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Facultad de Estudios Superiores Iztacala Revista
Electrónica de Psicología Iztacala
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Facultad de Estudios Superiores Iztacala Revista
Electrónica de Psicología Iztacala
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El Modelo Integrado de Desarrollo
de Supervisión Clínica: Investigación y Desarrollo
The Integrated Developmental
Model of Clinical Supervision: Research and Practice
Brian W. McNeill1
Washington State University
Cal D. Stolenberg
University of Oklahoma
Resumen
El propósito de este articulo es proporcionar una revisión teórica breve de los modelos del desarrollo de supervisión clínica para el entrenamiento de terapeutas, y presentar una introducción y resumen completo de estos modelos, El Modelo Integrado del Desarrollo (MID). También revisamos la investigación actualizada relacionada con este modelo y presentamos recomendaciones para la investigación a futuro y práctica clínica de este modelo. Palabras Clave. Supervisión clínica, psicoterapia, entrenamiento de psicólogos.
Abstract:
The purpose of this manuscript is to briefly review developmental models of clinical supervision in the training of psychotherapists, and provide an introduction/overview of the most comprehensive of these models, The Integrated Developmental Model (IDM). We also review the current research related to the model, and provide recommendations for future research and practice. Key Words: Clinical Supervision, psychotherapy, psychologist training.
1 Profesor de la Universidad del Estado de Washington mcneill@mail.wsu.edu
ferny_72@hotmail.com
Developmental models of clinical supervision have been described as the zeitgeist of supervision models (Holloway, 1987, p. 209), the most heuristic (Worthington, 1987), as well as the most researched and the most visible themes in recent years (Bernard & Goodyear, 1998). This manuscript briefly traces the history of developmental models of supervision and provides an overview of the most recent and comprehensive of these models, the integrated developmental model (IDM; Stoltenberg, McNeill, & Delworth, 1998). The manuscript summarizes the current state of the supervision research as it relates to this model and ends with an analysis of where the model needs further refinement and more extensive empirical investigation.
A treatise on human development and the utility of this metaphor for the process of clinical supervision is beyond the scope of this manuscript and has been adequately addressed elsewhere (see Stoltenberg & Delworth, 1987). We think, however, that it is crucial that the process of supervision should carefully incorporate the concept of change over time (Stoltenberg & Delworth, 1987) in considering the needs and responses of trainees. As discussed later, the research literature appears to support many of the key constructs of developmental models, including differential characteristics and training needs of supervisees, reactions to supervision, and behavior of supervisors across levels of experience (Stoltenberg, McNeill, & Crethar, 1994).
Although some supervision models that articulate a developmental framework do so as an extension of a developmental model of counseling or psychotherapy (e.g., Eckstein & Wallerstein, 1972; Mueller & Kell, 1972), a fundamental assumption of others is articulated by Loganbill, Hardy, and Delworth (1982). They argue that developmental models should be constructed specifically for the supervision process, not as extensions of approaches to counseling or psychotherapy. Unless one assumes that the issues faced by clients in psychotherapy and supervisees in supervision are fundamentally the same, which strikes us as flawed, we are left with the need to construct a model idiosyncratic to the supervision context, an issue echoed by Bernard and Goodyear (1992). This is the intent of the IDM.
EARLY DEVELOPMENTAL MODELS
Extensive discussions of early developmental models of supervision exist elsewhere (e.g., Russell, Crimmings, & Lent, 1984; Stoltenberg & Delworth, 1987; Worthington, 1987), so we limit our discussion here to a brief overview to set the context for discussing the IDM. Similar to individual counselor development, the model of supervision reflected by this perspective has developed into a complex integration of changing characteristics and needs of trainees and how these interact with various domains of counselor/psychotherapist activity and the supervision process.
In their 1987 book, Stoltenberg and Delworth review and critique seven developmental models of clinical supervision using Bartlett's (1983) categorization framework. Hogan's (1964) four-stage model was presented as one of the earliest models (other than Fleming, 1953) relying on developmental constructs. Although the presentation of this model was quite brief and, therefore, lacked detail, it had an important impact on subsequent model building. Indeed, along with the cognitive development work of Harvey, Hunt, and Schroder (1961) and Hunt (1971), Hogan's model formed the basis for Stoltenberg's (1981) developmental model of supervision.
Stoltenberg's (1981) counselor complexity model extended Hogan's (1964) work by more formally integrating developmental constructs into a supervision model. Additional guidelines for optimal supervision environments were proposed that more carefully delineated how supervision should be conceptualized across trainee experience levels from dependent novices to independently functioning "master counselors." Worthington (1984) noted in his review that this was the most heuristic model to date and stimulated the most empirical research.
Another important contribution to developmental supervision model building was the work of Littrell, LeeBorden, and Lorenz (1979). This article integrated four existing models of training counselors: teaching, counseling/therapeutic, consulting, and sel-fsupervision. The model proposed that the appropriate use of these approaches followed an orderly progression beginning with teaching and ending with selfsupervision.
