Psychotherapy and Applied Psychology

Supervisor vs Therapist: Knowing the Difference with Dr. Rod Goodyear

• Season 3 • Episode 20

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Dr. Rod Goodyear returns for part 2 to continue the conversation with Dan on Clinical Supervision.

Dr. Goodyear returns to explore the intricate dynamics of clinical supervision, emphasizing the importance of the supervisory relationship, the distinction between supervision and therapy, and the role of humility. Dan and Dr. Goodyear delve into supervisory ruptures, effective feedback mechanisms, and the cultural nuances that influence supervision practices. They also addresses the developmental trajectories of supervisors and the relationship between supervision and therapist expertise, highlighting the need for deliberate practice and collaborative evaluation to enhance professional growth.

Special Guest: Dr. Rod Goodyear

Fundamental of Clinical Supervision

International Interdisciplinary Conference on Supervision

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[Music] Broadcasting from the most beautiful city in the world, I'm your host, Dr. Dan Cox, a professor of counseling psychology at the University of British Columbia. Welcome to episode number 52 of Psychotherapy and Applied Psychology, where we dive deep with the world's leading applied psychology researchers to uncover practical insights, pull back the curtain, and hopefully have some fun along the way. If you find the show useful, it'd be much appreciated if you shared it with someone else who you think might enjoy it too. Today, I couldn't be more excited to welcome one of the world's authorities on clinical supervision. My guest is a professor emeritus at the University of Redlands and at the University of Southern California. He received the American Psychological Association's Award for Distinguished Career Contributions to Education and Training and Psychology, as well as an award for the International Advancement of Psychotherapy from the Society for the Advancement of Psychotherapy. He's also a fellow of the American Psychological Association and of the American Education Research Association. Additionally, he's the author of the book Fundamentals of Clinical Supervision, which is about to go into its seventh edition. In this part of our conversation, we discuss several aspects of clinical supervision, including addressing supervisory ruptures and building alliances, encouraging vulnerability in supervisors, evaluating supervision, the intersection of supervision and therapist expertise, best practices for clinical supervisors, and much more. This episode starts with my guest responding to my question about how the relationship differs between therapist and client and supervisor and supervisor. Without further ado, it is my pleasure to welcome back my very special guest, Dr. Rod Gurdier. So I think this gets into what the competencies are as we're training for and in the framework, I talk about six competencies. So competencies, depending on which group you talk to or look at, you've got different ways of parsing them. So APAs done as various task groups and there's the stuff that's come out of the competency conference, there's others. But they're all looking at the same thing. It's just how they parse it. It's my take. And so the way I'm thinking about it, but this framework is we have technical skills that we're working on. We have relationship skills. There's ethical and professional skills. There's self awareness, which kind of what is building up to with your point. So as supervisors work, of course, they're going to have reactions to the client that counter-transferrants and other things come up. And when we as supervisors work on those issues, that's sometimes been a slippery slope that the supervisors just having this huge reaction to the client. And we want to help them manage that to what extent do we then go down, continue down that path and provide what looks more like therapy. And the field's pretty clear that that's unethical, the constitutes a multiple relationship, it violates informed consent, all those things. It has been a slippery slope for some supervisors over the years. I think people are more attuned to it now. But it's often around those issues that the self awareness domain and particularly things like counter-transferrants that supervisors can allow themselves to be led down that path where they want to be their therapist. And I think that in a sense that this comes up in discussions then in training that what is appropriate, well, my take is as long as you're working to help the supervisor with this particular clients, you're okay. So this particular client just elicits a lot of irritation and it just gets in the way. I think it's okay to explore a little bit about what that you know where that's coming from, how you can manage it and so on. But it's anchored in this client. It's not anchored in your bigger history and we're not going to fix it for other people. So is that making sense? Yeah, I think that that does make sense sort of the idea of sort of like we're going to talk about stuff in relation to your interaction with this particular client. So it keeps it kind of focused. I guess one of the things that I was thinking is you were talking earlier about the relationship is the right. So if the stuff that happens between supervisor and supervisee. So actually maybe this would be a good place to jump into supervisory ruptures. And if you could shed a little bit of light, you know, I had a couple of months ago on the podcast, we had an episode about Alliance ruptures. For you banks, I was really interested to watch that. Oh yeah, it was great. It was great. Yeah, since then me and one of my students, we've started a project looking at some rupture repair stuff. But anyway, but I was curious if you could talk about that within the context of supervision. Okay, yeah. And just as a by the by, let me give a plug for the International Interdisciplinary Conference on Clinical Supervision, which is next month at Rutgers University and Catherine U Banks is one of the keynote speakers. She'll be talking about this very topic. So for those of your listeners out there who can can be responsive quickly to scheduling trip to Rutgers, please, please think about it. So there's a lot to talk lately about, well, I'll be back up. So I think this, it might