Toward effective service to individuals, and divorcing families and stepfamilies

Effective Supervision and Case Management with Multi-problem Client Families

By Peter K. Gerlach, MSW
Member NSRC Experts Council

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The Web address of this article is http://sfhelp.org/pro/basics/supervise.htm

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        This article is one of a series on effective professional counseling, coaching, and therapy with (a) low-nurturance (dysfunctional) families and with (b) typical survivors of childhood neglect and trauma. These articles for professionals are under construction.

        This series assumes you're familiar with:

        Before continuing, pause and reflect - why are you reading this article? What do you need?

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        This article is for professionals who train and supervise clinicians that work with divorced-family and stepfamily clients. It proposes that effective supervision requires additional knowledge and skills compared to supervising clinicians with other client-types. The article offers...
  • a definition of effective supervision or case management;

  • a summary of what's different about supervising therapists with these complex clients;

  • a checklist of 11 requisites for effective supervision with these clients; and...

  • perspective on common supervisory problems with these clients.

What is Effective Clinical Supervision?

        Because effective systemic therapy requires a complex set of skills and can significantly affect a client's wholistic health and relationships, novice and veteran clinicians need empathic, clear, unbiased feedback and seasoned guidance as they learn their craft. Premise: effective clinical supervision will clearly satisfy three to six sets of needs, as judged by all concerned:

clients' needs for effective, ethical, cost-effective professional help in (a) identifying and (b) filling their short and long-term primary needs; and...

each trainee's needs to...

  • feel respected and professionally competent,

  • learn - in general, and from mistakes,

  • be encouraged and inspired in difficult situations,

  • satisfy clients' needs well enough,

  • stay balanced and stimulated (avoid overload and burnout),

  • resolve individual case problems,

  • get human and other resources when needed, and...

  • manifest their life purpose; and...

the supervisor or case manager's needs to...

  • feel competent, respected, and useful as a professional coach,

  • help trainees develop their general and case-specific competencies,

  • meet ethical and legal responsibilities to clients and co-workers,

  • balance their needs with those of clients, clinicians, and administrators, and...

  • manifest their unique life purpose/s over time.

supervisors in an organization (vs. independent consultants) also need to understand, negotiate, and help fill their organization's human-service and financial goals and policies in a cost-effective way, as judged by themselves and the person/s they work for. Supervisors may also need to demonstrate their knowledge and competence to state licensing, accreditation, and professional-ethics examiners.

case managers supervising a group of therapists and/or cross-discipline co-workers need the above plus effective problem-solving, directing, and harmonizing everyone's goals and efforts to fill their respective needs well enough, in a way satisfying to all involved.

        Individual clinicians have (a) unique knowledge levels, skills, and traits, and (b) different styles of learning. Some therapists need more direction and discussion than others, and some are more reactive (defensive, guilty, anxious) to critical feedback than others. Typical supervisors have their own guidance styles: patient vs. curt; clear vs. vague; empathic vs. didactic/intellectual; collegial vs. authoritarian; direct vs. indirect; conflict-avoiding vs. confrontational; goal-directed vs. intuitive and organic; spiritual vs. practical; pessimistic/cynical to realistic to idealistic; and so on. Can you describe what your style is, and how trainees react to it?

        Effective supervisors need to (a) be aware of the interplay of these variables in their work with individual therapists, and (b) be able to flex situationally to fill their mix of current needs (above) without losing their integrity or personal and professional balances. A classic ethical and practical question is: who supervises (assesses, supports, guides, confronts) the supervisor?

        Recap: here, "effective supervision" means "filling the current mix of three or more sets of primary needs (above) 'well enough' according to each person involved." Reflect: do you need to edit this premise to better express your definition of "effective clinical supervision"?


What's Different about Supervising Stepfamily Therapists?

        Premise: Typical divorced-family and stepfamily systems are significantly more complex and needy than other client-family types. They have...

  • four or five primary stressors to manage; and...

  • a multi-home structure to stabilize, balance, and coordinate; and...

  • typical stepfamilies have more members; and...

  • many special biofamily-merger adjustment needs to fill; and...

  • extra developmental phases to negotiate; and...

  • more concurrent secondary stressors to resolve, including (a) identifying and filling kids' special adjustment needs, and (b) patiently reducing ex-mate barriers to co-parenting teamwork. And these client families usually have...

  • more psychological wounds and knowledge deficits to identify, accept, and reduce; and...