Other models addressed by Stoltenberg and Delworth (1987) included Ralph (1980), Yogev (1982), and Blocher (1983). These models, however, have had less impact on the field than the one proposed by Loganbill et al. (1982). Similar to Stoltenberg's (1981) model, Loganbill et al. (1982) relied heavily on existing models of human development to construct their supervision model. Loganbill et al.'s is a threestage model that suggested that trainees will continue to recycle through the same stages at deepening levels with respect to different content issues. The longest (monograph) of the seven models reviewed by Stoltenberg and Delworth (1987), Loganbill et al. (1982) elaborated on the elements of supervision (supervisor, supervisee, their relationship, and the environment), supervision interventions, and assessment.
In a landmark review of the supervision literature, Worthington (1987) examined 16 models of supervision of varying detail that incorporated the developmental perspective. He describes the models as having subtle differences, but being quite similar, with all of them using rather broad depictions of counselor development although lacking in specific details. In addition, Worthington (1987) notes that the stages of development are the focus of these models, but little attention is given to transitions among stages or how one gets from one to another.
In their manuscript in the Handbook of Counseling Psychology, Russell et al. (1984) organized their discussion of models into two categories: Ericksonian linear stage theories and stepbystep skill mastery or conflict resolution theories (similar to Stoltenberg and Delworth's, 1987, organismic and mechanistic distinctions, respectively). The former rely heavily on sequential stages to describe psychotherapist development (e.g., Hogan, 1964; Littrell et al., 1979; Stoltenberg, 1981) whereas the latter group of models propose a recycling through phases (usually three) either across certain critical issues in training (e.g., Loganbill et al., 1982) or for each new supervisor (Eckstein & Wallerstein, 1972; Mueller & Kell, 1972). As noted earlier, Russell et al. (1984) suggest that these models are "simplistic and vague" and go on to recommend that future research should focus on "the integration of the developmental approaches to supervision," particularly, incorporating stepbystep methods of task or conflict resolution with stage models.
In a review of the supervision literature in a recent edition of the Handbook of Counseling Psychology, Holloway (1992) failed to examine new developmental models of supervision, incorrectly noting that "no new models of supervision have appeared" (p. 179) since the earlier edition. One important new model of supervision has appeared since 1984. The remainder of this manuscript discusses this model, the IDM (Stoltenberg. McNeill, & Delworth, 1998), along with some of its recent extensions (e.g., Stoltenberg, 1993; Stoltenberg et al., 1995). ***THE INTEGRATED DEVELOPMENTAL MODEL
OF SUPERVISIONAlthough developmental models of supervision have stimulated considerable research and, as noted earlier, have commanded the most attention in recent years, the perspective has received criticism. Russell et al. (1984) accurately note that at that time current developmental models were too simplistic and inadequately addressed professional development, a position also supported by Worthington (1987). On the other hand, Holloway (1987) criticizes some developmental models as being "exceedingly complex" and more elaborate than what we typically expect of "truth" (p. 211).
Bernard and Goodyear (1992) note some of the disadvantages of developmental models. Their criticism includes an observation that current models do not account for the possibility that, occasionally, advanced trainees may need supervision conditions typically associated with beginning trainees. In addition, they believe that these models do not allow for divergent routes to development for different trainees. Finally, they argue that current models do not account for relapse or failure to progress on the part of the trainee.
The IDM attempts to address some of the shortcomings of earlier developmental models. The IDM presents a more complex model that addresses the criticism of Bernard and Goodyear (1992) in its examination of specific structures across varying professional activities or domains. We agree with Russell et al. (1984) that prior models are incomplete and somewhat simplistic. Given the brevity of the journal article format in which these models were presented, this is to be expected. Also, early reports of these models are intended to lay out a framework from which other issues could be examined. None are intended to be complete. By focusing an entire book on a particular model, Stoltenberg. McNeill and Delworth (1998) are able to address many of these issues with the IDM. In addition, consistent with Russell et al.'s (1984) recommendations, the IDM uses step-by-step approaches to task and conflict resolution (mechanistic development) within an overall linear stage model (organismic) to more fully articulate the process of growth over time. In addition, recent work (Stoltenberg et al., 1995) more carefully addresses influence strate-gies for supervision, consistent with Worthington's (1987) recommendations. Finally, Eichenfield and Stoltenberg (1996) discussed the problems of relapse and failure to develop for certain trainees.
The argument that developmental models may be too complex (Holloway, 1987) is curious. As argued by Stoltenberg and Delworth (1988), professional development is a complicated process and one that requires an awareness of a multitude of factors and how they interact. Our recent work (e.g., Stoltenberg, 1993; Stoltenberg et al., 1995) has focused on further delineating mechanisms of the IDM. Although more simple models are more readily comprehensible, they lack the elegance to capture important aspects of the process. Unfortunately, more complicated models also tend to increase the specificity necessary in empirical investigations that can create problems for the researcher and present the practitioner with a number of issues to consider at any given time.
The space constraints of a single manuscript necessarily limit the detail with which we can present the IDM. Interested readers are encouraged to examine other literature to broaden their understanding of the model (e.g., Stoltenberg, 1993; Stoltenberg & Delworth, 1987; Stoltenberg et al., 1995; Stoltenberg, McNeill, & Delworth, 1998). However, key concepts and assumptions related to the model and a brief discussion of applications are presented.