take is this begins again, the contract. I could be like a broken record about contracting, but you know, it seems to me, you know, we think about Ed Borden's notion of the Alliance. So, you know, agreement on goals, agreement on task, and then the kind of the bond that evolves out of that. I think the contracting process starts that as you start talking with each other, you know, what are we going to be doing together? How are we going to be doing it? That initiates that that alliance building process. And and I think there are a lot of steps we can take along the way to help ensure that that relationship grows and develops. I think again with the contracting process, there's the invitation to bring up issues as they emerge, you know, disagreements, conflicts, and whatnot. I think there's that Judith Beck, a protocol that I mentioned of checking at the end of sessions about how well things are going. And by the way, there's some there's some measures out there. There's the leads alliance, uh, in supervision measure, which is the three-odd measure, which captures relationships. So, you know, whether you use something formal like that, or just check in, I think is important to kind of head off the, you know, head it off before it gets big. And then I think the other, you know, along with that, then there's so much attention lately to the concept of humility. And, you know, this man applied, I think particularly to the multicultural orientation now, a lot of conversation about that. But I think even before that that, what we know in psychotherapy is that the most humble therapists tend to be the most effective. And there's several studies that bear on that, you know, there was some, some, some, some, some, some, and, and, I think, found that the most effective therapists were a little bit surprised at how well they were doing. Darryl Chao did another study with kind of the same findings that the most effective therapists were, oh, wow, really. And then there was the study, Liam Neeson, I'm going to, I'm going to get the name wrong. The group out of, or Lensky and Rana Stath, there's a group out of Europe that's been doing a multinational study. And I'm embarrassed, I can't think of the lead authors name on that. But they have a measure of professional self-doubt. And, and they're, and what they have found is the most effective therapists are high, score higher on professional self-doubt, which kind of, again, I see all those things as converging on the constructive humility that you just don't assume you're right and you're humble and always willing to, to take in new information. And to apply it to your question, then I think humility in our interaction with our supervisors, just, it's not assumed that we're the expert. You know, there's a lot of contextual pressure to make us experts. And of course, our supervisors do expect us to be competent in what we're doing. That doesn't mean that they don't bring things to the relationship that we should be paying attention to and particularly their reactions and so on. So I think, and that was kind of a long wind up to kind of a, a relational stance that we bring to the relationship, that humility. And then I think, and being willing to, along with that humility, is being willing to acknowledge that if there's some kind of a relationship challenge, that, you know, it's not necessarily the other person's fault that we have a role in it and be able to talk about that in a as non-defensive way as possible. And then to have skills like medical medication that we, you know, that we employ, you know, the, you know, skills we've learned from our work as therapists that we bring to bear on this. So be able to talk about what's going on between the two of us. So, and then you banks and and MIR and others have talked about other strategies as well. And I don't want to get too deep in the woods on this. But I think in general, those relationship qualities really go a long way. So one of the things I'm thinking about and sort of bring it together a bit is, so let's say that I'm a supervisor and I used to have, you know, a few supervisees a year or whatever. So I'm not a total novice. And I have a supervisee who is really not being very vulnerable. Like they're not bringing up challenges they're having. They're sort of closed off a little bit with that sort of stuff. And we're three, four, five meetings into it. And, you know, I have a norm reference to say like, all right, this is different. Like there's something going on here. Right. So in terms of the relationship, you know, in therapy, you know, sort of a therapeutic approach or, you know, a reasonable thing to say is, you know, we've been meeting for a while and it really seems like you're not bringing to sessions sort of the challenges and the struggles that you're having in therapy. Right. So right, that's the type of thing that one might say. Then I'm starting to think, but then does that start to get close to what therapy looks like? You know, because you could see how that, I don't know, and I would just be curious your thoughts about that. So in a teaching learning context, I think what you're talking, what you're doing is absolutely appropriate for you're inviting, you know, unless the person's willing to bring in their mistakes and to process them and feel vulnerable, certainly it overlaps with the relationship part, you know, is there something going on that, you know, they have some trust issues with you or, you know, or is it all about them? But I so I think being able to explore those things in the service of helping them have learning opportunities is absolutely appropriate and that and important to do. So that gets back to what you were saying earlier, at least who I'm trying to piece together where earlier you said when we were talking about that line between supervision and therapy, that focusing it, like keeping it focused on the client in that particular situation. So again, here if we sort of take that general framework and we say keeping it focused on learning, right? So it's not just you as a person and you're difficulty being vulnerable with others, but how this is working in this very specific context as it relates to learning. Yeah, yeah, exactly, exactly. I find that very helpful. Yeah, yeah, and and it is important to explore. So is it about that supervisee? Is there something about them? Is it affecting that and or is