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Carol Falender, Ph.D. - Guest
Carol Falender, Ph.D. is co-author of multiple books on clinical supervision including Clinical Supervision: A Competency-based Approach (2004; second edition, 2021), Getting the Most Out of Clinical Training and Supervision: A Guide for Practicum Students and Interns (2012) The Essentials of Competency-based Clinical Supervision (2017), co-editor of Casebook for Competency-based Clinical Supervision and all with Edward Shafranske; Multiculturalism and Diversity in Clinical Supervision: A Competency-based Approach (2014) edited with Edward Shafranske and Celia Falicov. She edited one book on consultation, Consultation in Psychology: A Competency-based Approach (2020) with Edward Shafranske. She has written numerous articles and conducted workshops and symposia internationally. She directed APA approved training programs for over 20 years and was a member of the Supervision Guidelines Group of the Association of State and Provincial Psychology Boards (ASPPB) and Chair of the Supervision Guidelines Task Force of the Board of Educational Affairs of APA. Dr. Falender is a Fellow of American Psychological Association (APA; Divisions 37. 29 and 43). She is an Adjunct Professor at Pepperdine University, Clinical Professor in the UCLA Department of Psychology. She was the recipient of a Presidential Citation from the American Psychological Association for innovative contributions to the theory and practice of clinical supervision, nationally and internationally, and in 2018 received the Distinguished Career Contributions to Education and Training in Psychology Award from the American Psychological Association. In 2023, she received The Chuck Faltz Lifetime Achievement Award from the California Psychological Association and the Distinguished Award for the International Advancement of Psychotherapy by APA's Division 29. |
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W. Keith Sutton, Psy.D. - Host
Dr. Sutton has always had an interest in learning from multiple theoretical perspectives, and keeping up to date on innovations and integrations. He is interested in the development of ideas, and using research to show effectiveness in treatment and refine treatments. In 2009 he started the Institute for the Advancement of Psychotherapy, providing a one-way mirror training in family therapy with James Keim, LCSW. Next, he added a trainer and one-way mirror training in Cognitive Behavioral Therapy, and an additional trainer and mirror in Emotionally Focused Couples Therapy. The participants enjoyed analyzing cases, keeping each other up to date on research, and discussing what they were learning. This focus on integrating and evolving their approaches to helping children, adolescents, families, couples, and individuals lead to the Institute for the Advancement of Psychotherapy's training program for therapists, and its group practice of like-minded clinicians who were dedicated to learning, innovating, and advancing the field of psychotherapy. Our podcast, Therapy on the Cutting Edge, is an extension of this wish to learn, integrate, stay up to date, and share this passion for the advancement of the field with other practitioners. |
Keith Sutton, Psy.D. (00:24):
Welcome to Therapy on the Cutting Edge, a podcast for therapists who want to be up to date on the latest advances in the field of psychotherapy. I'm your host, Dr. Keith Sutton, a psychologist in the San Francisco Bay Area, and the Director of the Institute for the Advancement of Psychotherapy. At the Institute for the Advancement of Psychotherapy, we provide training in evidence-based models, including Family Systems, Cognitive Behavioral Therapy, Emotionally Focused Couples Therapy, Eye Movement Desensitization and Reprocessing, Motivational Interviewing, and other approaches through live in-person and online trainings, on demand trainings, consultation groups, and one-way mirror trainings. We also have therapists throughout the Bay Area and California providing treatment through our six specialty centers, each grounded in an evidence-based approach, with our Lifespan Centers, Center for Children and Center for Adolescents, where all the therapists are working systemically; our Center for Couples, where all the therapists are using Emotionally Focused Couples Therapy; and our specialty issue centers, our Center for Anxiety, where all the therapists are using CBT and EMDR for trauma; and our center for ADHD and Oppositional & Conduct Disorder clinic, where we're integrating those four approaches.
Keith Sutton, Psy.D. (01:31):
In the institute, we have our licensed, experienced therapists, and for those in financial need, we have an associated nonprofit, Bay Area Community Counseling, where clients can work with associates, psych assistants, and licensed clinicians who are developing their abilities and expertise. Additionally, as part of our nonprofit, we also have the Family Institute of Berkeley, where we provide treatment, training, and one-way mirror trainings in family systems. To learn more about trainings, treatment, and employment opportunities, please go to sfiap.com and to support our nonprofit, you can go to sf-bacc.org to donate today to support access to therapy for those in financial need, as well as training in evidence-based treatment. BACC is a 501(c)(3) nonprofit, so all donations are tax deductible.
Keith Sutton, Psy.D. (02:20):
Today I'll be speaking with Dr. Carol Falender, Ph.D., who has written several books on the topic of clinical supervision with her co-authors related to her competency-based approach. She has written numerous articles and conducted workshops in symposium internationally and directed American Psychological Association approved training programs for over 20 years. She was a member of the Associate of State and Provincial Psychology Board's Supervision Guidelines group. She has received numerous awards, including two this year. One from the California Psychological Association's Chuck Felts Lifetime Achievement Award, and the second from APAs Division 29, distinguished Award for the International Advancement of Psychotherapy. Let's listen to the interview.
Keith Sutton, Psy.D. (03:02):
Well, hi Carol. Welcome. Thanks for joining today.
Carol Falender, Ph.D. (03:05):
It's my pleasure. Thank you.
Keith Sutton, Psy.D. (03:07):
Yeah. So, Carol, I heard from you, about your work from, our lawyer Adam Alban, who's also a psychologist, who's really great, and he was really just talking up about the the work you do with supervision. And so I was reaching out because we're doing some, some trainings through our practice and I really loved what you had to-- and wanted to learn more about it. I think you bring some, you know, kind of unique pieces to supervision. So before we get into even all that though, I always love to hear people's kind of evolution of their thinking and how they got to doing what they're doing and the way they're thinking about their work.
Carol Falender, Ph.D. (03:43):
Well, thank you for the opportunity. Yes. I came to this through the trajectory of directing training programs. After graduate school, I was hired to be an assistant director at a child and family guidance clinic for training. So I came up through the ranks, training interns and practicum students and some psychiatry residents. And social workers at certain points. And, became very, very intrigued with the processes of training. And became more involved in American Psychological Association activities and ultimately became a director of training at a different site. And had to develop what we call site visit documentation, documenting rationale and the theoretical orientation and the research support and all of that. So that led me on a path to developing a model, and I was very fortunate to meet my co-author Dr. Edward Franksy, and we started presenting programs together. And decided to write our first book. And this has led us to write eight.
Keith Sutton, Psy.D. (05:00):
Wow. That's great.
Carol Falender, Ph.D. (05:01):
So that’s exciting. So our model is called Competency-Based Clinical Supervision, and it's a model that is developmental and it's met theoretical. And so that means is regardless what your theory is of clinical supervision, it could be psychotherapy based. It could be, as I mentioned, developmental, or it could be really one of the many, myriad of models. This model can be superimposed upon it.
Carol Falender, Ph.D. (05:34):
Provide structure and systematic and intentional practice.
Keith Sutton, Psy.D. (05:37):
Oh, great. And when you're saying different models, do you mean different models of like orientation of people working with clients like CBT or psychodynamic or different models of supervision?
Carol Falender, Ph.D. (05:47):
Well, in fact, many people extrapolate from their psychotherapy model. To a supervision model, and there are books, many books written on the extrapolation Right. From a psychotherapy model to a supervision model. And how it can be conducted kind of in parallel or independently.
Keith Sutton, Psy.D. (06:08):
Oh, great. Wonderful. So, yeah. So tell me about the model, for the clinic, the competency-based clinical supervision.
Carol Falender, Ph.D. (06:15):
Sure. Well, what we found, and unfortunately sadly this may not have changed as much as we would've liked over the almost 20 years we've been doing this 20 years actually, we found that many, many, many professionals practice through osmosis. What that means is they practice the way they were supervised. So they supervised pretty much the same way they were in certain. Way, certain aspects and not necessarily informed at all by particular model or by the research. And there's incredible research base now for clinical supervision. And some of their experiences, unfortunately were not so good. Yeah. We also learned through work of various colleagues, including Mike Ellis and others, that not all supervision is adequate or good. We found that incredibly high rates of supervises report, inadequate supervision. And even high rates of harmful supervision which yeah is catastrophic. Because it not only does incredible harm to the supervisees, it is potentially very harmful to clients. And creates a basis for dissemination of yet another generation of osmosis of individuals that they're practicing the way they were supervised or trying to kind of flip it and do the opposite, which may or may not be a good idea, but it's not a good way to form a professional practice.
Keith Sutton, Psy.D. (07:58):
Yeah. So, great. So how, yeah. Tell me about the ways you think about, I guess, good supervision or, you know, the research that supports kind of what are the elements of good supervision? So I also supervise, mostly do group supervision for our nonprofit and I had done individual supervision, supervision classes and, you know, grad school and so on but yeah, this is really making me think about kind of the elements of supervision, kind of what
Carol Falender, Ph.D. (08:27):
Right. What are guiding it. You're raising, I'll get to that in a second. You're raising some other interesting points, which is the trajectory to become a supervisor is very uneven. So some people have one lecture on supervision and some people have two years of training. So, with experiential activities and videotape and feedback and all that, kind of state of the art, but others say, well, we read an article or a chapter or I think there was a book, I don't exactly remember, but something about it. Before done consultation or something like that. So there's that, as far as our model, our model, competency-based clinical supervision, the practice is systematic and intentional. So, we identify critical components that we address in all of our books, and they include such aspects as developing the supervisory alliance.
Carol Falender, Ph.D. (09:27):
Addressing the process ongoing, ensuring that we're attentive to strains or ruptures or unevenness. Hugely culturally humble, attitude and behavior. That relates to multicultural supervision facility, including knowing elaborate amounts of the literature and internalizing the multiple identities, not simply of the client, which many people tend to, but also the supervisee and improvisor, who's often the missing link in the equation. And we hold a lot of power. So all of that, of course, adhering to ethical and legal standards. And thinking specifically about supervision ethics, not simply looking at the ethics code, which is good. Yes. That's wonderful. But also thinking about through the lens of supervision. Attending to self-care, which is often at the end of the list, unfortunately Sure. Should be from the onset, addressing countertransference and reactivity and personal responses to clients, to situations, to supervises, to everything. I think I left a few out, but you're getting the sense. It's systematic and intentional, and we address each of these pieces and integrate them. In the process of supervision.
Keith Sutton, Psy.D. (10:59):
Yeah. Oh, that's great.
Carol Falender, Ph.D. (11:00):
You mentioned group supervision, which is a critical and actually distinct aspect that a lot of people never, never have training in.
