300
from intrusion of an observer. What Freud said of analysis is applied to the social work interview: “The dialogue which constitutes the analysis will permit of no audience; the process cannot be demonstrated.”
The group worker’s performance is more open to observation. Miller (1960) pointed out that “what goes on between the worker and the group is directly visible to many people” (72)—to group members, to other workers, and to supervisors. However, “observations of a work-er’s activity take place . . . on an informal, not a deliberately planned, basis” (75).
While the community worker’s activities also seem to be open to observation, this openness is more apparent than real. As Brager and Specht noted:
Community organization practice is at once more visible and more private than casework. Although it takes place in the open forums of the commu-nity, where higher authorities may be present, this is usually only on ceremonial occasions. Surveil-lance of the workers’ informal activities is another matter. The real business of community workers is less likely to occur within the physical domain of higher ranking participants than the activities of other workers. Thus the community worker has ample opportunity, if he wishes, to withhold or distort information. (1973:240)
Many of the community organizer’s activities are highly informal and unstructured:
Whereas casework interviews can be scheduled and group workers conduct meetings on some
Observation of Performance: The Nature of the ProblemAt different points in the earlier chapters, we have alluded to persistent problems that confront supervisors in social work. Some problems are methodological, related to how supervisors observe and teach social work prac-tice. Others, addressing supervisory goals and environments, are more basic. The first series of problems is primarily technical in nature. The second series deals with professional pol-icy issues. The intent in this chapter is to pull together and make explicit the different sets of problems and to review the innovative methods and procedures that have been proposed to deal with them.
The supervisor faces a technical problem related to access to the supervisee’s perfor-mance. If the supervisor is to be administratively accountable for the worker’s performance in order to help the worker learn to perform his or her work more effectively, the supervisor needs to have clear knowledge of what the worker is doing (Beddoe et al. 2011). However, the super-visor most often cannot directly observe the worker’s performance. This is particularly true in direct practice. The worker-client contact is a private performance, deliberately screened from public viewing. Concealment of what takes place in the physically isolated encounter is reinforced and justified by dictates of “good” practice and professional ethics. Protecting the privacy of the encounter guarantees the client his or her right to confidentiality and guards against the disturbances to the worker-client relationship which, it is thought, would result
c h a P T e r 1 0
Problems and Innovations
Copyright 2014. Columbia University Press.
All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.
EBSCO Publishing : eBook Collection (EBSCOhost) – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITYAN: 707141 ; Alfred Kadushin, Daniel Harkness.; Supervision in Social WorkAccount: s9174717.main.ehost
P r O b l e m s a N d I N N O v a T I O N s ] 301
do next would probably last no more than one season. Yet this is the way much of the teaching in psychotherapy is done. What is lacking is a systematic critique of actual performances as ob-served by peers or supervisors. (1977:37)
The problem of access to worker performance is compounded by the fact that not only is the performance itself “invisible,” but the outcomes of the performance are vague and ambiguous. The fact that automobiles come off an auto-mobile assembly line is assurance of the com-petence of the worker’s performance without actually having to see the performance. Social work supervisors never see a clear visible prod-uct of performance.
The traditional, and current, heavy depen-dence on record material and verbal reports for information regarding workers’ performance necessitates some evaluation of these sources. Studies by social workers (Everett et al. 2011; Maidment 2000) as well as other profession-als (Del-Ben et al. 2005; Farber 2006; Farnan et al. 2012; Mehr, Ladany, and Caskie 2010) indi-cate that case records and self-reports present a selective and often distorted view of worker performance.
To examine the nature, extent, and impor-tance of what supervisees withhold from their supervisors, Ladany et al. (1996) surveyed twenty counseling and clinical psychology training programs and received 108 usable responses from graduate students. Therapists-in-training acknowledged withholding negative aspects of their performance, such as clinical mistakes, evaluation concerns, impressions of their clients, negative reactions to clients, coun-tertransference reactions, and client-counselor attraction. The reasons provided for withhold-ing information were that supervisees per-ceived the information as unimportant or too negative or personal to reveal to the supervi-sor; that information was withheld to manage the supervisor’s impression of the supervisee; and that revealing information was a form of political suicide. In most cases, nondisclosures
scheduled basis, the activities of community workers defy regulation and schedule. Much time is absorbed with informal telephone conversa-tions, attending meetings in which they may have no formal role, talking to other professionals and other difficult-to-specify activities. (Brager and Specht 1973:242)
By far the most common source of informa-tion used by supervisors in learning about a worker’s performance is the written case-record material supplemented by a verbal report pre-pared and presented by the supervisee (Ameri-kaner and Rose 2012; Everett et al. 2011; Hicks 2009). Thus, in most instances, the supervisor observes the work of the supervisee at second hand, mediated through the supervisee’s per-ception and written description of it. A medical social worker supervisee wrote:
The only information my supervisor receives about my clients is through my filter, what I tell her at patient staffing and what she reads when I do all my charting. Her thoughts and recommen-dations are manipulated by what information I chart and choose to share.
A worker in an adolescent treatment facility added:
It’s pretty scary. In reality my supervisor has no clear idea of what I am doing. She knows only what I choose to tell her. Sometimes I feel pleased that she trusts my judgments. But sometimes I feel we might be placing my supervisor, as well as my clients, at risk and she could end up on the hot seat on the “Oprah Show.”
Discussing the supervision of psychiatric residents, Wolberg said:
A professional coach who sends his players out to complete a number of practice games with in-structions on what to do and who asks them to provide him at intervals with a verbal description of how they had played and what they intend to
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
302 [ P r O b l e m s a N d I N N O v a T I O N s
Comparisons of process recordings with audio or video recordings of the same contacts indicate that workers fail to hear and remember significant, recurrent patterns of interaction—discrepancies that can lead to important les-sons in supervision (Bransford 2009). Workers do not perceive and report important failings in their approach to the client. This omission is not necessarily intentional falsification of the record in order to make the worker look good, although that does happen. It is, rather, the result of selective perception in the service of the ego’s attempt to maintain self-esteem (Yerushalmi 1992). In 1934, Elon Moore wrote an article entitled, “How Accurate Are Case Records?” The question, which he answered negatively, is still pertinent today (Gillingham and Humphreys 2010). Supervision based on written records supplemented by verbal reports is supervision based on “retrospective recon-structions which are subject to serious dis-tortions” on the part of the supervisee (Ward 1962:1128). A supervisee wrote candidly:
The tendency in writing process notes is to sort of gloss over things that you found embarrassing or that you found difficult. I think there are times when I’ve made super boo-boos that I’ve left out purposely. And my reason for leaving out super mistakes is that I don’t feel like being embar-rassed. And if I know it’s a mistake, why I have to present it to the supervisor? (Nash 1975:67)
Seeking approval through selective reporting, another supervisee said:
If I’m concerned about my supervisor writing down in his evaluation that I tend to ignore trans-ference phenomena, then, even if I don’t believe it, I’ll make sure to include material that shows transference phenomena, because he happens to be interested in that. (Nash 1975:68)
There is some inevitable distortion of the reali-ties of the encounter in the intellectualized reconstruction for the purpose of verbal and/
remained secret because neither the supervisee nor the supervisor brought them up. Some find-ings from the study suggested that withholding information from the supervisor was related to perceptions of supervisory styles and rela-tionships; supervisees often revealed the same information withheld from their supervisors to their peers or friends in the field, particularly if the information was perceived as important. Studies by Farber (2006), Hess et al. (2008), and Mehr et al. 2010 have reported similar patterns of findings.
Distorted reports and withheld information are self-protective measures against the possi-bility of criticism and rejection by the supervi-sor (Doherty 2005; Hahn 2001;Yourman 2003)). They are also an effort to obtain approval and approbation for work seemingly well done, per-haps even an integral part of the social worker’s professional development (Lazar and Itzhaky 2000; Noelle 2002). It needs to be remembered that approval and criticism are intensified by inevitable transference elements in the relation-ship with the supervisor, and that autonomous decision-making is a cornerstone of profes-sional practice.
Pithouse (1987), studying the use of records by agency workers, noted that, among other things, they were sometimes constructed as a gloss—a protective device vindicating the worker’s practice. He noted that supervisors, having themselves once been workers, recog-nized records as presenting the appearance of expected practice, not necessarily a record of actual practice. As Gillingham and Humphreys (2010:2602) observed, “There may be an unof-ficial version of practice, which is quite differ-ent from the official version, as represented in formal procedures and practice guides.”
Case records are used not only to collect and store information for use, but they are used to justify a worker’s decisions, reconcile conflict-ing impressions, document events for worker protection, and present an understandable pic-ture of a confusing situation to communicate an impression of success (Bush 1984; Munro 1999).
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
P r O b l e m s a N d I N N O v a T I O N s ] 303
what workers are aware of may not be recalled; if they are aware of it and do recall it, they may not report it. The comment by two supervisors of child psychotherapy trainees is applicable to social workers:
In supervision of child psychotherapists over the year the authors have become impressed with . . . the unexpected degree to which direct observa-tion of the trainee’s psychotherapeutic hours re-veals important and often flagrant errors in the trainee’s functioning—errors which are somehow missed during supervision which is not supple-mented by direct observation. This seems to be the case despite the trainee’s attempt to be as hon-est as possible in talking with his supervisors, his use of the most detailed and complete process notes or his attempt to associate freely about the case without looking at his notes. (Ables and Aug 1972:340)
This clinical observation is confirmed in an empirical study by Muslin, Thurnblad, and Meschel (1981). They systematically compared the actual interview material as recorded on videotape with an audiotape of the reports of these interviews to supervisors. The interviews were conducted by medical students during their psychiatric clerkship. They found that less than half of the material was actually reported to the supervisor, and some degree of distor-tion was present in 54 percent of the interview reports. The four clinicians who indepen-dently studied the actual videotaped inter-views and the reports to supervisors also made a judgment on the significance of the interview material that was not reported to supervisors. Forty-four percent of the material that the judges felt would totally alter the evaluation of the patient was omitted and 9 percent of such material was distorted. “These results indicate that to proceed in supervision as if [emphasis in original] an adequate data base were pres-ent is misleading” (Muslin et al. 1981:824; see also Wolfson and Sampson 1976). Some addi-tional studies on the problem of assessment of
or written communication. Imposing order, sequence, and structure on the interview in reporting the typically discontinuous, redun-dant, haphazard interactions presents it differ-ently from the way it actually happened.
Stein et al. (1975) compared the psychiat-ric evaluations of patients made under two conditions. In one condition, the psychiatric resident described the patient in a supervisory conference and the supervisor completed an evaluation statement. In the second condition, supervisors directly observed the interview between the psychiatric resident and the same patient and on the basis of this observation completed an evaluation. “The results of the study supported the hypothesis that a supervi-sor who does not see the patient is handicapped in his evaluation of the patient’s psychopathol-ogy” (267), indicating that “indirect supervi-sion results in decreased accuracy” (268).
Differences between diagnostic reports pro-vided to supervisors and independent assess-ments by observers of the same interaction have been confirmed once again in studies of intake interviews (Del-Ben et al 2005; Spitzer et al. 1982). This is a significant concern in clinical settings (Ponniah et al. 2011), where misdiag-noses or underdiagnoses can have educational, legal and medical consequences for providers and clients (Farnan et al. 2012; Harkness 2010).
Even if worker reports formed a valid basis for educational supervision, using only those reports for evaluating worker performance would be a hazardous procedure. Valid evalua-tion requires that supervisors know what work-ers actually did, not what they think they did or what they say they did. By applying what is known about human behavior to the supervisee reporting on his or her own performance, one can recognize the inadequacies of such a pro-cedure as a basis for either good teaching or valid evaluation. As a consequence of anxiety, self-defense, inattention, and ignorance of what should be looked for, workers may be unaware of much that takes place in the encounters in which they are an active participants. Some of
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
304 [ P r O b l e m s a N d I N N O v a T I O N s
(Amerikaner and Rose 2012; Reiser and Milne 2012), and social workers (Beddoe et al. 2011; Everett et al. 2011). Direct observation is scarcer still in professional work settings, where “work environments lack needed resources,” “heavy productivity demands from agency adminis-trators have the effect of severely limiting their ability to make use of the supervision strategies they would prefer,” supervisors are often “only paid for the limited time needed for supervision sessions, and thus have little time or incentive for utilizing strategies such as live observation,” and agencies governed by HIPAA regulations have adopted “policies which limit or elimi-nate” the direct observation of clinical work (Amerikaner and Rose 2012:78–79; see also Fromme et al. 2009).
Feedback rooted in direct observation has been described as one of the key elements in developing worker skills in evidence-based practice (Carlson, Rapp, and Eichler 2010), but the evidence base for this claim is not well developed (Champe and Kleist 2003; Farnan et al. 2012). There is some evidence that supervis-ees who receive live supervision form a stron-ger working alliance with their supervisors (O’Dell 2008), if not with their clients (Moore 2004), and that feedback based on direct observation may change supervisee behavior (Craig 2011; Scheeler, McKinnon, and Stout 2012)—although, here, the evidence is mixed (Craig 2011). There is also some evidence that “live supervision” makes “a difference in thera-pists’ ratings of progress on the problem over the course of therapy” (Bartle-Haring et al. 2009:406), and that direct observation leads to better patient outcomes (Farnan et al. 2012) in medical settings, by offering medical stu-dents “the opportunity to see beyond what they know and into what they actually do” (Fromme et al. 2009:265). But, for the most part, the pertinent research has been con-cerned with the experiences and perceptions of students and workers (Champe and Kleist 2003; Haber et al. 2009), not clients (Champe and Kleist 2003).
performance on the basis of supervisee self-reports were cited in the chapter on evaluation.
In response to these difficulties, various innovations have been proposed to give the supervisor more direct access to the worker’s performance. A review of the literature by Goodyear and Nelson (1997) enumerated twenty-two strategies that supervisors have used to observe worker performance; Bernard and Goodyear (2009), Kaslow et al. (2009), and Walker (2010) identified even more. Of these, direct observation and the indirect observa-tion of audio- and video-recorded interviews have been rated highly by clinical supervisors and their trainees (DeRoma et al. 2007; O’Dell 2008), although few social work supervisors appear to use either method (Everett et al. 2011; Knight 2001; Scott et al. 2011). For both super-visors and workers, the postsession observa-tion of video-recorded practice has been the most highly rated supervisory method (Ber-nard and Goodyear 2009; Wetchler, Piercy, and Sprenkle 1989).
direct Observation of Performance“Supervision is a dynamic process that requires the use of a diversity of supervisory styles and approaches” (Graf and Stebnicki 2002:41).The simplest procedure is direct observation of the interview, either by unobtrusively sitting in on the interview or by observing the inter-view through a one-way mirror. The client’s informed consent is needed, of course, for this and any other procedure that opens the client-worker contact to outside observation (NASW 2008). (Whether social work’s involuntary cli-ents can give valid informed consent for direct observation is a controversial question.)
Although 51 percent of master’s degree pro-grams and 57 percent of doctoral programs in counselor education are said to use direct observation in training supervision (Champe and Kleist 2003), such methods are used more rarely in the training of physicians (Craig 2011; Fromme, Karani, and Downing 2009), and more rarely still in the training of psychologists
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
P r O b l e m s a N d I N N O v a T I O N s ] 305
special room, and it has its own hazards. Gruen-berg, Liston, and Wayne (1969) noted that “the physical setting of the one-way mirror arrange-ment has been less than conducive to continu-ous alertness in the supervisor. The darkened room is more often conducive to languor than attentiveness” (Gruenberg et al. 1961:96; see also Adler and Levy 1981).
In a study of ten social work graduate stu-dents on the other side of the one-way mirror, Wong (1997) found that social work students expected and experienced anxiety before and during supervision. In time, however, the trainees begin to relax, and by the end of their training they generally perceived this form of supervision as a valuable experience. As shown in table 10.1, the limited evidence suggests that this mode of observation is rare in social work supervision.
Co-Therapy SupervisionThe supervisor-observer, by sitting in on an interview (or otherwise intervening in real time), can easily move to a new role—that of co-worker or co-therapist (Tuckman and Fin-kelstein 1999). Co-therapy has also been termed multiple therapy and, in group work, co-lead-ership. If supervision through co-therapy is offered, it is generally provided as a supplement to, rather than a substitute for, individual super-vision. See Beddoe et al. (2011) and Evans (1987) for rich introductions.
Supervision conducted by sitting in with the worker and client has been championed
Sitting InKadushin (1956a, 1956b; 1957) tested the fea-sibility of sitting in on an interview in both a family-service agency and a public-assistance agency. Very few clients objected to the intro-duction of an observer. Postinterview dis-cussion with both the worker and the client, supplemented by some objective measures of interview contamination attributable to obser-vation, indicated that an unobtrusive observer had little effect on the interview.
Schuster and his colleagues used this proce-dure in the supervision of psychiatric residents: “We decided on a simple direct approach to the matter. We decided to have the supervisor sit with each new patient and the resident, as a third party, relatively inactive and inconspicu-ous but present…. In very few instances did our presence seem to interfere significantly with either the resident or the patient” (Schus-ter, Sandt, and Thaler 1972:155). For the most part, this has also been the conclusion of recent reviews of the research (Bernard and Goodyear 2009; Champe and Kleist 2003; Ellis 2010).
One-Way MirrorsThe one-way mirror permits observation with-out the risk, or necessity, of participation and minimizes observer intrusion on the inter-view or group session (Fleischmann 1955). The supervisor can see and hear the interview with-out himself being seen or heard. Peer group observation of the interview or group session is also possible. One-way viewing requires a
T a b l e 1 0 . 1 Observational methods used in intern, student, and trainee supervision
ProfessionClient records and/or process recording Self-report
Audio recording
Video recording
One-way mirror Co-therapy
Marriage and family therapistsa 34% 76% 53% 65% 58% Not reportedMarriage and family counselorsb 72% 83% 39% 57% 28% Not reportedPsychologistsc 58% 73% 3% 11% 3% 13%Social workersd 93% 81% 12% 7% 9% 68%
aNational sample of 330 approved American Association for Marriage and Family Therapy supervisors from Lee et al. (2004:65). bCalifornia sample of 389 supervisees from DeRoma et al. (2007:421). cNational sample of 173 supervisees from Amerikaner and Rose (2012:68–69). dRegional sample of 81 field instructors from Everett et al. (2011:258).
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
306 [ P r O b l e m s a N d I N N O v a T I O N s
The supervisor intervenes only when the super-visee is experiencing some difficulty, when the supervisee signals a request for intervention, or when the supervisor sees a clear opportunity of modeling behavior that he or she is anxious to teach.
Noting the developmental importance of observing supervisees directly early in their training, Hunt and Sharpe said:
[We] evaluated the perceptions of 37 interns and 49 patients regarding communication between supervisor and intern during the therapy ses-sion. Most supervisors used such communication infrequently. While some interns and patients viewed call-ins or walk-ins as intrusive and un-helpful, the majority did not. Indeed, some valued the feedback. No association was found between the use of call-ins or walk-ins and patient reports of therapist behaviours or intern reports of super-visory style. It is concluded that within-session communications is not deemed as necessary by most supervisors, who should remain cautious in their use of such communication, unless patient care is compromised. (Hunt and Sharpe 2008:121)
Productive use of co-therapy for purposes of supervision “requires a conscious effort by the supervisor to modify what tendency he might have to take over and be the expert and for the [supervisee] to resist a tendency to sit back and be an observer” (Sidall and Bosma 1976:210). Alternatively, the supervisor may elect to consult with the worker in the presence of the client, in order to “heighten” the client’s “awareness of particular dynamics” (Bernard and Goodyear 2009:265).