  • more major losses to grieve, and...

  • generally lower family nurturance levels, and...

  • fewer informed social supports;...

...than typical intact-biofamily clients. (a) Assessing clients' needs and resources, (b) forming an appropriate therapeutic strategy, and then (c) intervening effectively requires advanced clinical knowledge, skills, and resources.

        Because of these interactive factors, typical clinicians working with these complex client families often need (a) to acquire seven clinical requisites and (b) informed supervision in assessing and intervening individual cases. They also need (c) special empathic feedback on potential frustration, confusion, overwhelm, and/or burnout with these challenging multi-problem, multi-phase  clients.

        This is specially true for therapists, case workers, and counselors working with many divorcing families and stepfamilies at once, and/or with many client-families interacting with state welfare, law-enforcement, family court, and child-protective-service systems. These professional systems are typically low nurturance; overloaded and under-supported; must prioritize (triage) their services; and their workers are generally unaware of stepfamily basics, hazards, implications, and primary needs. Does this match your experience?

        Bottom line: for consistently effective clinical outcomes, counselors and therapists working with divorced-family and stepfamily clients need more knowledge + special attitudes + extra skills and resources than clinicians working with other types of family systems. A vital requisite is that they must be consistently guided by their true Selves. This means that effective supervisors and case managers must (a) have all these themselves, and (b) be able to competently assess their trainees for these requisites; and (c) guide trainees in acquiring the seven requisites, and using them effectively with each client case. That implies that whoever hires, assigns, and/or mentors such supervisors must know all these special requisites too. Is this true in your setting?


Requisites for Effective Clinical Supervision with These Client Families

        Each case and situation will have basic and unique requisites. Basic requisites for effective supervision as defined above include...

        1) the supervisor genuinely enjoys and prefers helping co-workers raise their direct-contact effectiveness, rather than working with clients directly.

        2) the supervisor has the requisites for direct client service, according to a knowledgeable observer. An essential among these is the supervisor (a) being consistently guided by her or his resident true Self, or (b) making significant intentional progress at identifying and reducing significant false-self wounds. And effective supervisors or case managers need...

        3) to be (a) clear on their definitions of effective therapy and effective supervision and/or case management; and (b) clear on and (c) confident in their version of this therapeutic model, and (d) be able to explain it effectively to therapists they guide and related colleagues, consultants, and administrators; and...

        4) supervisors need to be able to objectively spot clinician (a) requisite deficits and (b) process errors, and (c) help clinicians accept these, guide and encourage them to make needed corrections, and follow up to see that they do. And effective supervisors need...

        5) a high-nurturance, stepfamily- aware (a) agency or organizational administration, (b) Clinical or Program Director, and (c) Board of Directors. "Stepfamily-aware" means being able to spontaneously describe lay basics + clinical and agency/organizational requisites + these supervision requisites; and supervisors need...

        6) consistently- effective communication and problem-solving with co-workers, superiors, and relevant policy-makers and service regulators; and they need...

        7) clear authority to (a) select and assign clinicians to incoming cases, and/or to (b) make recommendations to the Clinical or Program Director on such assignments, and to (c) change or augment clinical case-responsibility if an assigned clinician isn't able to serve a given client family adequately. And effective supervisors also need...

        8) access to an effective in-service program to help (a) them gain needed supervisory skills, and (b) help clinicians gain requisite knowledge and skills for serving these complex clients; and they need...

        9) current accurate knowledge of local and national (a) stepfamily-aware consultants, cross-discipline human-service referrals, and (b) support programs, groups, and organizations; and...

        10) an informed, professional case-discussion (support) group to help identify and resolve supervision problems, including situational transference and burnout stresses; and effective supervisors need...

        11) the ability to enhance and access a local inventory of clinical and lay divorce and stepfamily-related educational resources including handouts, books, videos, games, and current resource lists like this.

        Pause and reflect - do these 11 basic requisites for effective supervision with these complex client families seem valid? If you need to modify this checklist, what do you need to change - and why? Note the option of using your version of this summary as a checklist for discussion and evaluation with co-workers, employers, and clinicians. Option: for specific cases, use this list with these client-assessment and intervention checklists to provide structure for the supervision process.


Common Supervisory Problems and Options

        Though [ client + clinicians + supervisor + setting ] combinations approach infinity, common supervisory "problems" (unmet needs) include...

1) Someone decides the supervisor lacks too many requisites (above). A major version of this occurs if the supervisor is denying significant false-self wounds and/or that s/he's in pseudo recovery from them.