Keith Sutton, Psy.D. (11:10):
Yeah. Yeah. I was fortunate to have a year long class in grad school where we were supervising two first years who were, you know, in a preschool program or so on. So it was a nice way to kind of get that experience and then, you know, supervising before licensed in pre-doc and post-doc but yeah, group supervision, you know? Yeah. It's not getting the training and, and particularly, you know, just going off of what, like you're saying, what, your experience was or, or whatever it might be. I know there's a lot of different ways that people, you know, kind of do the group supervision, models themselves. I am particularly interested too in, I think this lets me even maybe take the counter transfer burns reaction to clients, you know, that I'm always, you know, interested in that. Because you know, part often times right. Looking at the self therapists and particularly those that were supervising and how their own individual pieces come in, but at the same time, creating that balance where we're not necessarily doing therapy with our supervisors
Carol Falender, Ph.D. (12:19):
Absolutely. That never, never--
Keith Sutton, Psy.D. (12:20):
Exactly. With respecting their boundaries and holding, but, you know, sometimes being able to see, you know, kind of what might be popping out that's kind of, you know triggering for them client relationships or so on. And then, you know, my tactic has been to kind of help see that and then, you know, kind of help them get some support around that, or exactly. Not that they're in with their own therapist. , but yeah. Would love to hear some of your thoughts on that, on, on how, because I think other people do it differently and more people might go more deeply into the person's individual, or sometimes I've talked to folks where their supervision was like therapy and they were talking about everything that's going on in their life and, and so on. You know? In addition to the clients.
Carol Falender, Ph.D. (13:02):
Right. Well, I mean, you've raised an amazingly important topic because there is a huge continuum of experience with that, and part of it is psychotherapy based models. So individuals who are more psychodynamic or psychoanalytic tend to focus more on those aspects. But it can occur in virtually any other model. We feel very, very strongly, and my co-author at Fransky is actually a trained psychoanalyst. We feel very, very strongly that there needs to be a clear demarcation between supervision and psychotherapy. And that we do not cross that line. However, that being said, it is critical to identify aspects that are arousing or that are in fact significant to the process that impact the individual of the therapist. And to have a paradigm and process to address that reflectively and to have in the supervision contract, which is a critical component.
Carol Falender, Ph.D. (14:08):
Of supervision, an informed consent agreement, in which there's clarity about the limits of supervision and the aspects of it to adhere to encouraging identification of that collaborative identification in aspects when the supervisee may be less aware. And then to manage the reactivity we call it, which is potentially heightened arousal. And or, impact. Of those phenomena on the client and on the supervisee and on the supervisory relationship. And to ensure that all that occurs, even though we only have 60 minutes and who knows how many clients and a lot of pressures legally, ethically, and setting wise. So it's a high level of skill required.
Carol Falender, Ph.D. (15:03):
Yeah. You're working on all these different levels and really kind of, you know, also containing it all.
Carol Falender, Ph.D. (15:09):
Containing it in a way that, sometimes supervisees feel just pressured to say, I'm good, you know? Because we've got so much to do. I'm okay, sure. But in fact they're not
Keith Sutton, Psy.D. (15:23):
Yeah. Yeah.
Carol Falender, Ph.D. (15:24):
Impacting them personally and impacting their clinical work. And sometimes their behavior and attitudes toward their clients and the supervisor. Yeah. So it's highly sensitive and requires skills in terms of implementation.
Keith Sutton, Psy.D. (15:43):
Yeah. And it sounds like that also goes back to the alliance piece, like you're saying of how to create that safety where the supervisee is able to maybe share the hard parts that they're having with the clients, or, you know, the vicarious trauma or whatever might be. While at the same time. Not making it into a therapy or not, you know, them feeling too vulnerable or feeling like, oh, now the supervisor's gonna think less of me because I'm, you know, having a hard time with this. Do you have any thoughts or suggestions on that about kind of, you know,
Carol Falender, Ph.D. (16:19):
Well, what's you're beginning to address as a trauma-informed supervision, which is pretty new area, and there are some authors who are writing a lot about this, and one of the aspects of that is, first of all, normalizing the fact that trauma is inherent in much of our clinical work and trauma exposure and our own personal experiences can be triggered by client trauma. And there's a movement toward helping supervisees understand about self-regulation about amygdala activation, and about strategies for being present in the moment without, well, to regulate, to self-regulate, and actually to do that in supervision as well. And to directly address these phenomena and to talk about self-care and to model self care, rather than making it just a kind of add on, which it often is or even add out because no one even talks about it. So the toll that can be taken can be very high. So, I'm not sure if I addressed your question exactly.
Keith Sutton, Psy.D. (17:34):
I mean, I think it's just common that idea of like how to kind of create that sense of safety, but also helping the person kind of, you know, in a boundaried way. And I think, you know, it's, it's that dance of alliance, like we would do a sense of, you know, really kind of trying to both elicit what's going on and the ability to share that while at the same time, you know, , feeling like there's boundaries and not feeling intrusive or so on, or loss of control.
Carol Falender, Ph.D. (18:02):
And to be clear that our highest duty as a supervisor is protection of the client and the public. So it's a complex role. Because there are times when we actually have to say, you know, this supervisee is simply not doing an effective job, even with the amount of supervision I can give, which is often a lot. It's still not, and it is potentially harmful to this client. Who is at high risk. So I have to, or we have to have that discussion and explain that in fact, a different arrangement's gonna have to be made, plus they're gonna have to be implementation of strategies to help the supervisee to increase their competence and to greater mastery over the types of material that they found so difficult or that weren't those are gatekeepers for the profession.
Keith Sutton, Psy.D. (19:02):
Exactly. Yeah. And I think that's hard sometimes of teasing out how much of this is development in the skills and being able to have the skills with the clients.. How much of this is their own personal things that are continuing to get triggered, and what's the level of awareness and, you know, kind of addressing that.
Carol Falender, Ph.D. (19:21):
Well you identified also it's knowledge, skills, and attitude Many supervisors are really good at knowledge really, or even really good at skills. Attitudes. And that whole realm can be much more challenging and sometimes avoided by supervisors.
Keith Sutton, Psy.D. (19:42):
You mean the attitude of like how the supervisee's attitude with their clients or
Carol Falender, Ph.D. (19:49):
Or in supervision? Or in supervision or just their worldviews and how those intersect with the setting and with the client populations Yeah. And the types of problems that are being presented by the clients or the setting Yeah. Intersection of all of those.
Keith Sutton, Psy.D. (20:09):
Yeah. We use a couple of different models. We use family systems, CBT, emotionally focused couple therapy and EMDR or kind of the evidence-based models that we use and integrate. But I oftentimes find that particularly working with anxiety sometimes is hard for a number of therapists. And particularly we, we kind of use an ACT and CBT model of kind of, you know, being with the discomfort and sitting with it and staying with it and so on. Although sometimes for a lot of the clinicians, especially who's new, they get very anxious and they're like, oh, let's do some deep breathing, or, you know, it'll be okay. And so on. And helping them to kind of be able to, you know, figure out, right. Both have the tools and to be able to help their client sit with discomfort. And then also the internal ability to be able to sit with that discomfort, because sometimes that's just not intuitive for folks that their mind is like, oh, discomfort. Get away from that.
Carol Falender, Ph.D. (21:05):
Right. Or it could be a theoretical kind of issue that, you know, they feel like there has to be a quick intervention that's going to be effective, and when there's not, that's kind of treading water and trying to figure out what to do.
Keith Sutton, Psy.D. (21:20):
Definitely.
Carol Falender, Ph.D. (21:22):
So it requires the supervisors to be very, very, very , competent and open to learning and reflective and supportive and warm, and then to set limits and to put all that together.
Keith Sutton, Psy.D. (21:40):
Yeah. Yeah. Yeah. I think that's a hard balance to both kind of help the supervisee grow and also have their own autonomy of how they're going to kind of make the therapy their own because I think about it, I was at the Beck Institute and Aaron Beck talked about and learning a new approach. It's one part theory, one part technique, the other part is the art, and really how do we bring ourselves and our personality to our work. And so kind of creating enough space for supervisees to bring their self to the work rather than trying to be, you know, Sue Johnson or trying to be, you know, Salvador Mnuchin or whatever it might be. And learning how to bring themselves to it. While at the same time also bringing in the theory and the technique and not kind of abandoning that.
Carol Falender, Ph.D. (22:26):
And how to manage the theoretical realm when actually implementing, because some of the theories suggest that the alliance will grow out of the work and others purposefully, want to establish the alliance very carefully. And, you know, through certain steps and stages and how to put all that together. Especially if you have a supervisor who has a different theoretical model than you do, and you've been trained in one, and here's your supervisor with something completely different, and then you've got the client care and hard to know what to do and be
effective.
Keith Sutton, Psy.D. (23:05):
Yeah. I think that's one of the hardest, or at least in my own experience, having the hardest because sometimes you don't get to choose, you know, who your supervisor is or so on, or sometimes even you might go to a site that says they do therapy and or follow the model, but then the supervisors are doing other models and sometimes the supervises are getting triangulated between their group supervision, their individual supervisor, and so on. And it can be a kind of, you know, very confusing.
Carol Falender, Ph.D. (23:32):
Right. And that's a supervisory responsibility. We really encourage supervisors to take responsibility for discussing with their fellow supervisors the models they're using and the intersections they have when they're both supervising the same supervisee.
Keith Sutton, Psy.D. (23:49):
Yeah, definitely. Well, let's talk about, I mean you also talked about being culturally humble and, and addressing the process, and I think, you know, the aspect of power in the supervisory relationship because Right. Ultimately, we are the gatekeepers to the profession. And we do have the power in that way as well as we might also, as, you know, cisgender white male therapist, or supervisor, you know, I've got all the, all of these privileges too.
Carol Falender, Ph.D. (24:19):
Absolutely.
Keith Sutton, Psy.D. (24:20):
Yeah. And so oftentimes when, when working with my supervisees or talking about different clients, what, yeah. How do you think about that? Or how do you talk or teach about the aspects of cultural competency within the supervisee relationship?
Carol Falender, Ph.D. (24:34):
Yeah. We're working on a second edition of our book on multicultural supervision. , so we're deep in the weeds or whatever you want to call it. Yeah. But anyway, we encourage self-disclosure by the supervisor from the very beginning of identities and recognition of the critical aspect of these identities and a privilege. There's emerging research that privilege is not being a topic very much in clinical supervision. Privilege of the client, the supervisee or the supervisor. And we need to address more carefully and, specifically identities early on power and take drawing from feminist supervision work, a true discussion of power. And defining power and explaining how, in fact, we do hold tremendous power over our supervisees. We do, we control whether they pass or fail. We control their progression and also we promise that we will have no surprises, that we are going to be giving them feedback. And when we're concerned about something, we're not going to do what supervisors do, which is make a list. A secret list. And just think about it and worry about it, and lose sleep over it, and never tell the supervisee until the evaluation period. And then give them like a zero or something out of a hundred, we are going to be giving feedback systematically and intentionally in each session. We're going to be completely, truly honest and transparent with them about the feedback, and we're going to do our very best to figure out how to scaffold their strengths. To improve the areas that are in development. So, all of those aspects. Complicated.