The helping professions employ and evaluate co-therapy supervision differentially (Carlozzi, Romans, Boswell, Ferguson, and Whisen-hunt 1997), and this has changed over time. In 1986, McKenzie, Atkinson, Quinn, and Heath reported that 64.9 percent of marriage and fam-ily-therapy supervisors engaged in co-therapy supervision; eleven years later, DeRoma et al. (2007:419) noted that “direct supervision in the
for safeguarding client welfare, immersing the supervisor in the direct practice experience, and allowing clients to observe supervision in action (Bernard and Goodyear 2009). One of the principal advantages of co-therapy is that the supervisor, as an active participant in the supervisee’s performance, is in a position to witness firsthand the behavior of the super-visee (Finkelstein and Tuckman 1997). Having initiated co-therapy, a supervisor notes that he became immediately aware of a supervisee’s problematic approach to the client—a problem that “had not been clear to me during the few months of traditional supervision we had had” (Rosenberg, Rubin, and Finzi 1968:284). In ana-lyzing the experience over a six-month period of co-therapy between a supervising psycho-therapist and students, Rosenberg, Rubin, and Finzi noted that “the direct observation of the student did away with retrospective falsification in the student’s traditional role in reporting his work to the supervisor” (1968:293).
The power and manifestations of counter-transference are more apparent to the supervi-sor as he or she experiences the client firsthand. Co-therapy then makes more information and more valid information available to the super-visor. Consequently, it is an innovation that helps resolve the problem regarding the infor-mation needed by the supervisor for effective supervision.
Munson (2002) ranked the live co-therapy interview as the most effective method of social work supervision, but the use of co-therapy for educational supervision may present problems. If the supervisor becomes overactive in the worker-client meeting, then the dynamics may resemble those of co-therapy conducted by a novice paired with an experienced practitioner (Smith, Mead, and Kinsella 1998), in which “the junior therapist” tends to defer to the senior therapist, who tends “to take over” (Altfeld and Bernard 1997:381). Co-therapy supervision is also expensive.
During the co-therapy session, it is advisable for the supervisor to allow the supervisee to take primary responsibility for the interaction.
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
P r O b l e m s a N d I N N O v a T I O N s ] 307
that the experience as it actually occurred is lost forever. Similarly, direct interview observation and observation through co-therapy or a one-way mirror leave no record for retrieval, study, and discussion. To correct this deficiency, some social workers make audio or video recordings of their interviews for use in supervision. The use of such procedures is said to be widespread in the supervision of marriage and family counselors (DeRoma et al. 2007), but less so in psychology and social work, as shown in table 10.1. The importance of such technical aids for supervision is that their use enables one to observe performance indirectly and reenact the performance for examination.
Video may be recorded through an unob-trusive port from an adjoining control room that houses the equipment. Alternatively, the camera can “see” through a one-way mirror or (using more recent, inexpensive digital tech-nology) via one or more small webcams placed in the interview room (Chlebowski 2011). The simplest procedure is to turn the equipment on at the beginning of the interaction and off at the end, although ethical considerations may suggest the option of providing clients with some independent means to start, stop, or interrupt the recordings themselves. The use of multiple digital cameras allows the client and worker to record or be recorded independently or in concert, and software can be used to edit digital recordings for wide-angle shots, zoom close-ups, superimpositions, and split-screen images. Digital technology provides highly flex-ible options for recording group interaction and meetings.
The NASW Code of Ethics (2008) and the NASW and ASWB Standards for Technology and Social Work Practice (2005) require social workers to obtain informed consent from their clients before audio- or video-recording inter-views. HIPAA regulations (U.S. Department of Health and Human Services 2010) and state boards of social work examiners (McAdams and Wyatt 2010) may impose additional duties, obligations, prohibitions, and restrictions
presence of a supervisor was [still] more fre-quent than expected given manpower costs.” In contrast, only 13 percent of the current psy-chology supervisees surveyed by Amerikaner and Rose (2012) agreed that they conducted co-therapy with their supervisors, and it seems likely that social workers still use this form of direct observation infrequently (Kadushin 1992a), as table 10.1 suggests.
Co-therapy provides the supervisee not only with an opportunity for direct observation of the work of a skilled practitioner but also with a stimulating basis for joint discussions. “The supervisory conference takes on new meaning as the [supervisor] evaluates for the [super-visee’s] benefit not only the [supervisee’s] per-formance, but also his own” (Ryan 1964:473). The co-therapy experience is most productive if prepared for carefully and if followed, as soon as possible, by a joint discussion of the experi-ence which they have jointly shared. On the other hand, those reporting on the use of the co-ther-apy procedure in supervision cite the dangers of inhibiting the worker’s autonomous learning or promoting dependency on the supervisor (Champte and Kleist 2003; Smith, Mead, and Kinsella 1998).
Tanner (2011) examined the effectiveness of co-therapy supervision on treatment outcome, client retention, and therapy training by com-paring the outcomes reported by groups of clients treated by supervisor-trainee co-ther-apists with those treated by supervisees vary-ing exposure to co-therapy supervision. No between-group differences were found in cli-ent retention or in the magnitude or direction of change, suggesting that the co-therapy was no more effective than the therapy provided by solo supervisees. For that matter, co-ther-apy supervision was no more effective for the trainee than ex post facto supervision.
Observation via recordings: Indirect Observation of PerformanceDependence on retrospective verbal and written reports of the worker-client interaction means
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
308 [ P r O b l e m s a N d I N N O v a T I O N s
had a moderate effect on patient outcomes (Diener, Hilsenronth, and Weinberger 2007). Based on a psychotherapy research program affiliated with the Harvard Medical School and sister institutions, McCullough et al. (2011:129) published an internet-accessible and practical guide on how to rate video-recorded therapy sessions, using an automated training protocol for trainees and advanced clinicians, and a scale of common factors “empirically shown to play a role in therapeutic change” (published on www.ATOStrainer.com).
Practice recordings enrich the nuance and texture of supervision. The availability of recordings “retrieves” the client for the super-visory conference. The supervisor who knows the client only from the supervisee’s written record and verbal reports may have difficulty envisioning the client or holding the client as the focus of attention of the conference. The cli-ent is a disembodied, dehumanized abstraction. Audio or video recording makes the client’s presence immediate and vivid. This increases the certainty that the client is not “forgotten” during the supervisory conference, that clinical supervision remains truly triadic, including the supervisor, supervisee, and client.
Audio and video recordings allow the super-visor to discuss the client in a way that makes more vivid what he or she says to the supervisee. Telling is not as effective as showing. But to see for ourselves, which recordings make possible, is perhaps the most insightful method of learn-ing. Supervisees, through replaying record-ings, face themselves in their own performance rather than the supervisor’s definition of them. “One rather cocksure resident denied feeling much anxiety in the interview situation. On a replay of his videotape, however, he saw him-self chewing gum rapidly during several tense moments during the hour. In the discussion of his behavior, he was able to recall his ten-sion and consider the possibilities of its origin” (Hirsh and Freed 1970:45).
The disjunction between a supervisee’s men-tal image of his or her behavior and the actuality
governing protected information in settings linked to health care. Likewise, informed client consent is required before permitting super-visors and other third parties to observe the recordings. Informed consent requires clear and understandable language that informs cli-ents of the purpose of the recording, who will be reviewing the recording, the risks and benefits involved, the clients’ right to refuse or withdraw consent (by interrupting or stopping the record-ing), and the timeframe covered by the consent. Social workers should give clients the option of specifying that the recording be erased after use in supervision and invite clarifying questions. Echoing Jencius, Baltimore, and Getz (2010), Haggerty and Hilsenroth (2011:200) added that “videos should be kept locked and de-identified in some way so as to further protect the iden-tity of the patient,” and that digital recordings should “have the data password protected and encrypted.” Video recording through unobtru-sive webcams or ports—whether in the wall, behind a one-way mirror, or in the interview or conference room—is designed primarily to reduce distraction, not to hide the fact of recording from the clients.
In addition to making available complete, reliable, and vivid information regarding the worker’s practice in supervision, video- and audio recording lend themselves to methods of teaching and evaluation with promise for improving worker performance (Hammoud et al. 2012; Huhra, Yamokoski-Maynhart and Pri-eto 2008; VanDerWege 2011) and perhaps client outcomes (Haggerty and Hilsenroth 2011; Ham-moud et al. 2012). Based on a meta-analysis of 217 experimental comparisons from thirty-three experimental studies involving a total of 1,058 persons, for example, Fukkink, Tri-enekens, and Kramer (2011) have reported that video feedback has a significant effect on the interaction skills of workers in a range of pro-fessions. A second meta-analytic study, draw-ing on ten independent samples of short-term dynamic psychotherapy, found that that the use of audio- or video recordings in supervision
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
P r O b l e m s a N d I N N O v a T I O N s ] 309
mistake. The tape speaks for itself ” (Benschoter, Eaton, and Smith 1965:1160).
As participant-observers in the interview, group meeting, or conference, supervisees can devote only part of their time and energy to self-observation and introspective self-analysis. They must devote most of their time and energy to focusing on client needs and reactions. Fur-thermore, much of their behavior is beyond self-observation. They cannot see themselves smile, grimace, arch their eyebrows, or frown. Retrieving the interaction on a recording, supervisees can give their undivided attention to the role of self-observer. Video recordings come close to implementing Robert Burns “ wish “to see ourselves as others see us.”
Supervisees can play the recording when they are more relaxed and less emotionally involved, and they can therefore examine their behavior somewhat more objectively. At the same time, repeating their contact with the full imagery of the event as it took place tends to evoke some of the same feelings that were felt at the time. Thus, the recordings allow supervisees to observe themselves as they relive, to some degree, their affective experiences.
Viewing themselves on video recordings or listening to themselves on audio record-ings may be ego-supportive for supervisees. For many, their self-image is reinforced posi-tively by what they see and hear. Supervisees said, in response to the playback experience, “I look better, sound better than I thought” and “I did better than I realized.” Adjectives used to describe themselves, elicited after playback, were similar to, and as positive as, those elicited before playback (Walz and Johnston 1963:233). The direction of the limited change that had taken place was toward a more objective view of their performance. It was a humbling rather than a humiliating experience. Without super-visory intervention, but as a consequence of the playback alone, supervisees’ perceptions of their work tended to become more congruent with the supervisor’s perceptions (Walz and Johnston 1963:235). Seeing one-self engaged
becomes undeniably clear on replay of a record-ing. One student said, “You get an idea of what you really look like and project to the [client] but often this is not what you intended” (Suess 1970:275). The experience of self-discovery that follows video playback has been aptly described as “self-awkwardness.” One worker said, “I dis-covered by watching the tape that I was too halting in my speech and that there was not enough continuity in what I was saying. With-out videotape it might have taken months for a [supervisor] to convince me of this” (Ben-schoter, Eaton, and Smith 1965:1160).
Recording playback and review involves confrontation with self, by self—not, as so often is the case, confrontation by reflection from others (VanDerWege 2011). “A therapist was shocked when she saw and heard herself making cumbersome and convoluted inter-pretations of such semantic complexity that she could barely understand them while later viewing the tape. However, months of report-ing had given her supervisor the impres-sion that her interventions were precise and articulate.” Another “recognized while watch-ing a tape that he gratuitously mumbled ‘uh huh’ throughout the session regardless of the patient’s words” (Rubenstein and Hammond 1982:149–50).
Audiovisual playback permits considerable self-learning. It thus encourages the develop-ment of self-supervision and independence from supervision. The supervisee has the “opportunity of distinguishing between the model he has of his own behavior and the real-ity of his behavior” (Gruenberg, Liston, and Wayne 1969:49). He or she has a chance for a second look at what was done, an opportunity to integrate multilevel messages that might have been missed in the heat of the interaction. Play-back provides a less pressured, more neutral opportunity to detect missed interventions or formulate what might have been more appro-priate ones. As a supervisor said in pointing to the advantages for self-instruction in video-tape, “Sometimes there is no need to point out a
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
310 [ P r O b l e m s a N d I N N O v a T I O N s
of the literature, see Buser (2008) and Huhra, Yamokoski-Manhart, and Prieto (2008).
Self-defensive activity by the supervisee is just as probable in playback observation as during the interview itself. The use of record-ings is optimally productive only when there is a supervisor available who can gently, but insistently, call attention to what the supervisee would rather not hear or see. Mark Twain once said that “you can’t depend on your eyes when your imagination is out of focus.” The super-visor, watching or listening to the recording alongside the supervisee, helps keep imagina-tion in focus.
Video recordings are employed in group supervision as a stimulus for discussion (Brans-ford 2009; Brooks, Patterson, and McKiernan 2012). In the system used by Goldberg (2012:47), “During each session, supervisees are encour-aged to first process urgent counseling concerns and then show videotapes of counseling ses-sions to promote discussion. The supervisees rotate weekly the chance to show the first tape.” Chodoff (1972) played tapes of interviews in group supervisory meetings, stopping the tape at various points in an interview to elicit com-ments from supervisees as to how they would have handled the situation at that point if they were the interviewer and to speculate on what would happen next in the interview.
Supervisor evaluation feedback is likely to have greater effect under conditions of high vis-ibility of worker performance. Any assessment is likely to be easily dismissed by the worker who has little confidence in the supervisor’s evaluation because of limited opportunity to observe the worker’s performance. Recorded material can be used in evaluation to demon-strate or validate patterns of changing perfor-mance over a period of time. An interview or group session recorded at one point in time can be compared with a similar interview or group session recording several months or a year later.
Recordings can also be used, as records are currently, to induct new staff. Under appro-priate conditions, a library of audio and video
in behaving competently, intervening in ways that are helpful, tend to reinforce such behavior. Replay not only helps correct errors, but it helps to reinforce learning.
The nature of recording technology permits considerable flexibility in how it might be used in supervision. Through the use of audio and video recordings, the supervisor and super-visee can review the work repeatedly at their own time and at their own pace (Farmer 1987; VanDerWege 2011).
The opportunity for repeated replaying of the interactional events permits supervisor and supervisee to focus exclusively on a single aspect each time. At one time, they can focus on the client; another time they can focus on the worker. The same one or two minutes of interaction can be played repeatedly to focus on worker-client interchange. Shutting off the sound on a video recording permits exclusive concentration on nonverbal behavior; shutting off the visual image permits exclusive attention to verbal content.
Recordings do not diminish the desirability of supervision even though they do provide the supervisee with a rich opportunity for critical, retrospective self-examination of his or her work. Seeing and hearing this material in the presence of a supervisor who asks the right provocative questions and calls attention to what otherwise might be missed provides the supervisee with greater opportunities for learn-ing. The procedure has been used frequently in counselor training by Norman Kagan and his associates (Kagan, Krathwohl, and Miller 1963; Kagan and Kagan 1997) in what they term inter-personal process recall. Individual supervisees watch playbacks of their video-recorded inter-views in the presence of trained supervisors. The supervisors encourage the their supervis-ees, through sensitive questioning, to describe the feelings they experienced during the inter-view, to translate their body movements, and to reconstruct the thinking that led them to do and say the particular things they did and said at specific points in the interview. For reviews
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
P r O b l e m s a N d I N N O v a T I O N s ] 311
feedback on their audiotaped or videotaped cli-ent interviews reported significantly more sat-isfaction with their field practicum than those who did not (Fortune and Abramson 1993). Both supervisors and supervisees awarded their highest rating to reviewing videotaped interviews when Wetchler et al. (1989) asked marriage and family therapists to evaluate supervisory formats in use. However, Hicks (2009) found no association between the use of audio or video recordings and perceptions of the effectiveness of supervision in a national study of postdoctoral supervisees.
One of the principal advantages of the use of recordings for supervision is, at the same time, one of its principal disadvantages: audio and video recordings are complete and indiscrimi-nate. The supervisor faces an embarrassment of riches and may be overwhelmed by the detail available. It is possible to avoid the danger of being overwhelmed, however, by selecting lim-ited sections for viewing, judiciously sampling the interaction, and taking an “audiovisual biopsy.” On the other hand, a surgical approach to supervision may have contributed to the experience of the supervisee who felt that her supervisor was “just watching to correct” and felt the need to be “on guard at all times” (Phelps 2013:125).
The time involved in using the video record-ing for supervision can be reduced by asking the supervisee to select the points on the recording that he or she wants to discuss and identify the counter numbers where this interaction appears on the recording, giving this information to the supervisor in advance. Rather than reviewing the entire hour-long recording, the supervisor can merely spot-check and then focus on those interactions that the supervisee would like to discuss. Unfortunately, VanDerWege (2011:138) found that supervisors rarely asked to view practice recordings “marked and tagged” by their supervisees during supervision, leading to disappointment with supervision.
Recording procedures present a possibly hazardous challenge to the supervisor. If the
recordings might be developed to give the new worker a clear and vivid idea of the work the agency does.
There are some disadvantages, however, in the use of audio and video recordings. Con-scious of the fact that their entire performance is being recorded, with no possibility of change or revision, supervisees may be somewhat more guarded and less spontaneous in their behavior (Huhra et al. 2008; Mauzey, Harris, and Trusty 2000). They may tend to take more seriously La Rochefoucauld’s maxim, “It is better to remain silent and be thought a fool, than to speak and remove all doubt.”
The worker is more likely than the client to feel anxious, “since the therapist can feel him-self being examined while the [client] sees himself as being helped” (Kornfeld and Kolb 1964:457). For most supervisees, the gains from recording their performance appear to offset the risks. Itzin (1960) found that supervisees who recorded their interviews for supervi-sion were very much in favor of the procedure. They felt it introduced a desirable objectivity into supervision and helped them overcome evasions, distortions, and other defenses mani-fested in written reports of their work. One supervisee said, “I feel certain that the supervi-sor was able to pin down my problems quite early—and understood me much better than he could have had I been able to hide behind process recording” (198). Another commented, “It gave [the supervisor] a much more accurate account of what went on during the interview. When reporting happenings we tend to fla-vor them with our own thoughts, feelings and needs. I fail to see how it could be otherwise. He knew what we were doing rather than what we said we were doing” (198). One student said, “I can read a thousand books on theory but when I actually saw what was happening it was a great awakening” (Ryan 1969:128).
Thus, social work students who videotaped their interviews gained self-awareness and sensitivity. In a study by Hanley, Cooper, and Dick (1994), social work students who received
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
312 [ P r O b l e m s a N d I N N O v a T I O N s
clients are less disturbed than the workers, who are anxious about exposing their performance so openly to the evaluation of others; and that workers take longer to adapt comfortably to this situation than do clients.
The subjective reports of those who have used audio or video recordings for service, research, and supervision are consistently supported by systematic research on the effects of such pro-cedures. Some years ago, Kogan (1950) found that the use of an audiotape recorder had no significant intrusive effect on social casework interview. Subsequent studies (Ellis 2010; Ellis, Krengel, and Beck 2002; Gossman and Miller 2012) confirmed this conclusion.