Overarching Structures and Specific Domains
Some early models of counselor/psychotherapist development suggest that growth tends to occur in uniform stages. One was a Level 1, 2, 3, and so on trainee. This global view tends to obscure important differences in levels of development at which the trainee may be functioning across different professional activities or domains. For example, a trainee may function at a relatively high level of autonomy when conducting individual psychotherapy with a depressed client, but he or she may be an appropriately dependent novice when doing marital or family therapy. Similarly, a trainee with significant assessment training and experience but little psychotherapy training and experience may function at a high level in the former domain but may perform at a dramatically lower level in the latter domain. Thus, a single trainee may obviously be functioning at different developmental levels in different domains, requiring different supervision conditions for each.
Other models have suggested that one continues to recycle through stages in an ever deepening (Loganbill et al., 1982) or spiraling manner (Hess, 1986). In the extreme, these models contradict the notion that once development has occurred in a given domain, it should be consolidated by changes in cognitive structures. These models also lack markers that indicate how one monitors development across issues or when certain issues become prominent.
Stoltenberg and Delworth (1987) initially proposed using three overriding structures to monitor trainee development through three levels across various domains of clinical training and practice, thus integrating mechanistic and organismic models and providing markers to assess development across domains. These three structures areSelf and Other Awareness
(Cognitive)
(Affective)
Motivation
Autonomy
Briefly stated, trainees will begin with a primary focus on the self that includes attempting to keep in mind the skills and interventions they are learning while dealing with performance anxiety and evaluation apprehension. They will be highly motivated, wanting to learn quickly to get past the anxiety and uncertainty of the beginner. Also, they will tend to be dependent on their supervisors or other "experts" for advice and guidance. Toward the end of Level 1, as skills and confidence have increased, trainees can become quite confident (perhaps overly so) in their abilities and the impact of counseling.
Level 2 trainees have acquired sufficient skills, knowledge, and experience to enable them to attend less to their own uncertainties, including what they should do next, and experience reduced anxiety and apprehension. As with late Level 1, at times Level 2 trainees will be quite confident, perhaps overly so, in their abilities and skills. This presents the opportunity to increase their focus on the client (other awareness), which sets into motion both positive and negative influences on their work. Thus, although it is now possible for them to adequately empathize (affective component) and begin to understand the client's perspective (cognitive component), this richer database can create confusion and emotional turmoil in the trainee as simple approaches and interventions no longer appear adequate. Motivation often suffers in this stage as the trainee may exhibit high motivation when things are going well and remarkably decreased motivation for professional work and development when confusion and ambivalence are predominant. Similarly, one notices variations in autonomy, with negative independence (counterdependence) at times and dependence at other times.
Successful resolution of Level 2 issues sets the stage for movement into Level 3. Characteristics of this level of trainee include an ability to be appropriately and insightfully self-aware, but also being able to empathize with and understand the client's perspective. Additionally, motivation tends to stabilize at this level with fewer peaks and valleys. Finally, relatively autonomous functioning characterizes the work of this professional, who has an accurate understanding of relative professional strengths and weaknesses integrated with insightful self-understanding. This level of development is further expanded by Stoltenberg, McNeill and Delworth (1998) in their discussion of the Level 3i (integrated) professional. This person is capable of functioning with Level 3 structures across a number of domains of activity and can move comfortably across domains utilizing information and perspectives for each to enable more comprehensive professional practice.
Naturally, transitions among levels occur that change the quality of the trainee's characteristics and behavior. Consequently, supervision environments must change to augment development and appropriately challenge each level of trainee. We elaborate upon this, as space allows, in subsequent sections.
The domains of professional activity alluded to here can be conceptualized in varying degrees of specificity. In general, Stoltenberg, McNeill and Delworth (1998) offer the following categories:Intervention Skills Competence
Assessment Techniques
Interpersonal Assessment
Client Conceptualization
Individual Differences
Theoretical Orientation
Treatment Goals and Plans
Professional Ethics
Obviously, each of these could be further reduced to more specific domains (e.g., types of intervention skills, assessment techniques), but the general categories serve to highlight the fact that one must attend carefully to the focal activity in which the trainee is engaging to adequately assess the developmental level at which the trainee is functioning at any given time. To highlight the importance of specificity, Stoltenberg (1993) has suggested a slightly different collection of domains for consultant training. Consequently, global labeling of developmental levels becomes less useful in supervision (and research), although easier to understand and more simple to apply. Assessment of level for specific domains, however, becomes crucial for providing appropriate supervision environments for trainees across contexts.
LEVELS OF DEVELOPMENT
In the following sections, we briefly discuss important issues for Level 1, 2, and 3 trainees. The narrative is used to augment the outlines of material presented in Table 12.1.
Level 1
Beginning trainees come to us with varying backgrounds in experience related to the domains of activity typically associated with professional psychology. It is important to understand that these experiential differences may place trainees at different points along the developmental continuum for various domains; thus, not all trainees function the same. In addition, other trainees come to us with personal or psychological problems that work to confound the training process (see Eichenfield & Stoltenberg, 1996, for a discussion).