Keith Sutton, Psy.D. (26:40):
Yeah. Do you have any recommendations? Do you use any measures or anything that, or suggest any with, you know, I know. So we use the outcome rating, scale session with our client. Barry Duncan.
Carol Falender, Ph.D. (26:56):
Yeah, his work is wonderful. Yeah.
Keith Sutton, Psy.D. (26:58):
Scott Miller's work, and I was even playing around with kind of using a version of that in supervision for some time. Are there any specific measures that are helpful in giving that feedback with the supervisee in a way that kind of is more frequent than say, you know, six
month, you know, one year right?
Carol Falender, Ph.D. (27:19):
Well, in the appendix of our second edition, we have a panoply of measures, many of which we use, pretty much weekly. And they come from authors, you know, from the US all over the country Yeah. And measuring various aspects. But we do believe that client input is critical and we feel that that has been very much neglected. So getting outcome questionnaires is very critical. Finding out how the clients are perceiving both the relationship and the therapeutic progress. And feeding that into each supervision session would be state of the art. But beyond that, we do encourage self-assessment on a variety of scales. I know you're gonna think, where in the world do you have time for all this, right. Supervisor or assessment of the supervises and being very mindful of what the strengths are of the supervisees and what areas that maybe are a little bit hidden or something. But seem to be very much in development, or at least slightly in development. And to be focusing on these not to be afraid to give that kind of feedback. Many supervisors say, when we conduct seminars, they say, I don't wanna tell them that because I'm afraid it'll rupture the alliance. The reality is that a bigger rupture to the alliance will be at the midterm when you tell them
Keith Sutton, Psy.D. (28:45):
Yes, yes.
Carol Falender, Ph.D. (28:46):
That they're not up to par, and that they're not doing well, and you're gonna be calling the school or whatever it is that you have to do. So, we like authenticity and a lot of feedback and clarity and integrity. Definitely in relationship. One of our foundational principles is integrity in relationship.
Keith Sutton, Psy.D. (29:07):
Yeah. Which means saying hard stuff sometimes
Carol Falender, Ph.D. (29:11):
Very difficult conversations. Incredibly difficult because we often really like, not in a bad way, but we really like our supervisees, we do their work. We think they have so many strengths, but we identify that there are areas that are of lesser competence and how to give them the feedback without devastating them. And how to support them. And again, building from their strengths, being very attentive to that. We also use a technique where at the beginning of supervision, we ask them to self assess. Usually using benchmarks or some rating system that perhaps comes from their school or perhaps from psychology benchmarks or for social work has very elaborate kinds of competencies identified and in AMFT also. So losing those to self-assess. And many supervisors say, well, they're not accurate self-assess, none of us are. That's true. But in fact, it's a beginning. And in fact, if they give all strengths, we say that you have made progress. You've achieved all of these in the first week. It's a little extreme, but you know what I mean. And saying, actually, I noticed that one of the things that is difficult for you is when the client became angry. Or when you disagreed with what direction the client was going, even though you'd given a particular suggestion of how to interact with the child and you saw it, that it wasn't being implemented properly. And it seems like it was very difficult for you to address that. So to give them granular. And then to develop a new goal. And so you've already achieved the one about being strengths-based. You've been awesomely strengths-based, so let's move on and have this new goal, which is, and tracking that. And each session spend at least a minute or two saying excellent progress on that. I like the way this requires you to be able to get the input. Yes. After either a video, audio, live observation, or,
Keith Sutton, Psy.D. (31:18):
That's actually what I was gonna ask too, is that, you know, I'm sure you do. I encourage, we have all of our folks record their sessions with the client's consent, but 90% of the clients consent. So we just see some interaction. Just seeing that process happening is so valuable.
Carol Falender, Ph.D. (31:35):
It's invaluable. It's invaluable. Yeah. And it's a wonderful learning device. Yeah.
Keith Sutton, Psy.D. (31:40):
Yeah. Yeah. So somebody could tell you all about the client for 45 minutes, but that three minutes of video just kind of can help you so much see what's going on in the interaction between the client and the supervisee.
Carol Falender, Ph.D. (31:51):
And supervisees, like all of us do not know what we do not know.. So there are times that supervisees come in and say, it was the best session I've ever done. It was just phenomenal. And I say, yeah, there was some really wonderful aspects to it. I wonder what happened when. Yeah, the mother told you that her ex was coming to visit and you went home. like what was that like and what was happening and how do you think that impacted.
Keith Sutton, Psy.D. (32:22):
Yeah, yeah.
Carol Falender, Ph.D. (32:23):
Yep. And yeah,
Keith Sutton, Psy.D. (32:25):
Definitely. Yeah. I am a big, big supporter. And also why of supervision? One-way mirror training, you know, I think that's just invaluable too, and helping. Wonderful, yeah. Helping supervises kind of go outside their comfort zone. Also sometimes with the support of a supervisor. They're kind of coaching them along. And having that kind of experiential, you know, kind of experience of doing something differently.
Carol Falender, Ph.D. (32:49):
Right. No, it's wonderful. I agree with you a hundred percent. Yeah.
Keith Sutton, Psy.D. (32:52):
Yeah. Great. Well, I would love to actually get some of your thoughts, if you don't mind, on group supervision. because I think that it is a topic that's not often discussed so much, and I, myself always struggle with kind of the best way to structure it because, you know, and, and really actually, so we have a lot of MFTs and in California here, you can have up to eight MFTs in group supervision with potentially 10 clients each, which is 80 clients to cover in two hours, which doesn't feel ethical to me. So we actually have folks after five clients get an hour of individual supervision in addition to the group supervision. Would love to hear some of your thoughts or strategies on how a supervisor, you know, a group supervisor supports their clinicians as well as, you know, all those clients in, in a short period of time. Right.
Carol Falender, Ph.D. (33:43):
Yeah. Well, first of all, I'm sure you use group rules or parameters. So in fact, there's understanding amongst the group members and the leader leaders about what the expectations are and to have clarity about respectful process and about any kinds of strains or ruptures that arise during the group, how they're managed. Generally, they'll be managed within the group. Unless in fact, something happens, which is potentially so destructive to a particular participant or some or imminent risk that wasn't identified or something that the group has to be stopped. But otherwise, generally everything is managed and repaired within the group. Definitely a climate of cultural humility, you know, the emerging researches that so many microaggressions happen both in group therapy and unfortunately in group supervision. And sometimes they just often actually, they just go unnoticed and microaggressions are of course. Implicit kinds of statements that are lacking in cultural humility and harmful. To the clients and to the milia.
Keith Sutton, Psy.D. (34:59):
Yeah, definitely.
Carol Falender, Ph.D. (35:01):
So the group rules, which are generally collaboratively developed, sometimes we go in with a prototype or categories of things, or other times the group just wants to come up with their own.
Keith Sutton, Psy.D. (35:13):
Yeah.
Carol Falender, Ph.D. (35:14):
And then going from there to ensure part of the group rules is ensuring a process in which there are no group hogs, someone who always, not to be Midwestern, but a little who always, you know, is going, I have an emergency. It's 12 cases I have to talk about today. Yeah, sure. We have to share the experience that there's a respectful process that has to occur. So all of that realm has to be dealt with. There actually is some work in which Erics and Cornish and others have developed a group contract. They feel that it's not sufficient to have a supervision contract, but they need a group contract to be clear about the rules and respectful practice. Then we have to walk the walk, just talk to talk. So the group leader or leader, sometimes there are two, but generally just one has to assume a responsibility for each of those rules. And for cultural humility in the process. And has to take a strong leadership role without destroying the whole thing and making it just one person talking to the leader and the leader giving an answer, which is not group supervision, that's some kind of economical supervision. , many people in a room with one supervisor. Then the supervisor needs to be attuned to group dynamics. And I think this is where much of group supervision falls down. That people don't have adequate training or attention to what the processes are in the group, and how often there are parallel processes that arise. Which the actual client situation is being reenacted unconsciously, one could argue, amongst the group members. And how it's incumbent on the group leader to identify those and reflect on those and talk about the power of the process, what's occurring sometimes like in child work. How an oppositional child is just dominating the sessions and the thing. Yeah. And suddenly one of the other supervisees is just becoming super dominant and is managing everything. And we're saying, whoops, look what's happening here. That's a simplistic one, but you know what I mean? All of those types of things. So, having training in group is very important because ruptures and strains are sometimes so subtle. It's hard to identify them. Plus they're the pressures on the supervisor thinking, as you said, we have 80 cases here under supervision today. Do I have time to really stop and say, you , this just happened, we need to manage it. Should I just move on and try to deal with some of the more one, because 11 people said, or 11 cases were in crisis and we only have 20 more minutes, and how are we gonna handle this in a way that's effective and that protects the clients? So, well, I think that's, I dunno if that answered it.
Keith Sutton, Psy.D. (38:27):
Well, yeah. No, it's helpful to think about, you know, I think that group process part is such an important aspect. I think that I've always struggled with, you know, sometimes if going deeper into one case and then that, you know, and, but then you don't get to talk about enough cases kind of. Or sometimes, going with, you know, the ones in crisis, but then sometimes there's some of the therapists, like are saying maybe are always the ones with the ones in crisis. And so figuring out how to create that balance for everybody to get what they need. And also of course, ultimately protecting the clients and the work of the client Exactly. And how to kind of juggle that all at the same time. Yeah, I think that's it's a challenge of group supervision. I think it's, you know, that's, I oftentimes have a preference, you know, the individual supervision can go so much slower and you can really build that relationship and go in more depth in some of those ways than you can in a group supervision.
Carol Falender, Ph.D. (39:28):
But group supervision can be incredibly powerful. And I think it's an amazing learning experience, but there's very great reliance in both on supervisor competence and supervisor acceptance of the fact that we don't know everything. Meta competence. That we, you know, there are times when we have to just say, I do not know. Find out I need to get consultation on this and I'll get definitely very shortly. Or what happened here really perplexes me, what just happened in the group, and I need to think about it and get consultation even on that. And we're gonna have to reconvene, or I'll meet with the two people who had the disagreement about this and we'll briefly describe it next week. So to model that not everything can be solved in one minute. And to hopefully to train the supervisees to be respectful and to be concise. And to rotate so that they each get a chance to present cases in a systematic manner.
Keith Sutton, Psy.D. (40:42):
Yeah. Well, I think what you're saying too is that, you know, as kind of not knowing everything. And I think that that's something that's particularly hard for supervisees coming in and going into a session, wanting to play the role of the supervisor and like they've got it all. Or sorry, , the therapist and like they've got it all figured out. And oftentimes I talk to my super supervisees, is that right? By definition, they're not competent which is completely okay. And being able to kind of own that in this early period and sometimes collaborating with our clients around that of saying, you know, this is the knowledge I have and I wanna learn about the knowledge you have. And kind of bringing that together rather than trying to feel like they have to have all the answers. Because I think, you know, especially supervises oftentimes feel a great responsibility to fix it and fix it quick and so on. So, oftentimes getting overwhelmed
Carol Falender, Ph.D. (41:33):
And to please us. To do what we they think we want them to do and to be successful. And with all the pressures. And we talk about the pressures, and I think I've gotta cure everybody in about an hour.