it about the relationship? And, you know, there's so much literature now on, you know, but supervisees don't disclose, you know, beginning with the classic study by Nick Laddandi and his colleagues, that's been replicated so many times that, you know, supervisees withhold information. I mean, and and they tend to withhold information about two things. They tend to withhold information about what they're doing with their clients and that's a little bit worrisome. And they also tend to withhold information about their perceptions of us. And, you know, to some extent, that's okay. And to the extent that it may be that they're having some reaction to us that's affecting how, you know, what they then do next in terms of being disclosed of and what not then maybe not so much. So, so the non-disclosures tend to be, you know, heavily correlated with the quality of the relationship. So I think working on those, you know, working on the relationship, those trust issues and so on, you know, ultimately enables them to disclose more, which means they get to learn more and so on. So it all kind of goes together. How do you think about how supervisors should provide feedback and evaluation to supervisees? Ah, great question. So in the learning partnership framework, I talk about, it talks about six primary supervision teaching interventions. And I did a pretty thorough review of the literature. I looked at as much of it as I could to distill what seems to be core teaching interventions. And, you know, certain and feedback and listening reflection are kind of the, you know, the foremost among those, but then we have other things like role modeling, I think behavioral rehearsal is underused with role plays and deliberate practice, for example. I think giving information is something we all do. And then I would maintain we also had the formally evaluation is also a form of instruction. It's kind of a different category. And where I'm leading with this is it, I have both feedback and formally evaluation as separate interventions in that. And I think the two conflated a lot. And I think that's not helpful. So, you know, seems to me feedback is, first of all, there's there's data showing that supervisors don't give it as often as they could or should. And that supervisees value it may be more than the supervisors value giving it. But feedback tends to be emergent and responsive to what's happening in their work. So as you're watching a video, for example, or if they tell you something, then you see an opportunity to present them with information that's going to help them get better. And by the way, I use the Hattie and Temporally Definition of Supervision, a feedback rather of looking for a discrepancy between current performance, ideal performance. But then there's an instructional aspect. You know, here's, here's what you did. Here's how it, you know, here's what it could look like if it were optimal. And here's how you get there. So I think feedback has those components. And but they're responsive to what's emerging from the material supervision. And they tend to be focused on a particular competence or set of small set of competencies. Formally valuation is something that occurs on a periodic basis. And it's a chance to look at the full range of competencies. And to really look, so here's how you're doing across the board. Here's strengths, weaknesses, how do you think, what's next for you and so on. So those are different conversations. And also, of course, formal evaluation has some potential consequences to the supervisor, especially if they're not doing well, and we hit, you know, that kind of gets us into our gatekeeping kinds of functions. So, you know, it has a different affective loading than feedback. And I don't think supervisors do, probably for all those reasons, the affective overlay and so on. I don't think Supervisor do a particularly good job. Actually, either the feedback or the evaluative part. So, what do you think that like what do you see as the primary gaps? Well, in the feedback part, again, I'll separate feedback and evaluation, also maybe the same dynamics at play. You know, I think, you know, there's some data show. So, Hoffman at all did a qualitative study some years ago in which they looked at how Supervisors give difficult feedback. And what they concluded was that in those moments, Supervisors tend to become vague and kind of pulled back their punches. Because we got in this field because we want to help people. We don't be nurturing and it doesn't feel right to deliver bad news. And so, you know, of course, the issue is that often what that means is often that the people who most need to feedback are not getting very clear feedback. And there's kind of a related phenomenon. There've been a couple of studies that are cross-racial, particularly of white supervisors holding back feedback to supervise these of color because they don't want to look racist or those sensitive kind of the same dynamics, essentially, of holding back information that would be helpful to the Supervisors. So, I think that's one contaminant is that, you know, the students who often need it most are Supervisors who need it most aren't getting clear feedback. And then there's the fact that we tend not to give it as often in general. So, if you were to speak, there'll be people who are listening, I'm sure, who have some struggles giving difficult feedback. So, if you were to give them, you know, one or two suggestions, what would they be? Wow, that's a great one. I think I think it has to do with, first of all, you know, having clear behavioral anchors for what you're of what you're going to give the feedback on. I think this gets us into the conversation about how we get information about our Supervisors that's, I don't like this now, that you know, a best practice is that we directly observe at least some of our Supervisors work. And so, you know, the literature on how we get that information shows that most Supervisors heavily grounded on Supervisory self-report. And, you know, that's challenging because, you know, no verbal accounting of what went on in therapy sessions is going to be fully adequate. You know, Supervisors are still learning. They don't necessarily know what's relevant to report. Supervisors want to look good so they selectively remember. So, there's a whole host of things to get in the way of relying on that. So, I think direct