The prototypical beginning trainee, however, has had limited exposure to counseling/psychotherapy, assessment, consultation, and so on. As is typical for most people who enter into a new field of experience, novices tend to be anxious and rely on teachers and supervisors to provide specific guidance as they learn counseling, assessment, conceptualization, and other skills. Their motivation usually is high, largely because it is rather uncomfortable to perceive oneself as inadequate. Thus, a strong desire to learn quickly and reduce the high anxiety can be quite the motivator.
Consistent with the strong motivation to learn is a dependent approach toward supervision and training. It would be inappropriate for someone who has not yet mastered even rudimentary skills to exhibit much autonomous functioning, so this dependency on authority figures is appropriate and desirable. Level 1 trainees must rely on their supervisors and teachers to educate and train them in the theories, techniques, and concepts relevant for professional practice.
The early education and training of beginners usually focuses on an introduction to theories and techniques. Various approaches can be taken, but usually certain skills are taught that enable the trainee to acquire some (initially limited) repertoire of behaviors or strategies to use in sessions with clients (for counseling, psychotherapy, assessment, and so on). Learning these skills and strategies necessarily tends to result in a predominant focus on the self by the trainee. Performance is often positively evaluated by the degree to which he or she can faithfully perform a given technique or follow general guidelines. Little attentional space is left for considering the client's perspective or his or her affective reactions to the counselor.
Table 1-Integrated Developmental Model
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Developmental Levels
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Level Motivation Autonomy Self-Other Awareness
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I High motivation Dependent on supervisor Limited self-awareness
High anxiety Need for structure, positive feedback, Focus on self: anxiety-performance
Focus on acquisition of skills minimal direct confrontation Objective self-awareness
Learns from outside source
Difficulty seeing strengths, weaknesses
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Transition Issues May reduce for learning new May desire more autonomy than is Switches focus more to client and
approaches or techniques warranted away from own thoughts-performance
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II Fluctuating, at times quite confident Dependency-autonomy conflict Can focus more on client; empathize
More complexity shakes confidence; At times more assertive; develops with affect; understand worldview
result often is confusion, despair, vacillation own ideas May become enmeshed so
Independent functioning; may want not effective
specific help Issue is appropriate balance
Other times dependent, evasive
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Transition Issues Increased desire to personalize orientation Becomes more conditionally autonomous; Moves focus to include more
better understanding of parameters reactions of self to client
of competence
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III Stable Firm belief in own autonomy, Accepting of self, strengths, and
Remaining doubts not disabling not easily shaken weaknesses
Concerned with total professional Sense of when it is necessary to seek High empathy, understanding
identity and how therapist role fits in consultation Can focus on client and process
information, including own reactions
Can use self in sessions
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Transition to 3i Contrasts domains in which motivation More able to move conceptually and Personalized understanding crosses
is stable with those in which it is less so behaviorally from one domain to another domains
Professional identity is solid across Monitors impact of personal life
most domains changes on professional identity/
performance
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Intervention Skills, Fundamental counseling skills More developed skills but not well Well-developed skills
Competence Structured format for skill implementation integrated More creative and integrative in
Desire for learning and practice Ability to focus on client leads to application of skills
Applies skills to client confusion about what to do Can make changes as deemed
necessary based on idiosyncratic client
needs
Assessment Fits client into diagnostic categories Possible loss of interest in "impersonal" Solid sense of role of assessment
Techniques Structured "by the book" assessments as focus is on client Diagnostic classifications influenced
Table 12.1 (Continued)
Levels Across Domains
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Domain Level I Level II Level III
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Focus on consistency in results rather Little understanding of implication by setting and client environment
than discrepancies of label for client
Interpersonal Ignores or attributes too much pathology More aware of client's perspective Avoids stereotypic thinking
Assessment to normal responses May overaccommodate Focuses on client and personal
Difficulty in responding to unexpected Difficulty separating accurate reactions to client
statements perceptions from countertransference Understanding often more complete
Reliance on supervisor to validate or provide than supervisor's
alternate conceptualizations
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Client Focuses on discrete pieces of information, More accurate Sees how client interacts to produce
Conceptualization often selected for consistency with More complete understanding of whole person
theoretical orientation client's perspective Understands diagnostic label, focus on
Danger of over-accommodation pattern relevant for client as individual
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Individual Relies too heavily on own experiences, Awareness increases Views client as individual and
Differences perceptions of world Still has some stereotypic thinking; sees person-in-context
Develops stereotypes client as exception
Self-focused, empathy difficult to achieve Greater openness to varieties of human
Experience
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Theoretical Tends to focus on one approach More personalized, selective approach Knowledgeable, flexible
Orientation May rule out alternatives Unsure when to pursue which orientation, Not driven by theory
Limited flexibility approach or how to vary Theories' strengths and weaknesses
Difficulty in justifying choices acknowledged
Enjoys dialogue about different views
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Treatment Goals Difficult to visualize process from Difficult to be specific Great progress here
intake to termination May have confusion from conflicting Plans flow from assessment and
Difficult to translate goals into specific conceptualizations, hard to develop tight conceptualizations appropriately altered
interventions or vice versa plan as a result of interventions
Easily discouraged when initial treatment Plans more focused, coherent, realistic
plans do not work
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Professional Ethics Depends on supervisor to resolve ethical Understands ramifications of ethical Broadened perspective
dilemmas decisions Can handle complex issues
Rote memorization of code without Concerned with protection of client Motivated to look at other codes;
integration personally integrated ethics
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Note: Adapted from Supervising Counselors and Therapists by C. Stoltenberg and U. Delworth, 1987, San Francisco: JosseyBass.
