order and track, efficiency and effectiveness i.e. achieving objectives.
Supervisor –counsellors who are trained to oversee the professional clinical work of counsellors and counsellors-in-training and a counsellor is a trained and an accredited person who facilitates the other person (client) to cope or get solutions to life challenges.
Clifford, L., & Thorpe, S. (2007:77) defined supervision in a more comprehensive way as
“A formal process of professional support and learning, which enables individual practitioners to develop knowledge and competence, assume responsibility for their own practice and enhance consumer protection and safety of care in complex clinical situations. It is central to the process of learning and to the scope of expansion of practice and should be seen as a means of encouraging self-assessment and analytical and reflective skills (vision for the future 1993)”

Supervision thus is “Working alliance between two professionals where supervisees offer an account of their work, reflect on it, receive feedback and receive guidance if appropriate. The object of this alliance is to enable the worker to gain in ethical competency, confidence and creativity as to give the best possible service to clients”. Inskipp and Proctor (2001).

History of supervision
Hawkins and Shohet (2006:4) argued that there is an enormous upsurge in both Counselling and psychotherapy, and in Counselling and therapeutic approaches within many of the helping and people professions, that has brought in its wake the recognition that such work needs to be properly supervised. The need for skilled supervisors, good training in supervision and for theory and research in this area has increased much faster than the provision. There is also a dearth of theoretical papers and descriptive accounts by those practicing supervision. Only in 1980s did the British Association of Counselling start to look at the training and accreditation of supervisors and psychotherapy training institutes started to provide training courses in this crucial area of work.
In the United States, they have been concerned with this core area of practice for much longer but mostly centred on one particular model-namely developmental approach, Stoltenberg and Delworth (1987).
Holloway has done important work synthesizing American approaches to supervision and creating an integrated approach, Holloway (1995); Holloway and Carroll (1999).
Counselling is a relationship, a special form of communication, involving listening and in which one person helps another who is disatisfied with life, or with the loss of sense of direction or purpose. It is always at the request of the client as no one can be properly sent to counselling, Hough (2006), British Association of Counselling and Psychotherapy (2005).

Conceptualization of Supervision in Counselling Practice:
Figure 1.

Source: Ankwasiize (2009).

Re-conceptualization Supervision and Professional Development

Framing of supervision practice:
Case supervision modalities and counsellor Trainees’ Counselling Developmental level virtually affect each other and lead to professional effectiveness as illustrated in the figure below; therefore A B=C.

Figure 2.

Source; Ankwasiize (2009).

The Effectiveness of the Supervisory Process
According to Lewis A. Judith (2003: 313), the effectiveness of the supervisory process depends on the fit among the supervisors leadership style (the manner in which leaders interact with other people within an organization) Lewis (2003).The work to be accomplished and the supervisory relationship. Lewis (2003) argues that providing effective supervision requires supervisors to;
1. Offer appropriate levels of challenge, support, and structured guidance to supervisees (Bernard and Goodyear, 1992),
2. Stimulate workers ‘level of motivation (Lewis et al, 1991),
3. Foster the supervisee’s overall level of counselling skills (Rivas, 1998),
4. Address diversity, cultural dimensions within the process of supervision (Chen, 2001; D’Andrea and Daniel, 1996; Leong and Wegner, 1994),
5. Help supervisees integrate their personal and professional identities. (Bradley, 1989)
It is important for supervisors to know that everyone involved and to foster the supervisory experience in ways that foster everyone’s personal and professional development including their own.

Importance of supervision
Clifford, L., & Thorpe, S. (2007) came with importance of supervision and when it is effectively supervision provides an opportunity to:
1. Reflect upon working activities within an open and honest environment;
2. Consider future learning and development needs;
3. Discuss ways in which to continuously improve;
4. Identify and share good practice;
5. Take a step back and think creatively through a range of issues and problems;
6. Advocate peer support through peer supervision that can often be more effective than manager led supervision because of the risk of straying into disciplinary and performance management issues is taken away.

Roles and tasks of supervision
Proctor (Hawkins and Shohut, l989): describes three roles of supervision as Formative, which is educational, developing skill, and understanding.
Restorative this is the provision of a safe place for the professional to be restored, through expression of and a meeting of their needs.
Normative that considers structural component, monitoring and evaluating of work as well as normalizing best practice.
Proctor’s work does not elaborate on how these three supervision roles build effective counsellors. This same modality is quoted in Royal College of Nursing (2003) and this study explored this matter indicating how three supervision roles lead to effective counsellor trainees.

Seven Tasks of Supervision (Carroll, 1996):

Purpose of supervision
British Association of Counselling (1987) says that primary purpose of supervision is to protect the best interests of the client. It does not however, explain how this is to be done and how that primary purpose creates counsellor trainees professional development.

