The case study highlights a case where the supervisee is working at a non profit counselling center in New York. The supervisee named T previously worked as a CASAC before she completed graduate school. She is female, married and Muslim by religion. “T” identifies with the Black race. Her performance has been marked with inconsistent attendance, tardiness and unreliability. She is academically qualified although she struggles to connect with her patients. She is also excessively aggressive and unresponsive to suggestions made as a result of supervision. Currently, due to some disagreements with one of her patient, “T” has opted that she has the patient transferred off her caseload terming the patient as not “ a good fit;”. When confronted by her supervisor about her drastic decision, “T” becomes very defensive and emotional.
Qn 1.
This supervision needs the application of both the psychotherapy based supervision models and the developmental models of supervision. The reason for choosing the psychotherapy based supervision models is because this case study requires extensive receiving of feedback as well as assisting in the relegation of duties. Moreover, this approach allows for the observation and collection of the existing clinical data for further discussion during supervision. In this case, as a supervisor, I need also need the clinical data from the patient so that I can come up with a viable solution. The specific psychotherapy model to use is cognitive behavioral supervision ( Smith, 2009). The developmental model of supervision is also applicable in “T”‘s case. This is because it traces the professional development of the supervisee from an elementary or novice level to an expert level ( Smith, 2009) . The stage of progress determines and excuses some behaviour such as a lack of confidence. This is relevant to “T” because she previously worked as a Credentialed Alcoholism and Substance Abuse Counselor (CASAC). It is therefore expected that there will be some level of growth or progress after graduate school (Bennett-Levy & Lee, 2014).
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The models deviate from my style of counselling. Usually the focus of my counselling is on person centered therapy. I often combine empathy with respect and acceptance in order to make the client feel at ease. This comfort makes it easy for the client to open up and the sessions often result to greater progress and effectiveness ( Smith, 2009) . However, with “T” , the person centered approach will not work. She is already defensive and she views the supervision as an invasion. Her main interest is to use the supervision as a tool of convenience (Herbert & Caldwell, 2015). A case in point is where she uses a post supervision session to demand for the removal of her anxiety client. The cognitive behaviour therapy model is most suitable for her because it focuses on changing erratic or unusual behaviour into purposeful and important tasks. The developmental model will also assist to deal with “T”. It will help I the supervision role as it will be possible to illustrate that their is a mismatch between “T”‘s perception of her expertise and her actual expertise. Differentiating between her 6 years as a CASAC will also need to be examined in its role to her current disposition (Stoltenberg et al., 2014).
Q2
“ T” the supervisee has a lot of untapped potential. Her career is just starting and she needs to focus her energy on positive outcomes. However, she needs to work on her work ethic as this is the most hosting gap between her education and her professional conduct. T does not respect supervision and she does not acknowledge any form of leadership. She is a law unto herself. The supervision process can be of help to her by applying cognitive behaviour therapy modelling. This more can can be used to channel the source of “T” 's thoughts and beliefs. The model is believed to be the key to behavioral problems as it explains the rationale behind the deviance (Stoltenberg et al., 2014).
One of the major changes that this model is expected to create is the following of laid down protocol. The behavior of “T” points to a lack of commitment to her job because she prioritizes her comfort over the needs of he patients. This may be partly influenced by her 6 years as a CASAC. The program may have been more flexibility than the current sessions where time lines must be adhered to. “T” must undergo a fresh job orientation that brings out the new job requirements clearly. This must include all the protocol that governs the billable hours that each patient patient is entitled to. This will eliminate the faulty thinking where “T” thinks that she is in charge of her operations (( Smith, 2009 ).
An additional misconception that will be adressed is the suitability or fit of a patient. The behavioral model will help “T” realize that their are no good or bad fits when it comes to patients (Herbert & Caldwell, 2015). The essence will be to come to a realisation that patients come from all sorts of backgrounds. “T” is resistant to the anxiety patient because he offends a part of her essence. He openly displays his loath for same sex relationships which “T” practices. This makes creates enmity between the them as she is convinced that this is a veiled personal attack. Instead of ending his sessions completely, she recommends group therapy. This is the wrong approach as it is an escape from the schizoaffective client (Stoltenberg et al., 2014). A better move would be to engage the client in issues he feels comfortable discussing. To avoid personal offense, she can also steer the conversation away from sexual orientation. Take home assignment will help in the development of between procedures in the management of unpleasant patients ( Smith, 2009) .