The supervisor's task is to convey the necessary introductory information to the trainee that will allow him or her to begin to conceptualize the counseling, assessment, or other process yet avoid going too deeply into issues that can confuse this level of trainee. Skill development is also important and requires presentation of techniques and so forth via observation (of the supervisor or others), role-playing, practice, and repetitions. Encouraging an early focus of the trainee on self-performance is appropriate so he or she can accurately monitor skill development. Some attention is necessary, however, to the client's response to interventions so that the trainee becomes aware of the importance of this source of feedback. The supervisor should provide most of the structure for training, which should help reduce trainee anxiety and facilitate the most efficient use of supervision and other training experiences. The research literature is supportive of this view of beginners and their supervisory needs (see Stoltenberg & Delworth, 1987; Stoltenberg, McNeill, & Crethar, 1994; Worthington, 1987).
Carefully constructed learning experiences in controlled situations leading to clinical experiences with mildly distressed clients under close supervision should enable the trainee to acquire adequate skills, a rudimentary theoretical model, and understanding of the process. This should result in some degree of confidence and efficacy on the part of the trainee. As this occurs, we are approaching the transition from Level 1 to Level 2. To encourage this transition, the supervisor needs to carefully redirect the trainee's attention from adequate performance of skills, interventions, and so forth, to attending more to the client's conceptual and affective experience. At the same time, encouraging an appropriate increase in autonomy should be a goal as well as providing less structure for supervision. This will set the stage for movement into Level 2.
Appropriate supervisors for Level 1 trainees will have advanced in their own development to at least Level 2 (see following discussion). Often, advanced trainees under the supervision of a professional can do an excellent job of providing a facilitative supervision environment for beginners. Having only recently dealt with these same issues, Level 2 counselors (as supervisors) can empathize with and accurately convey information to Level 1 trainees in supervision.
Level 2
In our experience, what Stoltenberg, McNeill and Delworth (1998) conceptualize as the Level 2 trainee roughly coincides with advanced practicum status (e.g., third or fourth semester of supervised practicum) at least for domains that have been the target of training. Of course, in other domains receiving less (or no) attention, the trainee will remain at Level 1 and should be supervised accordingly. By Level 2, however, the trainee has mastered most of the basic listening and attending skills and has experienced some success in his or her work with clients (intervention skills competence domain). At the same time, however, the supervision process has identified not only the trainee's strengths, but also his or her weaknesses, as the trainee struggles to understand why he or she is unable to be effective with all clients. The trainee now begins to realize the real limitations of the counseling process, and these struggles may have negative effects on his or her level of motivation.
The primary conflict for the trainee at this level is a vacillation between dependency and autonomy. Trainees become more assertive in developing their own ideas in intervening with clients and may even resist discussing certain cases if they suspect that the supervisor will disagree or suggest on an alternative approach. At the same time, however, the trainee remains dependent on the supervisor for advice and direction in cases in which he or she still lacks the experience with certain client issues or types.
This struggle also affects the motivation level of the trainee. Exposure to more difficult client types and problems and subsequent lack of effectiveness with all clients resultsin the questioning of the trainee's skills and shakes his or her level of confidence. As aresult, motivation level fluctuates as the trainee becomes discouraged or distant with clientsone week and then may exhibit a high enthusiasm the next week. Some students at thisstage also begin to question their career decision to become a therapist and may distance
themselves cognitively or affectively from the therapeutic process.
At this stage, the trainee exhibits less of a self-focus and is able to attend more to the client and empathize with the client's emotional experience. This focus, however, can result in frustration for the trainee, as the complexity of the counseling process has become more apparent.The danger for the trainee at this point is over-identification with the client to the extent of being unable to provide effective interventions, along with the potential to engage in countertransference reactions. The trainee may become enmeshed in the
client's viewpoint, losing the objectivity necessary to provide effective treatment.
The characteristics of the Level 2 counselor are especially apparent in the domain of intervention skills competence as the trainee is increasingly comfortable with a wide array of intervention skills, although these skills are not well integrated within an overriding the
theoretical orientation or conceptual schema. Trainees will make repeated requests for more experience with diverse client types and problems yet fail to acknowledge or resist supervisor recommendations to expand their repertoire. Interpersonal assessment may be
severely limited due to the trainee's strong focus on the client's perspective. The trainee may be unable to separate responses to clients based on accurate perceptions from countertransferance reactions and may exhibit a lack of awareness in regard to this process. Whereas client conceptualizations are based on a more complete understanding of the client's perspective, they will also be largely based on the client's viewpoint without integration of other sources of information (e.g., objective psychological test data) as dis
crepancies or inconsistencies in information gathered are ignored or overlooked.