That is not to say that such procedures have no effects. Any change makes for some change. The important question is whether the effects are significant, whether the intrusive conse-quences are sufficiently deleterious to offset the clear advantages in the use of recordings. The answer clearly seems to be that there are no serious deleterious effects, when used with good judgment.
The use of recordings cannot be careless or indiscriminate. Some clients are affected more than others (Gelso and Tanney 1972; Van Atta 1969), and particularly with paranoid clients these procedures would be contraindicated. Niland et al. (1971) observed some of the inhibi-tory consequences of the use of tape recordings; they emphasized the need for sensitivity to the supervisee’s “index of readiness” to use audio and video recording.
Balancing the advantages and disadvantages and comparing audio and video recording with alternative supervisory procedures, these observational approaches might be seriously considered as desirable innovations. This was the conclusion of family therapist supervisors. In a questionnaire study of 318 approved family therapist supervisors and 299 of their supervis-ees, both groups agreed that “reviewing vid-eotapes of therapy sessions with supervisors” was the most effective supervisory technique (Wetchler et al. 1989:39). “Review written
supervisor can observe the supervisee’s per-formance through use of these procedures, the supervisee can likewise have access to the supervisor’s performance. There is an implied invitation to have the supervisor conduct an interview or lead a group so that the super-visee can observe how it should be done. The supervisee who is dependent solely on hear-ing the supervisor talk about social work has to extrapolate from the supervisor’s behavior in the conference how he or she might actually behave with clients. The role model available to the supervisee is largely imaginary. Direct observation of the supervisor in action would make available a more vivid, authentic, and realistic role model for emulation.
Video recording of interviews by the supervi-sor with clients allows the worker to “see their teachers at work removed from the unrealistic vacuum of didactic pontification. In seeing their supervisor’s sessions firsthand, warts and all, the [supervisees] not only see their super-visor’s skills and learn from them but may also be given the chance to renounce the previous idealization of the supervisor” (Rubenstein and Hammond 1982:159).
Supervisors as well as supervisees can profit from recording and reviewing their work. There is no reported use of such procedures in social work, but supervisors in education and psy-chology (Robiner, Saltzman, Hoberman, and Schirvar 1997) have tape-recorded their confer-ences for self-study.
There is a persistent question of the distortion of the worker-client interaction resulting from the use of all observational procedures and the threat to confidentiality. Reports by psycholo-gists, psychiatrists, and social workers who have used audio and video recordings of individual or group interviews are almost unanimous in testifying that no serious distortions of inter-action had taken place. With considerable consistency, professionals state that very few clients object to the use of these devices; that whatever inhibiting effects these devices have on client communication are transient; that
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
P r O b l e m s a N d I N N O v a T I O N s ] 313
supervisee to immediately test his or her ability to implement the supervisor’s suggestions and to ascertain immediately the client’s response to suggested interventions. This supposedly has a potent impact on learning (Munson 2002).
Having decided to supervise during the actual course of the interview, the supervisor has to decide on the method of live interven-tion. The choice involves use of the “bug-in-the-ear” and related methods of contact with the supervisee, calling the supervisee out of the session for a conference (Gold 1996), or walking into the session to engage in supervision.
Bug-in-the-Ear and Bug-in-the-Eye SupervisionA smartphone or computer with a wireless link to a small, unobtrusive, lightweight, behind-the-ear receiving device allows the supervisor to communicate with the supervisee during the course of the interview or group meeting. As Wade (2010:27) noted, a bug-in-the-ear (BITE) currently “is comprised of two major compo-nents: a Bluetooth earpiece and a USB adap-tor.” Watching and listening behind a one-way mirror or through a video transmission, the supervisor can make suggestions that only the supervisee can hear. The communication is in the nature of a space-limited broadcast, and no wires impede the movements of the supervisee.
Korner and Brown first reported the use of such a procedure in 1952, calling it “the mechanical third ear.” Ward (1960; 1962) and Boylsten and Tuma (1972) reported on the use of this device in psychiatric training in medi-cal schools. Montalvo (1973) detailed use of a similar procedure in a child guidance clinic, and Levine and Tilker (1974) described the use of the device in supervision of behavior modi-fication clinicians.
Barnett (2011), Chlebowski and Fremont (2011), Ford (2008), Goodman et al. (2008), Olson, Russell, and White (2001), and Scheeler et al. (2012) have reviewed the literature on the use of the BITE technology in a variety of disci-plines, citing the advantages and disadvantages
verbatim transcripts with supervisor” was given the lowest effectiveness rating by both super-visor and supervisee among eighteen different procedures listed.
Use of these measures that provide direct and indirect access to the worker’s performance helps mitigate the problem associated with the supervisor’s secondhand, perhaps distorted, knowledge of what the worker is actually doing. Some additional innovations include not only direct observation but also supervisory through input live supervision during the time the inter-view is actually conducted.
live supervision during the InterviewEven if the supervisor can observe the work of the supervisee more fully and directly, he or she is still denied the possibility of teaching at the moment when such intervention is likely to be most effective. Whether he or she sits in on the interview, observes through a one-way mirror, or listens to and sees the work of the supervisee on audio and video recordings, his or her discussion of the worker’s performance is retrospective. For the worker, supervision comes after the interview, at a point in time removed from his or her most intense affective involvement in the problem situation, when he or she might be most amenable to learning. The advantages of immediacy and heightened receptivity to suggestion while under stress are diluted. Assuming that the record of practice shows room for improvement, any retrospec-tive benefits of supervision may be lost on the client. Consequently, there have been a num-ber of attempts to use modern technology to permit the supervisor to supervise while the worker is actually engaged in an interview. However, if the supervisor’s direct observation of the worker-client interaction is intrusive, live supervision intrudes more.
The main thrust of live supervision is to move supervisory interaction closer to where the action is taking place, to increase the immediacy and spontaneity of the supervisor’s teaching. Live supervision also permits the
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
314 [ P r O b l e m s a N d I N N O v a T I O N s
[emphasis in original] fundamental techniques are mastered” (121).
The supervisor can call attention to nonver-bal communication, which is often missed, to the latent meaning of communication, to which the worker fails to respond, or to significant areas for exploration that have been ignored. As Montalvo (1973) noted, “This arrangement assumes that you do not have to wait until the damage is done to attempt to repair events” (345). Becoming aware of these considerations on the spot promotes immediate learning and helps to offer the client more effective service, as illustrated in the following vignette. A nine-year-old was very late for his interview, and the therapist was annoyed and upset:
[When the boy came in,] he was obviously anx-ious. He looked at the therapist and stated that the therapist looked different—his hair was “all messed up.” Misunderstanding the communica-tion, the therapist commented on his hair. When it was pointed out to the therapist (via the bug) that the boy recognized his more curt voice, the therapist was able to comment on the boy’s fear that perhaps the therapist was angry at him for being late. The interpretation of the boy’s fears of the therapist’s anger led to the patient’s being able to relax and promoted further psychotherapeutic intervention. (Boylsten and Tuma 1972:94)
Such a procedure enables the supervisor to directly evaluate the supervisee’s effectiveness in using supervision. It has an additional advan-tage for supervisors, in that they are in a better position to deter possible legal action against them by stopping the supervisees if there is any danger of harm to the client. The procedure combines client protection with enhancing the professional growth of the supervisees.
Direct supervisory interventions can differ in their degrees of concreteness and specific-ity. This intervention can be a general state-ment or a very specific prescription for action. The intervention can differ in the degree of direction. The supervisee can be directed to
of the procedure. A review by Wade (2010:iii) noted that “bug-in-the-ear Bluetooth technol-ogy has allowed supervisors to increase desired teacher behaviors by providing immediate feedback, coaching, and prompting during instructional delivery.” An empirical study of the effects of the use of BITE supervisory feed-back with four marriage and family therapy trainees found that the procedure produced sig-nificant improvement in trainees’ clinical skills (Gallant, Thayer, and Bailey 1991). A study by Jumper (1998) found that the immediate bug-in-the-ear feedback that counselor trainees received directly enhanced their self-efficacy. In addition, in a multiple-baseline study of three novice teachers of students with disabilities in K–8 classrooms, Goodman et al. (2008) found that “the rate and accuracy of effective teaching behaviors increased when in-class feedback was delivered via the electronic ‘bugs.’” However, although Goodman et al. (2008) found some evidence that some teachers’ practice effective-ness was sustained when BITE supervision was withdrawn, the outcomes of BITE supervi-sion were more equivocal in Thurber’s (2005) dissertation study of therapists receiving live supervision.
For a beginning worker, such a device may help lower “his initial encounter anxiety, thus allowing him more freedom to focus on the patient’s anxieties. The fact that a supervisor is immediately available provides significant support so that the therapist is able to be more relaxed, spontaneous, and communicative” (Boylsten and Tuma 1972:93).
In defense of directive intrusions by the supervisor during the therapy, Lowenstein and Reder (1982) stated that for the beginning therapist “there is a feeling of gratitude for a ‘powerful voice’ which offers generous help in moments of stagnation, perplexity, and chaos.” They noted further that the supervisor does or should know better than the supervisee, and directivity is not antithetical to development of creativity because “it is only reasonable to expect that creativity will be developed after
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
P r O b l e m s a N d I N N O v a T I O N s ] 315
found that it had been used by 36 percent of the seventy-four programs responding. Patients were not adversely affected by its use. Problems for the supervisee, including possible loss of control of the interaction, creation of depen-dency, and disturbance and distraction in using bug-in-the-ear, depended to a considerable extent on the supervisee-supervisor relation-ship. Where the supervisor was sensitive to the needs of the supervisee and was not dominant or intrusive, the procedure presented little dif-ficulty (Salvendy 1984). Training programs may overestimate how frequently they use live supervision, however. Medical residents and students report that direct observations of their practice during training are rare (Fromme et al. 2009), and a recent national survey of 150 pro-fessional psychology supervisees at all levels of training found that “methods permitting live observation of supervisee work were used very infrequently” (Amerikaner and Rose 2012:61).
Certain dangers associated with the use of the device are clearly recognized. In addition to anticipatory and initial performance anxi-ety (Champe and Kleist 2003; Saltzberg et al. 2010), these include the possibility of confus-ing and disconcerting the worker by too-fre-quent interventions, the possibility of addictive dependence on outside help, and the possibility of interference with the worker’s autonomy and his or her opportunity for developing his or her own individual style (Barker 1998). The danger lies in “robotizing” the worker or having him operate by remote control as a parrot:
A trainee pointed out that in my enthusiasm to be helpful via the ear—that “comments came so thick and fast it was hard to do any thinking of my own!” I think it is important for the bug to be a word in the ear rather than a cartridge in the brain! (Hildebrand 1995:175)
The evidence suggests that supervisors who intervene too much during live supervision are as unhelpful (Hendrickson et al. 2002) as those who just watch (Beddoe et al. 2011).
do something, or the intervention can be in the nature of a suggestion. The intervention can differ in terms of the degree of annotation. Supervisors can be very brief in explaining the reasons for what is being communicated, or they can elaborate on the justifications for the communication. The interventions can differ in the level of their intensity and can be com-municated with considerable emphasis or in a mild tone. Interventions can be more specific or more directive with beginning workers and more general with experienced ones.
Comments might be peremptory instruc-tions, telling the supervisee to do something: “Explore the parent’s conflicts on discipline,” “Confront father with his failure to respond to son,” “Get the mother to negotiate with daugh-ter on homework,” or “Include grandmother in the discussion.” More often, their supervi-sory comments tend to be suggestive: “Think about. . . , If you have a chance . . . See if you can . . . It might help to try . . . .” Their com-ments also may be supportive (e.g., “That was good. Keep it up. Fine intervention”) or sug-gestive (e.g., “Perhaps a short role play might help at this point”).
Although informed consent is required for the ethical use of BITE and related procedures (NASW 2008), client cooperation is sometimes solicited by being told that the services may be more effective if monitored by a more experi-enced supervisor (Kaplan 1987). Clients should always be informed in advance about methods of supervision in use; otherwise, clients who observe workers wearing ear buds or headsets may assume that a Bluetooth device is being used to receive incoming calls unrelated to the business at hand.
Although training with live supervision has long been proposed to prepare social work-ers for clinical practice (Evans 1987; Saltzburg, Greene, and Drew 2010), little is known about how often or widely it is used in social work supervision (Everett et al. 2011; Mishna et al. 2012). A questionnaire study of the use of the bug-in-the-ear in psychiatric residency training
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
316 [ P r O b l e m s a N d I N N O v a T I O N s
These procedures, involving supervisory guid-ance of supervisees as they work, have also been discussed, explained, and evaluated recently by Barnett (2011), Ford (2008), Ladany and Bradley (2010), Mishna et al. (2012), and Wade (2010).
In offering criteria for determining when personal contact with the supervisor is neces-sary and when a phone call via bug-in-the-ear will suffice, Berger and Dammann said:
We find it helpful to call the therapist out of the room to talk with the supervisor when changes in strategy are proposed. . . . It is difficult for the therapist to comprehend a change in strategy while in the presence of the family. Once a joint strategy is developed, however, phone calls from the supervisor to the therapist suggesting changes in tactics (e.g., “Have the therapist persuade his wife to go along with” or “tell the family you must explain the tasks further”) are very useful. (Berger and Dammann 1982:340–41)
With some empirical support, Bernard and Goodyear (2009) proposed that live supervi-sion has a number of putative advantages over less intrusive forms of supervised practice:
1. Live supervision protects client welfare, as there is increased probability that practice directed by a more experienced clinicians will help clients.
2. The helping alliance with supervisees may be strengthened in live supervision, as supervisors become more invested in the unfolding process of helping.
3. Live supervision allows supervisees to work safely with more difficult cases and chance greater risks if the supervisor is available to provide help as needed.
4. The credibility of the supervisor increases when live supervision is helpful.
5. Learning may become more efficient in live supervision.
Other reviews of the empirical literature, however, suggest that live supervision has
To manage these risks, supervisors should receive training in live supervision (Mauzey and Edman 1997) and provide an orientation “in which supervisees are given an informed consent statement about the purpose of live supervision, how the particular format works, and the expectations supervisors have for trainees” (Champe and Kleist 2003:272). The approach suggested by those who have used the device is for the supervisor to broadcast only during silences or when the worker is mak-ing notes; to limit such interventions to clearly important points in the interaction, when the worker is seriously in error or in difficulty; and to make suggestions that are phrased in general terms, “leaving the actual dialogue and action pattern” to the students. “Most trainees point to the fact that the real value for them lies in inter-pretations of general themes in the psychother-apy process rather than in specific interpretive remarks” (Boylsten and Tuma 1972:95). Alter-natively, Mauzey and Erdman (1997) argue that live supervisory interventions should be brief, clear, and concise.
Further, supervisor and supervisee might agree in advance that if the supervisor’s inter-ventions are at any point confusing or not help-ful, the supervisee can take the bug out of the ear using some agreed-upon signal. In general, although the bug-in-the-ear is among the least intrusive of the live supervisory approaches, the recent innovation of “bug-in-the-eye” supervision (Chapman et al. 2011) is even less so. In this method, the supervisor employs a mobile phone or smartphone, computer, iPad, or similar device with a keyboard to send text or e-mail to the supervisee on a video screen. Visible to the worker, but not to the client, a bug-in-the-eye provides visual supervisory feedback. Available when the supervisee wants it, unlike bug-in-the-ear feedback that may come when the supervisor deems it prudent, this form of feedback is less demanding of the worker’s immediate attention. Sometimes, for that very reason, messages from the supervisor can be ignored.
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
P r O b l e m s a N d I N N O v a T I O N s ] 317
live supervision is rarely used in social work education (Everett et al. 2011; Knight 2001), but even less is known about its use in social work practice. Social workers may feel some hesi-tancy about the use of such direct measures of observing and directing the supervisee’s perfor-mance. Where a social work supervisor strives for a collaborative relationship with his or her supervisee, the relationship in live supervision is more overtly hierarchical and directive. Fam-ily therapy supervisors have been less hesitant and less apologetic about being openly directive and acknowledge that such procedures clearly reflect the hierarchical nature and structure of their supervisor-supervisee relationships, although Hair and Fine (2012) suggest that this attitude may have softened somewhat.
Using Client Feedback and Client Outcomes in SupervisionConsistent with the social work emphasis on client strengths (Council on Social Work Edu-cation 2010), most social workers and super-visors believe that they are helping the clients they serve (NASW Center for Workforce Stud-ies 2004), and some evidence suggests that supervisors believe that they are providing more help to clients than the workers they supervise believe that they do (NASW Center for Workforce Studies 2004). However, those with “an overly optimistic view of client out-come” may be “especially poor” at identifying clients whom they are not helping (Worthen and Lambert 2007:49). Consequently, practitio-ners have been “encouraged to routinely moni-tor patients’ responses to . . . ongoing treatment [as] such monitoring leads to increased oppor-tunities to reestablish collaboration, improve the relationship, modify technical strategies, and avoid premature termination” because this is a “demonstrably effective” procedure that “works” (Norcross and Wampold 2011:98), based on a meta-analysis of the research. Accordingly, the use of client feedback and outcomes in social work supervision is rec-ommended (Collins-Comargo, Sullivan, and
counterbalancing disadvantages (McCollum and Wetchler 1995):
1. Live supervision takes time, is expensive, and is difficult to schedule.
2. Skills learned in live supervision may not generalize to other practice situations.
3. Live supervision may produce passive prac-titioners who take little initiative.
4. Live supervision is unduly disruptive.
In a review relating psychotherapy supervi-sion to patient outcomes, Watkins (2011a:248) noted a study by Kivlighan et al. (1991), in which undergraduate ‘‘clients,’’ exposed to live versus videotaped supervision, “rated their four counseling sessions as rougher and the working alliance as stronger during the live supervision condition.” Although live supervi-sion did not affect client perceptions of their relationships with workers in a study by Ford (2008), O’Dell (2010) found that supervisees who participated in live supervision reported a significantly stronger working alliance than those receiving supervision via videotape and verbal case presentation in a study of fifty-three matched pairs of supervisors and supervisees drawn from across the United States. Locke and McCollum’s (2001) study of clients’ views of live supervision and satisfaction with therapy found that clients were generally satisfied with live-supervised therapy, as long as the perceived helpfulness of live supervision outweighed its perceived intrusiveness, although an experi-mental manipulation of direct client exposure to supervisors conducting live supervision of initial sessions of family therapy—arguably an intrusion—had no effect on client satisfaction in the randomized trial reported by Denton, Nakonezny, and Burwell (2011). As noted by Bernard and Goodyear (2009), Milne (2009), and Watkins (2011a), the impact and efficacy of live supervision have been the subject of more speculation than research.
