Feedback in Supervision

Verbal and nonverbal feedback from clinical supervisors allows the supervisee to form an opinion about how they are going in their growth and development as a practitioner. Feedback offers clarity on specific areas, for example, on how well they might be applying micro-counselling skills or on the depth, quality and accuracy of individual case conceptualisation.

Supervisor feedback is best conveyed if it is tailored to suite the supervisee’s specific supervisory stage of professional developmental. Good feedback should be:

  • Clear: Be clear about any feedback delivered. Being vague and faltering will increase anxiety in supervisee and may not be understood.
     
  • Owned: The feedback given is the supervisor’s own perspective and not the ultimate truth. Therefore phrases used should reflect that it is the supervisor’s own perception or opinion
     
  • Regular: When feedback is given regularly it is more often useful to supervisees. Try to give feedback as close to the event as possible and early enough for the supervisee to do something about it. 
     
  • Balanced: It is good to balance negative feedback with positive feedback, whereby if feedback is given in either always a positive or always a negative way, then this can undermine the credibility of the feedback suggesting that the supervisor’s view may be distorted in some way.
     
  • Specific: Generalised feedback is hard to learn from. For example, phrases like, “You are irritating” will most likely only lead to hurt and anger. Whereas, “I feel irritated when you don’t use the pink phone message slips for phone messages because when you use plain white paper I do not register that I have to return a call back somewhere” is more constructive and informative offering greater clarity by keeping it focused specifically on the issue. Positive feedback also needs to be specific; otherwise it will not clarify the specific areas in which the supervisee has achieved. 

Feedback for Beginner Counsellors
 
Counsellors at this level need to be encouraged and affirmed for taking risks with the supervisor. Supervisory interventions that are most helpful to these new counsellors are praise, reinforcement of the appropriate demonstration of skills, careful and attentive listening, other indications of appreciation and care.
 
A study by Daniels and Larson (2001) demonstrated that when new counsellors experienced positive affirming feedback they interpreted the clinical encounter as a mastery experience and their sense of self efficacy increased while their performance anxiety decreased. Conversely when new counsellors who did the same intervention as the other group were given negative feedback about the strategy they attempted, they interpreted this as a failed experience and their sense of self efficacy decreased while their performance anxiety increased.
 
While prescriptive interventions are what many new counsellors may desire and at times need, they must be gradually exposed to and offered alternative interventions so they can begin to develop autonomy and a broader foundation of approaches and responses as a counsellor in the counselling process.
 
Stimulation of growth as a counsellor can also occur by encouraging the new counsellor to link an intervention to its theory. Also, while the supervisor will at times need to challenge or confront the new counsellor, it is best to try to wait until their anxiety has reduced and they have begun to demonstrate an increased level of autonomy.
 
Using confrontational feedback too early in the supervisee’s development can result in inhibiting the counsellor’s capacity to learn and grow due to its potential of increasing anxiety, stifle creativity and have them concerned about trying things out through fear of being criticised.
 
Once the supervisee exhibits increased comfort in their place within the supervisory process and show a willingness to take risks within the supervisory relationship then increased confrontation can be applied as it will be less likely to be taken personally and instead be embraced as part of the learning journey in the development of their professional competence and expertise.
 
Confrontation can also be used if the supervisee starts to show complacency or if overly comfortable in a standard approach to their counselling to encourage them out of their safety zone into trying new techniques and methods of approach.
 
Feedback should also be used to expand the awareness of the new counsellor to key aspects of clinical practice (e.g. comments on the treatment process, exploring the counsellor’s thoughts or feelings about a particular point in the counselling process with a client). This is usually more effective in the latter part of the beginner counsellor’s development helping them grow in awareness of client issues.
 
In this context, Fitch and Marshall (2002) found cognitive interventions with new counsellors during supervision helped to redress self defeating thoughts within the supervisee, thus helping to stop such thoughts sabotage their performance with clients.
 
Observation via direct or videotaped aspects of the counsellor’s interactions with clients is quite important for the new counsellor. Constructive feedback on these interactions helps to reinforce the successful use of skills while helping to refine those aspects needing more work.
 
Use of role playing and role reversal can also be used to allow opportunity to feedback on the new counsellor’s effectiveness in the execution of relevant skills and other aspects of the approach applied by the supervisee in such role-plays. Ultimately, when offering feedback to new counsellors, it is vital to ensure that it is balanced whereby comments on the strengths in the counsellor are offered first and then comments on growth areas needing to be addressed should follow.
 
Feedback for Intermediate Counsellors
 
Supervisors need to be flexible with counsellors functioning at this level. The task for supervisors when working with intermediate level counsellors is to provide a balance between guidance, support, autonomy and challenge. In order to foster independence and confidence in the counsellor, the supervisory environment must be different to the beginner level counsellor. Supervisors need to decrease the structure and increase the supervisee’s autonomy.
 
