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| What I’d Like to Know |
| Written by David J. Powell, PhD | ||||||||
| Tuesday, 22 July 2008 | ||||||||
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We don’t have an abundance of empirical research on clinical
supervision. Most of what is written, including my work, is anecdotal,
based on excellent experience but lacking in solid data. There are two
journals that publish research in supervision, the Clinical Supervisor,
and Counselor Education and Supervision, both of which have primarily
an academic focus, addressing counselor training issues. Both lack data
on supervision “in the real world of work” outside of the ivory tower
of academia or of “counselor in training” programs.
So, there remain many unanswered questions in clinical supervision, especially in the field of alcohol and drug abuse. Here are my top 10 things that I’d like to know and be certain of, based on solid empirical research. Top 10 1. Cost benefit analysis. What is the pay-off for organizations to invest in counselor training and supervision? We “know” — through our experience — the benefits of clinical supervision in staff retention and morale. However, I’d like to see data to support these assumptions. As a non-income generating activity, why should a program manager spend money for supervision? We see the value of supervision and have anecdotal evidence that supervision is worth the investment. However, I’d like to have research conducted that supports our experience of the value of supervision. 2. Client outcome. We speak about the isomorphic relationship between supervision and staff attitudes about their work. I see the evidence in the people I train that how a person feels about his or her work and agency will affect morale and ultimately, client outcome. I would like to have the data to show there is a relationship between quality clinical supervision, staff morale and how clients do in treatment. What is the nature of the parallel process between clinical supervision and these issues? 3. Empirical support for a conceptual framework for supervision. For decades I have written and spoken about the relevance of knowing your model of treatment and supervision. I’d like data to support that. We “know” from experience that the better run addiction treatment programs have a coherent, consistent model of treatment. What is the relationship between a theoretical model of counseling and supervision? Do certain models support the therapeutic and supervisory alliance more so than others? How can counselors apply fidelity to these models while still adapting the models to their unique settings? 4. Evidence-based practices and supervision. What approaches are needed so clinical supervision can best support the implementation of evidence-based practices (EBP)? The Northeast Addiction Technology Training Center (ATTC) has a training program on supervision and EBPs, as does the Mid-Atlantic ATTC on supervision and motivational interviewing. That’s good. But, all of the training done on this subject so far needs empirical research to demonstrate how to best prepare people to utilize EBPs. The training we’ve done so far has to answer these questions: how do we know good supervision is being done? How do we know if the supervisors and counselors know the EBP being taught? And ultimately, does it make a difference with improved client outcome, which is the bottom line of all of our training and supervision? 5. Supervision and client retention. Is there a relationship between improved clinical supervision and staff and client retention? Does supervision improve productivity of staff? Does it increase the units of service provided to clients? In a highly variable marketplace, with the constant ebb and flow of census, wouldn’t it be helpful if we knew what improved client retention in treatment, and perhaps if there is a relationship between staff training, supervision, and retention? 6. What makes a good supervisor? What are the qualities of a good supervision? What knowledge and skills are really needed to be an effective supervisor? TAP 21 and 21A spelled out the competencies of supervisors. How do we really know that these are the needed knowledge, skills, and attitudes to be an effective supervisor? What is, if there is any, the relationship between quality care and credentialing of supervisors? What makes a “bad supervisor?” What is ineffectual or even damaging to counselors and clients? 7. How do we best care for the caregiver? How do we assist counselors to overcome compassion fatigue? Outside of the myriad of lectures given (including my own) on compassion fatigue, do we really know how to best support staff? How do supervisors experience vicarious trauma themselves? How can supervisors aid counselors in addressing issues such as vicarious trauma? 8. Direct vs. indirect observation methods. What methods of observation are most preferred by the supervisor, counselor and client? What methods are most accurate in assessing counselor competency? 9. Changing scope of practice. What is the best means for a clinical supervisor to prepare counselors for an ever-changing scope of practice and compe- tency? Especially concerning co-occurring disorders? What does the field need to do to assist counselors gain these skills? 10. Training of supervisors. What is the most effective way to train clinical supervisors? This might seem like an odd question, especially since I have trained more than 10,000 clinical supervisors over 32 years. How do I assess the impact of this training on supervisors? Has it been effective? Is there a better way to train supervisors in the future? As I approach the end of my career, these are questions I’d like some ambitious graduate student to tackle. Some of these questions may be unanswerable, or at least difficult to assess and tease out all of the variables affecting outcome. However, as we move towards greater outcome measurement for what we do, clinical supervisors and those of us training counselors and supervisors need further data to support what we do. Anyone want to study these questions? If so, please write to me at This e-mail address is being protected from spam bots, you need JavaScript enabled to view it I’d love to hear of your interest.
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