It seems that what passes for clinical supervision in substance treatment today runs the gamut from administrative oversight and case management to an “involved” type of supervision such as live or in vivo, where supervision is done in the presence of a patient. When I conduct workshops on clinical supervision, I often begin by having participants give their definitions of clinical supervision, and I continue to be amazed at how many are still defining supervision at the “oversight” end of the continuum.

Lack of consistency and availability
Although training programs and credentialing opportunities are plentiful, a lack of consistency in preparing counselors for the profession continues. There also seems to be a dearth of training opportunities for senior-level counselors. Our field must develop and support training opportunities for counselors of all levels. This was supported by the Center for Substance Abuse Treatment (CSAT) in their National Treatment Plan initiative: “Such a career ladder provides a protocol for basic and continuing education and training, encourages development of supervisory and program management skills, and, potentially, would improve staff retention by providing a clear career path for the workforce,” (CSAT, 2000, p. 140). This important initiative also supports the notion that the substance abuse treatment workforce of the future must be grounded in training, clinical supervision, and a process for credentialing that is research-based while focusing on the complex and evolving needs of patients.

Consistent and need-driven supervision of substance abuse counselors requires a tutorial relationship between two individuals with a primary goal of fostering professional growth while maintaining and enhancing quality client care. The supervisory needs of each counselor are assessed and met with a developmental plan that is a need-based fit for each counselor. Unfortunately, this type of assessment and planning are rare, but when they occur a supervisory alliance is formed. This alliance is often built through live supervision, at the “involved” end of the supervisory spectrum, and has the potential for being growth-enhancing for both the counselor and the patient.

I recently completed a research study that measured self-efficacy of addiction counselors against two independent variables: whether they received live supervision and their level of development as a counselor. By using an instrument that measures five dimensions of counseling activity, results indicated that for two of those dimensions, the development of micro skills and the ability to deal with difficult client behavior, self efficacy is significantly higher for those who receive live supervision. The study also demonstrated positive change in self-efficacy as counselors develop and that the development is enhanced even more significantly for those who receive live supervision.

Numerous factors contribute to self-efficacy, but the environmental influence can be significant. One of the most notable environmental influences is the supervisory relationship — a dyad that creates a shared efficacy when collaboration is strong. This collaboration is often enhanced through modeling by the supervisor when the counselor and the supervisor are working side-by-side in a counseling session. Modeling, considered a form of live supervision, places the supervisor and counselor in a collaborative position. By working together with the patient, a synergistic influence occurs, providing growth for both parties while giving the supervisee an opportunity to observe interventions made by the supervisor.

In order to provide our counselors with the type of supervision I describe here, we must provide for them the career ladder proposed by CSAT. This comprises affordable, meaningful, and effective training for counselors at all levels including training for those who are to become the mentors and clinical supervisors of the future. We must keep and groom today’s entry-level counselors in order to continue our advances as a field and as a profession.

I am in no way suggesting that we abandon our roots that are grounded in the successes of self-help groups and twelve-step programs. After all, the best thing we can offer our patients is a pathway to follow in pursuit of their own self-help. However, to skillfully and ethically guide them to that path, treatment programs must offer a professional counseling staff that is equipped with proper training, experience and professional guidance. The latter can only come from those who have the experience and training to develop an effective working relationship marked by a willingness to join with each counselor in the provision of mentoring and tutorial learning.

Supervision is an educational growth experience and is most effective when marked by a strong supervisory alliance. It is a relationship at the “involved” end of the spectrum, far from the task of case management. Involved supervisors, such as those who provide live supervision, present an opportunity for two individuals to collaborate toward professional development and patient care. For many, this will evolve into an effective supervisory dyad that offers the counselor an opportunity for increased motivation and skill enhancement.

Some may question the financial viability of this level of involvement in clinical supervision. However, for states that have licensure for substance abuse counselors, “involved” supervision is expected, if not required, for licensure. As I stated above, credentialing, continuing education, and clinical supervision are at the vanguard of a significant crusade that must be pursued if we are to maintain our position as the profession best qualified to treat addicted patients. Treatment programs must recognize the importance of making supervision by qualified professionals available to all clinical staff members. The future of our profession may be at stake.

Thomas G. Durham, PhD, LADC, is Project Director of the Clinical Preceptorship Program at Danya International (www.danya.com) where he coordinates a worldwide program of clinical supervision to drug and alcohol counselors in the U.S. Navy and Marine Corps. As a certified clinical supervisor, he frequently conducts training workshops and is an adjunct faculty member at Tunxis Community College in Connecticut, where he teaches courses in counseling. He can be reached at This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

Reference
Center for Substance Abuse Treatment. (2000). Changing the conversation. Washington: Substance Abuse and Mental Health Administration.

This article is published in Counselor,The Magazine for Addiction Professionals, August 2003, v.4, n.4, pp. 44-45.

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