In the fall of 2009, the Center for Substance Abuse Treatment (CSAT) will issue a new Treatment Improve­ment Protocol (TIP) on clinical supervision. I was honored to chair a panel of experts in the writing and development of the TIP and I wanted to inform you of this important contribution to the literature in the alcohol and drug abuse field.

Like the other new TIPs, this one is stocked with vignettes of clinical supervision scenarios with master supervisory notes and practical issues that supervisors face. It is intended as a toolkit for management, supervisors and counselors to understand, design and implement a clinical supervision system in the behavioral health care field. 

The first section of the TIP is a “how-to” guide for clinical supervisors. After a brief introduction, the TIP provides:
• three commonly accepted definitions  of clinical supervision in the behavioral health field;
• a rationale for supervision to justify the expenditure of time and funds (in times of tight funding, it is important to have a rationale and justification for supervision);
• the functions and roles of a clinical supervisor, reflecting the competencies outlined in TIP 21A for supervisors;
• ethical and legal issues, including vicarious liability, dual relationships, boundary issues and confidentiality;
• models of supervision, with an emphasis on the Blended Model of Supervision designed for the alcohol and drug abuse field;
• monitoring counselor performance, including how to evaluate staff’s skills, writing an Individual Development Plan (IDP), behavioral contracting in supervision, getting to know your new supervisees, gatekeeping functions in supervision, and the boundary between supervision and therapy;
• balancing clinical and administrative functions (As most supervisors in the substance abuse field wear two hats (administrative and clinical supervisors), it is helpful to know what hat you are wearing at what time. This includes issues such as finding the time to do clinical supervision, and documentation of supervision.);
• how-tos and tips for supervisors, such as how to structure the first few supervision sessions, methods of observations of counselors “in action,” the use of the sociogram  and the developmental stages of counselors;
• contextual and cultural issues in supervision, including gender, race, corporate structure, types of treatment agencies, recovering vs. non-recovering counselors, degrees and academic backgrounds of staff and other cultural variables;
• guidelines for new supervisors, what to do in the first few days, after you realize you’ve been given the job of a clinical supervisor (This is under the sub-title, “Oh no, what have I gotten myself into?”);
• problems in supervision and resources to assist in dealing with these issues, including how to work within a treatment system, working with resistant staff, and things a new supervisor needs to know;
• administrative supervision, such as documentation and time management;
• resources available for further study.

The second section is a series of vignettes and practical situations to guide the supervisor through real-life issues that arise. For example, how does a new supervisor deal with staff when he or she has been promoted from within, over people that have been peers? Also, how does one implement evidence-based practices, integrating them into his or her clinical supervision system? How does one deal with counselors who don’t think they need supervision? How does one supervise a fresh-out-of-graduate school counselor without any experience in the substance abuse field? How does one explain to management the difference between administrative and clinical supervision? How does one address a dual relationship between a counselor and a client, especially when the counselor does not see this as a problem?

These vignettes include case studies, master supervisory notes, how-tos and suggestions to address common, practical, everyday situations encountered by most supervisors at some point in their careers.

The next section is for program managers and administrators on what to expect in supervision and how to implement a clinical supervision system. The panel believes that it is essential to have the full support of management when implementing a system of clinical supervision. Therefore, considerable attention was given in the TIP to these issues:
• Benefits and rationale for clinical ­supervision
• Key administrative issues for managers related to clinical supervision
• How to implement a clinical supervision system
• Legal and ethical concerns of management
• Differences between administrative and clinical supervision
• Designing and developing a model for supervision
• Phasing in a supervision system
• Documentation and record keeping for supervision and management
• Evaluating personnel
• Supporting supervisors in an agency so they can best do their job
• Training and development of supervisors
• Resources for management

The final section of the TIP is a series on resources available for further study, including online documentation, reading and resource materials. Special thanks are due to Susan Kimner, Bruce Carruth and Janet Humphrey of CDM Group for their outstanding role in parenting the TIP, and to CSAT for their ongoing contribution to improving the quality of services in the substance abuse field.

The TIP is designed for supervisors, supervisors-to-be, management and administration. It is a valuable addition to an organization’s library and a useful tool for managers and supervisors on how to design a sound clinical supervision system. For further information contact www.csat.gov or David Powell at
This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

David J. Powell, PhD, President, International Center for Health Concerns, Inc., is an internationally recognized lecturer, trainer and author. David has played a significant role in the develop­ment and operations of the Oya Bahadir Yuksel Rehabilitation Center.

This article is published in Counselor, The Magazine for Addiction Professionals, October 2009, v.10, n.5, pp.20-21.

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Henry C. Parks  - Substance abuse program supervisor   |71.0.151.xxx |2010-02-06 13:11:29 Dr. Powell, I have concerns about the use of learning labs to replace clinical supervision. I have attended several of you clinical supervision sessions in Wilmington, North Carolina and Chapel Hill, North Carolina. I have seen great progress with the counselors I provide clinical supervision. It appears to me that similations is replacing observation. Could help me with this. Am I just being rebellious? What are your thoughts on removing observation from clinical supervision? Reply 0   0

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