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Section 33
Strategies for Mental Health

Question 33 | Test | Table of Contents

Active Participation
Participation in each supervision session begins with taking an active role in establishing a tentative agenda for the meeting. Offering to update the supervisor on the status of follow-ups to directives or suggestions, crisis or emergency cases, or other important pending matters is a useful first step. Additionally, requesting time for specific questions or challenging cases is also helpful. Providing this information accomplishes a number of things. It lets supervisors know that MHC students are sensitive to supervisors' concerns (i.e., vicarious liability) and respectful of supervisors' expertise.

It also helps supervisors make decisions about how to utilize time in the session and what topics to initiate. Finally, it helps to ensure that students are more likely to get their needs met. By being active in structuring the meeting, students can help to reduce the frustration that results when one or both parties feel that essential matters were not addressed.

Being prepared for the various roles (i.e., teacher, counselor, and consultant) that supervisors might slip into and out of when addressing the aforementioned topics can also help to reduce potential confusion and frustration in MHC students. When supervisors provide feedback about performance, teach or model techniques, explain the rationale behind interventions, or provide interpretations of counseling interactions, they are trying to instruct students from the teaching role (Stenack & Dye, 1982). Operating from the counseling role, supervisors are trying to facilitate students' self-growth as it relates to their professional development. Questioning students about their feelings (e.g., whether in response to supervision, counseling sessions, or trying specific counseling interventions) and providing opportunities to explore affective responses, defensive reactions, worries, and personal strengths are all appropriate supervision interventions from the counseling role (Stenack & Dye). From the consulting role, supervisors focus on the client in order to generate information and ideas about treatment. Accordingly, supervisors encourage students to discuss client problems or motivations and brainstorm alternative conceptualizations or interventions. Rather than directing the interactions and providing answers, as is done in the teaching role, supervisors in the consulting role encourage student choice and responsibility by providing options and alternatives instead of answers (Stenack & Dye). Understanding the purposes of each of these supervisor roles can prepare MHC students for responding in a complementary fashion from the respective roles of student, client, and counselor.

Taking Initiative
In addition to merely responding to interventions from supervisors, MHC students can also consider initiating topics from the role of student, client, or counselor, depending on their developmental needs. In other words, MHC students who want specific feedback about the quality of their conceptualizations or interactions might consider using the following student-role statements or questions: I am uncertain about whether I am going in a useful direction with this client. Can you give me some ideas about how to avoid giving advice when clients keep asking? Would you mind reviewing my paperwork to see if my treatment plans are improved? Can you tell me how to work with addictions, or can you suggest where to find a resource?

MHC students can initiate discussions about personal reactions and feelings by moving into the client role with the supervisor. A transition into the client role could be facilitated by the following questions and statements: I have a hard time paying attention to this client. Could you help me explore the anger that I am feeling toward the client's parents? For some reason, I am reluctant to confront this client, and I would like to figure out what is blocking me. This dream I had about my client contained some powerful images that I am having trouble interpreting. I find that I cannot stop worrying about my clients once I get home with my family. Sometimes in our supervisions sessions, I feel like I will never know enough to work with clients on my own. When I work with this client, he or she reminds me so much of my older brother or older sister. How can I ensure that these feelings will enhance rather that inhibit my work with this client?

Still other comments and questions from students, in the counselor role, can invite supervisors to move into a consultant role. Examples include the following: I am puzzled by the client's presenting symptoms, particularly in light of previous diagnoses. Can we spend some time discussing better ways to establish trust with this client? What do you think the client is trying to communicate by holding the sofa pillow when she talks? What kind of stress management techniques might work best with this client? I cannot really make sense of what keeps the client so stuck in this pattern of behavior.

Monitoring Self and Reactions
Three common occurrences in supervision are worth noting: counselor anxiety, transference and countertransference, and parallel process. Normalizing anxiety as an inevitable part of supervision is an important aspect of preparing MHC students for the supervision process (N. Berger & Graff, 1995; S. S. Berger & Buchholz, 1993; Bernard, 1994). Liddle (1986) identified five possible sources of threat for MHC students: (a) evaluation anxiety, (b) performance anxiety, (c) personal problems or internal conflicts, (d) deficits in the supervisory relationship, and (e) fear of negative consequences for trying new or risky counseling interventions. Accepting anxiety as a natural part of the process can make it easier for students to explore feelings of anger, defensiveness, or disinterest as possible reactions to underlying anxiety by asking themselves what they might be anxious about. Additionally, understanding common sources of anxiety can help students cope with their anxiety. Coping strategies suggested by Liddle included cognitive restructuring of counselor self-statements, rehearsing positive self-statements, reframing vulnerability as an opportunity for growth, assessing student strengths, and relying on outside social support systems. Students might also consider the following strategies: discussing with supervisors anxious feelings the moment they occur in supervision sessions, asking supervisors how they coped with anxiety during their training, and asking for specific feedback and evaluation if uncertain about the supervisor's opinion of their counseling abilities and progress.