The foregoing characteristics of the Level 2 trainee have led Stoltenberg and Delworth (1987) to characterize this stage as one of "trial and tribulation." The task of the supervisor with Level 2 trainees is to provide a fine balance between structure and support and
a degree of autonomy and challenge in fostering the independence and confidence level of the trainee. Highly structured directives and didactic advice are likely to be met by resistance and even anger by the trainee for "always telling me what to do." It is important, however, for the supervisor to remain aware of the overriding concern of client welfare. Thus, the supervisor must be prepared to articulate his or her rationale for providing direction in certain client cases and must respond to trainee resistance and anger in a non
defensive, facilitative manner.
Client assignment should reflect a blend of cases in which the trainee exhibits confidence and independence, with more difficult, challenging cases requiring the application of underdeveloped skills and exposure to diverse client types and problems.
It is also extremely important to monitor the trainee's progress during this stage optimally by viewing session videotapes or by direct observation. In our experience, it is no uncommon for supervisors to back off on these activities as advanced trainees are viewed
as "knowing what they are doing." Given the issues characteristic of the Level 2 trainee, supervisees may selectively present client cases with which they feel successful and avoid those with which they have difficulties as manifestations of autonomy or lack of self-awareness. In some cases, trainees may actively avoid discussion of client cases in which they suspect the supervisor will challenge their choice of interventions. Thus, at this stage it is not adequate to simply respond to what trainees may appropriately present as needing direction on and allow complete autonomy in all cases through simple discussion of ongoing clients or monitoring of progress notes.
In order to enhance growth, trainees must be challenged to articulate their rationales for responding to various client concerns, and the cases for which supervisees may resist input, feel uncertain about, or become angry and impatient with may be the most important foci of the supervision session. Process comments by supervisors can increase self-awareness on the part of trainees enmeshed in only the client's viewpoint. These are consistent with Loganbill et al.'s (1982) description of "catalytic interventions," which are intended to "stir things up" and increase trainee's awareness. Conceptual interventions in which trainees are required to articulate alternative intervention plans or varying conceptualizations of the same client case by supervisors help to challenge and expand new information by trainees (see Table 12.2 for descriptions of categories of interventions across levels).
Despite the difficult issues experienced by supervisees at Level 2, research studies suggest that trainees at this level begin to demonstrate an increased readiness and openness to discussion and processing of personal issues of self-awareness, defensiveness, transference/countertransference, and the supervisory relationship (Heppner & Roehlke, 1984; McNeill & Worthen, 1989). A recent phenomenological investigation of "good" supervision events by Worthen and McNeill (1996) found that intermediate supervisees indeed experienced a fragile and fluctuating level of confidence and a generalized state of disillusionment and demoralization with the efficacy of providing therapeutic interventions and were anxious and sensitive to supervisor evaluation. Trainees in this study felt that their anxiety level decreased when supervisors helped to "normalize" their struggles as part of their ongoing development, and this type of intervention was often communicated in the form of a personal self-disclosure. They also characterized the supervisory relationship as one experienced as empathic, nonjudgmental, and validating, with encouragement to explore and experiment. These conditions appeared to set the stage for non-defensive analysis as their confidence was strengthened. In addition, participants reported an increased perception of therapeutic complexity, an expanded ability for therapeutic conceptualizing and intervening, a positive anticipation to reengage in previous difficulties and issues they had struggled with, and a strengthening of the supervisory alliance.
The style or manner in which a supervisor points out or confronts Level 2 issues may vary depending on the degree of sensitivity or defensiveness on the part of the trainee and in this sense requires more advanced skills or experience on the part of the supervisor, perhaps analogous to the development of therapeutic timing and acumen on the part of counselors. As a result, the Level 2 trainee may provide too much of a challenge for inexperienced supervisors or as an initial supervisory assignment for supervisors in training.Level 3
Stoltenberg and Delworth (1987) have characterized developmental Level 3 as "the calm after the storm" as the trainee is relatively free of the Level 2 fluctuations and is able to focus on further growth and respond to challenge within and across domains. This increased stability most often facilitates rapid development and often coincides with trainees' experience (in some domains) during the latter part of the pre-doctoral internship. It is further promoted by the engagement in fulltime clinical work and increased intensive supervision. Motivation at this stage is again high and stable. Although the trainee may experience doubts in his or her work, these doubts are not disabling, and commitment to
Table 2- Supervision Across Levels
Level Supervision Environment
---------------------------------------------------------------------------------------------------------------------------------------I General considerations-Provide structure and keep anxiety at manageable levels.
Supervisor perceived as expert and role model. Confidence in trainee develops in
response to greater clarity of theory/process and skills. Encourage early development of
autonomy (instruction often easier than problem solving). Encourage appropriate risk
taking.
Client assignment Mild presenting problems or "maintenance cases
Interventions Facilitative (supportive, encouraging
Prescriptive (suggest approaches, etc.)
Conceptual (some,tie-theoryDX-TX)
Catalytic (late Level 1, see Level 2)
Mechanisms Observation (video or live)
Skills training
Role-playing
Interpret dynamics (limited, client or trainee)
Readings
Group supervision
Appropriate balance of ambiguity/conflict
Address strengths, then weaknesses
Closely monitor clients
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II General consideration-Less structure provided, encourage more autonomy
particularly during periods of "regression" or stress. Clarify ambivalence, continue
modeling, but less of a didactic focus. May see trainee reactance against supervision/supervisor.