Keith Sutton, Psy.D. (41:47):
Yes. Yeah. Do you have any thoughts on kind of how you address that with your supervisees about, again, just helping them, you know, having that beginner's mind or kind of understanding right. That this is actually part of their process and where they are in their developmental journey?
Carol Falender, Ph.D. (42:04):
Well, the word we use is meta competence. And we talk about the fact that it's better to know what you do not know than to think you know everything. So it's very helpful for you to be thoughtful and reflective after your session. Think about what went well, what was a little more challenging and what didn't, you know, and what, what would be useful for you to increase your knowledge, skills, or attitude in. And we can discuss that in supervision. We can give you resources for that. So to also, for us to sometimes say when it's accurate, I do not know.
Keith Sutton, Psy.D. (42:43):
Yeah.
Carol Falender, Ph.D. (42:43):
And to say, but I'm gonna find out , you know, call colleagues and find out or read about that or something. But, to model that we do not know everything. It's so important for us to be thoughtful about the limits of our competence. I'm not sure I answered your question, but yeah.
Keith Sutton, Psy.D. (43:03):
No, I think that's good. And it is just making me think too, because we actually have a meeting where we all get together once a month. We have one practice where it's all licensed experienced folks, one that's nonprofit, and we come together and actually talk about cases. So them getting to see the licensed people presenting their cases and showing video and struggling and so on, or learning, I think is also, you know, kind of exactly really helpful for the supervisees to see that, you know, this is something that, we're continuing to develop throughout our career, you know, of learning and getting information and making mistakes and repairing and, and so on.
Carol Falender, Ph.D. (43:42):
Yeah, we encourage that actually to have supervisors video, their own sessions or maybe mock sessions, but of course with all the appropriate consents, concerns and all that, but to a model that none of us is perfect. That they may see the interventions through different lens and it's useful to think about that and reflect on that and think about with their own cases as well.
Keith Sutton, Psy.D. (44:10):
Yeah. Yeah. I've, I've been doing that a little bit too, or I've been showing some of my sessions also because I've been finding that when they're seeing some of the direction that I'm giving them. In action with it, oftentimes I think it helps to, to understand or comprehend even more a little bit to really kind of see what it looks like in process. Right, such a big piece. Well this is great. And so, and then, you know, when we get to the kinda legal, ethical, you know, pieces of that, you know, I think that there's always, you know, always again, that balance of covering the process of the, the supervisee as well as, you know, covering the clients and also making sure that we're really addressing all the things that we need to check off and make sure that's, that's going correctly. Can you speak to self-care? Because I think that that was one of the other big pieces.
Carol Falender, Ph.D. (45:03):
I don't wanna skip ethics.
Keith Sutton, Psy.D. (45:05):
Sorry. Sorry. Of course. No, definitely.
Carol Falender, Ph.D. (45:07):
Can we spend just a minute? Yeah, I think, you know, some countries actually have a supervision ethics code that's distinct like UK and Canada to some extent and others. So, and Australia and New Zealand. Yeah. So, we don't, and, and I'm talking again about psychology. Yes. But different things do as well. So I think it's so important for us as supervisors not to put ethics on the back burner. And to think through the lens of ethics and ethical standards and codes very specifically and to reference them. I encourage supervisors to reference them at least once each supervision session. Oh. To prepare something like, say, it seems like that's a complex multiple relationship kind of thing that's coming up. Let's see what, let's read that and see, reflect on that. I know who has time for all this, but to be sure. If we just said in passing that's multiple relationships, please read that and come back. We'll discuss it for a minute at the beginning because I think that's an important aspect or we're approaching the limits of confidentiality here and we need to attend to that very specifically or whatever the category is. To help to identify and to link supervision practice to ethical practice. That's right. And to make sure supervises are very clear about that. And also across disciplines there differences. And to help them to understand that so that they are familiar with their own professions ethics code. And what some of the sometimes subtle but distinct differences might be. So that would be that.
Keith Sutton, Psy.D. (46:57):
Yeah. No, I think, I think that's important. Yeah. Definitely. And, and I like what you're saying too, also like, let's look at this together just again to that way it's not the supervisor kind of wagging their finger. Yeah, exactly. And instead of it, you know, kind of like, let's look at this together, like how does this apply here or so on. So really kind of help them have that relationship with the ethics code rather than nestle us being kind of the teacher wagging the finger.
Carol Falender, Ph.D. (47:23):
Well, when I do workshops, sometimes I say, you have to have a written copy of the ethics code available. And everyone says, well, I can just get it on my cell phone. And I said, when's the last time you tried to read the ethics code on your cell phone?. Yeah. You have to go, you know, make it, whatever. So just to model that ethics is foundational. And then we think through that lens and how important that is.
Keith Sutton, Psy.D. (47:49):
Yeah. The basis of all it, the trust, the safety. Yeah.. Definitely.
Carol Falender, Ph.D. (47:55):
And then to move into self-care as you asked. Yeah it's a field that's very much in development. I'd say there's a lot of publication of it in the last two years, especially, you know, COVID took an incredible toll on our, on everyone. But our supervisees particularly, I think were hugely vulnerable and impacted in so many ways. And self-care is often at the very bottom of their list of concerns because there are so many others like financial and personal and trajectory getting through this and trying to get all their required courses and hours and so on. Right. And surviving. And having a life because many of them have families or extended families or health situations or all kinds of intersectional variables that are so difficult and often we have no idea what they are. Yes. Or if we do, we can't really do much of anything except support them a little bit. Very, very difficult. So, one thing that seems to be emerging and seems kind of basic, but we need to be talking about self-care more. We need to be modeling self-care more. We need to attend to self-care. And even though we are in a kind of conflictual relationship with self-care. Because one, our supervisors to work more and more hours, take on more and more cases, write their reports really quickly, get their notes up to date, et cetera, et cetera. We also want them to engage in self-care.
Keith Sutton, Psy.D. (49:40):
Yeah. Yeah. It's a lot. And being able to fit that all in, or even sometimes going the opposite way of carving it out and kind of creating those islands of self-care, because especially as a grad student, you know, there's just so much to do and not enough time to do it all.
Carol Falender, Ph.D. (49:57):
I think many agencies have come up, probably you have too, with pretty innovative things to have potlucks, to have lunches, to have surprise kinds of , you know, snack time or something to try to emphasize the fact that we're also human and people. And we need to take a deep breath now and then, because we're moving so fast and we have so much pressure from so many aspects of our lives and our training. So, but then supervisees tell me, I don't wanna dwell on it, I don't wanna think about it, I just wanna do it because I just need to focus on getting it done. I have one more year. Yeah. One more year and I'm going to be good.
Keith Sutton, Psy.D. (50:43):
Yeah. It's quite a marathon getting through to that point when you get licensed. And so many tests and, you know, requirements and such.
Carol Falender, Ph.D. (50:54):
And then-- and preparation and costs and all. Exactly.
Keith Sutton, Psy.D. (50:57):
Yeah. So, I love the work that you're doing and, and you were mentioning earlier those assessment measures, which book was that one in?
Carol Falender, Ph.D. (51:07):
Well, it's called Clinical Supervision, A Competency-Based Approach, second Edition. It came out in 2021.Okay, great. Yeah. And I was wondering as, , to talk a little bit about your books and can you highlight kind of the, the differences with the different books and maybe as kind of listeners are thinking about like where they're wanting to learn more of?
Carol Falender, Ph.D. (51:31):
Well that one is state of the art with all the recent research up to 2021. Although the research is growing quickly. Yeah. , and it provides the whole outline of competency-based clinical supervision. We have a book that's getting the most out of clinical supervision, A guide for trainees and something. Okay.. And that one provides a lot of guidance about how to negotiate supervision. What to do if you have a supervisor who's not meeting your needs, how to structure the supervision, what the contract might look like, how you prepare yourself for it, all those kinds of things. Very useful. Then there's a small book that's part of a PA supervision series. And it's also called, I think Competency-Based Clinical Supervision. It's here somewhere. But anyway, yeah. And it has a summary and it was published in 2018. Then we have a case book. It's older, but it's still very topical and there, articles, chapters written by leading experts in the field about each of the aspects we've talked about, like the alliance and countertransference and multicultural and all those different aspects through the lens of that.. We, sorry, us, there's so many. Then there's a consultation book. And that is another edited book that has articles on the different types of consultation, distinguishing consultation from other forms of clinical practice. Then we have the multicultural. And Diversity and Clinical Supervision that is out of print, but it's still available on Kindle. Oh, great. And the process of probably rewriting that or redoing that, writing a new
Keith Sutton, Psy.D. (53:17):
Yeah, that's the one that's in the works.
Carol Falender, Ph.D. (53:18):
Yeah. That's the one that's in the works. And I don't know if I left something out the first edition of course. 2004.
Keith Sutton, Psy.D. (53:26):
That's great. Yeah.
Carol Falender, Ph.D. (53:27):
So that gives you a little bit of an idea,
Keith Sutton, Psy.D. (53:30):
Yeah, this is perfect. And as you were saying too about the supervisee, you know, kind of, getting the most outta supervision I had, , actually in that supervision course that I had, , the, the person that was running it would always ask, , you know, what's your consultation question? Because the person would start saying, and this week did blah, blah, blah, blah, this happened. And then say, and it was always such a nice grounding to kind of ground and what do I actually want out of this case consultation right now rather than just let me report on what's happened in the last week or so. So that's always been kind of a nice, nice piece that I always found and I actually use with my supervisees, to help them kind of organize their thinking. And just kind of one quick statement.
Carol Falender, Ph.D. (54:14):
Not to be difficult, but we do feel it's really important to differentiate between supervision and consultation.
Keith Sutton, Psy.D. (54:20):
Yes, yes. Yeah. I guess we just mean, yeah. What is the thing you want help with? Consultation question is the term that was used, right? Like you're saying,
Carol Falender, Ph.D. (54:32):
Because you know, in supervision the supervisor is responsible for everything, but in consultation the consultee makes the fund. And implements. So would say, not to confuse them.
Keith Sutton, Psy.D. (54:44):
So you would say, what is your supervision question?
Carol Falender, Ph.D. (54:46):
Yeah. Or what's the basis accurate issue that came up for you this week that you wanna address is fine.
Keith Sutton, Psy.D. (54:51):
Definitely. Great.
Carol Falender, Ph.D. (54:53):
Or what have you been thinking about that?
Keith Sutton, Psy.D. (54:55):
Definitely. Well, this is wonderful. I really appreciate you taking the time and this is really great. I think supervision is, you know, is such an important piece of our field, right. Because it's helping to train the next generation of therapists. So really kind of thinking deeply about that and all that aspects that play in, because like you're saying too, it is also a very vulnerable position to be a supervisee and supervisors have a lot of power. So it needs to be something that's not taken lightly.