With a few exceptions (e.g., Wong 1997; Saltz-burg, Gilbert, and Drew 2010), it appears that
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
318 [ P r O b l e m s a N d I N N O v a T I O N s
directly with their clients about the goals and tasks of helping led first to increased client satis-faction with goal attainment, then to increased client satisfaction with worker helpfulness, and subsequently to increased client satisfaction with their partnership with workers (Harkness 1997). This suggests that client perceptions of their bond or working alliance with workers (Baldwin et al. 2007; Horvath et al. 2011) were strengthened when the supervisor encouraged workers to reach for client feedback—an inter-pretation that emphasizes how reaching for client feedback in supervision affects clients. Owing to its brevity of administration and sen-sitivity to changes in supervisor behavior, we encourage supervisors wanting to monitor the client outcomes of their practice to include the Poertner instrument in their dashboards, aug-menting the measures of alliance and process we recommended in chapter 7.
Another analysis emphasizes how reaching for client feedback in supervision affects work-ers. A number of important studies have exam-ined the effects of direct observations of client outcomes and their systematic use as practice feedback, the subject of a review by Green and Latchford (2012). These include the work of Bickman et al. (2011), De Jong et al. (2012), Harmon et al. (2007), Knaup et al. (2009), and the program of supervision research conducted by Michael Lambert and his colleagues. In brief, providing clinicians with client feedback in supervision has been found to improve client outcomes, especially when coupled with prob-lem-solving assistance, principally by identi-fying and addressing likely treatment failures early on, and primarily in university counseling centers where clinicians are being trained.
Some of the most effective feedback has been presented in a graphical form (e.g., Robinson and Dow 2001; Lambert et al. 2002; Harmon et al. 2007), timed to arrive between client appointments (Green and Latchford 2012), especially feedback signals that the difference between outcomes achieved and the outcomes that workers expected (Lambert et al. 2001).
Murphy 2011; Rapp and Poertner 1987; Whipple and Lambert 2011).
Because workers “who assume or intuit their client’s perceptions of relationship satisfaction and treatment successes are frequently inac-curate,” whereas those “who specifically and respectfully inquire about their client’s per-ceptions frequently enhance the alliance and prevent premature termination” (Norcross and Wampold 2011:101), a supervision intervention designed to address the problem was intro-duced in chapter 4. In this method, the super-visor asks the worker a series of questions that serve to challenge inaccurate perceptions of the helping process and prompt workers to discuss with clients the goals and methods of the help-ing process and make them more explicit.
What does the client want help with? How will you and the client know you are helping? How does the client describe a successful outcome? Does the client say there has been a successful outcome? What are you doing to help the client? Is it working? Does the client say you are help-ing?? What else can you do to help the client? How will that work? Does the client say that will help? (Harkness and Hensley 1991:507)
To evaluate this procedure, those ques-tions were used to change the focus of social work supervision with four workers serving 161 clients over the course of sixteen weeks of agency practice, monitoring client satisfaction on a weekly caseload basis, using a brief mul-tidimensional measure of counseling satisfac-tion developed, field tested, and validated by Poertner (1986). Reaching for client feedback in supervision increased client satisfaction with goal attainment by 10 percent, client satisfaction with worker helpfulness by 20 percent, and cli-ent satisfaction with worker-client partnership by 30 percent (Harkness and Hensley 1991).
One indication of how this method may have worked was gleaned from a cross-lagged panel reanalysis of the data. In temporal order, using supervision to encourage workers to speak
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
P r O b l e m s a N d I N N O v a T I O N s ] 319
“enter” button a graph and color coded messages (i.e., Red, Yellow, Green, White) as well as criti-cal items, full item responses, distress level, and norm comparison group information for both the total OQ scores as well as the three subscale scores are instantaneously delivered to the thera-pist. (Worthen and Lambert 2007:50)
The principal purpose of providing clinicians with systematic feedback is to draw attention to cases with suboptimal trajectories and poten-tial treatment failures. This may include critical item responses to the OQ-45 measure, such as marking the following items as occurring fre-quently: suicide—I have thoughts of ending my life, substance abuse—I have trouble at work/school because of drinking or drug use, or work violence—I feel angry enough at work/school to do something I might regret (Worthen and Lam-bert 2007:50). For cases such as these, the Lam-bert group provided additional assistance in a form that might be described as “manualized supervision,” using a decision tree designed to help the clinicians reassess the case and reor-ganize their interventions. The decision-tree hierarchy is structured to rule out issues and concerns in the following descending order: (1) the quality of therapeutic alliance, (2) the cli-ent’s motivation and readiness for change, (3) the adequacy of the client’s social support, (4) a reassessment of the diagnosis for effective treat-ment matching, and (5) referral for medication. (Whipple and Lambert 2011:101).
Initially, Worthen and Lambert (2007) found that workers and supervisors were lukewarm about the helpfulness of receiving client feed-back, but subsequently “counselors simply considered the evidence of client benefit too persuasive to ignore” (Worthen and Lambert 2007:52), reporting that they “continued to use progress feedback in supervision but increased the likelihood of discussion of this information by notifying supervisors each time a NOT [not on track] client of a supervisee is identified, so that the case will be considered in supervision as a matter of routine practice” (52). For related
This suggests that the amount, form, qual-ity, and timing of client feedback that work-ers receive in supervision may play a role in advancing client gains.
As an illustration, there is much to be learned from the work of the Lambert research group, who analyzed treatment data from a national database of more than ten thousand patients to develop a set of algorithms for expected tra-jectories of change in response to treatment, primarily for axis I mental disorders, using weekly administrations of the OQ-45, a propri-etary self-report measure of outcome, that takes about clients five minutes to complete. This weekly client feedback is provided to workers and their supervisors in the form of a progress graph with color-coded dots that signal the fol-lowing (Whipple and Lambert 2011:95–96):
White dots: The client is functioning in the nor-mal range. Consider termination.
Green dots: The rate of change the patient is making is in the adequate range. No change in the treatment plan is recommended.
Yellow dots: The rate of change the client is making is less than adequate. Recommen-dations include considering altering the treatment plan by intensifying treatment, shifting intervention strategies, and moni-toring progress especially carefully. The patient may end up with no significant ben-efit from therapy.
Red dots: The client is not making the expected level of progress. The patient has a chance of dropping out of treatment prematurely or having a negative treatment outcome. Steps should be taken to carefully review this case and decide upon a new course of action, such as a referral for medication or inten-sification of treatment. The treatment plan should be reconsidered.
In order to deliver this information in a timely manner . . . clients come to their session 10 min-utes early, and complete the OQ-45 through the use of handheld computers. After pushing the
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
320 [ P r O b l e m s a N d I N N O v a T I O N s
consultation in the selection of equipment from the bewildering array available, and some technical knowledge in the use of the equipment. These considerations may have acted as deterrents, but now audio and video recording equipment of high quality requires modest expense (Abbass et al. 2011), minimal knowledge for use, is unobtrusive, and its use is familiar and acceptable to most clients. More-over, sophisticated software for digital record-ing, playback, and analysis, such the Landro Play Analyzer (used by coaches to analyze and study athletic performance), is currently being adapted and priced for affordable use with an iPad in social work supervision (Melissa Wold, personal communication, June 8, 2012). (For illustrative applications in counseling supervi-sion, see Herd, Epperly, and Cox 2011; Jencius, Baltimore, and Getz 2010; and VanDerWege 2011.) Observation through one-way mirrors or sitting in on an occasional interview requires even less imposition, and observing practice through its outcomes by collecting routine cli-ent feedback may be less intrusive as well. Little justification remains for the neglect of these various methods for direct supervisory access to worker performance.
Yet a word of caution is also in order. As cybertechnology has “crept in” to social work practice, “core elements of the work have been affected” (Mishna et al. 2012:n.p.), changing our modes and habits of communication, with implications for rapid future growth in “cyber,” “digital,” “distance,” “online,” and “telehealth” supervision (Fenichel 2003; Perron et al. 2010; Reese et al. 2009). Although such innovations have proven value, in rural Idaho (Cunning-ham and Van der Merwe 2009), for example, some evidence suggests that there are sig-nificant methodological and qualitative dif-ferences between face-to-face and distance supervision (DaPonte 2011), and that distance supervision is often practiced in ethical and legal grey zones (Mishna et al. 2012; Panos et al. 2002), as foreshadowed by Parker (2011) in a thesis (aptly titled, Into the Wild West). For
findings and procedures, see Calahan et al. (2009), Reese et al. (2009), and an interesting study by Thurber (2005), who compared bug-in-the-ear, phone-in, and computer-assisted modalities of live supervision in the Lambert research setting, finding that superior “thera-pist adherence” to a treatment protocol, and “desired changes in client behavior and out-come assessments” were associated with the latter live intervention (Thurber 2005:v).
Observing Worker Performance: a recapitulation and caveatA principal problem for supervision concerns the supervisor’s access to the supervisee’s per-formance. Administrative supervision for evaluation and accountability, educational supervision for professional development, and, to a lesser extent, supportive supervision all require the supervisor’s firsthand knowledge of what the supervisee is actually doing and doing well. The nature of the social work interview is said to require privacy and protection from any intrusion, but this must be counterbalanced with due concern for the development of the worker and the achievement of successful cli-ent outcomes. Although innovations have been proposed that may be helpful, the supervisor typically learns what the supervisee has done after some delay and from the supervisee’s ver-bal and/or written self-report.
Case record material supplemented by the supervisee’s verbal report has served a long and useful purpose in social work supervi-sion, despite its deficiencies. There is nothing to suggest that it should be discarded. There is much to indicate that it does require selective supplementation through more frequent use of the other procedures discussed in this chapter. Despite the availability and clear utility of such procedures in meeting some of the problems of supervision, social workers, by and large, have made very limited use of them (Everett et al. 2011).
In the past, the use of video recording required a large initial expense for an agency,
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
P r O b l e m s a N d I N N O v a T I O N s ] 321
of supervision as cultivating “perpetual child-hood” in workers: “Much of the time, one must admit, supervision is a necessary evil and it becomes more evil as it becomes less necessary” (103). During the 1970s, continued supervision became not only professionally inappropriate but also appeared to violate the tenets of egali-tarian participatory democracy.
Subsequently, Veeder (1990) expressed a more general concern with continued supervision as related to the problem of the professional status of social work. Continued supervision, it was asserted, denied the worker of full autonomy in practice, which is one of the principal attributes of a profession.
Most of the assertions with regard to inter-minable supervision have been perhaps merely that—assertions based on limited evidence. Until recently, there was little factual data that let us know how many social workers were supervised for how long, and whether supervi-sion was, in fact, interminable for any sizable number of professionally trained workers. To shed light on the question, we returned to the NASW Center for Workforce Studies (2004) survey, in which 82.3 percent of 3,543 employed social workers in the sample reported having a supervisor. Although we have no information about the amount, frequency, or form of the supervision of Workforce supervision, our anal-ysis indicates that the percentage of the Work-force with supervision grows smaller, and that the corresponding percentage of autonomous workers grows larger, with years of experience, as shown in figure 10.1, until a point of parity is reached among those who have practiced for 36 years. Apparently, this is largely a function of attrition among supervised workers, rather than a light at the end of the tunnel of intermi-nable supervision, as the number of supervised workers in the Workforce dwindles over time, whereas the ranks of the smaller autonomous cadre remain relatively constant, as shown in figure 10.2.
There seems little doubt that the differ-ence in attrition between the two groups is
thoughtful discussions of key ethical and legal issues bearing on cyber supervision, see McAd-ams and Wyatt (2010) and Reamer (2012), who recently addressed these pressing concerns with the members of the Association of Social Work Boards that regulate social work practice and supervision in the United States. Finally, in set-tings and systems in which social workers have been overmeasured and overmanaged, unin-tended consequences have been noted (Adams 2006; Burton and van den Broek 2009).
The Problem of Interminable supervisionThe innovative procedures we have been dis-cussing are all intended to provide the supervi-sor with more open, more complete access to the worker’s performance. Another series of innovations has been proposed in response to the historical controversy regarding the con-tinued need for supervision of professionally competent workers. In 1950, the U.S. Census Bureau questioned the advisability of listing social work as a profession, “since its members apparently never arrived at a place where they were responsible and accountable for their own acts” (Stevens and Hutchinson 1956:51). Ken-nedy and Keitner (1970:51) noted that “there is no other profession where self-determination applies to the client and not the worker.”
Arguments about autonomy derived more often from considerations regarding the pro-fessional status of social work than from the demands of direct service workers. The limi-tations on autonomy implied in a system of supervision were perceived as an insult to the professional status of social work. A worker once said, “Supervision creates a poor image of social work in relation to other professions. As a mature, experienced, professional social worker, I am embarrassed to refer to someone as ‘my supervisor.’”
The literature reverberated with charges that supervision perpetuates dependency, inhib-its self-development, violates the worker’s right to autonomy, and detracts from profes-sional status. Reynolds, in 1936, complained
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
322 [ P r O b l e m s a N d I N N O v a T I O N s
much larger cadre of supervised social work-ers planned to leave. Emulating Mor Barak et al. (2006:548), we too asked “Why do they leave?” Two of the variables associated with intentions to leave the profession were the availability and quality of supervision in social work, variables that can only concern super-vised workers. Reductions in the availability of social work supervision, and a relative lack of supervisory support and guidance, predicted their intentions to leave. Thus, although dis-satisfaction with interminable supervision may prompt some workers to leave the supervised workforce for autonomous practice, it appears
multidetermined. In some cases, for example, it seems reasonable to assume that a number of supervised social workers pursue opportuni-ties to practice autonomously in any given year, just as some of the autonomous workforce find attractive opportunities in settings that provide supervision. But there was a significant differ-ence in the Workforce study between autono-mous and supervised workers in their intention to leave social work within the next two years to work in another field (NASW Center for Workforce Studies 2004). Where 2.8 percent of the autonomous workforce reported planned to leave the profession, nearly 5.1 percent of the
F I g u r e 1 0 . 1 . Estimated percentage of autonomous and supervised employed licensed social workers, by years of experience. (From National Association of Social Workers Center for Workforce Studies. 2004. A study of the Role and Use of Licensed Social Workers in the United States. Washington, DC: National Association of Social Workers.)
Years of experience0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36
Per
cen
tag
e (b
y ye
ars
of
exp
erie
nce
)
100%
80%
60%
40%
20%
0%
Supervised workersAutonomous workers
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
P r O b l e m s a N d I N N O v a T I O N s ] 323
professions governed by case law (Harkness 2010; Reamer 2003), the managed care practice environment (Jean-Francois 2008), and the privatization of health and social services (Jean-Francois 2008). To the constraints on autonomy that those forces have already imposed, rapid advances in information technology (Poertner 1986; Walter and Lopez 2008), growing advo-cacy for evidence-based practices (Institute of Medicine 2001), and the embrace of “new pub-lic management” (Evans 2013; Levay and Waks 2009) are likely sources of more constraints in the future (Burton and van den Broek 2009; Wastell et al. 2010). Owing to the growing cost
that too little supervision and a lack of super-visory guidance and support are much larger problems.
Moreover, it is no longer true that graduate social workers with practice experience are the only professionals who are supervised. Profes-sionally accredited teachers, engineers, and nurses continue to be responsible to supervi-sory personnel after years of practice. Further-more, the once highly independent professions of medicine and law are facing increasing super-vision as a majority of their members are now employed in organizational settings. It appears that this trend will continue for all helping
F I g u r e 1 0 . 2 . Autonomous and supervised employed social workers in the NASW workforce study, by years of experience. (From National Association of Social Workers Center for Workforce Studies. 2004. A study of the Role and Use of Licensed Social Workers in the United States. Washington, DC: National Association of Social Workers.)
Years of experience0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 52 63
Em
plo
yed
so
cial
wo
rker
s (n
= 3
,543
)
250
200
150
100
50
0
Supervised workersAutonomous workers
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
324 [ P r O b l e m s a N d I N N O v a T I O N s
term for the direct service worker—confirmed a picture of very considerable discretionary behavior on the part of such workers. Lip-sky (1980) concluded that two characteristic interrelated aspects of the direct service posi-tion in the human service profession were the “relatively high degree of discretion and rela-tive autonomy from organizational authority” (13). Prottas (1979:388) observed, “There is a surprisingly large degree of autonomy and self-direction displayed in the behavior” of the direct service worker; workers are successful in capturing the autonomy they need to “respond to a complex and unpredictable” situation (7). Although the amount of discretion formally allocated to the direct service public welfare worker is modest, the study indicated “that considerable discretion is in fact exercised” (18). This had been noted previously by Handler (1973; 1979), who pointed to the considerable autonomy exercised by social workers in mak-ing day-to-day decisions.
A questionnaire study of social work pro-fessionalization asked a nationwide sample of 1,020 NASW members about the level of autonomy they experienced in their practice (Reeser and Epstein 1990). Of the respon-dents, 68 percent indicated they had consider-able autonomy in their work. Only 16 percent indicated that “any decision I make has to have the supervisor’s approval” (Reeser and Epstein 1990:91, table 3.7). “The profile that emerges from their responses—suggests that social workers in the eighties experience[d] relatively high autonomy in their work—social workers have more discretionary power in dealing with clients than is generally assumed” (Reeser and Epstein 1990:92), reflecting the general conclu-sions of the studies cited previously. In support of this observation, a majority of the licensed social workers in the NASW Workforce sur-vey reported satisfaction with their ability to influence the design of client services, respond effectively to requests for assistance, spend time with their clients, help them navigate the system, address a range of problems, and meet
of health and welfare (both real and perceived), a conservative political climate, and recession-ary fiscal pressures, this trend appears to have become global (Hair 2012; Grant and Schofield 2007; Yoshie et al. 2008).
Interminable Supervision and Worker AutonomyThere is an additional point of controversy regarding the question of interminable super-vision. At the same time that the contention was made that social workers were supervised too much and too long, there was the counterar-gument that social workers were unsupervised and had too much autonomy and discretion. While social workers, regarding themselves as professionals, pressed for more autonomy, more discretion, and fewer administrative controls over their actions, client advocates and civil libertarians, acting in defense of clients’ rights, pressed for greater restrictions on worker dis-cretion (Handler 1973, 1979; Gummer 1979).
It is clear that occupational dissatisfac-tion and an increased likelihood of burnout is associated with infringements on profes-sional autonomy (Kim and Stoner 2008; Lloyd, King, and Chenoweth 2002). The question is the extent to which employment in the social agency bureaucracy actually restricts profes-sional autonomy.
Past studies of worker autonomy and discre-tion in a variety of settings such as public wel-fare (Kettner 1973), child welfare (Gambrill and Wiltse 1974; Satyamurti 1981), and rural social work (Kim, Boo, and Wheeler 1979), and stud-ies by McCulloch and O’Brien (1986), Protas (1979), and Butler (1990), supplemented by rel-evant studies in England (The Barclay Report 1985; Pithouse 1987; Davies 1990), and in Israel (Eiskovitz et al 1985) tended to confirm the fact that in reality workers had exercised a consider-able amount of autonomy and discretion in the performance of their work.
The detailed studies by Prottas (1979) and Lipsky (1980) of the actual decision-making procedures of “street-level bureaucrats”—their
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
P r O b l e m s a N d I N N O v a T I O N s ] 325
worker is involved. The complex nature of the work may require continuation of the availabil-ity of supportive supervision (Barth et al. 2008; Kossek et al. 2011). A significant body of subse-quent research, reviewed in chapter 7, supports this conclusion.