Goals of supervision
On effectiveness of case supervision Sitenda, (2008) in Uganda Counselling association Conference outlined goals of supervision as to; facilitate effective Counselling practices, develop or enhance professional skills, process the emotional reactions of supervisees to their work, ensure strong focus on ethical responses, challenge and stimulate new ideas and skills and facilitate delivery of quality Counselling services in accordance with professional standards.
These are the ideal expectations to be acquired as one receives quality supervision but this is not automatic acquisition and are acquired at different levels depending on circumstances of supervision, levels of training of supervisors and their personal endowments. It also depends on the personalities and life experiences of the clients.
Bradley (1989) and Carroll (1996) were quoted by Sitenda that they say counselling supervision facilitates personal and professional development of the counsellor (supervisee), develops counsellors’ competencies, promotes accountable Counselling and guidance services, and is for the welfare of the clients and the development of the counsellor.
Hough (2006) strongly believes that Supervision is a requirement for all counsellors, no matter their experiences. We may become hardened without realizing it, which will affect our work, we may get out of date and be encouraged to continue our professional development, we may become exploitative of our clients without realizing it.
It provides for counsellors an opportunity to explore the way they work, stand by and get different perspectives on their clients and the way they work on them, become more aware of the way they affect and are affected by their clients.

Jones (2000) shows that Supervised practical experience is the excellent way to develop helping skills. Trainees require good support and supervision especially when first assuming responsibility for clients. Experienced should help the less experienced and experienced may find it beneficial to have some supervision. Much of the quality of the supervised practical experience depends on the quality of supervision.
Jones argues that of all methods of supervising trainees’ practical work is listening and commenting on the cassette-recordings of their interviews. Without these, the supervisor is unable to focus on how the trainee responds to the client. Other possible elements of supervision including focusing on; trainees ability to operationalize problems; their intervention skills; their thoughts and feelings towards their clients and about their understanding and effectiveness within the institutional or agency context in which they work.
In short, the four goals of supervision are:
(1) to promote supervisee growth and development;
(2) to protect the welfare of the client;
(3) to monitor supervisee performance and to serve as a gatekeeper for the profession; and
(4) to empower the supervisee to self-supervise and carry out these goals as an independent professional.
(5) To promote the supervisee’s self-awareness and ability to recognize personal characteristics that could have a negative impact on the therapeutic relationship.

Goal may be impeded by an emphasis on the supervisor’s legal responsibilities and the threat of being sued. Concerns lead to the supervisor to become more directive and controlling. The overall purposes or goals of supervision as presented include; (a) facilitating supervisee personal and professional development, (b) promoting supervisee competency development, and (c) monitoring client care.

Queensland Health Practice Supervision Program for Mental Health Practitioners Practice Supervision Workbook – Supervisor (2008).

Counselling supervision practice:
a) How supervision practice works best in counselling setting.
1. When the team and the individuals involved understand and agree on the process
2. When supervision meetings are viewed as confidential meetings to discuss incidents and events, share practice and participate in an open and honest dialogue about what is currently happening within the workplace.
3. When participants are encouraged to develop skills in active listening and effective questioning in order to gain most benefit.
4. When the process of supervision is defined and followed in every meeting.
5. Each meeting should have beginning, middle, and end and should be recorded in a way that is agreed upon by participants.
6. When the method of evaluating the success of the process is agreed upon.
b) Case supervision in counselling practice.
Case supervision practice means that a counsellor or psychotherapist uses the services of another counsellor or psychotherapist to review their work with clients, their professional development, and often their personal development as well. (http://counsellingresource.com/supervision/index.htm surfed on 13th June 2009”).
Case supervision procedure: Due to the importance of supervision, there is a need to have a regular and if possible, a weekly presentation of a particular case by a counsellor trainee and the manner of selection remains the responsibility of the trainee.
In counselling practice, the type of supervision is modelled according to the need and time available. It can be based on dyad that is a counsellor –client. This can be a triad that is a counsellor-client, one or two observers. In the process, the supervisor chooses which type that will be of greater benefit to the students in supervision. As practitioner presents the case, the other members in the group supervision give an attentive ear and the keen observation especially to the client and avoid interrupting. Supervisees give their observations and critique. The critique takes into account the clients feelings and responses, which reflect the level of the skills of the counsellor trainees.

In the process, the supervisees will practice counselling skills and attitudes for accurate identification of the client’s problem presented by the client. For establishing accurate treatment or intervention, plan feelings are to be taken into account. Then the supervisees is checked on his/her skills of the writing up of the process notes/follow up notes etc when the presentation is ended.

Supervision process and stages:

Stage 1: Assessment
Assessing: Supervisee, Supervisor, Supervision Context, Roles and Responsibilities, Methods of Evaluation, Practicalities (such as. Availability)

Stage 2: Contracting
Practicalities, Management of Supervision, Roles, evaluation, Responsibilities, Appeals, Emergencies, Learning Goals

Stage 3: Engaging
Use of Time, Presentation/Methods of Supervision, Learning Needs of Supervisee, Level of Development, Parallel Process, External Influences, Focus of Supervision

Stage 4: Evaluation
Evaluating: Supervisee, Supervisor, Supervision Relationship, Attainment of Learning Goals, Organisational Context, Effectiveness of Supervision

Stage 5: Termination/Cessation
Overview and Review of Work, Review of Learning Goals, Future Directions, Professional Development Focus

Carroll (1996) identified five Stages of the Supervision Process that are designed to be a guide to the overall process of supervision.

Procedure of supervision and case write up in counselling practice

Case Write up Procedure during supervision involves the following:
1. General introduction
General background of the problem
Analysing the problem
 When did it start?
 How did it start?
 Who was involved?
 Where did it start?