Facilitative interventions that express care and support are also important. Sharing or disclosing one’s own past difficulties in similar situations with supervisee’s is very helpful to the counsellor at the intermediate level. Prescriptive interventions are also periodically needed but at times the intermediate level counsellor may get defensive or resistant to such things, while at other times shift to being overly dependant on them.
 
Supervisors can and should challenge the counsellor in this stage of professional development and encourage the supervisee to state rationales and conceptualisations for choosing certain strategies with clients over others, that they wish to implement.
 
There should also be an increase in catalytic feedback which is meant to further facilitate the counsellor’s awareness of them selves and any personal issues that appear to be triggered by the clients’ problems or the dynamics between the client and the counsellor. Pointing out transference and counter-transference issues as well as delivering process comments about the relationship between the supervisee and supervisor can be a great catalyst towards increasing his or her awareness of self, the client’s and the supervisor.
 
Challenge that is supportive is essential to assist the intermediate counsellor to continually increase their level of competence. Counsellors at the intermediate level begin to demonstrate a greater level of openness to discussing and processing personal issues of; self awareness, defensiveness, transference and counter transference found within the client-counsellor relationship and the supervisor-supervisee relationship. Monitoring through videotapes and direct observation should continue to be regularly done at this level.
 
As supervisees progress through this level of competence and experience they progressively come to understand, accept and appreciate that fluctuations in motivation within themselves are a normal part of their professional development and that the complex array of issues clients bring into the counselling room are wide and varied. As a consequence, they become more secure, less defensive and more open as they move onto a more advanced level of functioning as a therapist
 
Feedback for Advanced level Counsellors
 
These are professionals who have substantial experience and are well aware of what works for them within the supervisory relationship. They are able to effectively communicate their needs and they possess the ability to use the consultation or supervision process to their benefit. These supervisees are less likely to bring into supervision the good work they are doing with clients. Rather, they tend to focus on the glitches experienced instead.
 
This is because they will normally feel secure in their self efficacy, as a therapist thus appreciate the challenge of extending themselves through difficult case scenarios. Because of this, while facilitative interventions of support and affirmation continue to be important they are far less crucial when supervising the advanced practitioner.
 
At the advanced level the supervisee has developed considerable confidence in their capacity as a counsellor and prescriptive interventions are used rarely due to the greater depth and breadth of experienced gained in practice. A more focused prescriptive approach may still be appropriate whenever the counsellor is less skilled in certain domains.
 
Confrontational or challenging interventions are still occasionally needed but the response of a counsellor in this stage is very different compared to the beginner and intermediate level supervisee. This is because the challenge or insightful confrontation by the supervisor is usually met with acceptance and a commitment to self analysis on the issue.
 
While the advanced supervisee may not agree with the subject of conversation the analysis of the issue will almost certainly be done. Catalytic interventions are used in response to the supervisee being blocked or stagnated in a particular process of approach with a client and occasional viewing of videotapes can still be beneficial.
 
Feedback Do’s
 
Below is a list of things to do and/or apply when giving feedback as a supervisor to supervisees:

  • Acknowledge that supervision is an unequal relationship right from the beginning despite the high level of empathy that most supervisors try to provide. Show sensitivity to the position of the supervisee to ensure the supervision involves compassionate evaluation.
     
  • Be clear. Explain administrative supervision versus clinical supervision and the various roles that the supervisor might play. Discuss early on about the whole feedback process both in week to week sessions and in the summative evaluation process. Give a copy of the forms used right away.
     
  • Address supervisee defensiveness openly. Remember that clinical supervision can make the supervisee feel quite vulnerable, particularly in the initial stages or in those times critical analysis and review is required. Because defenses are natural, don’t hold the supervisee’s vulnerability against them and also, don’t take it personally.
     
  • Address individual differences openly.
     
  • Make feedback a mutual and continuous process where the supervisee is actively involved in identifying his or her own growth objectives and is also involved in evaluating the effectiveness of the supervision.
     
  • Remain as flexible as possible. From this context realise that short term intrusions on the supervisee’s life (e.g., a new baby, a new partner, elderly parents, death of a love one etc.) should not jeopardize the overall summative evaluation of them.
     
  • Avoid evaluating the supervisee too prematurely prior to gaining enough information and clarity. 
     
  • Model professional development to your supervisee by taking time for relevant training and by keeping a balanced life.
     
  • Pay attention to the health of the supervisor/supervisee relationship. Even though it is an unequal relationship it should still be positive and supportive.

References

  • Daniels, J., & Larson, L. (2001). The impact of performance feedback on counselling self- efficacy and counsellor anxiety. Counsellor Education and Supervision, 41, 120-130.
  • Fitch, T, & Marshall, J. (2002). Using cognitive interventions with counselling practicum students during group supervision. Counsellor Education and Supervision, 41, 335-342.

Source: www.mentalhealthacademy.com.au