Reflecting on her years of experience in supervision, Norman said:
During my early years of supervising I would have said that one’s emotional dependency on supervision lessens with experience. However, experience has taught me that this is not true. Al-though at some point a therapist may no longer need the educational aspects of supervision, he or she continues to need the emotional support of supervision or consultation because of the nature of clinical work. (1987:379)
The principal dissatisfaction with continued supervision seems to lie with prolonging educa-tional supervision. Continuing obligatory edu-cational supervision suggests that the worker does not know enough, is not fully competent, and is incapable of autonomous practice. As Toren said:
Trained social workers are willing to concede administrative authority to their supervisors as part of the limitations imposed by the organiza-tional framework; however, they resent and resist the teaching function of the supervisor which they perceive as encroaching upon their profes-sional judgment, responsibility, and competence. (1972:79)
One might, however, see continuing supervi-sion not as a reflection on the workers profes-sional competence but as a procedure to help workers to continue to improve and upgrade their practice. This is a professional obligation with no end in an era of evidence-based prac-tice (Mullen, Bledsoe, and Bellamy 2008; Thyer and Myers 2010). Even the skill of the most advanced practitioners can stand improve-ment. Such a perspective justifies continuation
their objectives (NASW Center for Workforce Studies 2004)—an indication, perhaps, of some residual degree of professional autonomy and discretion in social work practice.
More recent studies of worker autonomy and discretion in a variety of settings such as child (Wells 2006) and public welfare (Evans 2003), clinical (Probst 2012) and rural (Green 2003) social work, and managed care (Sossin 2005), including important studies by Mor Barak et al. (2006, 2009), Graham (2010), and Kim (2008), supplemented by relevant studies in Denmark (May and Søren 2009), England (Evans 2011; Evans and Harris 2004), and other nations (Weiss-Gal 2008), tend to confirm the fact that workers still exercise a considerable amount of autonomy and discretion in the performance of their work, notwithstanding extensive “attempts to control and direct [social work] practice (Evans 2011:381) with information sys-tems (Parton 2009), managed cost (Munson 1998a) and care (Sosin 2010), and “prescriptive rules [and] procedures” (Lees, Meyer, and Raf-ferty 2013:542).
Attitudes Toward Interminable SupervisionThe research raises questions then about the reality of the negative aspects of continued supervision. The continuation of supervision gets support from advocates who point to the positive aspects of continued supervision.
There have been cogent defenses of support provided by extended supervision (Eisenberg 1956a and 1956b; Levy 1960). Eisenberg (1956a) pointed to the continuing supportive needs of the supervisee: “It would be an extraordinary worker who did not, at times, experience some burden and some guilt, some anger and some despair––even a mature and experienced prac-titioner [does]. . . . In all of this the supervi-sor stands as helper of the caseworker for the agency; the worker is not alone” (49). The argu-ment is also made that supervision of even the most experienced worker is necessary because help is always needed in objectifying the com-plex interpersonal relationships in which the
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
326 [ P r O b l e m s a N d I N N O v a T I O N s
Administrative supervision functions to pro-tect the client from possible abuse of worker autonomy. The possibility that the worker’s real power may be used in oppressive, arbitrary, or inequitable ways argues for the need for some continuing procedural controls (Wilding 1982). Handler (1979) noted that good supervi-sion serves the same function as a fair hearings appeal on the part of the client. Both serve to check discriminatory practices and failure to comply with rules and regulations—matters that can have an adverse effect on client rights and interests.
At the same time, few experienced social workers endorsed unsupervised practice. In a national survey of 885 members of NASW, Kadushin (1992a:25) noted:
A high percentage of both supervisors (48 per-cent) and supervisees (52 percent) agreed that as the worker developed professional competence, the relationship should be changed to consulta-tion to be used when, and as, the supervisee de-cides . . . [but] a sizeable percentage of both super-visors and supervisees (38 percent supervisors; 41 percent supervisees) indicated a preference for continued moderated supervision.
Greenspan et al. (1992:41) found that expe-rienced social workers who have developed practice wisdom on a par with their super-visors yearned for more “highly skilled . . . more senior level supervision” with a clinical focus—not practice without supervision. Bogo et al. (2011) and Hair (2012) reported similar findings. Although Laufer (2003) found that an Israeli sample of experienced social work-ers, even if willing to receive supervision with knowledgeable supervisors, may have preferred supervisors who were not too knowledgeable, she also found that their willingness to receive supervision diminished with age.
Despite the fact that the negative aspects of continued supervision seem to be less serious than had been presumed, and despite the fact that there are positive aspects of continuing
of clinical supervision. We are all in the process of becoming; none of us has ever fully arrived. The need for continuing professional education receives support in the requirement in most states that maintenance of a professional license requires annual continuing education. Trained experienced workers who do not have supervi-sion available frequently express a need for this in furtherance of professional development (Garrett and Barretta-Herman 1995; Hair 2012)
In contrast to the opposition to prolonged educational supervision, there is a readier acceptance of the necessity for continued administrative supervision. One of the earli-est advocates of freedom from supervision believed that because social workers “work in agencies that are accountable for the per-formance of each staff member,” autonomous practice would still require “that agencies continue to maintain structural channels for enabling staff to be most effectively accountable to administration” (Henry 1955:40). As Leyen-decker (1959) noted, freedom from authority of others in autonomous practice does “not seem to be truly applicable to the operation of a social agency requiring, as it does, an organizational structure in which responsibility and account-ability are clearly defined and allocated” (56). The recognition that someone in the hierarchi-cal agency structure must continue to perform the functions of administrative supervision has been echoed and reechoed by those who have advocated greater independence from supervi-sion, from Aptekar (1959) and Austin (1961) to Mastekaasa (2011).
Even if all the workers were well trained, were objectively self-critical, and had developed a level of self-awareness that eliminated the need for educational supervision—even if all workers were so highly motivated, so self-assured, and so rich in inner resources that they felt no need for supervisory support—administrative super-vision would continue to be necessary as long as the workers were employees of an agency, as recent experiments in new public management and governance have shown (Benish 2010).
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
P r O b l e m s a N d I N N O v a T I O N s ] 327
“at least two years of post-master’s experience under appropriate professional supervision” (9) before achieving the level of independent professional practice. To a large extent, that benchmark standard has been widely adopted, but the formal, institutionalized procedures for termination of educational supervision after a given period are governed now by the licensure laws of the individual states and their boards of social work examiners—subject, as always, to additional standards that imposed by an agency employer, third-party payers, and other market forces.
Professional autonomy and social Work licensureStriving for professional autonomy and status fueled a movement, gathering steam in the second half of the twentieth century, in which social workers launched a series of state-by-state campaigns to license social work practice (Bibus and Boutte-Queen 2011; Groshong 2009; Hardcastle 1977). As their efforts became suc-cessful, Baretta-Herman (1993) suggested “that life-long supervision contradicts the movement toward professional autonomy” (57), “based on the assumption that practitioners holding a license to practice independently, as offered by state boards of licensing, is an indication of competence” (56).
Now that social work practice is regulated by the states, a license to practice without supervi-sion generally requires an earned MSW, a mini-mum of two years of full-time experience under the supervision of a social worker licensed for independent practice (usually in clinical social work), and a passing score on a national exami-nation (ASWB 2010b). Moreover, to credential the supervisors who guide them through the licensure process for independent practice, the ASWB task force convened to analyze super-vision for social work licensure recommended four requirements: (1) a license to practice in the area in which supervision is going to be provided, (2) specified coursework in supervi-sion and/or a specified minimum number of
supervision and an expressed desire for ongo-ing instruction, there has been controversy about the need for modification if not termina-tion of interminable supervision. In response to this concern, the social work profession has considered a number of formal, institutional-ized procedures for termination of educational supervision after a given period. Despite efforts to clarify the criteria of readiness for worker emancipation from supervision (Henry 1955; Lindenberg 1957), they are often ambiguous. Decades ago, The Jewish Children’s Bureau in Chicago had a classification of “workers inde-pendent of supervision,” achieved after workers had been under supervision for “three or four years” (Richman 1939:261). Other recommen-dations have varied from one year in practice following graduation from a school of social work (Stevens and Hutchinson 1956:52) to three years (Leader 1957:464) to “four to six years” (Hollis 1964:272). Respondents to a survey by Hair (2012) endorsed the need for supervision of up to three years for new employees and graduates in Canada, and Laufer’s (2003:153) respondents suggested that it may take seven years for a social worker to become “long-expe-rienced” in Israel.
Wax (1963) described one agency’s use of “time limited” supervision for master’s-degree social workers, permitting them to move toward independent practice within a period of two years in the agency. Supervision is fol-lowed by formal and informal peer consulta-tion, and “social pressure from the colleague group replaces the pressure of the parent sur-rogate supervisor” (41).
In one highly professionalized agency, the procedure in 1982 was to have “regularly sched-uled supervision” with new staff members “until the worker and supervisor agree that it was no longer needed. Generally this is six months to one year after hiring. “Supervision in group continues beyond this” (Dublin 1982:234).
The National Association of Social Workers statement on Standards for the Classification of Social Work Practice (NASW 1981) required
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
328 [ P r O b l e m s a N d I N N O v a T I O N s
many state agencies and even non-profits seem to be moving towards hiring only licensed social workers due to reimbursement issues, there is a group of new MSWs in desperate need of clini-cal supervision in order to secure a livelihood. Yet seasoned clinicians, wary of vicarious liability, are voicing their hesitation about providing supervi-sion. . . . As clinical social workers, afraid of licens-ing boards, we have adopted a very narrow model of clinical work, one where we are focused on our protection. . . . Perhaps one of the most disturbing trends in the movement from licensure boards as agents of the profession, to monitors of the profes-sion, is the growing fear with which we begin to view our clients and each other. If we begin to see our clients as potential vehicles of our own pro-fessional destruction, then we cannot avoid the negativity with which the therapeutic relationship becomes tinged. Without the satisfaction of au-thentic therapeutic relationships, what then is left in this often challenging profession? (Floyd and Rhodes 2011:309–13)
As the large majority of licensed social work-ers in the United States have supervisors they report to, they may be assumed to receive some form of supervision. If this implies that social workers have not yet acquired the idealized autonomy of doctors and lawyers, then it may soften the blow to consider that “the impact of licensure, coupled with developments in litiga-tion filed against mental health providers and complex managerial control systems, has had a profound effect on the exercise of autonomy by all professional groups” (Baretta-Herman 1993:57), and that doctors and lawyers are also well on the road to becoming semiautonomous. Against the backdrop of major reforms in the administration and funding of health and social services, there is little reason to predict that a majority of the profession is likely, any time soon, to achieve the degree of autonomy that social workers once imagined. Moreover, they may no longer wish to, as there are indications of nostalgia for social work supervision in addic-tions (Bogo et al. 2011; Barth et al. 2008), child
continuing education hours, (3) a minimum of three years of post-licensure experience in a supervisory role, and (4) continuing education courses in supervision that are updated every five years, and approved by the licensing board (ASWB 2009).
Has licensure brought an end, once and for all, to interminable supervision? Our analysis of the NASW Center for Workforce Studies (2004) survey indicates that only 18.8 percent of licensed social workers practice without super-vision. As a group, the unsupervised workers earned significantly higher estimated salaries than their supervised peers, and they also reported significantly more satisfaction with their ability to spend time with, access services for, and be helpful to their clients. On the other hand, the effect sizes of the differences in their satisfactions were generally modest, and the characteristics and resources of the clients they served may have also been different.
Although licensure may emancipate some social workers from interminable supervision, through professional regulation social work-ers thereby become the servants of more than one master. Not surprisingly, this development has led to some expressions of buyer’s remorse (Adams 2006; Hair 2012).
The license becomes the lifeblood of a clinical social worker, and without one, most of us could not engage in our chosen field of social work. The process of obtaining a clinical license can become costly, arduous, and stressful. Once obtained, however, the stress of having one does not end. There are yearly CEUs to attend and dues to pay, which are not concerns for most clinicians. More troubling is the sense that one’s career somehow hangs in the balance between a regulatory and liability issues. . . . In effect, clinical social work-ers become the sum total of their clinical license credentials, since this will generate income for an agency where one is employed. . . . The fear of los-ing one’s clinical license, either through some li-able action or sanctioning by the licensing board fuels fear for the clinician. Additionally, since
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
P r O b l e m s a N d I N N O v a T I O N s ] 329
supervision, peer-group supervision invests the peer group with control of group meet-ings; the supervisor, if he or she sits in at all, is just another member of the group. It has been defined as a process by which “a group of pro-fessionals in the same agency meet regularly to review cases and treatment approaches without a leader, share expertise and take responsibil-ity for their own and each other’s professional development and for maintaining standards of [agency] service” (Hare and Frankena 1972:527). In such peer supervision, each member of the group feels a responsibility for the practice of the others and for helping them to improve their practice (Marks and Hixon 1986). What a worker does with the suggestions and advice offered by peers is his or her own responsibil-ity. Peer supervision is suggested as a substitute for, or supplement to, educational supervision (Counselman and Weber 2004; Kadushin et al. 2009).
Peer-group supervision symbolizes the capac-ity for greater independence of the worker; it also allows greater spontaneity and freedom in the absence of an authority figure. None-theless, it presents its own difficulties. Rivalry for leadership and control is often present, and unless the group is composed of workers with somewhat equal education and experience, some staff members may be reluctant to partici-pate, feeling that they cannot learn much from “peers” who know less than they do.
In describing a productive peer-group super-vision experience, Schreiber and Frank (1983) attributed the success to the fact that the group was composed of social workers of “comparable experience, length of training and background” (31). Difficulties related to exposure of practice to peers with whom they felt competitive and to the fact that members felt hesitant about being vigorously critical (see also Counselman and Weber 2004 and Granello et al. 2008).
Although peer supervision “has received only modest coverage in the professional litera-ture” (Bernard and Goodyear 2009:260), there is some empirical support for a conclusion
welfare (Meezan and McBeath 2011); direct practice in non-profit settings (Stein 2005), home health care (Egan and Kadushin 2005, 2007), hospitals (Kadushin et al. 2009; Sterling 2009), and managed care (Acker 2010b, Acker and Lawrence 2009), where the reforms men-tioned above have displaced social work super-visors and reduced the amount and scope of supervision.
After a prolonged period of education and supervision, licensed social workers may “wel-come the opportunity to practice their profes-sion without supervision for some period of time. However, once they have been practicing without supervision, they may find themselves wanting supervision, in some form, once again (Goldsmith, Honeywell, and Mettler 2011:204).
Innovations for balancing Worker accountability and autonomyAlthough the need for a structured approach to granting increasing autonomy for experienced practitioners has been largely achieved through social work licensure, other innovations have been proposed to allow workers who continue to receive or want supervision strike a new bal-ance between their desire for autonomy and accountability to the agency that employs them.
Peer Group SupervisionWe noted in chapter 9 that group supervi-sion can offer the worker a greater measure of autonomy than that permitted through individ-ual supervision. Peer-group supervision is an extension of this procedure in the direction of still greater independence. Bernard and Good-year (2009) describe peer group supervision as a popular forum for reflection on practice experiences—an environment conducive to adult learners, peer review, transmitting new knowledge, and obtaining feedback. To this list, Milne (2009) added the advantages of an assembly for the development of professional consensus, and an environment that lends itself to giving and receiving social support (see also Evans 2003). As distinguished from group
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
330 [ P r O b l e m s a N d I N N O v a T I O N s
experiences. In another sense, it applies to a program of continuing education organized by peers employing their own case material as the basis for group discussion (Kuechler and Bar-retta-Herman 1998; Powell 1996; Richard and Rodway 1992).
In a related context, Suter et al. (2012:261) used the term interprofessional collaboration to describe “the process through which different professional groups work together to positively impact health care,” noting, in their review of forty-one peer-reviewed articles, that “there is mounting evidence that interprofessional col-laboration in healthcare positively impacts cli-ent outcomes” in such domains as “mortality, pain, admissions, post-operative complications and hospital stays when patients are cared for by collaborative teams.” Although there are many barriers to collaborative care (Meyer, Peteet, and Joseph 2009), social workers who overvalue their autonomy and independence, to the extent that they eschew consultation and collaboration, may put clients at risk.
Although these procedures encourage greater autonomy and independence in the examina-tion of clinical practice, peer group supervi-sion and peer consultation as reported does not attempt to take responsibility for the necessary administrative functions of supervision. Peer collaboration, consultation, and supervision are best viewed as an adjunct to and supplement to traditional supervision, not a substitute.
Interminable supervision and debureaucratizationOther proposals for dealing with the nega-tive reactions to continuing supervision con-cern alterations in administrative structure or relationships. Suggestions for changes in the administrative structure involve a redis-tribution of power and responsibility so that a greater measure of both is given to worker peer groups (Weber and Polm 1974). Instead of an agency whose administrative structure is sharply pyramidal (large numbers of workers at the base, supervised by a more limited number
that it offers enhanced learning opportunities in feedback from peers under conditions of greater independence and lower anxiety (Bor-ders 2012; Goldsmith, Honeywell, and Mettler 2011), a source of interpersonal support that “combats loneliness and isolation” and buffers workers against burnout (Milne 2009:178).
Peer Consultation and CollaborationA less authority-bound version of peer-group supervision is peer consultation. Peer consul-tation can be organized in the context of the individual conference. For example, Fizdale discussed a worker in her agency:
[The worker had] done considerable interviewing of both partners together in marital counseling cases. She had, therefore, developed a special skill in handling these “joint” interviews and had spe-cial knowledge about when they can be produc-tive. It is quite usual for any staff member to con-sult with her about the value of a joint interview in a particular case or to get her help in preparing for such an interview or in reviewing the results. (1958:446)
Asking for consultation with peers is not without its consequences. The consultee admits to a limited measure of competence. He or she must accept some measure of dependence as well as lower status, however temporary, in the dyad. Frequent requests from the consultee accentuate these negatives.
Peer supervision works best between peers with approximately equal levels of compe-tence, so that the consultee today may be a consultant tomorrow to his or her consultant of yesterday. This possibility of reciprocation equalizes status.
As reflected in the material presented previ-ously, the term peer-group supervision as used in the literature is a very loosely defined term. In one sense, it is an extension of the infor-mal kind of consultation that goes on in “bull sessions” between workers in any agency as they talk with each other about their clinical
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
P r O b l e m s a N d I N N O v a T I O N s ] 331
of team members’ work, and meeting educa-tional needs of team members is invested in the group.
Supervisory functions still need to be per-formed in team service delivery. They can be differently allocated and distributed, but such functions cannot be eliminated or ignored. Team service delivery takes group supervision one step further as a procedure for augment-ing worker autonomy. It gives administrative mandate to the peer group to perform the main functions previously performed by the supervi-sor. The team can, as a team, engage in much significant decision making, but the impera-tives of organizational life still have to be imple-mented. Final decisions have to be validated by the supervisor, who has ultimate administrative responsibility for team performance.
The problems of organizational coordina-tion and communication may even be inten-sified with team service delivery, making the functions of supervision especially important. Because different members of the team may be involved with the same family at different times, this approach requires having up-to-date record and reporting material available. It also requires constant coordination to see that team members are not falling over each other in offering service to the family. However, see Shamai (1998) for a case study of the salutatory benefits of team supervision during periods of traumatic political upheaval.