observation helps as well. So, I think, so then to kind of back to the point, then I think, you know, having clear behavior that you can point to, you can both verify that we're seeing the same things that we're talking about, having criteria that are clear and being able to talk about it, it makes all the difference in the world. And, you know, it's still, you know, we still have those interpersonal issues of not wanting to hurt the other person's feelings or worrying about coming across this racist or insensitive. I think those things are still in play, but it's so much easier if we can behaviorally anchor it and be looking at the same things. Do you think that this would be probably, this could be an overstatement, but the question is, do you think that supervision could be done without some sort of video or audio from the session? That's a little bit dramatic because, you know, obviously there would be exceptions to that, but, you know, as a general rule. So, so yet, sure, I think, well, first of all, I think there are different ways to directly observe supervisees. So, video recording is, an audio recording is one. We can, there's live observation. We can do that. We can do code therapy with them, which some supervisors do. And as a by the by, one thing I learned when I talked about going to Korea and kind of seeing the world in a different way after that trip in Korea, supervisees are expected to show up to sessions with a written transcript of the therapy session all annotated. And I'm finding the same thing in China. And I don't, I don't think it's cultural. I think it's just one of those things that evolved regionally, but I think it's an interesting way. And so, that's not a, you're not directly observing what's goes on, but, but you're getting a picture. It's clear enough. I think there's some value in that. And I think I've lost the thread. You'd, you'd ask about, oh, can you do good supervision without, so I think ideally that you get some, you know, you're able to at least see some of what they're doing. It doesn't have to be video. I think we also get an awful lot out of self-report. I think, in part, it depends on the competency. So, if we're dealing with issues of counter-transference, some of that you can pick up with video recordings as you watch the recording and say, you know, have you noticed that, you know, with this client, you tend to go over time every week, or you know, it's behavioral indicators. But so much of what we deal with with counter-transference is self-report. And we can't, so, you know, as the supervisor comes in, says, you know, this, I just dread seeing this client, you know, I've got to see him again Tuesday and it's just not a pleasant experience. And, you know, I want to talk about that. So, so yeah, so I guess the qualifier there is it kind of depends on what, what area of competence we're working on. So, self-report becomes, you know, really essential. Can you talk about collaborative evaluation? Sure. Yeah, and I would maintain, well, at least in my mind to kind of track what you might mean by that, is that, you know, again, the the guiding aspiration of no surprises, I would maintain that, you know, the ideal would be that you're giving feedback all along. So, by the time this supervisor gets to the evaluation session, they've got a pretty good sense of what you think of their work. So, and so that, and that kind of collaborative in that sense. But the other thing is that I would, you know, I would hope that a supervisor would show up for that session having self-evaluated. You know, for a couple reasons, one is that's really the ultimate goal of training is that supervisors, you know, once they become professionals, have to self-evaluation skills. So, I think anytime we can reinforce that by asking them to, to do that helps. And then it helps inform the conversation during the session. So, so for that evaluation session, whatever it occurs, you know, the term, whatever supervise you should come in, having self-evaluated, you should have evaluated it, and then have that conversation and discuss whether discrepancies and so on. So, is that what you were thinking of for collaborative evaluation? Yeah, and so I guess there's that, then I was also wondering about the supervisee providing feedback to the supervisor. Oh, absolutely. Yeah, that's what I was getting at with the checking in at the end of each submission. And by the way, when I would maintain that, when you do the evaluation session, that's another opportunity that we go through, where you're going to talk about you, the supervisee, what you're doing. And then I always end those sessions with, you know, so we've been talking about you, but you know, I'd like your feedback for how this experience has been for you, what's worked, hasn't worked, anything I should know. So, so that we're both learning from each other. One of the things that we're having a conversation about as a program now is what it comes to students, her supervisees, evaluating supervisors. Should we have the, should there be an expectation that the supervisor sits down with the supervisor to go through that evaluation with them? Ideally, yes. I think if you have a supervisor who's open to feedback and has been soliciting on the way, again, the no surprises rules should work both directions here, the supervisor shouldn't be surprised. Ideally, the supervisor shouldn't be surprised, although they've got the, they have a burden to help make sure that it doesn't happen. So, again, I would think if you're checking in regularly with the supervisor, so they have a chance to tell you what they're not liking or what needs to be fixed, when you do that summative evaluation of you at the end, it shouldn't be a surprise to you and you should be able to talk about it. That's the ideal. I think then we have the supervisors who aren't as evolved, who may be punitive, and I think that becomes, I think the burdens on the program at that point to be monitoring for those, to make, to do your very best to make sure students are being assigned to those people, because if you've got a supervisor, it's the worth that the supervisor is going to have difficulty having those conversations with, I think that should be a red flag. Yeah, that's sort of where, at least where I've come down on it, is that sort of like, typically that there's value in having those conversations, and then for