Carol Falender, Ph.D. (55:24):
Also, there's no end to the learning that supervisors need to be constantly definitely learning and exploring and being open to the fact that there are supervises who come in with very sophisticated knowledge, skills, and attitudes. And we need to be open to that and be vulnerable ourselves.
Keith Sutton, Psy.D. (55:45):
Yeah. Well, thank you so much. I really appreciate your time today.
Carol Falender, Ph.D. (55:49):
Thank you for the opportunity. Okay.
Keith Sutton, Psy.D. (55:51):
Take care. Bye-bye.
Carol Falender, Ph.D. (55:53):
Thank you.
Keith Sutton, Psy.D. (55:54):
Thank you for joining us today. If you'd like to receive continuing education credits for the podcast you just listened to, please go to therapyonthecuttingedge.com and click on the link for CE. Our podcast is brought to you by the Institute for the Advancement of Psychotherapy, where we provide trainings for therapists in evidence-based models through live and online workshops, on-demand workshops, consultation groups, and online one-way mirror trainings. To learn more about our trainings and treatment for children, adolescents, families, couples, and individual adults, with our licensed experienced therapists in-person in the Bay Area, or throughout California online, and our employment opportunities, go to sfiap.com. To learn more about our associateships and psych assistantships and low fee treatment through our nonprofit Bay Area Community Counseling and Family Institute of Berkeley, go to sf-bacc.org and familyinstituteofberkeley.com. If you'd like to support therapy for those in financial need and training and evidence-based treatments, you can donate by going to BACC’s website at sfbacc.org. BACC is a 501(c)(3) nonprofit so all donations are tax deductible. Also, we really appreciate your feedback. If you have something you're interested in, something that's on the cutting edge of the field of psychotherapy, and you think therapists out there should know about it, send us an email. We're always looking for advancements in the field of psychotherapy to create lasting change for our clients.
Welcome to Therapy on the Cutting Edge, a podcast for therapists who want to be up to date on the latest advances in the field of psychotherapy. I'm your host, Dr. Keith Sutton, a psychologist in the San Francisco Bay Area, and the Director of the Institute for the Advancement of Psychotherapy. At the Institute for the Advancement of Psychotherapy, we provide training in evidence-based models, including Family Systems, Cognitive Behavioral Therapy, Emotionally Focused Couples Therapy, Eye Movement Desensitization and Reprocessing, Motivational Interviewing, and other approaches through live in-person and online trainings, on demand trainings, consultation groups, and one-way mirror trainings. We also have therapists throughout the Bay Area and California providing treatment through our six specialty centers, each grounded in an evidence-based approach, with our Lifespan Centers, Center for Children and Center for Adolescents, where all the therapists are working systemically; our Center for Couples, where all the therapists are using Emotionally Focused Couples Therapy; and our specialty issue centers, our Center for Anxiety, where all the therapists are using CBT and EMDR for trauma; and our center for ADHD and Oppositional & Conduct Disorder clinic, where we're integrating those four approaches.
Keith Sutton, Psy.D. (01:31):
In the institute, we have our licensed, experienced therapists, and for those in financial need, we have an associated nonprofit, Bay Area Community Counseling, where clients can work with associates, psych assistants, and licensed clinicians who are developing their abilities and expertise. Additionally, as part of our nonprofit, we also have the Family Institute of Berkeley, where we provide treatment, training, and one-way mirror trainings in family systems. To learn more about trainings, treatment, and employment opportunities, please go to sfiap.com and to support our nonprofit, you can go to sf-bacc.org to donate today to support access to therapy for those in financial need, as well as training in evidence-based treatment. BACC is a 501(c)(3) nonprofit, so all donations are tax deductible.
Keith Sutton, Psy.D. (02:20):
Today I'll be speaking with Dr. Carol Falender, Ph.D., who has written several books on the topic of clinical supervision with her co-authors related to her competency-based approach. She has written numerous articles and conducted workshops in symposium internationally and directed American Psychological Association approved training programs for over 20 years. She was a member of the Associate of State and Provincial Psychology Board's Supervision Guidelines group. She has received numerous awards, including two this year. One from the California Psychological Association's Chuck Felts Lifetime Achievement Award, and the second from APAs Division 29, distinguished Award for the International Advancement of Psychotherapy. Let's listen to the interview.
Keith Sutton, Psy.D. (03:02):
Well, hi Carol. Welcome. Thanks for joining today.
Carol Falender, Ph.D. (03:05):
It's my pleasure. Thank you.
Keith Sutton, Psy.D. (03:07):
Yeah. So, Carol, I heard from you, about your work from, our lawyer Adam Alban, who's also a psychologist, who's really great, and he was really just talking up about the the work you do with supervision. And so I was reaching out because we're doing some, some trainings through our practice and I really loved what you had to-- and wanted to learn more about it. I think you bring some, you know, kind of unique pieces to supervision. So before we get into even all that though, I always love to hear people's kind of evolution of their thinking and how they got to doing what they're doing and the way they're thinking about their work.
Carol Falender, Ph.D. (03:43):
Well, thank you for the opportunity. Yes. I came to this through the trajectory of directing training programs. After graduate school, I was hired to be an assistant director at a child and family guidance clinic for training. So I came up through the ranks, training interns and practicum students and some psychiatry residents. And social workers at certain points. And, became very, very intrigued with the processes of training. And became more involved in American Psychological Association activities and ultimately became a director of training at a different site. And had to develop what we call site visit documentation, documenting rationale and the theoretical orientation and the research support and all of that. So that led me on a path to developing a model, and I was very fortunate to meet my co-author Dr. Edward Franksy, and we started presenting programs together. And decided to write our first book. And this has led us to write eight.
Keith Sutton, Psy.D. (05:00):
Wow. That's great.
Carol Falender, Ph.D. (05:01):
So that’s exciting. So our model is called Competency-Based Clinical Supervision, and it's a model that is developmental and it's met theoretical. And so that means is regardless what your theory is of clinical supervision, it could be psychotherapy based. It could be, as I mentioned, developmental, or it could be really one of the many, myriad of models. This model can be superimposed upon it.
Carol Falender, Ph.D. (05:34):
Provide structure and systematic and intentional practice.
Keith Sutton, Psy.D. (05:37):
Oh, great. And when you're saying different models, do you mean different models of like orientation of people working with clients like CBT or psychodynamic or different models of supervision?
Carol Falender, Ph.D. (05:47):
Well, in fact, many people extrapolate from their psychotherapy model. To a supervision model, and there are books, many books written on the extrapolation Right. From a psychotherapy model to a supervision model. And how it can be conducted kind of in parallel or independently.
Keith Sutton, Psy.D. (06:08):
Oh, great. Wonderful. So, yeah. So tell me about the model, for the clinic, the competency-based clinical supervision.
Carol Falender, Ph.D. (06:15):
Sure. Well, what we found, and unfortunately sadly this may not have changed as much as we would've liked over the almost 20 years we've been doing this 20 years actually, we found that many, many, many professionals practice through osmosis. What that means is they practice the way they were supervised. So they supervised pretty much the same way they were in certain. Way, certain aspects and not necessarily informed at all by particular model or by the research. And there's incredible research base now for clinical supervision. And some of their experiences, unfortunately were not so good. Yeah. We also learned through work of various colleagues, including Mike Ellis and others, that not all supervision is adequate or good. We found that incredibly high rates of supervises report, inadequate supervision. And even high rates of harmful supervision which yeah is catastrophic. Because it not only does incredible harm to the supervisees, it is potentially very harmful to clients. And creates a basis for dissemination of yet another generation of osmosis of individuals that they're practicing the way they were supervised or trying to kind of flip it and do the opposite, which may or may not be a good idea, but it's not a good way to form a professional practice.
Keith Sutton, Psy.D. (07:58):
Yeah. So, great. So how, yeah. Tell me about the ways you think about, I guess, good supervision or, you know, the research that supports kind of what are the elements of good supervision? So I also supervise, mostly do group supervision for our nonprofit and I had done individual supervision, supervision classes and, you know, grad school and so on but yeah, this is really making me think about kind of the elements of supervision, kind of what
Carol Falender, Ph.D. (08:27):
Right. What are guiding it. You're raising, I'll get to that in a second. You're raising some other interesting points, which is the trajectory to become a supervisor is very uneven. So some people have one lecture on supervision and some people have two years of training. So, with experiential activities and videotape and feedback and all that, kind of state of the art, but others say, well, we read an article or a chapter or I think there was a book, I don't exactly remember, but something about it. Before done consultation or something like that. So there's that, as far as our model, our model, competency-based clinical supervision, the practice is systematic and intentional. So, we identify critical components that we address in all of our books, and they include such aspects as developing the supervisory alliance.
Carol Falender, Ph.D. (09:27):
Addressing the process ongoing, ensuring that we're attentive to strains or ruptures or unevenness. Hugely culturally humble, attitude and behavior. That relates to multicultural supervision facility, including knowing elaborate amounts of the literature and internalizing the multiple identities, not simply of the client, which many people tend to, but also the supervisee and improvisor, who's often the missing link in the equation. And we hold a lot of power. So all of that, of course, adhering to ethical and legal standards. And thinking specifically about supervision ethics, not simply looking at the ethics code, which is good. Yes. That's wonderful. But also thinking about through the lens of supervision. Attending to self-care, which is often at the end of the list, unfortunately Sure. Should be from the onset, addressing countertransference and reactivity and personal responses to clients, to situations, to supervises, to everything. I think I left a few out, but you're getting the sense. It's systematic and intentional, and we address each of these pieces and integrate them. In the process of supervision.
Keith Sutton, Psy.D. (10:59):
Yeah. Oh, that's great.
Carol Falender, Ph.D. (11:00):
You mentioned group supervision, which is a critical and actually distinct aspect that a lot of people never, never have training in.
Keith Sutton, Psy.D. (11:10):
Yeah. Yeah. I was fortunate to have a year long class in grad school where we were supervising two first years who were, you know, in a preschool program or so on. So it was a nice way to kind of get that experience and then, you know, supervising before licensed in pre-doc and post-doc but yeah, group supervision, you know? Yeah. It's not getting the training and, and particularly, you know, just going off of what, like you're saying, what, your experience was or, or whatever it might be. I know there's a lot of different ways that people, you know, kind of do the group supervision, models themselves. I am particularly interested too in, I think this lets me even maybe take the counter transfer burns reaction to clients, you know, that I'm always, you know, interested in that. Because you know, part often times right. Looking at the self therapists and particularly those that were supervising and how their own individual pieces come in, but at the same time, creating that balance where we're not necessarily doing therapy with our supervisors
Carol Falender, Ph.D. (12:19):
Absolutely. That never, never--
Keith Sutton, Psy.D. (12:20):
Exactly. With respecting their boundaries and holding, but, you know, sometimes being able to see, you know, kind of what might be popping out that's kind of, you know triggering for them client relationships or so on. And then, you know, my tactic has been to kind of help see that and then, you know, kind of help them get some support around that, or exactly. Not that they're in with their own therapist. , but yeah. Would love to hear some of your thoughts on that, on, on how, because I think other people do it differently and more people might go more deeply into the person's individual, or sometimes I've talked to folks where their supervision was like therapy and they were talking about everything that's going on in their life and, and so on. You know? In addition to the clients.