Interdisciplinary teams, as contrasted with intradisciplinary teams, face the additional problems of differences in status between members and the understanding and accep-tance of the claims of expertise of team members from different disciplines. A coun-terbalancing factor, however, is the benefit of transdisciplinary teaching and learning (Gillig and Barr 1999). Wood and Middleman (1989) viewed the team approach to supervision as a growing and desirable alternative to more tra-ditional supervision.
Quality circles are voluntary problem-solving groups of employees from the same work group
of middle managers, topped by an administra-tor), the suggested shape is somewhere between pyramidal and rectangular. Instead of an agency with a hierarchical orientation, the suggested orientation is more egalitarian.
Intensified implementation of participatory management procedure tends to enhance the autonomy of the worker. Deliberate efforts have been made in some agencies to actively involve direct service workers in the determination of significant policy decisions and in formulation of operating procedures (Weber and Polm 1974; Pine, Warsh, and Malluccio 1998).
Similar efforts have involved application of the principles of management by objectives (MBO) to supervision (Raider 1977; Kwok 1995). Management by objectives (or, more appropriately, supervision by objectives) is an effort to establish a procedure of control that is acceptable and measurable. With the par-ticipation and cooperation of the supervisee, definite objectives are formulated for achieve-ment in each case. These objectives are stated in precise and explicit terms that lend them-selves to observation and measurement. Once objectives have been formulated in conferences between worker and supervisor and measur-able outcome criteria have been defined, a time limit is established for achievement of objec-tives and the different objectives are ranked in priority. The process is monitored by the supervisor with active worker participation (Fox 1983). Work efforts are evaluated by estab-lishing the extent to which such objectives are achieved in each case.
Another innovation involves team service delivery (Brieland, Briggs, and Leuenberger 1973; Gillig and Barr 1999). A team of workers, working together as a unit, is given responsibil-ity for supervision. The “supervisor” is merely one of the team members, although somewhat more equal than the others. He or she acts as a consultant, coordinator, and resource person to team members and, when necessary, as team leader. However, the responsibility for work assignments, monitoring quantity and quality
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
332 [ P r O b l e m s a N d I N N O v a T I O N s
Although new forms of management periodi-cally become fashionable in social work, fol-lowing private-sector trends, Abrahamson and Fairchild (1999) viewed many of their putative benefits as management superstitions.
Workers may be given greater control over the supervisory process by instituting a con-tract system (Fox 1974). The supervisee negoti-ates a contract with the supervisor, specifying the kinds of things he or she feels the need to learn within a specific period of time. Osborn and Davis (1996) recommended a structured contract to define: (1) the purpose, goals, and objectives of supervision; (2) the context of supervision; (3) the duties and responsibilities of supervisor and supervisee; (4) supervision procedures; (5) performance evaluation; and (6) the scope of supervisory competence. Oth-ers encourage contracts that define the super-visor’s and worker’s legal and ethical duties to agency clients (Reamer 1994; Knapp 1997; NASW 2003). Munson (2002) believes that supervision agreements should be negotiated for renewable six-month periods, specifying what procedures will be followed if either party fails to fulfill the contract conditions.
If the purpose of supervision contracts is to bring key practice issues into the conscious awareness of both parties, contracts will have modest value unless both parties participate psychologically in the process of their develop-ment (Shulman 1999). Nevertheless, Holloway (1995:255) contended that a supervision con-tract “increases the probability that both partic-ipants will behave congruently with established expectations,” by inviting the supervisee “to participate in the construction of the [supervi-sory] relationship.”
Not everyone is sanguine about the benefits of supervisory contracts, however. Designed to empower workers by articulating the recipro-cal obligations and duties of supervisor and supervisee, supervision contracts may not be legally binding (Holloway 1995; Bernard and Goodyear 2009), and their advocates rarely take into account the power differences in
to identify, analyze, and solve work-related problems (McNeely, Schultz, and Naatz 1997). Springer and Newman (1983) reported on the use of a quality circle system in social work. The quality circle system, as used by the Texas Department of Human Resources, “consists of a small group of staff members who usually work in related areas, meeting regularly to identify, analyze and propose solutions to problems of productivity, quality of operations service and work life” (417). The quality circle program sup-posedly emphasizes a more humanistic, demo-cratic, collaborative relationship between labor and management. It encourages greater mana-gerial receptivity to worker grassroots input in organizational problem solving. Although this and related forms of worker participa-tion in management (e.g., Gowdy and Free-man 1993) may improve worker morale (Baird 1981) and ameliorate or prevent worker burn-out (Cherniss 1985), Smith and Doeing (1985) raised questions about the problems in apply-ing the approach to social work administration, and any benefits may be short-lived (Lawler and Mohrman 1985).
Work groups manage service by monitoring customer satisfaction in total quality manage-ment (TQM) (Martin 1993), for example, but this alternative to supervision is rarely imple-mented in settings that offer human services (Boettcher 1998). Although Mersha, Sriram, and Herron (2009) found that introducing TQM in a public service agency helped improve teamwork and had a positive effect on employee willingness to accept change, a meta-analytic study of the empirical TQM research reached another conclusion:
TQM has been promoted by governments throughout the world and forms a central aspect of many public organizations’ improvement strat-egies. We are now able to say that this has been done in the dark, because there is no systematic evidence on the validity of the TQM-performance hypothesis in public organizations. (Boyne and Walker 2002:127)
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
P r O b l e m s a N d I N N O v a T I O N s ] 333
Reporting on debureaucratization of a profes-sional voluntary child welfare agency, Taylor (1980) noted the agency’s success in eliminating some supervisory positions and in assigning cases on a peer level. Success of the innova-tion was explained in part by the fact that peers “were comparable in experience and skill” at a high level. The agency, however, was still strug-gling with the problem of “how evaluations of caseworker performance will be done” (587).
The success of increasing autonomy through agency debureaucratization, increased partici-pation in decision making on the part of the workers, and increased responsibility of super-visory task performance by workers is largely predicated on conditions that obtain in only a minority of agencies. A collegial model requires a highly trained and experienced staff, with a consensual commitment to clearly understood objectives and a mutual sense of trust and regard—conditions that are not easy to achieve.
The innovations outlined here are expres-sions of a series of fundamental and related problems. These concern the place of the pro-fessional in organizations and the larger society, the distribution of power in the organization, and the prerogatives of worker autonomy. Such questions are of particular relevance to the focus of this text because they get played out in the organization most explicitly at the supervi-sory level.
supervision in the managed care contextSweeping changes in health care financing and delivery have affected all human services (Dzi-egielewski 2004; Rodwin 2010). With national health care expenditures estimated to have reached $2.7 trillion in 2011 (Centers for Medi-care and Medicaid Services 2012), the United States turned to managed care and privatization long ago in an attempt to regulate and slow the pace of this runaway growth (Coffey et al. 2000; Rehr and Rosenberg 2000). (For a brief history of U.S. health care economics with implications for managed care social work practice, see Cum-mings, O’Donohue, and Cummings 2009.)
the supervisory dyad (Munson 2002). Thus, although the American Association of State Social Work Board (1997) encouraged social workers seeking licensure to file written super-vision plans with state licensing boards, con-tracts with heavy-handed supervisors may be difficult to negotiate or enforce from the sub-ordinate position.
agency debureaucratization experiencesNo systematic information is available that would enable us to know how many agencies have “flattened” their organizations by adopt-ing quality circles, team supervision, TQM, or related innovations in participatory manage-ment. By the same token, little is known about the adoption of MBO procedures, supervision contracts, or other related techniques used to sharpen the focus of supervised social work services.
Generally the reports of peer supervision and consultation describe workers who were professionally trained, had considerable prac-tice experience, and, in addition, often had advanced training. Agency administration had confidence that the workers were sufficiently competent, committed, and self-disciplined to operate autonomously without harm to clients. Many experienced workers have been eman-cipated from supervision as a consequence of having social work licenses. Evidence from the NASW Workforce study indicates that many licensed social workers still yearn for supervi-sion from colleagues with advanced practice wisdom and skill (NASW Center for Workforce Studies 2004). As Stein concluded in her study of social work supervision in not-for-profit agencies, “Career-long supervision is requested and relied upon in practice. Supervisees regard-less of experience level find supervision useful . . . at all levels of experience in their work with clients” (2005:73).
Agencies reporting successful efforts to reduce or eliminate supervision recognize that these innovative efforts were made possible by virtue of special staff and structural qualities.
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
334 [ P r O b l e m s a N d I N N O v a T I O N s
questionnaire study of more than three hundred hospitals affiliated with the American Hospital Association found that one-on-one supervi-sion by social workers decreased between 1992 and 1996. “Traditional models of supervision are beginning to erode while non-social work supervision experienced a significant increase over all three years of the study” (Berger and Mizrahi 2001:15).
Based on an analysis of the membership of NASW, Gibelman and Schervish (1996) observed that not long ago new social work-ers began supervised practice in social service agencies, earned licenses to practice clinical social work independently, and then devel-oped unsupervised private practices in solo or group or settings within several years (Cor-nelius 1997). But as managed care is loath to reimburse unlicensed social workers for their services (Mauch, Kautz, and Smith 2008), each hour of supervision provided represents an hour of net loss for agencies and practitioners that earn their livings by the “billable hour,” and thus supervision has become harder for beginning social workers (NASW Center for Workforce Studies 2004) or social work stu-dents (Dalton, Stevens, and Mass-Brady 2011; Ligon and Ward 2005) to acquire. Thus, in one care-managed profile, 69.9 percent of surveyed workers received group supervision, 50 percent received brief episodes of individual supervi-sion, and 32.9 percent received no supervision at all (Schroffel 1999:98). In a more recent pro-file, social workers were often found to practice in host settings with supervision by other dis-ciplines (Kadushin et al. 2009; NASW Center for Workforce Studies 2004), purchase social work supervision in the private marketplace (Altoma-Matthews 2001; Todd 2002; Ungar and Costanzo 2007), or practice with little or no supervision (Hair 2012; Giddings, Cleve-land, and Smith 2007). As noted by Hoge et al. (2011:184), “There is growing alarm in many sectors of the behavioral health field that staff members are receiving neither the support nor the direction needed to deliver safe and
Corcoran and Vandiver (1996:309) defined managed care as “any health care delivery sys-tem in which various strategies are employed to optimize the value of provided services by controlling their cost and utilization, promot-ing their quality, and measuring performance to ensure cost-effectiveness [by actively man-aging] both the medical and financial aspects of a patient’s care.” Long the dominant form of health care delivery in the United States (Almgren 1998; Mechanic 2011), most social workers work in the shadows of a managed care environment (Acker 2010a; Rodwin 2010; Vandiver 2008). The effects have been par-ticularly striking in child welfare (McBeath, Collins-Comargo, and Chuang 2011; McBeath and Meezan 2009, 2011) and health care (Acker 2010b; Egan and Kadushin 2005; O’Brien and Calderwood 2010), but the effects of managed care have been felt all fields of practice, as 81.5 percent of the employed workforce serve clients whose health care is managed by Medicaid, Medicare, or private insurance (NASW Center for Workforce Studies 2004).
What have been the consequences of these changes for social work supervision? One gen-eral effect has been a decline in the number of social work supervisors and a reduction in the significance of supervisory functions, although isolated exceptions have been noted (Ginsberg 2009). Gibelman and Schervish (1997a) exam-ined changes in the status of social work super-vision between 1998 and 1991 based on NASW membership data. The overall conclusion was that “resources of staff time and allocation of personnel costs associated with supervision are shrinking” (4). There had been a decrease in the number of members listing supervision as their primary function. Most of the supervi-sors indicated that the time they allocated to purely supervisory functions had been reduced.
Schroffel (1999:92–93) quoted the Ameri-can Board of Examiners in The Clinical Super-visor to the effect that “there is currently less agency support for consistent individual ses-sions between supervisee and supervisor.” A
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
P r O b l e m s a N d I N N O v a T I O N s ] 335
managers, many of whom have no clinical back-ground. In this process, clinicians not only lose control of the treatment process, but also, in many instances, of reasonable access to case managers who make crucial decisions regarding the avail-ability, outcome, and duration of care. (Munson 1996:249–250)
Managed care has had a different impact on each of the three principal supervisory functions.
Administrative Supervision and Managed CareThere has been a reduction in the supervisory role in staff recruiting and hiring. Managed care organizations, not supervisors, determine which workers will become providers of reim-bursable services.
Managed care organizations manage and evaluate worker performance by requiring documentation of client diagnoses, treatment plans, and the practice procedures of contracted social work employees. Although “the managed care company (and the agency, if any)” may “desire to measure and hence gain some control over what the clinician actually does with the client, how the client does or does not improve, and how quickly this can be accomplished with limited resources” (Adams 2006:176), the actual reviews performed by the managed care com-pany, and any parallel reviews conducted by agency supervisors, often have little bearing on quality assurance in the managed care context. Adams found:
The supervisor of the clinical social worker work-ing for a mental health agency has little control over what that that worker does with clients and has little in the form of objective measures by which to evaluate the outcome, even if an agreed upon outcome could be found. The same is true for the managed care organization that is charged with assuring that their client’s behavioral health dollars are spend in the most effective manner. The task of monitoring and controlling the activi-ties and outcomes of the clinical social worker is
effective care to the individuals they serve, who are among the most ill and vulnerable in society.”
Managed care may not be totally responsible for such changes, but the ideology and orien-tation of managed care practice has pushed and pulled the profession inexorably in this direction. Cost containment, maximization of productivity, increased efficiency, and rigor-ous fiscal management exert financial pressure to flatten organizational structures, imple-ment horizontal integration of related func-tions, eliminate positions of lesser priority, and reduce time allotted to unprofitable functions.
Gibelman and Schervish (1996) noted that while retrenchment stimulated by managed care pressures affected all organizational levels, downsizing tended to target middle-manage-ment positions, and that supervisory “positions are classified within the middle management categories” (14).
It is instructive to note that a nationwide survey in 1998 by the Child Welfare League of America about “the management of child welfare services that is consistent with man-aged care models” (McCullough and Schmitt 2000:117) found nothing to say about supervi-sion. This signal of the reduction in significance of social work supervision may herald a trend in response to the pervasive bottom-line ideol-ogy of managed care. The managed care insis-tence on packaged, systematic, time-limited procedures of “medical necessity” (Sabin and Daniels 1994) makes the supervisory cadre vul-nerable unless it can demonstrate clearly that supervisory functions and activities make a sig-nificant contribution both to the “bottom line” and positive client improvement. As Munson observed:
Managed care companies do not require supervi-sion because their model of accountability is not passed on supervisory oversight. Face-to-face individual and group supervision provided by a seasoned clinician has been replaced by telephone and written contracts with managed care case
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
336 [ P r O b l e m s a N d I N N O v a T I O N s
mastered, but connote concepts that need to be accepted (Sabin 1999). The origin and devel-opment of managed care is another important supervisory lesson for teaching and learning (Rodwin 2010).
For educational purposes, many supervisors have had to reorient their traditional biopsycho-social perspective to include a significant new element. The reorientation is toward a biopsy-chosocial-fiscal perspective within a medical model of practice. Cost-consciousness concerns have had to become part of the supervisee’s per-spective as well (Cummings et al. 2009).
Managed care systems demand rapid assess-ments of presenting problems, the ability to conclude client contacts within a limited time-frame, and the ability to competently employ the diagnoses and interventions for which man-aged care agencies are most likely to provide reimbursement (Adams 2006; Ginsberg 2009). Corcoran and Vandiver (1996) argued that supervisors should be prepared to help their supervisees master the art of demonstrating the medical necessity of treatment, formulat-ing behavioral treatment goals informed by the signs and symptoms of mental disorders codi-fied in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition of the American Psychiatric Association (2013).
These have had to become part of the super-visor’s educational agenda in the managed care context, as the professional social work cur-riculum has generally not included a strong emphasis on the diagnosis of mental disorders (Harkness 2010) or the evidence-based prac-tices used to treat them (Howard et al. 2009; Howard, McMillen, and Pollio 2003). The necessity for such training and retraining is confirmed by studies that examine what social workers need to know to operate effectively in the managed care context (Adams 2006; Mee-zan and McBeath 2011; Vandiver 2008).
Supportive Supervision and Managed CareThe managed care context presents the social worker with situations that are likely to generate
made even more difficult for managed care com-panies because they are further removed from the clinician than those directly supervising the clinician. The resultant policies developed by those who manage coping agencies place restric-tions and controls on areas that they can observe and create performance standards for those ac-tivities that they can document. This is the case with managed care’s oversight of the clinician’s work. They can observe such things as number of sessions utilized, recidivism rates, paperwork compliance and reported compliance with “best practices.” The lack of good, objective, client-based outcome measures prohibits them from accurately evaluating the results of the clinician’s efforts. (Adams 2006:47–48)
Supervisory decisions regarding choice of clients to be assigned, the nature of services to be provided, and the duration of treatment are typically preempted by managed care organi-zational decisions. To the extent that managed care systems are driven by the documentation of the signs and symptoms of medical disorders and their standardized treatments, supervisors have to make certain that details are clearly, accurately, and completely documented in the record of service. Monitoring of worker activity becomes detailed and precise.
Clinical-Educational Supervision and Managed CareIt has been suggested that social work educa-tion has not done an adequate job of preparing students for evidence-based practice (Howard et al. 2009; Howard, McMillen, and Pollio 2003) or managed care environments (Cohen 2003; Kane 2002). Like many of the social work-ers and supervisors trained before them, new workers have to learn to speak the language of the corporate market culture of managed care in order to practice. The client is a consumer; the worker is a service provider; case manage-ment is benefits management; service planning is benefit design. Capitation, co-payment, and utilization reviews are not only terms to be
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
P r O b l e m s a N d I N N O v a T I O N s ] 337
may feel torn between practicing pro bono and the malpractice specter of client abandonment.
Following the time-limited treatment pro-tocols dictated by managed care utilization review managers may compromise the social worker’s ethical duty to champion every client’s right to self-determine the course and nature of treatment.
Having to share details about clients and practice interventions with managed care orga-nizations for monitoring and review purposes results in some loss of control of how and by whom the information will ultimately be used. As many social workers, if not all (e.g., Jean-Francois 2008), view this as tantamount to an unethical violation of the client’s right to pri-vacy (Coles 2011), “over half of the respondents” to a survey of eighty-nine social workers from a managed care panel “reported a conflict” in “maintaining confidentiality” (Ginsberg 2009:vi).
If Evans (2013:1) is correct that social work-ers retain significant freedom in their work, “even in rule-saturated organizations,” it would not be altogether surprising to learn that a sig-nificant number of social workers have resisted managed care constraints on their profes-sional autonomy by engaging in what might be described as bureaucratic insurrection, gue-rilla warfare from the trenches, inauthenticity (Floyd and Rhodes 2011), even fraud (Boland-Prom 2009); however, owing perhaps to the stakes, the “true facts” may be hidden from view. In a sophisticated mixed-methods sur-vey of eighty-eight social workers from eleven agencies practicing in a Medicaid managed care environment, for example, Jean-Francois (2008) found workers’ exposure to Medicaid managed care was unrelated to their reported ability to practice in accordance with tradi-tional social work mission and values, define practice problems collaboratively with their clients, or serve as advocates for their profes-sional group in policy and practice. However, even as her respondents reported a greater sense of practicing “in a manner coherent with
considerable professional and ethical stress (Acker 2011; Ginsberg 2009).