the outlier case, then you know, we can be a little bit compassionate to the student and figure out, you know, and maybe not have that same expectation. So, you've talked about it a little bit, but I wanted to sort of follow up on sort of universality versus cultural specificity when it comes to supervision. Okay. Yeah. So it seems to me that, you know, there's some practices we have in the US that other people don't, that do we see a central to our work that doesn't pertain to other countries. So, gatekeeping, for example, is a big deal here, and we really expect it in other countries, and particularly countries where they haven't really developed the infrastructure, like in China, there's no licensure yet for psychotherapists, and the training programs have different structures. So, gatekeeping really isn't possible in the way we know it here, and the same thing in Latin America and other parts of the world, I'm sure, that I haven't had a chance to get involved in. So, I think, so that's one distinction. Something that's so central to our identity is supervisors here, doesn't pertain elsewhere, and I'll start with things that are different, and I'll get back to your question about what's core. Another thing that other countries do is that the supervisors will pay for their supervisors. So, in China and in Latin America, there are people who are in private practice who, you know, contract with supervisors. So, supervise comes in and gets supervision and pays you for that service that does lead to some interesting issues about power dynamics, so that I think the supervisor, you know, it delutes the kind of power we usually think of having. So, the supervisors in those contexts sometimes withhold negative feedback, because they don't want to piss off the supervisor, who's going to fire them and move to another supervisor. So, I think those are some differences, but I think the things that are central to the process everywhere is I think these teaching learning processes that I talked about, and the importance of the relationship. And I think the relationship, there can be different nuances across cultures, but still the rock bottom point is that the super, there needs to be a relationship of trust and mutual support. So, I think those are foundational and that the goals are the same everywhere in terms of wanting to, you know, turn out competent professionals. So, I think we take it at those really broad levels of, you know, the kind of teaching processes, the kind of relational focus and the goals of training. I think those are pretty similar. How do you think about the trajectories of supervisor's development? I'm trying to try and put that in the framework here. You know, it seems to me that, and we published an article on this some years ago. I think there's a trajectory. It's not just about skills, it's about a developing sense of identity. Diane Borders talks about the trajectory of thinking like a supervisor so that, you know, when you're a beginning supervisor, you know, you might be prone to referring to your supervisors as my client. Soops, I mean, my supervisors. So, you've internalized the sense of, you know, who does your working with in your goals? That there's, you know, kind of an evolution of confidence that, you know, I guess true in learning any new domain of practice is feeling confident what you're doing. And that takes some time and, and evolve. So, I think those are kind of the two big ones. That kind of sense of identity, thinking like a supervisor and then having the competence to, not only competence, but then the confidence to exercise that confidence or kind of the main themes that affect that. I think in preparing for this, I hadn't really thought about supervisor development. And, you know, I wonder if you actually, you know, if you, when you talk to supervisors, how much they think about that, you know, because I mean, I think that all people, all therapists think about, especially in training about their development to getting better and feeling more comfortable and all that sort of stuff. But in, I was like, oh, yeah, I guess, you know, and this gets back to thinking about supervision differently than it used to be thought of, right? And so it does make sense. So it was, it was interesting thinking about that. And for supervisors, the value of supervisors being self reflective and thinking about, you know, their own struggles and supervision. How can I get better at this process? Yeah. Yeah. And it does seem to me that even this goes back to our earlier conversation about training that even though courses are now being offered in supervision, I think that next step of heading supervision of supervision, it is, you know, less of that's occurring than there are courses. So that's a big, big step getting supervised. And then as you were talking, I was remembering, so Cal Stoltenberg and Brian McNeil and the integrative developmental model have talked about supervisor development. And I remember one thing they talked about is that, you know, they talk about three levels of supervisee development, the first level being the supervisor, really is heavily dependent on the supervisor and really wants a lot of kind of direct teaching. Just tell me what to do kind of stuff. And I may, this may be an inaccurate memory, but my memory of what Cal and company talk about is that that that's an ideal match for beginning supervisor because that the beginning supervisor is inclined to want to be in charge and be the teacher and whatnot. And I don't know, the first law may be misremembering that. The other is, I think that'd be an empirical question. I don't think once actually looked at that, it would be a good question. So before we start recording, one of the things that we briefly touched on was how supervision relates to therapist expertise and that sort of stuff. So what are your thoughts about that? That is an interesting, interesting and I think an important area. So you know, we talked about how I developed my interest and kind of my career trajectory with supervision. And I think an important piece I left out was that back in the late 90s, Jim Lichtenberg pulled together a group of us and we would meet at least annually, Bruce Wampold, Terry Tracy, Jim, me and for a while Chuck Clayborn. And I always felt like I was kind of the dummy in the group. These are just incredibly bright people with great ideas. And