Supervision: Who Is It For?

October 15, 2017 5:33 pm

This blog is based on a recent comment (Duncan, 2016) published in the Australian and New Zealand Journal of Family Therapy. The purpose of supervision is to promote the developmental needs of the supervisee and ensure that clients receive ethical and competent treatment (Bernard & Goodyear, 2014). More emphasis is typically placed on the interpersonal processes and development of the supervisee in supervision. This supervision leans heavily toward the supervisee’s experience rather than the client’s and gives little attention to whether clients benefit from the services provided. Both of these issues seem isomorphic to therapy, i.e., the therapist’s perspective remains the privileged one in the room and the client’s perception of outcome is missing in action.

PCOMS provides a different emphasis: consumer perspectives and outcomes (Duncan & Reese, 2015). PCOMS shifts the conversation in supervision away from our love affair with models and preoccupation with psychopathology. Based on outcome data instead of theoretical explanations or pontifications about why clients are not changing, supervision is aimed at identifying clients who are not benefiting so that services can be modified in the next session. This is a departure from tradition because rather than the supervisee choosing who is discussed, clients choose themselves by virtue of their ORS scores and lack of change—bringing their voices into supervision.

Although most of supervision focuses on improving services to clients, the final component shifts to the supervisee and his/her development. ORS data provide an objective way to know whether development is actually happening as well as the impetus for the therapist to take charge of it. From the frank discussion of effectiveness and the supervisee’s ideas about improvement, a plan is formed. Also here the supervisor harvests what has been learned from successful and unsuccessful clients, about anything that happened that was new or different, and about the supervisee’s reflections about what it means to be a therapist. Clients identified by PCOMS as not benefitting provide fertile ground for learning because they compel us to step outside of our therapeutic business as usual to promote change.

PCOMS supervision is about improving outcomes via the identification of at risk clients first and foremost, and then focuses on the supervisee and professional development using ORS data as an objective standard of effectiveness over time. PCOMS not only privileges the client in therapy, it carries a consumer first priority into the supervisory process, and ultimately to the way that effectiveness at all levels of service are evaluated. For a full discussion of this kind of supervision, see the chapter by Duncan and Reese (2015).

I call this supervisory process “supervision for a change—in clients and therapists.” Better Outcomes Now addresses both, providing a one page look at the clients who are not changing as well as easy to understand individual therapist effectiveness stats across four indicators of outcome (average change, reliable and clinically significant change, expected treatment response, and effect size). Email me at barrylduncan@comcast.net or call at 772.204.2511 for a free trial and join the many organizations committed to improving consumer outcomes.

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