Managed care practice is stressful because its policies and procedures erode the worker’s pro-fessional autonomy and prerogatives (Strom-Gottfried 1998). As a competent professional, the worker might expect to determine, along with the client, the nature and content of the service that the presenting problem requires, the appropriate duration of service, and the desirable outcomes of social work practice. These decisions, however, are made by the man-aged care organization through prospective, concurrent, and retroactive utilization reviews. It is the managed care organization that autho-rizes the necessity, appropriateness, applicabil-ity, and duration of the reimbursable service, providing practice guidelines and protocols that detail how approved treatment modalities should be implemented. An altogether different approach might be selected by the worker with more professional freedom.
The result of such constraints lends itself to the standardization and routinization of per-formance, which was once the antithesis of autonomous professional practice. If autonomy and decisional prerogatives are a source of job satisfaction, as research suggests that they are (Gagné and Bhave 2011), then curtailing profes-sional autonomy leads to a loss or reduction of job satisfaction (Kim and Stoner 2008).
Operating in the managed care context exposes the social worker to a host of ethical problems (Metzl 2012). Restricting access to services for unprofitable consumers—the dis-abled, those with chronic illnesses, the aged, those requiring heroic treatment—is in conflict with the ethical mandate of providing unfet-tered access to social work treatment for vul-nerable persons and groups.
Restricting the number of reimbursable ser-vice contacts that a client may have implies that the worker may have to terminate services unethically before the presenting problem is resolved. When client health care requirements exceed managed care limits, the social worker
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
338 [ P r O b l e m s a N d I N N O v a T I O N s
care environment because time and energy devoted to clinical and supportive supervision do not directly generate revenue. Time devoted to these functions is not financially reimburs-able. Professional education and development, sustaining worker morale, are not perceived to be responsibilities of the managed care system. The result is a relative increase in the adminis-trative supervisory function and a reduction in the total time devoted to supervision.
Notwithstanding the pervasive spread of managed care throughout social work, a word of perspective may be in order. There are some signs that the initially heavy-handed grip of managed care may relax in the future. Given the political backlash against its initial excesses, Rodwin (2010) noted that forty-seven states passed legislation to regulate managed care between 1995 and 2001, leading Draper et al. (2002:11) to suggest that “managed care plans—pressured by a variety of marketplace forces that have been intensifying over the past two years—are making important shifts in their overall business strategy. Plans are moving to offer less restrictive managed care products and product features that respond to consumers’ and purchasers’ demands for more choice and flexibility.” Although, anecdotally, most social workers still describe managed care as intru-sive, oppressive, unhelpful, and unwieldy, the Patient Protection and Affordable Care Act of 2010 offers hope for further reforms, as well as new challenges:
The Affordable Care Act, along with Medicaid ex-pansions, offers the opportunity to redesign the nation’s highly flawed mental health system. It promotes new programs and tools, such as health homes, interdisciplinary care teams, the broad-ening of the Medicaid Home and Community-Based Services option, co-location of physical health and behavioral services, and collaborative care. Provisions of the act offer extraordinary op-portunities, for instance, to insure many more people, reimburse previously unreimbursed services, integrate care using new information
their core professional identity” as they gained years of practice experience, Jean Francois (2008:87) noted, they “most often indicated dis-agreement” that “the role of the social worker in mental health today is defined by the social work profession itself, and not by others outside the discipline of social work.” In like fashion, after arguing that “social workers may some-times find it necessary to overstate the severity of symptoms or diagnosis to obtain treatment; or submit to insurance in one manner as a way to obtain more services, and then treat a client as the social worker initially intended” (Gins-berg 2009:4), the author seemed surprised to find that more than half of the private practi-tioners who responded to her survey of their reactions to managed care “felt that managed care supported the social worker in providing services that the client’s condition warrants,” hastening the caveat “it is essential to mention again that this researcher is an employee of a managed care organization, which could have affected the responses” (Ginsberg 2009:53–54). In what may be a more typical pattern, 181 clini-cal social workers “expressed a belief that the practice of altering diagnoses is widespread,” in a study of managed care practices in Mas-sachusetts and Maine (Adams 2006:vi), and a majority of respondents indicated that clini-cal social workers alter client diagnoses some, often, or a great deal of the time to protect client confidentiality or to help the client or clinician get reimbursed.
The consequences of practicing in a man-aged care environment call for increased time and effort devoted to supportive supervision to help workers manage their ethical conflicts and private feelings. Because supervisors may also find it difficult to balance the financial, humani-tarian, ethical, and legal dilemmas endemic in managed care (Foglia et al. 2009), managed care has a negative impact on supervisors as well.
Despite the fact that managed care appears to increase the need for clinical and support-ive supervision, both aspects of supervision are likely to receive less attention in the managed
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
P r O b l e m s a N d I N N O v a T I O N s ] 339
agency. The client’s needs have been shrunk to be made to fit the evidence based criteria for their stated problem. (Wharton 2010:41)
If social workers are going to practice evi-dence-based interventions, the evidence sug-gests that the role of the supervisor is going to prove crucial (Accurso, Taylor, and Garland 2011). At present, social work students have lim-ited opportunities for evidence-based training in graduate schools (Drisko and Grady 2012; Weissman 2009), and the two-day intensive workshops (Addis et al. 1999) that employed social workers might attend for training, if they had the time and the money to afford them (Carroll et al. 2010; Wharton 2010), are unlikely to provide adequate training (Beidas and Ken-dall 2010), as “didactic training alone . . . has minimal influence on clinician’s behavior or ability to implement treatments effectively” (Carroll et al. 2010:36). Apparently, it takes a good deal more than readings and lectures for practitioners to acquire and master the skills required to implement EBP (Accurso et al. 2011; Frey et al. 2012). To paraphrase Weissman et al. (2006:926), the “gold standard” for training requires both didactic learning and supervised practice that attends to the process and client outcomes of helping.
To implement evidence-based treatments in their clinic, Donohue et al. (2009) et al. intro-duced standardized supervision, as illustrated in the following excerpt from the protocol they used:
Although live supervision is often impractical, it is a preferred supervisory technique. . . . There-fore, [our] supervisors sometimes attend sessions, particularly when therapists are inexperienced or when sessions are expected to be difficult. Supervision is scheduled to occur weekly for 90 minutes with a licensed supervisor. All program therapists (usually up to 7 therapists), and volun-teers who sometimes assist therapists with child management during sessions, attend supervision. . . . Therapists bring audiotape recordings of the
technology tools and treatment teams, confront complex chronic comorbidities, and adopt unde-rused evidence-based interventions. (Mechanic 2012:376)
Supervision and Evidence-Based PracticeHow well prepared are social workers to con-duct the evidence-based interventions that Mechanic (2012) envisioned in the managed care of the future? In the Workforce study, 30.7 percent of social workers reported working for agencies that provided best-practice training and 21.2 percent reported an interest in obtain-ing best-practices training, but 40 percent of those interested in more evidence-based train-ing were already employed in agencies said to provide it, suggesting that 43 percent of the workforce has had recent best-practices expo-sure or interest (NASW Center for Workforce Studies 2004). Many of the 115 social workers sampled in Wharton’s (2010) mixed-methods survey reported positive feelings about evi-dence-based practice, and a significant number considered themselves to be evidence-based practitioners, but they also reported varying degrees of supervisory support for evidence-based practice (EBP) in the workplace and significant barriers to its adoption, making it difficult to determine how many social workers are really prepared to practice evidence-based interventions, as illustrated in the following comment from one of Wharton’s respondents:
Evidence based practice becomes a tool for reim-bursement and people who want a cookbook to therapy. It creates a system of therapists similar to school teachers who can get by on good enough as long as they write the correct thing down on paper (insurance documentation) and agree with the system (insurance/poorly trained supervisor). It rewards the task doer. . . . The goal becomes the completion of treatment plans and treatment within the required amount of time. The needs of the client are mad to fit in the box issued by the insurer and protected by the clinician and his/her
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
340 [ P r O b l e m s a N d I N N O v a T I O N s
(Glastonbury, Cooper, and Hawkins 1980). This tension is mediated by the supervi-sor, who represents both the worker and the organization.
Social workers have always conceded, how-ever grudgingly, the need for some sort of con-trol structure in order to accomplish the work of the agency. However, the clearly preferred control structure was that of the profession rather than that of the bureaucracy. The ori-entation of a profession and that of a bureau-cracy are, supposedly, inherently in conflict. The needs of the bureaucracy for standard-ization, uniformity, role specificity, efficiency, impersonality, and rule adherence—like those of managed care and EBP—are antithetical to the needs of the professional for flexibility, maximum discretion and autonomy, sensitiv-ity to the uniqueness of individual situations, and a primary concern with client needs. What is professionally correct is more impor-tant that what is organizationally desirable or found in a manual. There is recognition that a complex algorithm or organization requires the performance of certain tasks, but the basis for obtaining conformity to organizational and procedural needs, for ensuring coordina-tion, and for limiting individual, idiosyncratic behavior lies not in hierarchically delegated authority but in professional self-discipline and voluntary adherence to practice standards of care, professional norms, and peer gover-nance. The essential difference between these control structures was outlined by Toren:
The distinctive control structure of the profes-sions . . . is fundamentally different from bureau-cratic control exercised in administrative organi-zations. Professional control is characterized as being exercised from “within” by an internalized code of ethics and special knowledge acquired during a long period of training and by a group of peers which is alone qualified to make profes-sional judgments. This type of authority differs greatly from bureaucratic authority which ema-nates from a hierarchical position. (1972:51)
sessions they have conducted since last supervi-sion, and the chart records of each of the clients. The supervisor brings a standardized form to monitor cases, and guide supervision.
Systematic assessing, reviewing, and brain-storming methods of preventing adverse events and factors that may lead to adverse events have been shown to substantially reduce harm to cli-ents and significantly decrease clinical liability. . . . Therefore, supervision is initiated with an inquiry of any adverse events occurring in treatment ses-sions during the previous week (e.g., suicide risk, suspected child treatment, domestic violence). Of course, when adverse events are identified they are discussed, including safety plans and appro-priate consultation with others . . . .
Supervision meetings focus of various aspects of treatment implementation, including therapist style, utilizing role-playing to teach therapeutic skills, providing descriptive feedback on adher-ence rating forms, and descriptively praising suc-cessful efforts to implement treatment. . . . When trainees are learning to implement evidence-based treatments, it is essential to measure adher-ence to treatment implementation. . . . Therefore, therapists are provided feedback regarding the quality and extent to which the provided therapy with integrity during the past week according to reviews of their session audiotapes by other ther-apists [using] a protocol checklist to guide them in mentioning outstanding strengths relevant to therapeutic style, and methods of accomplishing treatment adherence. (Donohue et al. 2009:428)
Problem: The Professional and the bureaucracyAgainst the backdrop of the EBP and managed care movements, the problem of professional worker autonomy in a bureaucratic context raises once again the central question encoun-tered earlier in the chapter on administrative supervision. It speaks to the strain between the requirements for worker discretion dictated by the nature of social work practice and the need to accommodate to the requirements that have to do with working in an organization
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
P r O b l e m s a N d I N N O v a T I O N s ] 341
The findings clearly indicate that while social workers may value autonomy, flexibility, and in-novation in their work situations they may at the same time value bureaucratic organizational arrangements. Assertions that bureaucratic val-ues, which guide the policies and procedures of organizations, are antithetical to the professional values of workers are highly questionable. (Wil-son, Voth, and Hudson 1980:29; see also Eagerton 1994)
Heraud also noted:
The relationship between bureaucracy and the profession is not, as is frequently depicted, in all cases one of conflict and in social work in par-ticular there is considerable congruence between bureaucratic and professional criteria. Concepts such as organizational professionalism or bureau-professionalism have been developed to express this relationship. Bureaucracy and professional-ism have, for example, both been seen as subtypes of a wider category, that of rational administra-tion. (1981:135)
Thus, it might be concluded that although there is a dynamic tension between the needs of the professional and the needs of the organi-zation, these differences are reconcilable, that bureaucratization does not necessarily result in deprofessionalization, that identification with the organization does not necessarily occur at the expense of identification with the profes-sion. Supervision and professionalism are not necessarily antithetical concepts.
The difference (however subtle) between pro-fessional autonomy and accountability needs clarification. Professional autonomy suggests that professionals are responsible to them-selves for the service they offer. Accountability requires something beyond professional auton-omy and personal responsibility for service offered. Accountability requires that, beyond responsibility to oneself as a professional, the worker is also responsible to agency admin-istration and, beyond agency administration,
The difference lies in the basis of the legiti-mated authority that supports the differing control systems—one based on expertise which prompts voluntary compliance, the other based on power vested in a position which obligates compliance. For the supervisor, the profes-sional control structure recognizes colleagues as having equal authority and power rather than supervisor and supervisee with differing amounts.
The strain between the professionals’ pref-erence for self- and peer-government and the bureaucratic-hierarchical control structure encountered in working in complex organiza-tions such as managed care and social agencies is the subject of very considerable discussion (Abrahamson 1967; Biedas and Kendall 2010; Brooks, Patterson, and McKiernan 2012; Frey et al. 2012). However, with the bureaucratization of the professions and the professionalization of bureaucracies, there has been increasing accom-modation between the two systems of control. “Organizations are increasingly governed by professional standards and professionals are increasingly subject to bureaucratic controls” (Kornhauser 1962:7). The basis for accommoda-tion efforts lies in the fact that the professional needs the organization almost as much as the organization needs the professional.
There has been some rethinking generally about the inevitability of conflict between pro-fessionals and the bureaucracy (Gagné and Bhave 2011; Levay and Waks 2009; Mastekaasa 2011). There is greater current acceptance of the idea, first proposed by Harris–Jenkins (1970), that “the contemporary professional who works in an organizational setting is quite likely to feel at home and at ease there because professions and organizations are fused into a new social form” (Blankenship 1977:38). A questionnaire study of 267 professional social workers in health and welfare agencies found that bureau-cratic and professional value orientations were not necessarily in conflict. The two sets of val-ues were perceived as separate, rather than polar opposites on one continuum:
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
342 [ P r O b l e m s a N d I N N O v a T I O N s
identified as correlates of job satisfaction (Mor Barak et al. 2009). Through the agency, the pro-fessional is provided with community and legal sanction and support for the work he or she is doing. The organization provides the profes-sional with clients so that less energy needs to be spent in developing a clientele. The agency provides resources that assist the professional in task performance—clerical and financial help, technical materials, paraprofessional assis-tance, insurance coverage, specialized consulta-tion, and so on. The organization provides the stimulation that derives from immediate, close contact with other professionals, the emotional support that comes from an immediately acces-sible peer group, and the technical advisement that comes from good supervision. Within the context of a complex organization, the profes-sional has available a rich network of related specialists with whom he or she can coordinate his or her own activities.
If bureaucratic controls limit the worker’s discretion and autonomy, they make for reli-able, predictable, nondiscriminating decision making. The statement that may come closest to reality is that professionalism and bureaucracy, being multidimensional, may be in conflict with regard to some considerations, but con-gruent and mutually supportive with regard to others (Anderson and Martin 1982).
ethical dilemmas in supervisionAlthough concerns are often raised about ethi-cal supervision (Ellis et al. 2008; Greer 2002; Ladany et al. 1999), there is no question regard-ing the duty of a supervisor to act in an ethi-cal, humane manner toward supervisees. There is an ethical obligation to meet the legitimate needs of the supervisee, to evaluate objectively and fairly, to refrain from taking advantage of differences in power, and to implement the functions of supervision conscientiously and responsibly. It is unethical for supervisors to assign a case to a supervisee who is without the necessary skills and knowledge to offer effec-tive service, yet assigning another difficult case
to the community for the service offered. Accountability is based on the fact that the social worker’s licensed actions are sanctioned not only by professional expertise, which justi-fies professional autonomy, but also based on “delegated discretion”—the authority to pro-vide service deriving from the agency’s admin-istration and third-party payers. Professional autonomy suggests that social workers are free agents. Accountability points to the fact that, as agency employees social workers are not free agents, but they are acting as representatives of the agency and through the agency as represen-tatives of the community. The worker in orga-nizational settings is not carrying a personal caseload, but an agency caseload.
Related to this is the distinction that needs to be made between autonomy over ends and autonomy over means (Raelin 1986). Determin-ing the mission of the organization is the proper responsibility of agency administration. Gener-ally, the professional cedes autonomy of such ends to administration. Professionals are more likely to advocate for autonomy over means. What they should do in treating the client and how they should do it is their prerogative—an autonomy earned by their specialized knowl-edge and skills—constrained by public and private demands for efficiency in the face of limited resources. The justification for mana-gerial control in the face of agreeing to grant the professional autonomy regarding means is that there needs to be some certainty that the professional is employing appropriate means to achieve the goals of the agency and its external stakeholders (Lewis 1988).
There might be less conflict than supposed between the professional and the bureaucracy, but there are significant advantages for the professional in operating in an organizational context. Although worker and supervisor autonomy has been associated with job satis-faction in every context and culture (Gagné and Bhave 2011), the counterbalancing variables of adequate organizational resources, supervisory support, and co-worker trust have also been
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
P r O b l e m s a N d I N N O v a T I O N s ] 343
vis–à–vis the supervisee. Beyond this, however, the supervisor might be confronted with ethical questions that are more controversial and about which there may be little consensus. Such prob-lems relate to the kinds of ethical dilemmas that might be posed for the supervisee, who then turns to the supervisor for help in resolving them. A dilemma for the supervisee becomes a dilemma for the supervisor. A dilemma poses a question to which any answer has some nega-tive consequences and/or violates an alternative significant value.
Many questions faced by the worker do not yield to technical solutions because they are primarily ethical rather than technical ques-tions. No amount of technical skill can help a worker answer a question regarding situations in which confidentiality might need to be set aside to protect threatened people, in which agency rules and regulations might need to be bent to accommodate highly individualized client needs, or in which a white lie might be considered to mitigate a client’s pain or suffer-ing. To resolve a difficult decision between one good and another conflicting good, the worker is more likely to turn to the supervisor than to an ethical code (Hair 2012), as workers vary in their belief in and adherence to the NASW Code of Ethics (DiFranks 2008). The opportu-nity to talk things over with a supervisor might provide the worker with relief and a sense of direction—provided that the supervisor has formulated a sense of direction.
sexism and social Work administrationSexism is defined as discrimination based on gender. There is a problem in social work relating to equitable access of females to administrative positions. The term social work administration covers a variety of levels from the lowest supervisory position to agency executive director. For both men and women, supervisor is the entry-level position to the administrative hierarchy.