In addition to anxiety, transference and counter transference can be the root of confusing, difficult, and sometimes negative interactions between supervisees and supervisors alike (Pearson, 2000). If unrecognized, such unconscious processes increase the potential for ineffective supervision or conflict within the supervisory relationship (Pearson). Recognizing these processes requires a willingness by MHC students to engage in serious personal reflection. Students' expectations for what should be happening in supervision can be influenced by current and prior relationships with other authority figures, including parents, teachers, and bosses. For instance, if students perceive their supervisors as overly critical, aloof, uncaring, smothering, stifling, or untrustworthy, they need to examine the degree to which they have had similar feelings toward other authority figures. Students might also ask others who have worked with the supervisor about their experiences and perceptions. When students realize that their reactions are unique or exaggerated compared to others' reactions and that they have reacted similarly to other authorities, transference is the likely explanation. With such a realization, students are more likely to act constructively rather than react negatively.

Parallel process (Friedlander, Siegel, & Brenock, 1989) is another unconscious phenomenon that is less familiar to MHC students. Parallel process occurs when supervisees unconsciously present themselves to the supervisor in much the same fashion that the client presented to the supervisee. Thus, the supervisee unconsciously replicates the conflict of the client (S. S. Berger & Buchholz, 1993). S. S. Berger and Buchholz argued that MHC students who understand parallel process may be able to observe themselves more effectively and may be more receptive to related interventions by the supervisor. Because parallel process is often subtle, making it difficult to detect, MHC students can be alert to situations in which their responses, reactions, or needs in supervision are atypical for themselves and ask the following: What client am I currently discussing or reminded of? To what degree could the client be feeling similar to the way I am feeling now? Do you have any insights regarding my description of the client and how it compares to your and my feelings in this situation.
- Pearson, Quinn, Getting the Most Out of Clinical Supervision: Strategies for Mental Health; Journal of Mental Health Counseling; Oct 2004; Vol. 26; Issue 4.

Personal Reflection Exercise #8
The preceding section contained information about getting the most out of clinical supervision. Write three case study examples regarding how you might use the content of this section in your practice.
Reviewed 2023

Update
First Results of Peer Training for Medical Staff-Psychosocial
Support through Peer Support in Health Care

- Hinzmann, D., Koll-Krüsmann, M., Forster, A., Schießl, A., Igl, A., & Heininger, S. K. (2022). First Results of Peer Training for Medical Staff-Psychosocial Support through Peer Support in Health Care. International journal of environmental research and public health, 19(24), 16897. https://doi.org/10.3390/ijerph192416897

Peer-Reviewed Journal Article References:
Fukui, S., Wu, W., & Salyers, M. P. (2019). Mediational paths from supervisor support to turnover intention and actual turnover among community mental health providers. Psychiatric Rehabilitation Journal, 42(4), 350–357.

Malcolm, K. T., Taylor, K. K., Mitchell, J., Saile, M., Heatly, M., & Alpert-Gillis, L. J. (2019). Why, what, and how: Training community clinicians on evidence-based practice for youth mental health. Training and Education in Professional Psychology, 13(4), 279–286.

Mitchell, S. M., Taylor, N. J., Jahn, D. R., Roush, J. F., Brown, S. L., Ries, R., & Quinnett, P. (2020). Suicide-related training, self-efficacy, and mental health care providers’ reactions toward suicidal individuals. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 41(5), 359–366.

Ralston, A. L., Holt, N. R., & Hope, D. A. (2020). Tele-mental health with marginalized communities in rural locales: Trainee and supervisor perspectives. Journal of Rural Mental Health, 44(4), 268–273.

QUESTION 33
Normalizing anxiety as an inevitable part of clinical supervision is an important aspect of preparing MHC students for the supervision process. What five possible sources of threat for MHC students did Liddle identify? To select and enter your answer go to Test.