The next move will be to apply the integrative developmental model of supervision. This will take place by going through past files of “ T” . The successful points will be used to show her what her strengths are. The model will show how “ T” lacks a self appraisal mechanism. This reduces her confidence in applying the therapeutic interventions that she is theoretically familiar with. She is also unable to use her interpersonal skills to evaluate and put client issues into perspective ( Smith, 2009) . This is what leads her to wrongfully assigning of an anxiety patient to a group session. This was a self preservation move that can be conquered by accepting individual differences. The model will also present the professional requirements that show personal growth. This will motivate “T”‘ to her career. Finally, the model will be used to promote client actualization. “T” will be made to ensure that she evaluates a client wholistically. She will then take the client as a package that is shaped by experiences, past and present issues (Stoltenberg et al., 2014). This will help her learn to distance herself from personal offense as she will not take anything as an attack.
Q3
“ T” ‘s perception of her anxiety client seems to be directly related to counter interference. “T” is repulsed by his behaviour and by his impolite habit of interrupting while others speak. This irritation is not a new phenomenon as Freud described its usefulness in therapy. The schizoaffective patient has probably had a long history of being ignored by authority figures ( Smith, 2009) . He may then ignore “T” as his therapist as a form of transference. The therapist now becomes the source of his failures and she is treated with equal disdain. The therapist reacts with counter transference and she seeks a way out. “T” will be assisted during the supervision exercises to realise that she can channel counter transference (Bennett-Levy & Lee, 2014).
“ T” must first use counter transference as a self audit method. This is because the feelings are not always as a result of genuine transference. Once this is ruled out, “T” must decide to put aside her personal motives and feelings and do her job. The second option comes about if “T” realizes that the situation is actually counter transference. The realisation will help her to pick out aspects of the clients behaviour that may jeopardize the chances of successful relationships with others. Focus will now shift to establishing whether these provocations are conscious or are hidden in the subconscious. “T” will be required to develop a personal checklist based on the frequency of negative feelings experienced (Herbert & Caldwell, 2015). She will also need to go through her self analysis to determime whether the feeling originates from a subconscious trigger or from an obvious cause and effect situation.
From the series of evaluation carried out above, it is safe to conclude that the supervisee “T” must be supervised by extending the therapy. “T” seems to display some gaps in her personal growth that limit her performance on a professional level. Dealing with her personal inhibitions will be key to her developing a sound practice. The other reason to use therapeutic supervision is because the supervisee seems to be torn between her past occupation and her current role ( Smith, 2009) . This leads her to wrongefully ignore her training and rely more on her past experience. The developmental model of supervision will help to bridge the gap between training and practice. It will also correct the initial problems that lead most therapists to mistakes at the beginning (Herbert & Caldwell, 2015). The cognitive behaviour therapy model will help to correct misconceptions and help T to develop a self appraisal mechanism.
References
Bennett-Levy, J., & Lee, N. K. (2014). Self-practice and self-reflection in cognitive behaviour therapy training: what factors influence trainees’ engagement and experience of benefit? Behavioural and Cognitive Psychotherapy, 42 (1), 48-64.
Herbert, J. T., & Caldwell, T. A. (2015). Clinical supervision. Counseling theories and techniques for rehabilitation and mental health professionals, 2, 443-462.
Smith, L. Kendra. (2009). A BRIEF SUMMARY OF SUPERVISION MODELS .
Stoltenberg, C. D., Bailey, K. C., Cruzan, C. B., Hart, J. T., & Ukuku, U. (2014). The integrative developmental model of supervision. CE, Watkins, JrD. Milne, (Eds.), Wiley international handbook of clinical supervision, 576-597.