2. Client’s Biodata
Biodata analysis by the use of NASATORIMER acronym AND HISTORY PROBLEM
NASATORIMER acronym of identifying problem (demographic data)
T=Tribe/ethnic group
M=Marital Status

3. Referral
Three types of referral:
i. Self referred
ii. Other referred
iii. Proactive referred (counsellor initiates dialogue)
4. Presenting and conceptualization of problem

5. Present difficulties and previous disorders.

6. History of the problem
Personal complaint
 Nature of concern
 Time of onset and circumstances surrounding inception of concern
 Accompanying symptoms
 History of concern
 Dynamics of concern (what seems to cause it to develop, change or abate)
 Secondary gains (any benefits from it-SWOT analysis)
 Previous treatment for concern or Past medical history (if any)
 Impact of concern on clients’ life style, activities, relationships, bodily functions and mood.
In looking at the history of the problem, the following causative factors are considered:
4 P’S
1. Precipitating factors
2. Predisposing factors
3. Perpetuating factors
4. Protecting factors
The above 4Ps are analyzed by assessing the client as a person, his/her place, problem at hand, and procedure of treatment. In other words the first 4Ps are analysed using the later 4Ps. All these (4X4) are looked at basing on three dimensions below:
1. Social,
2. Biological and
3. Psychological dimensions.
In analysing of the history of the problem, the past, Present and future are bought on board.
7. Family history (Family Constellations)
1. Background Data of family history
 Social origins and influences
 Economic origins and influences
 Ethnic origins and influences
 Genetic origins/historical patterns
 Significant crises and episodes
 Patterns of physical or emotional illness in family
2. Nature of family constellation
• Power structure of family
• Degree of closeness
• Family values
• Parenting styles
• Birth order and impact on client.
3. Relationships
 Paternal,
 Maternal,
 Siblings
 Spouse(s)
 Children
 Other significant relatives
4. Developmental History/level
i. Birth history
ii. Infant history
iii. Early Childhood(Preschool Years)
iv. Middle Childhood
v. Late Childhood/Puberty
vi. Adulthood
8. Medical history
• Past and current illness
• Medical treatments/nature and purpose
• Nature of hospitalisation
• Any treatment for emotional difficulties
9. Psychiatric history
10. Forensic history
11. Mental status examination (MSE)
• Appearance (groomed, clients’ presentability, age appropriate physiognomy, attitudes, facial disfigurement, anorexia. bulimia)
• Speech (rapid, slow, monotony, loud, mumbled, slurred, prosody, hesitant, pressured and whispered)
• Behaviour (mannerisms, agitated, tics, twitches, giat, combative, psychomotor agitation and akatisia-hyper-excited )
• Mood (expansive, appropriateness of mood expression, irritability, demanding, flirtatious (mood swings), and no emotional commitment).
• Affect (Labile, intense, rapid, depressive and switches)
• Perceptions (illusions, hallucinations, derealisation and depersonalization)
• Thoughts (tangentiality, circumstantialities, content (delusions, obsessions and paranoid), possession (insertions and broadcasting), orientation to the place, intelligence, interests and values )
• Cognitions (concentration, orientation of place and time, general knowledge, abstraction, memory, alertness and insight).
• Self regulation (managing one’s life and keeping appointments).
12. Identified and prioritized Problem
a. Clients Identified Problem (s)
i. Is it Physical?
ii. Is it Psychological/ Emotional?
iii. Is it Social/cultural/spiritual?
iv. Is it Economic/material?
v. Is it behavioural?
b. Prioritized problem

13. Goal setting (Goals are mutually agreeable by the counsellor and client, but implemented by the later).
Goals of the Sessions:
• Ultimate Goal
• Specific Sessions and Specific Goals. 1st,2rd,3rd,4th,5th,6th (specific goals)

14. Theoretical and therapeutic approaches
• Theory/theories Applied
• Synchronize with Specific Skill and Techniques.
15. Action/treatment plan
To make an intervention to address the Problem the following is needed
• Short Term Plans
• Medium Terms Plans
• Long Term Plans
16. Outcomes
 Worked or
 Did Not Work
17. Evaluations
Evaluate if the case and sessions were successful or unsuccessful and why?
• Session Evaluation
• Self as Counsellor (strength, weaknesses, opportunities, threats) this is called SWOT (= Strength, Weaknesses, Opportunities, Threats) analysis
• Client (SWOT)
• Challenges during the sessions (client and counsellor relationship)
• Strategies to overcome the challenges.
18. Way forward
• Is it on going?
• Comments and why
• Referral/termination
• Post session follow up
19. General conclusion.

It should be noted that writing a case entails following a counselling process incorporating counselling skills, techniques, attitudes and actual narrations from the client(s) (verbatim)
The above communication process leads to informed consent.
This process of educating clients begins in the initial session and continues to the duration of termination of counselling.
It is important for counselling to strike a balance between giving clients too much information and giving too little. The clients can be overwhelmed however if the counsellors go to much detail about the interventions they are likely to make.
Uninformed consent can easily be exploited by un-ethical counsellors.
Providing for informed consent tends to promote the active cooperation of the clients in the counselling plans.
Clients who feel desperate for help may unquestionably accept whatever their counsellors say or do. They seek for expertise from professional without realising that the success of this counselling relationship depends largely on their own investment in the process of counselling.