so we would get together, we would play, we would, you know, one trip we took to the Virgin Islands and spent a week on a sailboat and did this or anything. But also some really neat ideas came out of that and I'll credit with Terry with having the idea of really wanting to run with the work on expertise. And we ended up publishing an article in the American Psychologists in 2014 in which we took the stance that it's almost impossible as a therapist to become an expert. And without getting into all the nuances, you know, the punchline really is that super, we don't as therapists get good immediate feedback on our work to be able to correct it and fine tune it. And the data show by the way that Simon Goldberg's done one of those studies, there's been another more recently from Europe showing that therapists tend not to get better over time without that extra, you know, without those kinds of feedback options. And I think more recently, some discussion about delivery practice. So, so that's really been a very interesting thread for me lately and it's helped me think about competence, for example, because the site guy's right now in psychology is competence. And I think it's a good path. Competence based training forces this to articulate our goals, like what are we working toward, how are we going to measure those, how we're going to hold each other accountable, all of those things that go with that. The data though don't support the therapist competence relates to treatment outcomes when you measure by, you know, client improvement, which I think, you know, and people are often surprised to hear that is, oh my god, there's there's not a relationship. Well, there's, you know, some explanations for that that we need to get into, but, but it does lead to some interesting questions, but if that's not, if that's not the case, then what do we do next? And I think that's where, you know, the, that whole thread that's terry started around expertise comes to play, which is there's competence and, and then there's expertise competence is, um, competence is something that's agreed upon through consensus. So kind of the wise elders in our profession get together, they have discussions and, you know, to some extent, those are grounded in empirical work, but most of us consensus, you know, this is an important competence. This, so it's about consensus and in many respects, it's an aesthetic is kind of like, uh, in the Olympics grading, ice skating, we're at the end of the, the routine, the judges hold up a little number, uh, as a score. And I think competence has that same kind of quality. It's important is something to be striving toward. Uh, and I think, you know, we're working with students. That's great. I think a next step then, uh, and it's a good question that how to get there is, uh, is working toward actual expertise. So that, uh, again, if therapists tend to plateau pretty early in their careers, how do we get them off that plateau? And I think we, we don't have a good answer for that as a field. I think we don't have the structures in place to encourage it. I think it takes, you know, a lot of hard work and commitment that we don't have the structures in place to reinforce. I think the work on deliberate practice has been kind of an exciting development. Uh, but it hasn't, you know, and it's, it's still new and kind of it's, it's being worked out as to how it applies and, and should be used. Uh, but I think it's probably our, at the moment, our best avenue forward as we look toward expertise. Um, but again, we just don't have the structures in place. They really, really realize on, uh, the people who have the most energy and commitment to developing their skills or the ones are going to pursue that. Uh, and maybe those are the, be the ones who would have done best anyway. Uh, so I think there's a confound of, you know, self-selection. Um, so did, did that make sense or did it? No, I mean, I think it makes a lot of sense. I think the question that I'm with is, you know, so where does clinical supervision fit in? And, you know, so, uh, just, well, uh, uh, I won't hold you to anything. Um, what are some thoughts you have about where clinical supervision could fit in to facilitate expertise? Uh, again, and, and by the way, we, uh, we just, uh, did a chapter on expertise. It was Bruce and Scott Miller and Jim Leicester, Bergen Terry, Tracy. Um, which, which was an opportunity to have some great conversation about where do we start this? And Scott, uh, I'm sure he'd be okay with me saying this in, in a public forum is of the stance that we don't start with competence, that we really, that each training should be individualized and driven entirely by, uh, people's, the, the clients' response and the therapist and you fight, you know, so every training is highly individualized. Um, you know, I, I, my take is different. My take is, it's useful to have goals that are kind of standard across trainees that, you know, we should have, you know, certain relationship skills. I think we can probably all agree on, uh, certainly ethical and legal behavior. We, you know, there's certain things we just absolutely should insist on. Uh, and, you know, what we're working with trainees in graduate programs, that's that may be enough. Uh, we need to get them to the point where they're not going to harm the public and that's really what we're working towards. I think for going beyond that becomes more challenging. Um, and, and I know one person who's trying to, trying to work on this is Tony Ruminier. Tony, uh, Tony is one of the most entrepreneurial people I know. Tony has found the his own university, sent to university, which has just been, uh, approved by the state of California to offer graduate degrees. So, uh, they've got a graduate program in Merchant Family Therapy, uh, that is based entirely on, uh, deliver practice models. So, uh, so what Tony's trying to do is to put into play this thing that we're talking about here that deliver practice is so central to, uh, everything they do that, you know, presumably they're going to be different kind of outcomes. And, uh, and we haven't defined deliver practice. So, just quickly for, for those who aren't familiar with it, uh, is a concept that came out of the work of Andrews Erickson back in the early 90s. Uh, and, you know, and deliver practice is something that athletes and musicians have done for