Client assignment More difficult clients with more severe presenting problems
(e.g., personality disorders), shakes confidence.
Interventions Facilitative
Prescriptive-used only occasionally
Confrontive-now able to handle confrontation
Conceptual-introduce more alternative views
Catalytic-process comments, highlight countertransference,
affective reactions to client or supervisor
Mechanisms Observation (video or live)
Role-playing-although less important
_ Interpret dynamics-see catalytic above, parallel process
Group supervision
Broaden clientele
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III General considerations--Most structure provided by trainee, more focus on
personal/professional integration, career decisions. Don't assume Level 3 for all
domains. Focus on bringing up lower level domains and encourage development
toward Level 3i. Assess for "pseudo 3's" and alert trainee to parallel process (if
supervising other trainees).
Interventions Facilitative
Confrontive-occasionally necessary
Conceptual-from personal orientation
Catalytic-in response to blocks or stagnation
Mechanisms Peer supervision
Group supervision
Broaden clientele
the profession as well as to the further development of a professional identity is strong. At this level, the trainee is open to personal exploration of motivations toward becoming a therapist and the implications of these motivations on therapeutic interactions.
Level 3 trainees exhibit a strong sense of autonomy in their clinical work but appropriately consult with the supervisor when necessary, or when seeking further professional growth. In terms of self and other awareness, trainees demonstrate a higher level of insight into personal strengths and weaknesses and address areas of weakness with increased confidence and non-defensiveness. Accurate empathy with clients (first emerging in Level 2) remains a focus but is tempered by an ability to pull back in an objective manner and process reactions, feelings, and thoughts. Thus, the Level 3 therapist is now able to fully access and utilize the array of information available from the client, personal responses to the client, and theoretical and empirical information developed in training to date.
Level 3 trainees possess a variety of intervention skills across diverse client types but are still challenged to better integrate interventions with treatment plans and client conceptualizations in order to be flexible within sessions. At this time, trainees may also seek out additional training with new or unfamiliar techniques. It is important to remember, however, that they may function at Level 1 in these new areas if they are significantly different from prior training experiences. Client conceptualizations are reflective of a greater complexity and integration of diverse sources of information. A conceptualization of one client may differ from another with the same diagnostic label, accounting for individual unique client patterns.
The supervisor of the Level 3 trainee avoids an intrusive and overly structured supervisory environment. The primary task in the supervision of these trainees is to carefully assess consistency in performance across domains (particularly those in which the trainee is functional at Levels 1 or 2), identify any deficits, and work toward integration across domains. Thus, careful monitoring of client sessions, progress notes, written conceptualizations, assessment reports, and so forth remains important. As a result of increased levels of insight and self-awareness, supervisees at Level 3 not only display an openness, but also a preference to further acknowledge and confront issues of transferencecountertransference, therapy/supervision overlap, and parallel processes in supervisory and client relationships (McNeill & Worthen, 1989; Rabinowitz, Heppner, & Roelke, 1986). It remains important for the supervisor to establish a supportive supervisory environment in which confrontation is not avoided. Joint exploration of personal issues affecting therapy is necessary in order to fully examine the implications of these issues. Gently leading trainees to personal self-discoveries has more impact than simply imparting information. Worthen and McNeill (1996) found that intern level supervisees exhibited a basic sense of confidence and autonomy and that inadequacies were identified as domain specific. Interestingly, they also reported previous unrewarding supervision experiences, perhaps resulting in an aversion to overt evaluation and a strong desire for more rewarding supervision. In common with lesser experienced trainees, the interns also viewed good supervision as characterized by an empathic, nonjudgmental relationship with encouragement to experiment and explore, and they were pleased when their struggles were normalized. As a result, positive outcomes of good supervision events were similar to those of their less experienced peers. In addition, their confidence was affirmed and they reported an increased impetus for refining a professional identity.
Given the issues apparent in the Level 3 trainee, it is important to match these trainees with a supervisor whose own functioning is at or above the level of the trainee so as to not impede development. Supervisees at this level may also look toward supervisors for advice concerning professional development (e.g., job searches).Empirical Research
Stoltenberg et al. (1994) exhaustively reviewed the supervision research reported in the literature since Worthington's (1987) article. They examined the methodology used in the 50 or so studies and summarized the results. More specifically, however, they carefully reviewed the 12 studies that included in their methodology the possibility of examination of levels of counselor development or, minimally, levels of counseling experience. Of these 12 studies, only 2 reported finding no effect for experience. One of these two studies (Borders, Fong, & Neimeyer, 1986) had a restricted range of experience levels for the supervisees who participated (functionally masters students). The other study (Ellis, Dell, & Good, 1988) only allowed for an indirect examination of levels of participant experience. The remaining studies reviewed, however, reflected differences in counselors as a function of experience (or measured developmental level) from beginning through intermediate to postdoctoral (e.g., Cummings, Hallberg, Martin, Slemon, & Hiebert, 1990; Hillerbrand & Claiborn, 1990; Martin, Slemon, Hiebert, Hallberg, & Cummings, 1989; McNeill, Stoltenberg, & Pierce, 1985; Robyak, Goodyear, Prange, & Donham, 1986; Winter & Holloway, 1991). Stoltenberg et al. (1994) reported that
In agreement with Worthington's (1987) conclusions, we can say there is support for general
developmental models, perceptions of supervisors and supervisees are consistent with devel
opmental theories, the behavior of supervisors changes as counselors gain experience, and the
supervision relationship changes as counselors gain experience. (p. 419)An interesting study by Tracey, Ellickson, and Sherry (1989) highlighted the importance of attending to specific domains when choosing supervision environments. In their study, beginning and advanced practicum students viewed videotapes of supervision environments designed to vary in terms of structure (high or low structure provided by supervisor) and content (suicidal client or relationship issues). Their results indicated that all of the participants preferred highly structured supervision (directive teaching and prescription) in response to the suicidal condition (low experience for all trainees). In reaction to the relationship condition, however, beginners continued to prefer high structure, but more advanced trainees preferred low-structured supervision. This difference highlights the importance of not assuming advanced level of development across topics and domains, but' ,rather reinforces the need to assess specific developmental levels for trainees.