Presenting a Case for Supervision

Some frameworks for supervision and case study:

1. Identification
1.1 A first name only, gender, age/group/life stage
1.2 Family genogram
1.3 Your first impressions, physical appearance

2. Antecedents/Background Information
2.1 Contact (how the client came to see you eg, self referred)
2.2 Context/location (eg, agency, hospital clinic)
2.3 Pre contact information (what you know about the client, previous contacts)

3. Presenting Problem and Contract
3.1 Summary of client's presenting problem
3.2 Your initial assessment, duration of problem, precipitating factors (ie, why the client came at this point), current conflicts or issues
3.3 Contract (frequency, length and number of sessions, initial plan)

4. Questions for Supervision
4.1 Key question(s) or issues you want to discuss in supervision

5. Focus on Content
5.1 Client's account of problem situation:
(a) work
(b) relationships
(c) identity (self concept, feelings, attitudes about self)
5.2 Problem definition:
(a) client's view of present scenario
(b) how the client would like things to be/would like to happen
5.3 Assessment and reformulation (how you account for and explain the presenting problem):
(a) patterns, themes
(b) in what way are these things important to explore? What theoretical concepts/models or explanatory frameworks for assessments?
(c) what else which has not been mentioned might be important to explore? (any underlying issues or past problems).

5.4 Counselling plan:
(a) what direction or focus for future work?
(b) what are the criteria for change, theoretical frameworks and assumptions?
(c) review and/or formulation plan(s)

6. Focus on Process
6.1 Strategies and interventions
(a) what strategies and interventions have you used?
(b) what were you trying to achieve?
(c) effect on the client?
(d) generate alternative options
6.2 Relationships
(a) what was happening between you and the client? Describe relationship, reframe relationship
(b) what was happening within the client (transference)?
(c) what was happening within you (countertransference)?
(d) how has your relationship changed?
6.3 Evaluation
(a) review process
(b) consider alternative tasks and ways of implementing counselling plan

7. Focus on Parallel Process
7.1 What was happening between you and the supervisor?
7.2 Any parallels (thoughts, feelings, experiences)? Does what was going on in the supervisory relationship tell you anything about what was going on between you and the client?
Adapted from
C Feltham and W Dryden
Developing Counselling Supervision (1994)
Sage Publications

Preparation for Session

Ideas for Preparation

1. Set aside some time for reflection on professional development issues.

2. Develop a system for noting issues you want to raise in sessions (ie, a log book, diary).

3. Develop your own agenda to bring to each session.

4. Do the suggested preparation, such as, reading.

Counselling supervision techniques and models:
The models of supervision/approaches to supervision include the following: Psychotherapy based models of supervision, Developmental models of supervision, incorporating supervisee individual difference for effective supervision, Integrated process model of supervision, The seven-eyed supervisor model. The details of the other models can be found in (Queensland Health Practice Supervision Program for Mental Health Practitioners Practice Supervision Workbook - Supervisor, 2008).
However, this chapter emphasizes the seven-eyed supervisor model, because of its comprehensiveness in the counselling supervision process.

The 7 Eyed Model of supervision

The seven elements have equal supervisory importance. This model puts into consideration seven elements during the counselling process and supervision as depicted below:

Source: adapted from Inskipp and Proctor (2001)

Interventions used in the 7 eyed model is diagrammatically illustrated:

Critical Incidents
Career Tools Skills

Pace Techniques



Source: adapted from Inskipp and Proctor (2001)

The counsellor-client relationship as demonstrated in the 7 Eyed Model

The tape
Transference and Boundaries
Counter transference

Development Emotions


Source: adapted from Inskipp and Proctor (2001)

The counsellor as described in the 7 Eyed Model of supervision

Training Issues

Counter Transference Theories

Feelings and images

Source: adapted from Inskipp and Proctor (2001)

The systems as applied in the 7 Eyed Model of supervision

Discrimination and Power

Clients organization

Race Client’s family

Culture Your Organization
Your Profession

Source: adapted from Inskipp and Proctor (2001)

The seven eyed model is applied in counselling supervision, practices and processes as demonstrated in these elements; the client, intervention, counsellor-client relationship, the counsellor, supervisor-supervisee relationship, the supervisor and the systems. This is a well integrated model that places both the supervisor/counsellor and supervisee/client at a therapeutically liberating level in the interpersonal relationship. The seven eyed model is connected to the clear supervision model.

The Clear Supervision Model
As put forward by Hawkins and Shohet (2003:61) in their book, CLEAR model is essential and is applicable to counselling practice.

 Contact and rapport building
 Establishing the clients desired outcome
 Understanding needs to be covered
 The process
 Agreeing on basic ground rules or roles.
 Using active listening and catalytic interventions
 Understanding the situation that affects a difference
 Listen to themselves fully
 Questioning
 Reflection
 Generation of new insight and awareness
 Create different options
 Way forward
 Next steps
 Do fast forward rehearsal to enact the first step alive in the room
 Actions that have been agreed
 Feedback
 Motivation
 Projection for future
1. Rapport and Relationship building = Contract;
2. Exploratory stage= Listen
3. Understanding stage= Explore
4. Option/Goal setting stage= Action
5. Termination and post Counselling issues= Review
A Supervisee is a professional counsellor or counsellor-in-training whose counselling work or clinical skill development is being overseen in a formal supervisory relationship by a qualified trained professional.
Case Supervision Modalities
Oxford Advanced Learner’s Dictionary (2006) defines Modality as a particular way, in which something exists, is experienced or is done.