centuries, that, uh, it's a matter of taking, of isolating a particular skill and practicing it in isolation from your usual routine over and over and over until you get good at it. They usually under this tutelage of a coach or a supervisor. So, uh, you know, so an Olympic athlete will spend thousands of hours in, you know, deliver practice of, you know, basketball dri- you know, dribbling and shooting baskets and over and over again are figure skating. Uh, all- all those things that go on, in the athletics and in music, it's practicing, uh, by yourself and so on. And, and what Erickson demonstrated in his similar article in 1992, uh, was that, uh, the very best musicians who graduated from, uh, I'm beginning to name Berlin Music Academy. I'm going to butcher the name. Um, that the very best graduate was the ones who went on to become concert level performers, had put in, um, much more time and deliver practice than, uh, than others. And, and, and he, he's got a graph in the article. You can see the ones who went on to become concert level. Those who went on to become teachers, those who just became hobbyists. Uh, and, and it all, it has, he maintains that, you know, the, the defining variable is the amount of time put into deliver practice. And so, uh, it didn't, so it's pretty new to apply that then to therapy. And so, Daryl Chow, uh, and his dissertation, which was later published, uh, looked at that and found that, uh, the very best therapist put a lot more time into deliberate practice, uh, than the less effective therapist. See, and he talked about super shrinks. Uh, and, and so that was really, you know, that was really the article that's kind of brought that whole domain into, uh, psychotherapy training. And, and again, the elements then are isolating a specific skill, uh, practicing it over and over again, separate from your individual practice, uh, and, and having a coach. And, um, and, and, and, and just one quick example. So, uh, some years ago, I had a master student who was struggling with an issue with a client. And I was working with Tony and I thought it'd be fun to connect him and her. So, uh, Tony worked with her, uh, wait, those days was my Skype, brothers, and zoom. And, uh, you know, and the issue you had to do with the client who's having difficulty, expressing affect. And the student was new and kind of hesitant to push for it. So, Tony's scripted her, uh, you know, they worked out the wording and I think it was something the effective. Is it so difficult to express your painful feelings? So, once they'd agreed on that, uh, my student then would play the video, stop the video, say those words, play the video, say those words. And each time Tony would say, how did that feel? How did it feel this time? So, it, it's repetitious, not a lot of fun. Uh, but that's an example of deliver practice, this tailored to the, the supervisees needs. Uh, and boy, I went on way too long on that. So, let me just back up and see what, what I need to do to clarify any points. No, I mean, I think it makes a lot of sense. It provides a different way of thinking about what supervision looks like than how I would say typically it looks like. Um, so one coincidentally, uh, Tony's going to be the next person I talked to on the podcast. Oh, wonderful. Yeah. So that's kind of funny. Um, we know one of the things I'm working with, uh, collaborator and there are people all over the world doing this right now, but using some AI stuff to sort of facilitate these types of trainings where, you know, one of the challenges that we have unlike in sports where you can simulate lots of different things, which can still be sort of challenging, but, you know, you can, you know, you can use a pitching machine to throw the curve, the high, high and inside curveball or the, you know, you can do those things to simulate what it's like in a game, um, or, or in chaser or in many, many professions in psychotherapy. It's so challenging because you just, you know, you can do mock therapy, but it's not the same. And it really, you know, it's very different. And even when you do mock therapy, you still need another person there. So one of the things a colleague and I are working on, we're playing with some of the AI models to create, um, uh, sort of specific clients who are, who are, who are engaging in certain behaviors. So that way, and then with, obviously, the expectation that the, the student will then, you know, learn to respond to that specific client. And the nice thing is you get these, and using these, we're just doing a, um, voice, you know, a voice, uh, GPT. So it's not, you know, you can't see a person's face, the client's face, but you hear their voice. It's, you know, the voice sounds like a human. So, you know, it's very real, but it creates it, but you know, it's not going to be the exact same, quote unquote, recording every time. And the person, you know, you can program the, you know, the AI client or, or patient to respond in certain types of ways, but it's not a verbatim. So you get a little bit of variability there. Right. So the idea that, and then at the end, we actually programmed it so that it would give the student feedback, um, on what they did and whatever. Anyway, so all these things that limit, what's that? You can share with us. Yeah. Well, eventually, we're working on it. So we sort of have a little in-house model and we got to figure out all the nuance of it, but it's really easy to do just like, so like I did it for me just to try it. Like, how can I create? And then, um, so it's nice because the idea is a student or, I mean, hell, it doesn't have to be a student. It can be someone 15 years out. And they really struggle with, oh, older men who have these sorts of angry responses, right? You could create a simulated patient that's an older man that has certain type of angry response and you have the opportunity then to just respond to it over and over and over again. And they're going to respond back to you, right? So it is dynamic and it's pretty, I mean, it's very realistic. It's not perfect, but it is very realistic. And so you're able to do it without burdening another person, which is nice, but it feels mostly like another person. And I'm able to fail in private, you know, which is great. Because then I'm just more likely to just fail. It still feels uncomfortable. But anyway, so it's just sort of as you were talking, I was thinking