Carol Falender, Ph.D. (13:02):
Right. Well, I mean, you've raised an amazingly important topic because there is a huge continuum of experience with that, and part of it is psychotherapy based models. So individuals who are more psychodynamic or psychoanalytic tend to focus more on those aspects. But it can occur in virtually any other model. We feel very, very strongly, and my co-author at Fransky is actually a trained psychoanalyst. We feel very, very strongly that there needs to be a clear demarcation between supervision and psychotherapy. And that we do not cross that line. However, that being said, it is critical to identify aspects that are arousing or that are in fact significant to the process that impact the individual of the therapist. And to have a paradigm and process to address that reflectively and to have in the supervision contract, which is a critical component.
Carol Falender, Ph.D. (14:08):
Of supervision, an informed consent agreement, in which there's clarity about the limits of supervision and the aspects of it to adhere to encouraging identification of that collaborative identification in aspects when the supervisee may be less aware. And then to manage the reactivity we call it, which is potentially heightened arousal. And or, impact. Of those phenomena on the client and on the supervisee and on the supervisory relationship. And to ensure that all that occurs, even though we only have 60 minutes and who knows how many clients and a lot of pressures legally, ethically, and setting wise. So it's a high level of skill required.
Carol Falender, Ph.D. (15:03):
Yeah. You're working on all these different levels and really kind of, you know, also containing it all.
Carol Falender, Ph.D. (15:09):
Containing it in a way that, sometimes supervisees feel just pressured to say, I'm good, you know? Because we've got so much to do. I'm okay, sure. But in fact they're not
Keith Sutton, Psy.D. (15:23):
Yeah. Yeah.
Carol Falender, Ph.D. (15:24):
Impacting them personally and impacting their clinical work. And sometimes their behavior and attitudes toward their clients and the supervisor. Yeah. So it's highly sensitive and requires skills in terms of implementation.
Keith Sutton, Psy.D. (15:43):
Yeah. And it sounds like that also goes back to the alliance piece, like you're saying of how to create that safety where the supervisee is able to maybe share the hard parts that they're having with the clients, or, you know, the vicarious trauma or whatever might be. While at the same time. Not making it into a therapy or not, you know, them feeling too vulnerable or feeling like, oh, now the supervisor's gonna think less of me because I'm, you know, having a hard time with this. Do you have any thoughts or suggestions on that about kind of, you know,
Carol Falender, Ph.D. (16:19):
Well, what's you're beginning to address as a trauma-informed supervision, which is pretty new area, and there are some authors who are writing a lot about this, and one of the aspects of that is, first of all, normalizing the fact that trauma is inherent in much of our clinical work and trauma exposure and our own personal experiences can be triggered by client trauma. And there's a movement toward helping supervisees understand about self-regulation about amygdala activation, and about strategies for being present in the moment without, well, to regulate, to self-regulate, and actually to do that in supervision as well. And to directly address these phenomena and to talk about self-care and to model self care, rather than making it just a kind of add on, which it often is or even add out because no one even talks about it. So the toll that can be taken can be very high. So, I'm not sure if I addressed your question exactly.
Keith Sutton, Psy.D. (17:34):
I mean, I think it's just common that idea of like how to kind of create that sense of safety, but also helping the person kind of, you know, in a boundaried way. And I think, you know, it's, it's that dance of alliance, like we would do a sense of, you know, really kind of trying to both elicit what's going on and the ability to share that while at the same time, you know, , feeling like there's boundaries and not feeling intrusive or so on, or loss of control.
Carol Falender, Ph.D. (18:02):
And to be clear that our highest duty as a supervisor is protection of the client and the public. So it's a complex role. Because there are times when we actually have to say, you know, this supervisee is simply not doing an effective job, even with the amount of supervision I can give, which is often a lot. It's still not, and it is potentially harmful to this client. Who is at high risk. So I have to, or we have to have that discussion and explain that in fact, a different arrangement's gonna have to be made, plus they're gonna have to be implementation of strategies to help the supervisee to increase their competence and to greater mastery over the types of material that they found so difficult or that weren't those are gatekeepers for the profession.
Keith Sutton, Psy.D. (19:02):
Exactly. Yeah. And I think that's hard sometimes of teasing out how much of this is development in the skills and being able to have the skills with the clients.. How much of this is their own personal things that are continuing to get triggered, and what's the level of awareness and, you know, kind of addressing that.
Carol Falender, Ph.D. (19:21):
Well you identified also it's knowledge, skills, and attitude Many supervisors are really good at knowledge really, or even really good at skills. Attitudes. And that whole realm can be much more challenging and sometimes avoided by supervisors.
Keith Sutton, Psy.D. (19:42):
You mean the attitude of like how the supervisee's attitude with their clients or
Carol Falender, Ph.D. (19:49):
Or in supervision? Or in supervision or just their worldviews and how those intersect with the setting and with the client populations Yeah. And the types of problems that are being presented by the clients or the setting Yeah. Intersection of all of those.
Keith Sutton, Psy.D. (20:09):
Yeah. We use a couple of different models. We use family systems, CBT, emotionally focused couple therapy and EMDR or kind of the evidence-based models that we use and integrate. But I oftentimes find that particularly working with anxiety sometimes is hard for a number of therapists. And particularly we, we kind of use an ACT and CBT model of kind of, you know, being with the discomfort and sitting with it and staying with it and so on. Although sometimes for a lot of the clinicians, especially who's new, they get very anxious and they're like, oh, let's do some deep breathing, or, you know, it'll be okay. And so on. And helping them to kind of be able to, you know, figure out, right. Both have the tools and to be able to help their client sit with discomfort. And then also the internal ability to be able to sit with that discomfort, because sometimes that's just not intuitive for folks that their mind is like, oh, discomfort. Get away from that.
Carol Falender, Ph.D. (21:05):
Right. Or it could be a theoretical kind of issue that, you know, they feel like there has to be a quick intervention that's going to be effective, and when there's not, that's kind of treading water and trying to figure out what to do.
Keith Sutton, Psy.D. (21:20):
Definitely.
Carol Falender, Ph.D. (21:22):
So it requires the supervisors to be very, very, very , competent and open to learning and reflective and supportive and warm, and then to set limits and to put all that together.
Keith Sutton, Psy.D. (21:40):
Yeah. Yeah. Yeah. I think that's a hard balance to both kind of help the supervisee grow and also have their own autonomy of how they're going to kind of make the therapy their own because I think about it, I was at the Beck Institute and Aaron Beck talked about and learning a new approach. It's one part theory, one part technique, the other part is the art, and really how do we bring ourselves and our personality to our work. And so kind of creating enough space for supervisees to bring their self to the work rather than trying to be, you know, Sue Johnson or trying to be, you know, Salvador Mnuchin or whatever it might be. And learning how to bring themselves to it. While at the same time also bringing in the theory and the technique and not kind of abandoning that.
Carol Falender, Ph.D. (22:26):
And how to manage the theoretical realm when actually implementing, because some of the theories suggest that the alliance will grow out of the work and others purposefully, want to establish the alliance very carefully. And, you know, through certain steps and stages and how to put all that together. Especially if you have a supervisor who has a different theoretical model than you do, and you've been trained in one, and here's your supervisor with something completely different, and then you've got the client care and hard to know what to do and be
effective.
Keith Sutton, Psy.D. (23:05):
Yeah. I think that's one of the hardest, or at least in my own experience, having the hardest because sometimes you don't get to choose, you know, who your supervisor is or so on, or sometimes even you might go to a site that says they do therapy and or follow the model, but then the supervisors are doing other models and sometimes the supervises are getting triangulated between their group supervision, their individual supervisor, and so on. And it can be a kind of, you know, very confusing.
Carol Falender, Ph.D. (23:32):
Right. And that's a supervisory responsibility. We really encourage supervisors to take responsibility for discussing with their fellow supervisors the models they're using and the intersections they have when they're both supervising the same supervisee.
Keith Sutton, Psy.D. (23:49):
Yeah, definitely. Well, let's talk about, I mean you also talked about being culturally humble and, and addressing the process, and I think, you know, the aspect of power in the supervisory relationship because Right. Ultimately, we are the gatekeepers to the profession. And we do have the power in that way as well as we might also, as, you know, cisgender white male therapist, or supervisor, you know, I've got all the, all of these privileges too.
Carol Falender, Ph.D. (24:19):
Absolutely.
Keith Sutton, Psy.D. (24:20):
Yeah. And so oftentimes when, when working with my supervisees or talking about different clients, what, yeah. How do you think about that? Or how do you talk or teach about the aspects of cultural competency within the supervisee relationship?
Carol Falender, Ph.D. (24:34):
Yeah. We're working on a second edition of our book on multicultural supervision. , so we're deep in the weeds or whatever you want to call it. Yeah. But anyway, we encourage self-disclosure by the supervisor from the very beginning of identities and recognition of the critical aspect of these identities and a privilege. There's emerging research that privilege is not being a topic very much in clinical supervision. Privilege of the client, the supervisee or the supervisor. And we need to address more carefully and, specifically identities early on power and take drawing from feminist supervision work, a true discussion of power. And defining power and explaining how, in fact, we do hold tremendous power over our supervisees. We do, we control whether they pass or fail. We control their progression and also we promise that we will have no surprises, that we are going to be giving them feedback. And when we're concerned about something, we're not going to do what supervisors do, which is make a list. A secret list. And just think about it and worry about it, and lose sleep over it, and never tell the supervisee until the evaluation period. And then give them like a zero or something out of a hundred, we are going to be giving feedback systematically and intentionally in each session. We're going to be completely, truly honest and transparent with them about the feedback, and we're going to do our very best to figure out how to scaffold their strengths. To improve the areas that are in development. So, all of those aspects. Complicated.
Keith Sutton, Psy.D. (26:40):
Yeah. Do you have any recommendations? Do you use any measures or anything that, or suggest any with, you know, I know. So we use the outcome rating, scale session with our client. Barry Duncan.
Carol Falender, Ph.D. (26:56):
Yeah, his work is wonderful. Yeah.
Keith Sutton, Psy.D. (26:58):
Scott Miller's work, and I was even playing around with kind of using a version of that in supervision for some time. Are there any specific measures that are helpful in giving that feedback with the supervisee in a way that kind of is more frequent than say, you know, six
month, you know, one year right?