Medieval developmental model
The medieval developmental model is so far the most frequently referred to as developmental stage models (htt://www.infed.org/biblio/functions-of-supervision.htm surfed on 28th April 2009). A supervisee as the Apprentice, a journeyman, artisan, is an independent Craftsman and as master artisan.
This model does not show if counsellor trainees have by necessity to pass through all the above stages before they finally reach stage four and it does not take into considerations the expertise of the supervisor and the motivation of the supervisees.

Forms of supervision
Hough (2006:294),Falender & Shafranske (2004) give different forms of supervision and these include; Individual supervision, Group supervision, Peer group supervision, these are important forms of supervision which can be applied in counselling supervision processes.
Jones. N.R. (2000:253) argues that on the issue of supervision model illustrates that Options differ about whether supervision is best done with just one person at the time, in twos, in threes or with even larger numbers.
Reasons for keeping supervision on an individual basis include the possibility that trainees explore themselves as helpers more deeply on one to one basis. Reasons for supervising groups of twos, threes or more include making it possible for trainees both to comment on the others work and to learn from each other. In addition, there are the obvious reasons of economy and practicability if there is a shortage of the supervisors.
For practising helpers, in peer supervision one facilitates, confronts and learns from each other. Co-Counselling is one model of Peer supervision and Peer supervision groups are another model of peer supervision.

Three stage processes of supervision
D’Andrea (1989) outlined a comprehensive theory of supervision that one can use in a variety of settings based on the person process model of supervision as, supervisee’s level of psychological development, motivation, and the stage of supervision (D’Andrea, 1989).
Using Loevinger’s (1979) the theory of ego development as a guide, D’Andre (1989) discusses ways supervisors can determine the development stage of each supervisee and design specific strategies that effectively match this stage. In doing so, supervisors can more effectively stimulate their supervisee’s personal and professional growth (D’Andrea, 1989).
Supervision normally proceeds through a set of predicable stages (Bernard and Goodyear, 1992; D’Andrea, 1989; Glatthon, 1990). Several researchers have noted that supervision generally involves three stage processes (Lewis et al; Rivas, 1998). These three stages are analyzed below:
1. Working relationships established between the supervisor and the supervisee. During this initial stage, the supervisor serves as a counsellor, teacher, and mentor. This stage involves active involvement by the supervisor, who takes the lead in negotiating the supervisee about the goals and the objectives to be accomplished in supervision.
2. Take more initiative and responsibility
In the second stage, the supervisees are encouraged to take more initiative and responsibility in setting work related goals. Supervisors are like consultants; provide less structure, they continue to offer information and support to the supervisees. This fosters a great sense of personal confidence as the supervisees strive to heighten his or her professional competence.
3. Help supervisees develop skill
The goal of the final stage is to help supervisees develop skill that will allow them to meet future challenges on their own, particularly to monitor and supervise themselves effectively (Lewis et al 2001) Thus, in the final stage supervisees develop a mature sense of their own professional identity, growing confident about working effectively and autonomously. Lewis et al (1991) pointed out that autonomy does not mean isolation (pg. 219)

Methods of Supervision
The most important element in the supervisory process is the kind of person the supervisor is. Supervisors need to create a collaborative relationship that encourages trainees to reflect on what they are doing. The methods of supervision include:
• Verbal exchange and direct observation are the most commonly used forms of supervision.
• Self-report is one of the most widely used methods, but it may be the least useful.
• Process notes build on the self-report by adding a written record explaining the content of the session and the interactional processes.
• Audiotapes are a widely used procedure that yields direct and useful information about the supervisee.
• Videotape recording allows for an assessment of the subtleties of the interaction between the supervisee and the client.
• Live supervision provides the most accurate information about the therapy session.
Styles of Supervision
1. Autonomy promotion style: Supervisors try to promote autonomy without overwhelming supervisees.
2. Socratic style: Socratic supervisors function as a catalyst for exploration to help trainees realize that the answers lie within themselves.
3. Interpersonal style: Although the trainee’s ability to assess and treat a client’s problems is important, in supervision, we are MORE concerned with the interpersonal aspects that are emerging.
The style of the supervisor is usually detected based on the Supervisory Styles Inventory (SSI).

Factor Domains of the Supervisory Styles Inventory (SSI)
Task-Oriented Attractive Interpersonally
Goal Oriented Warm Invested
Explicit Trusting Resourceful
Practical Open Committed
Structured Friendly Perceptive
Evaluative Flexible Intuitive
Prescriptive Positive Creative
Didactic Supportive Therapeutic
Thorough Reflective
Source: adapted from Queensland Health Practice Supervision Program for Mental Health Practitioners Practice Supervision Workbook – Supervisor (2008).

In summary, supervisory style, as operationalised by the SSI, is crucial to the development and ongoing maintenance of an effective supervisory relationship. Supervision research

Multi-cultural supervision
These stages and the effectiveness they create in counsellor trainees depends on the considerations of the multi- cultural aspects. Multi-cultural supervision serves several goals similar to those of counselling in general.
These goals include; providing an environment and set of experiences that facilitate the supervisee’s personal and professional development, fostering the development of more effective counselling and consultation skills, increasing overall accountability for the quality of counselling services clients receive (Bradley, 1989; Chen, 2001).
In addition, multicultural supervision aims at addressing the specific ways supervisors’, supervisee’, and clients’ cultural backgrounds and levels of ethnic/racial identity development affect both counselling and supervision D’Andrea and Daniels, (1996).