Another study utilizing single-subject designs by Bear and Kivlighan (1994) provided additional support for the IDM. An experienced supervisor worked with both a beginning and an advanced supervisee. In response to the beginning trainee, who was more dependent, the supervisor was more structured and directive. For the advanced trainee, who responded more autonomously, the supervisor was more collaborative and collegial. The directive and structured supervisor interventions produced more deep elaborative information processing by the beginner whereas this preferred type of processing was stimulated by the collegial or consultative supervisor interventions for the advanced trainee.
Although issues of gender, multicultural, and gay and lesbian supervision have been discussed in the literature (e.g., Stoltenberg & Delworth, 1987; Stoltenberg, McNeill, & Crethar, 1995), few empirical investigations have been conducted to examine their interaction with developmental models (see Stoltenberg, McNeill, & Crethar, 1994, for a review). Given the importance of these issues, readers are encouraged to examine the general guidelines provided by Stoltenberg, McNeill, and Delworth,(1998), and those of Vasquez and McKinley (1982) for ethnic and racial minority trainees. In addition, recommendations regarding the influence of gender issues on training and supervision have been addressed by Brodsky (1980) and Gilbert (1992), and for gay and lesbian clients by Buhrke and Douce (1991), which have relevance for supervision and training.Future Directions
As Stoltenberg et al. (1994) point out in their review of the literature related to counselor development, research investigating developmental constructs would benefit from the use and development of measures specifically designed for the supervision process, as well as from measures designed to address constructs relevant to individual supervision models. More diverse research paradigms including longitudinal designs, case studies, and qualitative methodologies are also needed in the investigation of counselor development. It is also imperative that any investigations into counselor growth or development control or account for trainee developmental level or differences in experience (although this remains a crude index). Research studies need to clearly explicate how “beginning”, “intermediate”, and “advanced” trainees are operationally defined.
Developmental theorists must also begin to attend and account for the unique training and supervisory needs of trainees representative of diversity in terms of race, ethnicity, gender, and sexual identity. For example the influence of a trainee’s level of ethnic identity on the development of counseling skills as suggested by Vasquez and McKinley (1982) has yet to be empirically investigated. In addition, a number of authors (e.g., Hunt, 1987; Zuniga, 1987) recommend that the variety of issues that diverse trainees face in training programs, such as racism, backlash as a result of “political correctness” and hostile environments, should be dealt with in the supervisory relationship. Thus, it is incumbent on all supervisors to take responsibility to create a supervisory relationship and environment in which these issues are openly dealt with (McNeill, Hom, & Perez, 1995). To facilitate this task, supervisors must be knowledgeable in regard to issues of diversity in working with trainees and clientele. Finally, Worthen and McNeill’s (1996) innovative investigation into the phenomenological experiences of supervisees suggests a greater role for the supervisory relationship in developmental theorizing, as trainees in this study frequently cited the importance of their relationship with their supervisors as crucial to the process of development.Conclusion
Refinement of developmental models of supervision continues as does the empirical investigation of the utility of this perspective. Although the research to date is generally supportive of the tenets of the IDM, considerably more research is necessary to validate specific counselor-trainee characteristics according to level as well as the recommended supervisory environments. Recent expansions of the model for other areas of professional practice (Stoltenberg, 1993; Stoltenberg et al., 1997) also need to be investigated. In addition, work should continue to explore the interpersonal influence mechanisms used for different types of trainees over time (cf. Stolbenberg et al., 1995).
Supervision, like psychotherapy, is a complex undertaking. Rather than "shooting from the hip" or relying on simple formulations of complicated processes, practitioners and researchers of clinical supervision need constantly to attend to the specifics of supervisee
developmental level(s) and the concomitant supervision environments. Consistent with Kiesler's (1966) recommendations for psychotherapy research, Stoltenberg et al. (1994) suggested that "Efforts should be directed at determining which level of supervisor using
which supervisory interventions is most effective in supervising which level of trainee at a given point in time working with what types of clients in what contexts" (p. 422).
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