Carol Falender, Ph.D. (27:19):
Well, in the appendix of our second edition, we have a panoply of measures, many of which we use, pretty much weekly. And they come from authors, you know, from the US all over the country Yeah. And measuring various aspects. But we do believe that client input is critical and we feel that that has been very much neglected. So getting outcome questionnaires is very critical. Finding out how the clients are perceiving both the relationship and the therapeutic progress. And feeding that into each supervision session would be state of the art. But beyond that, we do encourage self-assessment on a variety of scales. I know you're gonna think, where in the world do you have time for all this, right. Supervisor or assessment of the supervises and being very mindful of what the strengths are of the supervisees and what areas that maybe are a little bit hidden or something. But seem to be very much in development, or at least slightly in development. And to be focusing on these not to be afraid to give that kind of feedback. Many supervisors say, when we conduct seminars, they say, I don't wanna tell them that because I'm afraid it'll rupture the alliance. The reality is that a bigger rupture to the alliance will be at the midterm when you tell them
Keith Sutton, Psy.D. (28:45):
Yes, yes.
Carol Falender, Ph.D. (28:46):
That they're not up to par, and that they're not doing well, and you're gonna be calling the school or whatever it is that you have to do. So, we like authenticity and a lot of feedback and clarity and integrity. Definitely in relationship. One of our foundational principles is integrity in relationship.
Keith Sutton, Psy.D. (29:07):
Yeah. Which means saying hard stuff sometimes
Carol Falender, Ph.D. (29:11):
Very difficult conversations. Incredibly difficult because we often really like, not in a bad way, but we really like our supervisees, we do their work. We think they have so many strengths, but we identify that there are areas that are of lesser competence and how to give them the feedback without devastating them. And how to support them. And again, building from their strengths, being very attentive to that. We also use a technique where at the beginning of supervision, we ask them to self assess. Usually using benchmarks or some rating system that perhaps comes from their school or perhaps from psychology benchmarks or for social work has very elaborate kinds of competencies identified and in AMFT also. So losing those to self-assess. And many supervisors say, well, they're not accurate self-assess, none of us are. That's true. But in fact, it's a beginning. And in fact, if they give all strengths, we say that you have made progress. You've achieved all of these in the first week. It's a little extreme, but you know what I mean. And saying, actually, I noticed that one of the things that is difficult for you is when the client became angry. Or when you disagreed with what direction the client was going, even though you'd given a particular suggestion of how to interact with the child and you saw it, that it wasn't being implemented properly. And it seems like it was very difficult for you to address that. So to give them granular. And then to develop a new goal. And so you've already achieved the one about being strengths-based. You've been awesomely strengths-based, so let's move on and have this new goal, which is, and tracking that. And each session spend at least a minute or two saying excellent progress on that. I like the way this requires you to be able to get the input. Yes. After either a video, audio, live observation, or,
Keith Sutton, Psy.D. (31:18):
That's actually what I was gonna ask too, is that, you know, I'm sure you do. I encourage, we have all of our folks record their sessions with the client's consent, but 90% of the clients consent. So we just see some interaction. Just seeing that process happening is so valuable.
Carol Falender, Ph.D. (31:35):
It's invaluable. It's invaluable. Yeah. And it's a wonderful learning device. Yeah.
Keith Sutton, Psy.D. (31:40):
Yeah. Yeah. So somebody could tell you all about the client for 45 minutes, but that three minutes of video just kind of can help you so much see what's going on in the interaction between the client and the supervisee.
Carol Falender, Ph.D. (31:51):
And supervisees, like all of us do not know what we do not know.. So there are times that supervisees come in and say, it was the best session I've ever done. It was just phenomenal. And I say, yeah, there was some really wonderful aspects to it. I wonder what happened when. Yeah, the mother told you that her ex was coming to visit and you went home. like what was that like and what was happening and how do you think that impacted.
Keith Sutton, Psy.D. (32:22):
Yeah, yeah.
Carol Falender, Ph.D. (32:23):
Yep. And yeah,
Keith Sutton, Psy.D. (32:25):
Definitely. Yeah. I am a big, big supporter. And also why of supervision? One-way mirror training, you know, I think that's just invaluable too, and helping. Wonderful, yeah. Helping supervises kind of go outside their comfort zone. Also sometimes with the support of a supervisor. They're kind of coaching them along. And having that kind of experiential, you know, kind of experience of doing something differently.
Carol Falender, Ph.D. (32:49):
Right. No, it's wonderful. I agree with you a hundred percent. Yeah.
Keith Sutton, Psy.D. (32:52):
Yeah. Great. Well, I would love to actually get some of your thoughts, if you don't mind, on group supervision. because I think that it is a topic that's not often discussed so much, and I, myself always struggle with kind of the best way to structure it because, you know, and, and really actually, so we have a lot of MFTs and in California here, you can have up to eight MFTs in group supervision with potentially 10 clients each, which is 80 clients to cover in two hours, which doesn't feel ethical to me. So we actually have folks after five clients get an hour of individual supervision in addition to the group supervision. Would love to hear some of your thoughts or strategies on how a supervisor, you know, a group supervisor supports their clinicians as well as, you know, all those clients in, in a short period of time. Right.
Carol Falender, Ph.D. (33:43):
Yeah. Well, first of all, I'm sure you use group rules or parameters. So in fact, there's understanding amongst the group members and the leader leaders about what the expectations are and to have clarity about respectful process and about any kinds of strains or ruptures that arise during the group, how they're managed. Generally, they'll be managed within the group. Unless in fact, something happens, which is potentially so destructive to a particular participant or some or imminent risk that wasn't identified or something that the group has to be stopped. But otherwise, generally everything is managed and repaired within the group. Definitely a climate of cultural humility, you know, the emerging researches that so many microaggressions happen both in group therapy and unfortunately in group supervision. And sometimes they just often actually, they just go unnoticed and microaggressions are of course. Implicit kinds of statements that are lacking in cultural humility and harmful. To the clients and to the milia.
Keith Sutton, Psy.D. (34:59):
Yeah, definitely.
Carol Falender, Ph.D. (35:01):
So the group rules, which are generally collaboratively developed, sometimes we go in with a prototype or categories of things, or other times the group just wants to come up with their own.
Keith Sutton, Psy.D. (35:13):
Yeah.
Carol Falender, Ph.D. (35:14):
And then going from there to ensure part of the group rules is ensuring a process in which there are no group hogs, someone who always, not to be Midwestern, but a little who always, you know, is going, I have an emergency. It's 12 cases I have to talk about today. Yeah, sure. We have to share the experience that there's a respectful process that has to occur. So all of that realm has to be dealt with. There actually is some work in which Erics and Cornish and others have developed a group contract. They feel that it's not sufficient to have a supervision contract, but they need a group contract to be clear about the rules and respectful practice. Then we have to walk the walk, just talk to talk. So the group leader or leader, sometimes there are two, but generally just one has to assume a responsibility for each of those rules. And for cultural humility in the process. And has to take a strong leadership role without destroying the whole thing and making it just one person talking to the leader and the leader giving an answer, which is not group supervision, that's some kind of economical supervision. , many people in a room with one supervisor. Then the supervisor needs to be attuned to group dynamics. And I think this is where much of group supervision falls down. That people don't have adequate training or attention to what the processes are in the group, and how often there are parallel processes that arise. Which the actual client situation is being reenacted unconsciously, one could argue, amongst the group members. And how it's incumbent on the group leader to identify those and reflect on those and talk about the power of the process, what's occurring sometimes like in child work. How an oppositional child is just dominating the sessions and the thing. Yeah. And suddenly one of the other supervisees is just becoming super dominant and is managing everything. And we're saying, whoops, look what's happening here. That's a simplistic one, but you know what I mean? All of those types of things. So, having training in group is very important because ruptures and strains are sometimes so subtle. It's hard to identify them. Plus they're the pressures on the supervisor thinking, as you said, we have 80 cases here under supervision today. Do I have time to really stop and say, you , this just happened, we need to manage it. Should I just move on and try to deal with some of the more one, because 11 people said, or 11 cases were in crisis and we only have 20 more minutes, and how are we gonna handle this in a way that's effective and that protects the clients? So, well, I think that's, I dunno if that answered it.
Keith Sutton, Psy.D. (38:27):
Well, yeah. No, it's helpful to think about, you know, I think that group process part is such an important aspect. I think that I've always struggled with, you know, sometimes if going deeper into one case and then that, you know, and, but then you don't get to talk about enough cases kind of. Or sometimes, going with, you know, the ones in crisis, but then sometimes there's some of the therapists, like are saying maybe are always the ones with the ones in crisis. And so figuring out how to create that balance for everybody to get what they need. And also of course, ultimately protecting the clients and the work of the client Exactly. And how to kind of juggle that all at the same time. Yeah, I think that's it's a challenge of group supervision. I think it's, you know, that's, I oftentimes have a preference, you know, the individual supervision can go so much slower and you can really build that relationship and go in more depth in some of those ways than you can in a group supervision.
Carol Falender, Ph.D. (39:28):
But group supervision can be incredibly powerful. And I think it's an amazing learning experience, but there's very great reliance in both on supervisor competence and supervisor acceptance of the fact that we don't know everything. Meta competence. That we, you know, there are times when we have to just say, I do not know. Find out I need to get consultation on this and I'll get definitely very shortly. Or what happened here really perplexes me, what just happened in the group, and I need to think about it and get consultation even on that. And we're gonna have to reconvene, or I'll meet with the two people who had the disagreement about this and we'll briefly describe it next week. So to model that not everything can be solved in one minute. And to hopefully to train the supervisees to be respectful and to be concise. And to rotate so that they each get a chance to present cases in a systematic manner.
Keith Sutton, Psy.D. (40:42):
Yeah. Well, I think what you're saying too is that, you know, as kind of not knowing everything. And I think that that's something that's particularly hard for supervisees coming in and going into a session, wanting to play the role of the supervisor and like they've got it all. Or sorry, , the therapist and like they've got it all figured out. And oftentimes I talk to my super supervisees, is that right? By definition, they're not competent which is completely okay. And being able to kind of own that in this early period and sometimes collaborating with our clients around that of saying, you know, this is the knowledge I have and I wanna learn about the knowledge you have. And kind of bringing that together rather than trying to feel like they have to have all the answers. Because I think, you know, especially supervises oftentimes feel a great responsibility to fix it and fix it quick and so on. So, oftentimes getting overwhelmed
Carol Falender, Ph.D. (41:33):
And to please us. To do what we they think we want them to do and to be successful. And with all the pressures. And we talk about the pressures, and I think I've gotta cure everybody in about an hour.
Keith Sutton, Psy.D. (41:47):
Yes. Yeah. Do you have any thoughts on kind of how you address that with your supervisees about, again, just helping them, you know, having that beginner's mind or kind of understanding right. That this is actually part of their process and where they are in their developmental journey?
Carol Falender, Ph.D. (42:04):
Well, the word we use is meta competence. And we talk about the fact that it's better to know what you do not know than to think you know everything. So it's very helpful for you to be thoughtful and reflective after your session. Think about what went well, what was a little more challenging and what didn't, you know, and what, what would be useful for you to increase your knowledge, skills, or attitude in. And we can discuss that in supervision. We can give you resources for that. So to also, for us to sometimes say when it's accurate, I do not know.