2) Someone decides a clinician lacks too many requisites to work with these clients effectively. Ditto the above.

3) The supervisor (a) denies s/he is ambivalent, or would really rather work with clients directly, and becomes over-involved in clinicians work; and/or (b) s/he won't assert his or her needs toward being reassigned. Both suggest significant false-self dominance.

4) The supervisor is intimidated, overwhelmed, and/or paralyzed by individual or collective case complexities, and denies this. Another sign of false-self dominance.

5) The supervisor can't (a) identify or (b) resolve significant therapist transference and/or burnout stressors

6) A clinician "resists" acquiring needed knowledge, skills, and resources to work well with these clients

7) A clinician feels her or his supervisor or case manager isn't qualified and/or able to provide needed guidance with one or all divorced-family and stepfamily cases. If the clinician confronts the supervisor on this, the latter may deny, ignore, excuse, freeze, collapse, or counterattack. All are symptoms of (a) false-self dominance, (b) lack of effective communication skills, and/or (c) a low-nurturance (wounded, ignorant) organization

8) Someone feels the supervisor's and clinician's professional styles and values clash "too much," despite both of them being qualified to work with these clients. Inability to compromise on this suggests one or both are significantly wounded and lack process- awareness and effective communication skills.

9) The caseload inhibits a therapist from taking time to acquire needed knowledge, guidance, and/or encouragement - and s/he doesn't (a) recognize this, or (b) assert for needed case-reduction. Another sign of false-self dominance and/or a low-nurturance workplace.

10) There are no adequate in-service training programs and/or relevant resources available to the supervisor and/or clinicians. This is a clear sign of an unaware and/or wounded (low-nurturance) administration - including the supervisor, if s/he isn't asserting for an effective educational program and resources

11) Local family-law judges lack requisite knowledge of divorced-family and stepfamily client families, and issue orders that hinder or block effective service to court-referred clients. A corollary problem occurs if supervisors or organizational administrators tolerate this, rather than helping judges (and attorneys, mediators, and psychological evaluators) to learn and apply requisite knowledge for everyone's sakes.

12) Funding, licensure accreditation, professional association (e.g. APA, NASW, etc), religious, and/or state legal requirements and policies hinder delivery of effective service - and the supervisor and/or organizational administration accepts this passively vs. asserting for positive change.

13) Agency, clinic, or departmental management lacks too many requisites to support effective supervision and clinical outcomes with these clients - and the supervisor tolerates this and/or working in an unqualified (ignorant, wounded, low-nurturance) organization.

        Each of these generic "supervisory problems" are surface issues caused by underlying primary needs. For example, if a clinician is clearly providing ineffective service, the gross problem is the inability of the professional, supervisor, or agency to identify and acquire the missing requisites.

        A common related problem is one or more of the involved professionals lacking effective communication (problem-solving) basics, attitudes and skills. Premise: generally, each person whose current primary needs are unmet is responsible to...

  • insure their true Self is guiding their other subselves (personality),

  • dig down and identify their (and others') primary needs, and...

  • use the other six communication skills and supportive attitudes to choose the best local option/s (problem-solve) to fill their needs.

Where these don't seem to work (fill needs permanently), use these communication options, blocks, and tips to achieve better outcomes if each involved person's true Self usually leads their personality. If not, (a) check yourself for wounds first, and then (b) adapt these options to fit your situation.

        An important universal option is to apply these wise guidelines, in case some factors are beyond the needy person's ability to affect them. Another option is to invite a qualified consultant to advise. Other common options are...

  • denying or minimizing the problem/s and/or their impacts,

  • delaying needed confrontations or changes, and/or...

  • justifying and trying ineffective first-order (superficial) solutions.

       All these suggest significant false-self dominance.

Recap

        This article exists because of the premises that (a) effective therapy with stepfamily and divorced-family clients is unusually complex, and (b) therefore, effective case supervision or management requires special knowledge, skills, and resources. The article defines "effective clinical supervision," and proposes factors that make supervising these cases more complex. The article then offers 11 special requisites for effective supervision of therapists working with these complex multi-home, multi-problem clients. These are in addition to the normal requisites for supervising other types of family clients well.

        The article outlines 13 common supervisory problems with these client cases, and offers direction toward effective resolutions. Effective supervision or case management is one of seven requisites for providing effective clinical service to these complex, needy client families.

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Updated September 30, 2015