Dimensions of a good multicultural supervision model:
– pluralistic philosophy
– cultural knowledge
– consciousness raising
– experiential training
– contact with racial and ethnic minorities
– practicum or internship with culturally diverse populations
Ethics of Supervision
Association of Christian counsellors (ACC), Ethics and practice revised Dec. 2004 Bangor, Northern Ireland pg. 3 on good practice in Christian counselling, No. 4.1.1 states that Counsellors, trainers and supervisors must have regular supervision or consultative support for their work. They strongly encouraged managers, researchers, and providers of counselling skills to consider their professional needs and to obtain appropriate support for themselves.
ACC argues further in 4.1.2 that as essential part of maintaining good practice members should regularly evaluate the work they have done. They recommended that this evaluation should include feedback from colleagues, supervisors, managers as well as client satisfaction feedback. Responding openly and constructively to evaluation helps to maintain and enhance competent practice.
The evaluation that gives feed back from supervisors and colleagues indeed can act as a source of trainees’ effectiveness. In which aspects has this been given to the trainees in the under study and to the researcher’s population area and still on supervision in Members are exhorted to provide services with clients’ explicit consent, this will normally be in writing. It is best to avoid relying on implicit consent because it is prone to misunderstanding.
UCA’s position is in line with APA, BAC and ACC in terms of the counselling ethical conducts of the practitioner.

Legal Aspects of Supervision
Legal considerations include:
• informed consent
• confidentiality and its limits
• direct & vicarious liability.
Supervisors have a relationship with the trainee’s clients. Supervisees and their clients are fully informed about the limits of confidentiality, including those situations in which supervisors have a duty to warn or to protect. McCarthy et al., (1995) recommend addressing the following areas in a written informed consent document: purpose of supervision, professional disclosure statement, practical issues, supervision process, administrative issues, ethical and legal issues, and statement of purpose.
Supervisors are both ethically and legally vulnerable to the work performed by those they are supervising. The legal issues include both direct and vicarious liabilities:
Direct liability
• derelict in the supervision of their trainees
• if they give trainees inappropriate advice about treatment
• if they give tasks to trainees that exceed their competence
Vicarious liability
• the responsibilities supervisors have due to the actions of their supervisees.
Confidentiality in supervision
 Areas specified in practice supervision agreement
 Duty of care issues may be excepted (that is, unsatisfactory performance)
 Professional development goals and activities shared with line manager
 Any disclosure negotiated where possible
 Supervision requires atmosphere of mutual trust and safety

Informed Consent in Supervision
Welfel (2006:299) McCarthy, Kulakowski, and Kenfield (1994) identified specific topics that the supervisor ought to address in the informed consent process with trainees. Supervisees should be instructed first about the purpose of supervision –that is to foster their development as competent professionals and to protect the welfare of their clients. They have the right to know the qualifications, credentials, style, and theoretical orientation of the supervisor as consumers of the professional service. They should be briefed about the logistics of supervision-time, frequency, emergency, procedure, paperwork, and other demands imposed by licensing boards or internship requirements. Supervisees have the right to understand the process and procedures for supervision, including the roles, expectations, and responsibility of each person.
Supervisees should be instructed about the procedures of evaluating their performance, instruction on the ethical and legal issues in supervision and practice. The issue of having supervision done with a written consent is another crucial issue to be explored by the investigator to assess the effectiveness it has on the trainees because Welfel (2006:299) has not shown how it is done.
ACC 7.1 illustrates that those who provide supervision and management should provide appropriate training so that they are able to monitor and improve practice by members with the aim of protecting clients from incompetent practice.
7.3.3 Concludes that all counsellors, supervisors and trainers must receive supervision.
10.1.3 Members should discuss with the supervisor, manager and other experienced practitioners any circumstances in which they may have made errors in their work to ensure that they have taken appropriate steps to minimize harm and prevent those errors taking place again.

Rights of Supervisees

1. Supervisory sessions free from distractions
2. To be fully informed of supervisor’s approach
3. Confidentiality with regard to supervisee’s disclosure
4. Confidentiality with regard to clients except as mandated by law
5. Continual access to records maintained during supervision
6. To provide feedback to supervisors concerning supervision experience
7. To seek consultation from other professional as necessary
All the above areas about supervision as highlighted by Association of Christian counsellors need to explore and to investigate how they contribute to the counsellor’s effectiveness.