Although the majority of social workers are women, for many years the administrative
to an excellent worker who “already has a full workload” may “contribute to caseworker burn-out and turnover, and then to both diminished unit performance over time and the need for supervisors to spend more time on training new caseworkers” (Maceachron et al. 2009:181). Reamer (1989) noted that supervisors are ethi-cally liable if they fail to meet regularly with supervisees to review their work, fail to pro-vide timely evaluations, fail to provide adequate coverage in a supervisee’s absence, or fail to detect or stop a negligent treatment plan. It is unethical for either supervisors or supervisees to present themselves as competent to deliver professional services beyond their training level of experience and competence.
The supervisor is obligated to respect the con-fidentiality of material shared in the process of supervision. If information obtained in super-vision needs to be communicated to others, the supervisor should inform the supervisee about the person(s) to whom it will be communi-cated and for what purpose. The supervisor has a gatekeeper function in protection of clients. If it is clear that a supervisee is not competent and is not likely to become competent, the supervi-sor is responsible for advising a change of career or terminating employment. There is an ethical responsibility on the part of supervisors to avoid dual relationships with supervisees, particularly those related to sexual exploitation. Supervisors have an ethical responsibility to make explicit their expectations of the supervisee and the arrangements for working together. Supervi-sors have an ethical responsibility for continued self-development, to upgrade skills and moni-tor their own effectiveness.
Supervisors have to make themselves avail-able in case of emergencies when crisis decisions need to be made. Throughout, the supervisor’s responsibility is initially and primarily to the needs of the client and only secondarily to the needs of the supervisee.
These statements comprise the consensu-ally accepted, standard, noncontroversial ethi-cal obligations that a supervisor must observe
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
344 [ P r O b l e m s a N d I N N O v a T I O N s
that remained is evidence that sexism still hold sway in the agency settings where most social workers practice.
Because becoming a supervisor is often the first rung on the administrative ladder, we extended our analysis to examine social work supervisors. Unlike the significant dif-ference in hours the genders reported spend-ing in administrative and managerial roles, we found no difference in the number of hours that male and female supervisors spent pro-viding supervision (NASW Center for Work-force Studies 2004). However, as was true for the administrators in the Workforce study, the estimated mean full-time salary of $65,921 for male supervisors was significantly greater than that for supervisors who were women, with a mean estimated full-time salary of $50,386. Once again, although the 30 percent difference of $15,535 in estimated full-time salary favoring male supervisors over supervisors who were women was mitigated somewhat after con-trolling for estimated age, highest social work degree, public or private sector employment, and years of experience, the significant differ-ence that remained indicates that sexism plays a major role in the incomes that social work supervisors earn.
In addition to salary and wage discrimina-tion, there are a number of other gender and gender-role issues related to problems of sexism and heterosexism and social work administra-tion. As discussed in chapter 7, these include gender as a factor in the transition to supervi-sion, gender and sexual orientation as factors in ongoing supervision, the problem of sexual harassment in the workplace, and the role that sexism plays in case assignments that dispro-portionately expose male social workers to risk.
The Problem of education for supervisionWe have noted above that lack of training is one of the problems encountered by direct service workers making the transition to supervision. Education for supervision is a problem for the profession as well.
enclave in many social work agencies was dis-proportionately male (Szakacs 1977; Chernesky 1980). In a global sense, this still appears to be true, as employed male respondents to the NASW Workforce study reported spending significantly more hours per week than females in administration and management (NASW Center for Workforce Studies 2004). On the other hand, the size of the gender effect was quite small, and further analysis indicated that the gender disparity in weekly hours spent in administration and management roles was lim-ited to social workers who spent less than 19 hours per week performing those duties. The gender effect disappeared among social workers reporting 20 or more hours per week in admin-istration and management. Because it appears that the licensed workforce has achieved some degree of gender parity in their occupation of full-time administrative and management posi-tions, it may be that the very small difference in reports of their part-time performance of administration and management differences can be explained as a social desirability phe-nomenon, in which men were more likely than women to describe similar tasks as administra-tion and management.
Women who occupy administrative social work positions continue to earn significantly less income than their male counterparts (Gibelman 2003; Koeske and Krowinski 2004). This was certainly true for the administra-tors in the Workforce study (NASW Center for Workforce Studies 2004), as the estimated mean full-time salary of $76,014 for male social workers reporting 20 or more hours per week in administration and management was signifi-cantly greater than that for their colleagues who were women, with a mean estimated full-time salary of $54,938. Although the whopping 38 percent salary difference in favor of men was mitigated somewhat after controlling for esti-mated age, highest social work degree, public or private sector employment, and years of experience—a model suggested by Koeske and Krowinski (2004)—the significant difference
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
P r O b l e m s a N d I N N O v a T I O N s ] 345
vary widely in how or whether they prepare students to provide supervision is still valid. Some schools require all social work students to complete a course in supervision; other schools offer elective courses in supervision, embed supervision content in courses on administra-tive or clinical practice, or provide no supervi-sion content at all. Hoge et al. determined:
Postgraduate certificate programs in supervision are probably the most substantive training models available to individuals. . . . They involve a more intensive educational experience that may include from 40 to 80 hours of classroom learning that is both didactic and experiential and is spread over a substantial period of time that may range up to 2 years. The formal training is typically aug-mented with additional learning opportunities and requirements, such as advanced course work on clinical techniques and online learning com-munities that connect students in the program. Educational content tends to cover topics such as supervisory roles, supervisory relationships, ethics, confidentiality, models of supervision, and the implications of cultural diversity. (Hoge et al. 2011:191)
With growing recognition of the signifi-cance of supervision—for quality assurance and client protection, for the implementation of competency- and evidence-based practices, for the amelioration of practitioner burn-out and workforce retention—some schools of social work have joined with community partners and state authorities to develop and test promising models of supervision train-ing in behavioral health care (Tebes et al. 2011) and child welfare (Landsman 2007; Lietz and Rounds 2009; Strand and Badger 2005). But, given the panoramic curricular scope of social work education and its diverse, embed-ded interests, the time and resources available for achieving its ambitious mission are often quite limited (Stoesz et al. 2010; Weissman et al. 2006). Noting that perhaps one-quarter of social work graduates are unable to pass the
Decades ago, Olmstead and Christensen (1973), in concluding a national study of social work personnel problems, called attention to the need for formal and explicit training for supervision: “There appears to be a pressing need for supervisory training. The function of supervision is too critical to leave to trial-and-error learning. Systematic instruction in the fundamentals of supervision warrants a high place on any list of training requirements” (6).
Educating supervisors to supervise remains a problem today. Relatively few supervisors have had any extended systematic education in supervision. Aikin and Weil (1981) once noted that role adoption (learning to do the job after being assigned the title) and emulation or modeling (imitating supervisors previously encountered) are the principal ways of learning to supervise. A more recent review of the super-vision of behavioral health care in the public sector reported the following:
The policies, procedures, and practices within service organizations lack clear standards regard-ing the format and minimum frequency of super-vision, and few monitor data to ensure that those standards are met. Individuals become supervi-sors based on seniority, academic degree, or pro-ficiency as a direct care provider . . . and generally do not receive training in supervision practice. (Hoge et al. 2011:186)
Whether described as role adoption or “role shock” (Borders 2010), on-the-job experience is still how most supervisors get their training.
Although the Council on Social Work Edu-cation (2010:3) recognized the importance of training students for competency to use super-vision in its Educational Policy and Accredita-tion Standards, it has not identified the ability to supervise as a competency that social workers shall acquire. Although the sample of respon-dents to our recent Internet survey of deans and directors of schools of social work was small, we can report with confidence that Munson’s (1983) observation that schools of social work
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
346 [ P r O b l e m s a N d I N N O v a T I O N s
O’Donoghue and Tsui 2013). By now, the basic elements of evidence-based supervision, includ-ing those used to “standardize” (Donohue et al. 2009) and “manualize” (Milne and Reiser 2012) supervision, will have already become familiar to our readers: (1) conduct initial and ongoing assessments of workers’ educational needs, (2) develop, monitor, and maintain collaborative working relationships with supervisees, (3) hold routine supervisory meetings that follow work-ing agendas, (4) use multiple methods (e.g., demonstration, discussion, modeling, role-play, and verbal instruction) to teach workers specific knowledge and skills, (5) make frequent direct and indirect observations of worker per-formance, (6) provide timely performance feedback and coaching, and (7) monitor client progress and outcomes.
a Perspective: The Positive values of Professional supervisionFocusing on the problems of supervision tends to obscure the very real contribution made by supervision to the effective operation of social work agencies, and the general satisfaction with current supervisory procedures.
Despite some dissatisfaction, agency super-vision is, for the most part, doing the job it is charged with doing. A nationwide sample of 377 MSW supervisees anonymously answered the following question: “In general, how satisfied do you feel with the relationship you now have with your supervisor?” Of the respondents, 30 percent indicated that they were “extremely satisfied” and 36 percent were “fairly satisfied” with their relationship with their supervisor. Only 5 percent indicated they were “fairly” or “extremely” dissatisfied (Kadushin 1992a). Other studies available also tend to indicate considerable satisfaction with social work supervision (Greenleigh Associates 1960:132; Galambos and Wiggens 1970:18).
Munson’s (1980) study of sixty-five super-visees from a variety of agencies indicated that satisfaction scores with supervision are “fairly high, indicating that there is overall satisfaction
national examination required for a license to practice (Deangelis 2009), the American Board of Examiners in Clinical Social Work (2004) and the Association of Social Work Boards (2009) have assumed compensatory leadership in development of a supervisory workforce, notably by convening expert panels to evaluate and synthesize practice wisdom and published research and itemize, define, and publish basic competencies for social work supervision.
Incrementally, the individual states with leg-islative authority to regulate social work have begun to follow suit by requiring clinical super-visors to complete some form of initial training and, increasingly, continuing education, before authorizing them to provide licensure super-vision (ASWB 2010b). Arizona, for example, recently began “stricter enforcement of clinical supervision training [that requires] completion of 12 clock hours of training before a supervi-sor begins providing supervision and six clock hours of clinical supervision training before renewal of a license to practice” (Hymans 2012:15). Although this is a promising develop-ment, the quality of such training is difficult to ascertain, as self-reports of trainee satisfaction have been the principal method, if any, used to measure those training outcomes. A recent ran-domized controlled trial of supervision training found little evidence to suggest that supervisor skills are enhanced by supervision workshops (Kavanagh et al. 2008), nor have reviews of the literature by Carroll and Rounsaville (2007), Decker et al (2011), Lyon et al. (2010), and Bei-das and her colleagues. However, a cross-com-parison of the empirical evidence and expert panel findings points to a growing consensus about what social workers and their supervisors need to learn.
Watkins (2011b:193) predicted that the supervision of the “new millennium” will become “evidence-based,” as the pivotal role of “evidence-based supervision” in the imple-mentation of evidence-based practice becomes the focus of growing attention (Carlson et al. 2010; McHugh and Barlow 2010; Milne 2009;
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
P r O b l e m s a N d I N N O v a T I O N s ] 347
and negatively correlated with anticipated turn-over at levels of high statistical significance. In a more contemporary study of eighty-four cli-nicians serving clients with mental illness in a managed care environment, Schroffel (1999:101) found that individual supervision was always or very helpful for 64 percent of the surveyed practitioners, and that satisfaction with group supervision was significantly correlated with job satisfaction.
The value of supervision for more effec-tive agency administration is noted in several studies. Community mental health centers are among the agencies that depend heavily on third-party payments for support and conse-quently face legislative mandates for rigor-ous accountability. A questionnaire study of community mental health center supervisors’ perceptions of effective accountability mecha-nisms found all 117 respondents saw “a well-coordinated and explicit system of supervision as the most preferred approach to facilitating a community mental health center based quality assurance program” (Smith 1986:9).
Sosin (1986) studied the effects of supervisor inputs in implementing administration of child welfare permanency planning programs in all seventy-two Wisconsin counties. There were wide variations in the extent to which super-visors in different counties reminded workers to conduct case reviews of children in place-ments, monitored reviews, conducted discus-sions of case reviews, and reviewed workers’ records regarding permanency planning. In analyzing the effects of supervisor actions on permanent planning outcomes, Sosin con-cluded that supervisors’ actions in reminding workers to conduct reviews was significantly related to reducing time in care. Other admin-istrative actions of the supervisor (“discuss rou-tine review results” and “perform review from records”) were modestly related to time in care (372, table 4).
Program review teams surveying child wel-fare programs in Illinois repeatedly mentioned the relationship between supervision and
with supervision” (7). A survey of the job satis-factions of some 370 workers in mental health settings found that “respondents tended to be most satisfied with their supervision, followed closely by satisfaction with co-workers and with their work” (Webb et al. 1980).
A study of job satisfaction of school social workers in Iowa found that satisfaction with supervision was significantly associated with job satisfaction. “If respondents were satis-fied with supervision they were more likely to be satisfied with their job” (Staudt 1997:481). Studying job satisfaction in a department of human resources, Newsome and Pillari (1991) found that overall job satisfaction and the over-all quality of supervision were positively cor-related. Evans and Hohenshil (1997), in a study of substance abuse counselors, found a relation-ship between job satisfaction and the quantity of supervision received.
At a state human services agency, 636 supervisees rated their supervisors on seven dimensions reflecting their attitudes toward supervisees. The dimensions included such aspects as communication, unit management, personnel policies, and personnel evaluations. Overall, the supervisors rated a mean of 3.27 on a five-point scale from 1 (not at all) to 5 (very well), indicating a reasonable level of satisfac-tion with supervisors on the part of the 636 supervisees (Russell, Lankford, and Grinnell 1984:4, table 1).
Olmstead and Christensen’s nationwide study concluded that good supervision is an important determinant of agency effectiveness:
The data are conclusive. High agency scores on the supervision variable were accompanied by greater employee satisfaction, better individual performance, less absenteeism, better agency performance, and higher agency competence. (1973:304)
In a study of 102 child-care workers, Shinn (1979) found that the quality of supervision was positively correlated with job satisfaction
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
348 [ P r O b l e m s a N d I N N O v a T I O N s
much of the evidence is confounded by meth-odological problems, as noted in five reviews of the literature (Ellis and Ladany 1997; Frietas 2002; Inman and Ladany 2008; Wheeler and Richards 2007; Watkins 2011a). Thus, as Wat-kins (2011a:252) concluded, “We still cannot empirically answer that question.”
Our review of the literature leads us to con-clude that agency supervision, despite some dis-satisfaction, is, for the most part, doing the job it was charged with doing. Although licensed social workers reported larger caseloads, cli-ents with more severe problems, the more fre-quent assignment of non-social work tasks, and increased levels of oversight and paperwork in their jobs over the two years preceding the NASW Workforce study, 25.9 percent of the employed participants in the survey agreed and 41.4 percent strongly agreed that they received support and guidance from their supervisors, notwithstanding reduced levels of job security, staffing, supervision, and reimbursement for services (NASW Center for Workforce Stud-ies 2004). At the same time, 19.1 percent of the employed workforce identified supervision as one of the five most important factors that would influence a decision to change their cur-rent position (NASW Center for Workforce Studies 2004). For clarification, nearly one-fifth of the employed workforce meant to say that they would consider leaving their positions for better supervision, as both the 9.1 percent of the workforce who identified the quality of supervi-sion as a reason to consider leaving, and the 13.9 percent of the workforce who identified having a different supervisor as a reason to consider leaving (and some workers listed both as rea-sons to consider leaving), also reported signifi-cantly lower levels of supervisory guidance and support than their colleagues (NASW Center for Workforce Studies 2004).
Thus, although some social workers may have viewed supervision as a problem of abun-dance for a time in the past—with longing for professional autonomy, and emancipation from interminable supervision—the more common
performance. A 1988 program review of an area office noted:
Positive indicators such as case documentation and case closing were found within those teams whose supervisors were more structured and for-mal in their management. Within those teams where supervision was vacant, sporadic and in-consistent, we found a lower rate of case closing and documentation.
Another area reviewed by the Office of Pro-gram Review noted that “those teams where the supervisor had developed systems for periodic review of case records had noticeably better quality records than those who had not.”
In chapter 6, we discussed in some detail the value of good supervision as a prophylactic for burnout.
The importance of supervision in preventing child maltreatment in institutions for children was cited by Rindfleisch (1984). In asking for suggestions as to what is likely to reduce the incidence of maltreatment, different respon-dents to a questionnaire returned by some one thousand institutional personnel suggested bet-ter supervision, experienced supervision, thor-ough supervision, strong supervision, effective supervision, regular supervision, accessible supervision, consistent supervision, and qual-ity supervision.
It might be noted that the research cited indicates the positive effects of supervision on supervisee job satisfaction and administrative procedures (Mor Barak et al. 2009). A ques-tion might be raised about the consequences of effective supervision for client change.
Harkness and Poertner (1989) reviewed the social work supervision research literature between 1955 and 1985 and noted that this research had generally neglected the effects of supervision on clients and their outcomes. Although some evidence suggests that super-vision can improve client outcomes (Bambling et al. 2006; Callahan et al. 2009; Harkness and Hensley 1991; Worthen and Lambert 2007),
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
P r O b l e m s a N d I N N O v a T I O N s ] 349
reliable view of the worker’s performance and provide the worker with the opportunity for self-supervision; affordable and unobtrusive technology has been developed for this pur-pose. Practice skills are enhanced by observing client outcomes and collecting client feedback.
Peer supervision and time-limited supervi-sion have been proposed to balance the profes-sional autonomy of experienced workers with the need for accountability in agency settings. With the advent of social work licensure, there is agreement that the supervisory relationship should yield to consultation, although some administrative supervision will continue to be required.
A variety of procedures have been tried to debureaucratize the agency and redistribute managerial decision-making power. These include team service delivery, participatory management, and a supervisory contract sys-tem. Many such initiatives are difficult to sus-tain in a managed care environment and may be incompatible with evidence-based practice.
The problem of the professional in a bureau-cracy was discussed, suggesting the possible sources of reconciliation between these two sources of control. Sexism, managerial oppor-tunities for women, and risks for men were reviewed.
Studies show that most supervisees express satisfaction with the supervision they are receiving and that supervisors do a more effec-tive job as a result of formal training, although the training opportunities that exist are limited and often unproven.
perception now seems to be that social work supervision has become fleeting and scarce, sug-gesting the adage “Be careful what you wish for.”
With less than half of the workforce receiv-ing supervision from a social worker (NASW Center for Workforce studies 2004), and given its importance, the profession might consider a more active program of explicit, formal training for social work supervision in order to increase the number of social work super-visors doing good supervision. In a compan-ion initiative, we encourage our colleagues to advance social work’s portfolio of supervi-sion research. It is comforting to know that supervision makes a significant contribution to worker’s job satisfaction and that agency administration operates more effectively as a consequence of the availability of supervi-sion. A very important question that needs to be far more adequately addressed by research is the extent to which good supervision is significantly related to the certainty of client improvement—a problem alluded to a number of different times in different ways in various contexts throughout the text.
summaryThe lack of direct access to supervisees’ perfor-mance is a problem for supervisors. Workers’ reports of their activities often suffer from sig-nificant omissions and distortions. Procedures such as direct observation, audio and video recordings, and co-therapy supervision are being used in response to this problem. Record-ings provide the supervisor with a complete,
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
EBSCOhost – printed on 6/7/2023 10:36 PM via CAPELLA UNIVERSITY. All use subject to https://www.ebsco.com/terms-of-use
