Training Public Sector Clinicians in Competency-Based Clinical Supervision: Methods, Curriculum, and Lessons Learned

Abstract

This article describes an initiative to train public sector clinicians in competency-based clinical supervision. It was delivered as an 18-session course taught online to clinicians employed in departments of behavioral health in nine Southern California counties. The curriculum was co-constructed by a team of clinical supervision scholars and leaders who then served as instructors. Each two-hour meeting addressed a specific topic for which a training video had been prepared, usually featuring a member of the training team who had expertise in that topic. The second part of each meeting focused on a class member’s supervision case presentation. Those presentations revealed 35 themes; the four most frequently occurring were: developing supervisees’ clinical competencies, addressing countertransference and parallel process, balancing clinical and administrative supervisory roles, and addressing record keeping/paperwork. Participants’ pre-to-post supervisory self-efficacy changes demonstrated a moderate effect size (Cohen’s d = .46) for the training, with the greatest pre- to post-training changes being in the use of technology, multicultural competencies (awareness of oppression, bias, and stereotyping in clinical work and in clinical supervision), and contracting. They reported that the strengths of the course included an inclusive learning environment and opportunities to reflect on and apply new knowledge and skills, though they also reported struggling with the assignments and the course platform software. Lessons learned reflected the use of technology in this online program, the importance of obtaining buy-in from agency decision makers and being prepared to address challenges related to the use of direct observation in supervision, gatekeeping, and enacting the simultaneous roles of administrative and clinical supervisor.

The MATRIX: A deliberate practice approach for clinical supervision in the public sector.

“…Several authors have already identified the promising potential of DP for psychodynamic supervision (e.g., Hilsenroth & Diener, 2017; Miller et al, 2008; Rousmaniere et al, 2017; Tracey et al, 2014), proving the time psychotherapists spend engaged in DP significantly predicts better treatment outcomes (Chow et al, 2015). Nevertheless, despite longstanding efforts to implement DP and other competency-based models in clinical settings, researchers continuously point to the fact that it has yet to become a standard practice in the real world (e.g., Falender & Shafranske, 2017; Hutman et al, 2021). Thus, many are calling for feasible DP frameworks judiciously tailored for real-life clinical supervision (Clements-Hickman & Reese, 2020).…”

“…However, some challenges are inherently shared by all public psychotherapeutic services around the world, which could be broadly summarized as follows:Public psychotherapy must adhere to the principles of distributive justice (i.e., overarching equality of access to scarce health resources; Daniels, 2001), including, for example, the issue of patient prioritization and maintaining cost-effectiveness. Thus, supervision in publicly funded settings carries the dual task of serving not only the needs of the supervisee and the therapeutic dyad, but also the broader organizational interests of the health care system (Carroll & Rounsaville, 2007; Hutman et al, 2021). In other words, it serves a gatekeeping function by supporting decision-making processes such as rationing care (Walton & Grenyer, 2002), responsible not only for those who get treated, but also for those who do not.…”

Supervision of psychotherapy for psychosis: A meaning-making approach.

“…While progress has been made in developing competency-based supervision to support clinicians in delivering specific evidence-based treatments targeting measurable outcomes (e.g., Danzi et al, 2020; Dorsey et al, 2017; Hutman et al, 2021), none of this work really addresses the complex needs of supervision for clinical work with patients diagnosed with psychosis described above. Concrete strategies for measuring supervisory competencies and improving fidelity to these treatment models offer little to clinicians struggling to form relationships with patients for whom connection may be threatening or overwhelming.…”