Competence to supervise
Modelling responsible behaviour by Welfel, (2006) focuses on Competence to supervise. She quoted The Association for Counsellors Education and Supervision (ACES) standards for counselling supervision (1990).It elaborates in great detail the characteristics and competences of effective supervisors.
In a way, they provide a road map for professionals who want to asses their supervisory competence as counsellors themselves, including skills in assessment and intervention case conceptualization and case management, record keeping, and evaluation of counselling outcomes.
The focus goes on to the Attitude and traits consistent with the role, such as
sensitivity to individual differences, motivation, commitment to supervision, and comfort with authority accompanying that role, familiarity with the ethical, legal, and regulatory dimensions of supervision, knowledge of the professional and personal facets of the supervisory relationship and the impact of the supervision on the supervisee.
It further contends that understanding of the methods and techniques of supervision, appreciation of the process of counsellor development and its unfolding in supervision, capacity to evaluate a supervisee’s counselling performance fairly and accurately. To provide constructive feed back and the grasp of the rapidly expanding body of theory and research on counsellor supervision are needed (A.C.A SECTION F A.P.A SECTION 2.05).
For A.C.A SECTION C.6. Addresses sensible use of supervisory power while A.P.A SECTION 3.04. Illustrates how at all costs clients ought to be protected from any harm. Hence, the power of counsellor’s supervisors or psychologists should minimize harm where it is foreseeable and avoidable.
Kurpius, Gibson, Lewis and Corbet (1991) assert that supervisors who foster unhealthy dependency on them are misusing their power. The goal of supervision is not to have the supervisee delay all judgments to the supervisor; it is to help the supervisee develop the skills, judgments, and confidence to accurately discriminate when to work independently and when to seek assistance.
The researcher agrees with Welfel, (2006) that the number of supervisees depends on the several factors; as the clinical and supervisory experience and competence of the supervisor, the experience and competence of the supervisee, time available for supervision activities, the nature of client population served, and the existence of any state law/regulations stipulating a maximum number of supervisees. The researcher believes that these have an impact on professional development of counsellor trainee.

Documentation in supervision
Other scholars have recommended the documenting each supervisory session, both to improve evaluation of supervisees and to monitor the care given to the clients (Falender and Shafranske 2004; Harrar, Vander Creek, and Knapp, 1990).
The content of documents should include five items; date and time for the meeting, a listing of the cases discussed, notes about client progress, recommendations to the supervise, issues for follow-up in future meetings. The investigator sees this as a professional way of working and a basis of effectiveness.
The supervisor is also obligated to avoid actions that reflect gender, ethnic, age religious, or sexual orientation bias as seen in ACA SECTION. F.2.b.and Supervisors also need to be aware of the ways in which other personal beliefs and values may affect the supervisory process. The responsibility closely parallels the counsellor’s duty with clients (A.C.A .SECTION .A.4 and A.P.A. Principle A).

Beliefs and Values in Supervision
When faced with issues of beliefs and values, supervisors should try to find if this belief or value is relevant to professional behaviour, if they are treating supervisees or their clients unfairly by their actions, if they are fostering growth of the supervisees by this action, would objective colleague be likely to come to the same conclusion? What alternatives to the course of action under consideration may better comply with professional standards? Will supervision or therapy assist one in meeting ones obligations to the supervisee? If they have already acted in inappropriate ways, how can they undo or minimize the harm that they have already done? Further more, supervisors have the responsibility to the welfare of their supervisee’s clients A.C.A Section F.1 and Boundaries in supervision (A.C.A. SECTION F.5.)

Benefit to Counsellors
The researcher supports Hough (2006:292)as she writes that supervision is of benefit to counsellors for a number of reasons like provision of a more objective view of the counsellors work, loss of confidence and’ burn out’ are less likely when supervision is regular. It gives the counsellor a clearer picture of transference/counter transference issues; it allows the counsellor to appraise the skills and approaches used with individual clients,
This provides support, guidance, encouragement and differing perspectives,
It is argued that in the past counsellors acted as supervisors but now this is not an applicable situation since supervision needs a formal training and is becoming a profession on its own right (Carroll, 2004).Thus finding a trained and competent supervisor lies on cooperation of trainees and trainers. This is a thorn in the flesh in Uganda where there are very few trained supervisors.

Relationship between Counsellor and Supervisor
The relationship between counsellor and supervisor needs to be based on trust and mutual respect if it is to work effectively. This means that supervisors should be prepared to discuss their qualifications, training and theoretical approach with their supervisees before work begins. All administrative and practical details of the supervisory contract should be open.

Aspects of Supervision
Supervision can be seen as having three aspects: administration (normative); education (formative) and support (restorative) as seen in Royal College of Nursing (2003).

Critique/Feedback during Supervision
During supervision, the counsellor trainees need to be conversant with the ways of delivering the feedback.
This can be based on:
1. Putting under consideration the demographics of age, sex, marital status, education level, occupation etc
2. Presenting problems
3. The level of rapport built
4. Type of questions and the rate of questions and relevance
5. Issues of confidentiality
6. Role of the counsellor
7. Congruence between the spoken and body language does the counsellor look congruent /real
8. Did the counsellor understand the real problem of the counselee
9. The level of motivation
10. level of self knowledge
11. Practical skills and attitudes
12. Self confidence demonstrated
13. How was the conclusion handled and how were the accomplishments summarised
14. The plan for the next sessions, if any
Supervision of counsellor is meant for the professional development

Providing Feedback

1. Structure sessions well (use contract).

2. Ask at the beginning what needs to be discussed /reviewed.

3. Allocate time well.

4. Keep a record of the supervision session (that is, material presented, feedback given, any requirements for next session).