about it. And I do want to be kept abreast of that's exciting stuff. And it made me think of Bruce Wampol's work with Skill Setter. I'm familiar with it. Yes. Skill Setter is an online deliberate practice platform where you have little vignettes where, you know, person talks to you, you know, a little one minute vignette about some issue. And then you, you give your verbal response back according to some criteria. And I understand I haven't looked at it lately, but I understand from Bruce that they're now using AI to score it and give feedback. So I think AI is just going to be a game changer in so many ways. Yeah, I completely agree. Because it's just as a therapist, how do you, how do you practice these simulated set? It's just, you know, so we actually have some tools to do it in, you know, reasonably efficient ways. So, okay. So before I let you go, just a couple, let's do a couple quick hits if you don't mind. Okay. Very applied. So they disagree, very anecdotal. Okay. But if there are one or two things that you would tell clinical supervisors to stop doing things you see clinical supervisors doing, they're like, yeah, we might be better off if we did a little bit less of that. Or maybe things that are getting in the way. What would those be? And I'm going to do the other side of that coin too, which is one or two things that you would tell clinical supervisors to do more of. And you know, there are, that you know, the great clinical supervisors already aren't doing these things or are doing those things, right? But just generic feedback for the supervisor who's listening. So, so I've thought a lot more about the second of those than I have first. So the second of those, you know, the there's a whole list, I think of, you know, best practices that aren't being practiced. And I think, you know, for example, contracting we talked about directly observing supervises, at some point, I think, being able to give effective feedback and evaluation. There's a list of those kinds of things. And I think that I hadn't thought so much about the flips. I've what not to do. I think the what not to do is that immediately come to mind are all relational that to what not to do don't come across as, you know, needing to be the expert and and not allowing your supervisor to have input into the relationship and to not to don't be defensive if you get negative feedback. I think it again, those are those are the ones that come in most of mind. It's a great, great question. I'm going to continue to think on that after we hang up. Okay. Okay. So the other applied question is you have a student, a supervisor. So it doesn't necessarily be a student, but a supervisor who's struggling with their supervisor. How do you, I know there's a lot of nuance here, but what would you tell that student in terms of how to address it with their supervisor? Yeah. It depends on it's one of those it depends questions. Yeah, of course. Of course. Of course. If the if the relationship solid and if we know that the supervisor is someone who's going to be responsive, you know, absolutely, you know, what my default is, let's, you know, go talk to the supervisor and raise that and hope that the supervisor is that type. And if you have some evidence that the supervisor is going to be punitive and not respond well, then I think this is where it's important that to kind of be thinking in terms of training systems that you should in our country, usually supervision, at least during graduate training, isn't occurring in isolation. There's a training system. There's a, you know, training director in the program. Someone that the supervisor can go to to to get consultation and advice and, you know, in worst case scenarios, because there are harmful supervisors out there. My, my Allison's team of demonstrating a non-tribute subset of supervisors actually harm supervisors. And if it's one of those, then I think having, you know, someone higher and someone else in the food chain, someone else in that training system to intervene on their behalf is so important. So, so that's kind of the it depends. So ideally, encourage the supervisor to have the conversation with the supervisor. But if that doesn't look like it's going to go well, then, then look to other sources. Makes sense. So one thing I ask everybody is, if you've gotten any pushback for your work? No, not really. I think I've been fortunate to be in an area where everyone agrees that this stuff is important, whether they're doing it or not. It, you know, does it different matter? I think, you know, there's some of the issues around expertise and competence we talked about has met with some resistance and pushback. You know, people are always surprised to learn that they aren't, you know, if they're the average therapist, they're probably not getting better. And the competence is not going to predict that they're doing better and so on. So kind of at those, you know, at that very specific kind of domain level, there's been, it's not so much pushback, but are, well, arguments, yeah, I think so. But in terms of the overall picture, I think people embrace the concept of what we're doing, it's just whether they're following through and doing it or not. Right. And are there for folks who are listening who want to learn more about your work, other than your book, which I'll link to, are there one or two resources that you'd like to need a point folks to? Great question. I can make available a draft of, again, the seventh edition, still evolving, but the chapter where I talk about the new framework, I can give you a link to it and we could send it out. Also, just because we kind of tiptoed into that expertise area, we have a, Bruce is the lead author on the chapter we've got coming out in the new Cambridge encyclopedia, Cambridge Handbook of Expertise. And I can make that available. Because I think that's interesting stuff because it kind of parses some of the stuff we talked about. Ladies and gentlemen, Dr. Rod, good year. That's a wrap on our conversation about clinical supervision. As I noted at the top of the show, be much appreciated if you spread the word to anyone else who you think might enjoy it. Until next time.(upbeat music)[Music]

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Dr. Dan Cox

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Dr. Rodney Goodyear

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