Keith Sutton, Psy.D. (42:43):
Yeah.
Carol Falender, Ph.D. (42:43):
And to say, but I'm gonna find out , you know, call colleagues and find out or read about that or something. But, to model that we do not know everything. It's so important for us to be thoughtful about the limits of our competence. I'm not sure I answered your question, but yeah.
Keith Sutton, Psy.D. (43:03):
No, I think that's good. And it is just making me think too, because we actually have a meeting where we all get together once a month. We have one practice where it's all licensed experienced folks, one that's nonprofit, and we come together and actually talk about cases. So them getting to see the licensed people presenting their cases and showing video and struggling and so on, or learning, I think is also, you know, kind of exactly really helpful for the supervisees to see that, you know, this is something that, we're continuing to develop throughout our career, you know, of learning and getting information and making mistakes and repairing and, and so on.
Carol Falender, Ph.D. (43:42):
Yeah, we encourage that actually to have supervisors video, their own sessions or maybe mock sessions, but of course with all the appropriate consents, concerns and all that, but to a model that none of us is perfect. That they may see the interventions through different lens and it's useful to think about that and reflect on that and think about with their own cases as well.
Keith Sutton, Psy.D. (44:10):
Yeah. Yeah. I've, I've been doing that a little bit too, or I've been showing some of my sessions also because I've been finding that when they're seeing some of the direction that I'm giving them. In action with it, oftentimes I think it helps to, to understand or comprehend even more a little bit to really kind of see what it looks like in process. Right, such a big piece. Well this is great. And so, and then, you know, when we get to the kinda legal, ethical, you know, pieces of that, you know, I think that there's always, you know, always again, that balance of covering the process of the, the supervisee as well as, you know, covering the clients and also making sure that we're really addressing all the things that we need to check off and make sure that's, that's going correctly. Can you speak to self-care? Because I think that that was one of the other big pieces.
Carol Falender, Ph.D. (45:03):
I don't wanna skip ethics.
Keith Sutton, Psy.D. (45:05):
Sorry. Sorry. Of course. No, definitely.
Carol Falender, Ph.D. (45:07):
Can we spend just a minute? Yeah, I think, you know, some countries actually have a supervision ethics code that's distinct like UK and Canada to some extent and others. So, and Australia and New Zealand. Yeah. So, we don't, and, and I'm talking again about psychology. Yes. But different things do as well. So I think it's so important for us as supervisors not to put ethics on the back burner. And to think through the lens of ethics and ethical standards and codes very specifically and to reference them. I encourage supervisors to reference them at least once each supervision session. Oh. To prepare something like, say, it seems like that's a complex multiple relationship kind of thing that's coming up. Let's see what, let's read that and see, reflect on that. I know who has time for all this, but to be sure. If we just said in passing that's multiple relationships, please read that and come back. We'll discuss it for a minute at the beginning because I think that's an important aspect or we're approaching the limits of confidentiality here and we need to attend to that very specifically or whatever the category is. To help to identify and to link supervision practice to ethical practice. That's right. And to make sure supervises are very clear about that. And also across disciplines there differences. And to help them to understand that so that they are familiar with their own professions ethics code. And what some of the sometimes subtle but distinct differences might be. So that would be that.
Keith Sutton, Psy.D. (46:57):
Yeah. No, I think, I think that's important. Yeah. Definitely. And, and I like what you're saying too, also like, let's look at this together just again to that way it's not the supervisor kind of wagging their finger. Yeah, exactly. And instead of it, you know, kind of like, let's look at this together, like how does this apply here or so on. So really kind of help them have that relationship with the ethics code rather than nestle us being kind of the teacher wagging the finger.
Carol Falender, Ph.D. (47:23):
Well, when I do workshops, sometimes I say, you have to have a written copy of the ethics code available. And everyone says, well, I can just get it on my cell phone. And I said, when's the last time you tried to read the ethics code on your cell phone?. Yeah. You have to go, you know, make it, whatever. So just to model that ethics is foundational. And then we think through that lens and how important that is.
Keith Sutton, Psy.D. (47:49):
Yeah. The basis of all it, the trust, the safety. Yeah.. Definitely.
Carol Falender, Ph.D. (47:55):
And then to move into self-care as you asked. Yeah it's a field that's very much in development. I'd say there's a lot of publication of it in the last two years, especially, you know, COVID took an incredible toll on our, on everyone. But our supervisees particularly, I think were hugely vulnerable and impacted in so many ways. And self-care is often at the very bottom of their list of concerns because there are so many others like financial and personal and trajectory getting through this and trying to get all their required courses and hours and so on. Right. And surviving. And having a life because many of them have families or extended families or health situations or all kinds of intersectional variables that are so difficult and often we have no idea what they are. Yes. Or if we do, we can't really do much of anything except support them a little bit. Very, very difficult. So, one thing that seems to be emerging and seems kind of basic, but we need to be talking about self-care more. We need to be modeling self-care more. We need to attend to self-care. And even though we are in a kind of conflictual relationship with self-care. Because one, our supervisors to work more and more hours, take on more and more cases, write their reports really quickly, get their notes up to date, et cetera, et cetera. We also want them to engage in self-care.
Keith Sutton, Psy.D. (49:40):
Yeah. Yeah. It's a lot. And being able to fit that all in, or even sometimes going the opposite way of carving it out and kind of creating those islands of self-care, because especially as a grad student, you know, there's just so much to do and not enough time to do it all.
Carol Falender, Ph.D. (49:57):
I think many agencies have come up, probably you have too, with pretty innovative things to have potlucks, to have lunches, to have surprise kinds of , you know, snack time or something to try to emphasize the fact that we're also human and people. And we need to take a deep breath now and then, because we're moving so fast and we have so much pressure from so many aspects of our lives and our training. So, but then supervisees tell me, I don't wanna dwell on it, I don't wanna think about it, I just wanna do it because I just need to focus on getting it done. I have one more year. Yeah. One more year and I'm going to be good.
Keith Sutton, Psy.D. (50:43):
Yeah. It's quite a marathon getting through to that point when you get licensed. And so many tests and, you know, requirements and such.
Carol Falender, Ph.D. (50:54):
And then-- and preparation and costs and all. Exactly.
Keith Sutton, Psy.D. (50:57):
Yeah. So, I love the work that you're doing and, and you were mentioning earlier those assessment measures, which book was that one in?
Carol Falender, Ph.D. (51:07):
Well, it's called Clinical Supervision, A Competency-Based Approach, second Edition. It came out in 2021.Okay, great. Yeah. And I was wondering as, , to talk a little bit about your books and can you highlight kind of the, the differences with the different books and maybe as kind of listeners are thinking about like where they're wanting to learn more of?
Carol Falender, Ph.D. (51:31):
Well that one is state of the art with all the recent research up to 2021. Although the research is growing quickly. Yeah. , and it provides the whole outline of competency-based clinical supervision. We have a book that's getting the most out of clinical supervision, A guide for trainees and something. Okay.. And that one provides a lot of guidance about how to negotiate supervision. What to do if you have a supervisor who's not meeting your needs, how to structure the supervision, what the contract might look like, how you prepare yourself for it, all those kinds of things. Very useful. Then there's a small book that's part of a PA supervision series. And it's also called, I think Competency-Based Clinical Supervision. It's here somewhere. But anyway, yeah. And it has a summary and it was published in 2018. Then we have a case book. It's older, but it's still very topical and there, articles, chapters written by leading experts in the field about each of the aspects we've talked about, like the alliance and countertransference and multicultural and all those different aspects through the lens of that.. We, sorry, us, there's so many. Then there's a consultation book. And that is another edited book that has articles on the different types of consultation, distinguishing consultation from other forms of clinical practice. Then we have the multicultural. And Diversity and Clinical Supervision that is out of print, but it's still available on Kindle. Oh, great. And the process of probably rewriting that or redoing that, writing a new
Keith Sutton, Psy.D. (53:17):
Yeah, that's the one that's in the works.
Carol Falender, Ph.D. (53:18):
Yeah. That's the one that's in the works. And I don't know if I left something out the first edition of course. 2004.
Keith Sutton, Psy.D. (53:26):
That's great. Yeah.
Carol Falender, Ph.D. (53:27):
So that gives you a little bit of an idea,
Keith Sutton, Psy.D. (53:30):
Yeah, this is perfect. And as you were saying too about the supervisee, you know, kind of, getting the most outta supervision I had, , actually in that supervision course that I had, , the, the person that was running it would always ask, , you know, what's your consultation question? Because the person would start saying, and this week did blah, blah, blah, blah, this happened. And then say, and it was always such a nice grounding to kind of ground and what do I actually want out of this case consultation right now rather than just let me report on what's happened in the last week or so. So that's always been kind of a nice, nice piece that I always found and I actually use with my supervisees, to help them kind of organize their thinking. And just kind of one quick statement.
Carol Falender, Ph.D. (54:14):
Not to be difficult, but we do feel it's really important to differentiate between supervision and consultation.
Keith Sutton, Psy.D. (54:20):
Yes, yes. Yeah. I guess we just mean, yeah. What is the thing you want help with? Consultation question is the term that was used, right? Like you're saying,
Carol Falender, Ph.D. (54:32):
Because you know, in supervision the supervisor is responsible for everything, but in consultation the consultee makes the fund. And implements. So would say, not to confuse them.
Keith Sutton, Psy.D. (54:44):
So you would say, what is your supervision question?
Carol Falender, Ph.D. (54:46):
Yeah. Or what's the basis accurate issue that came up for you this week that you wanna address is fine.
Keith Sutton, Psy.D. (54:51):
Definitely. Great.
Carol Falender, Ph.D. (54:53):
Or what have you been thinking about that?
Keith Sutton, Psy.D. (54:55):
Definitely. Well, this is wonderful. I really appreciate you taking the time and this is really great. I think supervision is, you know, is such an important piece of our field, right. Because it's helping to train the next generation of therapists. So really kind of thinking deeply about that and all that aspects that play in, because like you're saying too, it is also a very vulnerable position to be a supervisee and supervisors have a lot of power. So it needs to be something that's not taken lightly.
Carol Falender, Ph.D. (55:24):
Also, there's no end to the learning that supervisors need to be constantly definitely learning and exploring and being open to the fact that there are supervises who come in with very sophisticated knowledge, skills, and attitudes. And we need to be open to that and be vulnerable ourselves.
Keith Sutton, Psy.D. (55:45):
Yeah. Well, thank you so much. I really appreciate your time today.
Carol Falender, Ph.D. (55:49):
Thank you for the opportunity. Okay.
Keith Sutton, Psy.D. (55:51):
Take care. Bye-bye.
Carol Falender, Ph.D. (55:53):
Thank you.
Keith Sutton, Psy.D. (55:54):
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