5. Make the supervisee/counsellor do some introspective work before offering suggestions.

6. Be clear with feedback: only give advise if you think the supervisee will be able to follow through.

7. Ask for comments.

8. If repeated problems, explore why (review contract, tasks among others).
Giving Feedback

1. Review what health professional and supervisor is most pleased about.

2. a. If you notice other helpful attitudes or behaviours that were not mentioned, point these out (current).
b. Check out why, how and in what ways these were helpful or unhelpful to the client.

3. What would the health professional have liked to do differently? What else?

4. a. Point out potentially problematic attitudes or behaviours that are not mentioned by the health professional (future).
b. Check out why, how and in what ways these may be helpful or unhelpful to the client

Problems faced in supervision
In educational supervision, the primary problem of supervision according to Kadushin (1990) is worker ignorance and/or ineptitude regarding the knowledge, attitude and skills required to do the job. The primary goal is to dispel ignorance and upgrade skill.
The classic process involved with this task is to encourage reflection on, and exploration of the work. Supervisees may be helped to understand the client better; become more aware of their own reactions and responses to the client; understand the dynamics of how they and their client are interacting; look at how they intervened and the consequences of their interventions; Explore other ways of working with other clients in other similar client situations (Hawkins and Shohet 1989).
The work of Kadushin lacks practical ways on how knowledge, attitude and skills are required doing the job of Counselling.

Signs of Supervisor Impairment
1. Boundary violations
2. Misuse of power
3. Sexual contact with supervisees
4. Substance abuse
5. Extreme burnout
6. Diminished clinical judgment
Multiple Roles & Relationships in the Supervisory Process.
I. The crux of the issue of multiple-role relationships in the training and supervisory process is the potential for abuse of power.
II. Certain multiple relationships are unavoidable in most training programs.
III. It is misleading to confuse nonsexual dual or multiple relationships with unethical sexual relationships.
IV. Sexual intimacies during training:
• core issue is difference in power and status
V. Providing counselling for trainees:
• dual relationship standard of ethical conduct should be used

Professional Development in counselling supervision
Supervision is a consciously planned programme for the improvement and consolidation of instruction. This is to create professionalism. The profession is “a vocation requiring knowledge of some department of learning or Science.” A professional is one who follows “an occupation as a means of livelihood or gain,” or one who is “engaged in one of the learned professions.” The term profession thus refers to an occupation, vocation or high-status career, usually involving prolonged academic training, formal qualifications and membership of a professional or regulatory body. Professions involve the application of specialized knowledge of a subject, field, or science to fee-paying clientele. It is axiomatic that “professional activity involves systematic knowledge and proficiency.” Professional bodies may set examinations of competence, act as a licensing authority for practitioners, and enforce adherence to an ethical code of practice usually regulate professions (http:www.ed.gov/inits/teachers/development.html surfed on 16 October 2008):
Professions include, Nurses, Dentists, Physicians, Pharmacists, Lawyers, Accountants, Engineers, Teachers, Diplomats, Commissioned Officers, Professors, Clergy, Town and Transport Planners, Architects, Pilots, Physical Therapists, and Librarians.
Professionalism entails following the guidelines, rules, directives, and norms of a specific work by doing what is good and avoiding what is bad. Every profession has (in some form) a code of ethics. This code in some cases may be contained in long standing traditions, which have been accepted by profession.
Other professions, however, have their code of ethics in black and white so that it may be readily available to their members.
Further, the legal authority of the country protects some tenets of the code of ethics of some professions. For example in the U.S.A “Attorneys, Physicians, Surgeons, Priests or Ministers of the Gospel may not testify against persons with respect to information originating within the context of confidential professional relationship except upon waiver by the person involved. This continues to create confidence in these people. Fuster (2006).
Formation of a Profession
A profession arises when any trade or occupation transforms itself through the development of formal qualifications based upon education and examinations, the emergence of regulatory bodies with powers to admit and discipline members, and some degree of monopoly rights.
Regulation enforced by statute distinguishes a profession from other occupations represented by trade groups who aspire to professional status for their members. In all countries, professions have their regulatory or professional bodies, whose function is to define, promote, oversee, support and regulate the affairs of its members. For some professions there may be several such bodies.
Professions tend to be autonomous, which means they have a high degree of control of their own affairs: professionals are autonomous insofar as they can make independent judgments about their work. This usually, means the freedom to exercise their professional judgment However, it has other meanings. Professional autonomy is often described as a claim of professionals that hajs to serve primarily their own interests. This professional autonomy can only be maintained if members of the profession subject their activities and decisions to a critical evaluation by other members of the profession, the concept of autonomy can therefore be seen to embrace not only judgment, but also self-interest and a continuous process of critical evaluation of ethics and procedures from within the profession itself.
Status and Prestige
Professions enjoy a high social status, regard and esteem conferred upon them by society. This high esteem arises primarily from the higher social function of their work, which is regarded as vital to society as a whole and thus of having a special and valuable nature. All professions involve technical, specialized and highly skilled work often referred to as professional expertise. Training for this work involves obtaining degrees and professional qualifications without which entry to the profession is barred (occupational closure). Training also requires regular updating of skills through continuing education.
All professions have power. This power is used to control its own members, and also its area of expertise and interests. A profession tends to dominate, police and protect its area of expertise and the conduct of its members, and exercises a dominating influence over its entire field which means that professions can act monopolist, rebuffing competition from ancillary trades and occupations, as well as subordinating
  Ankwasiize.Evarist | Jun 27, 2016 |
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