Clinical supervision is a daunting task and therefore those performing such duties require nurturing.  Prioritizing training and supporting the people who are the teacher-coach-mentor-consultants to newly assigned staff requires a concerted effort by everyone involved in the process.

Introduction

Embedded in supervision is the role of the supervisor, as a motivator, who encourages subordinates to carry out the organization’s plans and policies at the operational level.  Clinical supervision, however, focuses on the intervention from a senior member who cultivates knowledge and experience in a junior member of the profession.  According to Bernard and Goodyear (2004), clinical supervision foments a relationship that is evaluative in nature, extends over a period of time, and enhances the professional functioning of clinicians. Moreover, SAMHSA’s Treatment Improvement Protocol No 52 (2009) posits that clinical supervision provides a bridge between what counselors learn in the classroom and their clinical practice.  As a result, clinical supervisors are tasked with translating theory to practice. Regardless of which operational definition we use, clinical supervision is an essential part of the development of new and seasoned counselors.

The Substance Use Disorder profession (SUD), as does the counseling field in general, strives to balance the provision of great services, implement sophisticated interventions, and cultivate evidence-based knowledge in newly assigned personnel. This balancing act is accomplished primarily by clinical supervisors who are often saddled with administrative duties, tasked with the responsibility of maintaining staff morale, while ensuring that subordinates stay on task.  How do overworked SUD professionals manage these tasks and provide great clinical supervision? A question many supervisors in the field ask themselves.

An imperative question relates to what clinical supervision really entails. Not understanding the importance of clinical supervisors in the workplace can lead to confusion, stress, and ill-prepared staff. Thus, newly assigned SUD professionals often feel overwhelmed due to a lack of appropriate or sustained level of clinical training. This pervasive deficiency in clinical oversight can adversely affect the supervisor-mentee relationship.  Hence, this potential clinical deficit can leave newly assigned counselors floundering to learn new skills from ill-equipped peers or overwhelmed seasoned counselors who lack supervisory experience. This perpetuates misinformation used to treat clients in the throes of substance use disorder and can lead to poor quality of care, program failure, problems with retention, and low morale.  What can we do to remedy the problem?  In order to answer this question, we must first define the role of the clinical supervisor.

Role of the Clinical Supervisor

Clinical supervisors wear many hats in the organization.  According to the Substance Abuse and Mental Health Service Administration (SAMHSA), the most important hat is a hybrid that encompasses the roles of the teacher-coach-mentor-consultant.  The literature on clinical supervision outlines the synergy between these roles and demonstrates how professionals in the SUD field embody these roles. Each role is interdependent and offers a holistic approach to staff development.  The following is a synopsis of each role: 

  1. The role of the teacher is to identify learning needs and gaps that present as opportunities for professional development.  In turn, the clinical supervisor assist the trainee to develop professional competence, which is periodically assessed to determine if the trainee has met agreed upon milestones.
  2. The role of the consultant is to monitor performance and provide potential solutions by encouraging dialogue.  The supervisor-consultant constantly assesses programmatic needs and how staff perform key tasks. Moreover, the supervisor acts as a fiduciary that ensures the clinical integrity of the program and the wellbeing of the client.
  3. The role of the coach is to provide support, morale building, and encouragement.
  4. The mentor models professional behaviors, clinical expertise, and quality care for the mentee to follow. In turn, mentees model these behaviors for their clients and other counseling professionals.

Quality of Care

Recidivism or the return to substance abuse following or completing addiction treatment is of great concern.  Some researchers estimate that between 40 and 60 percent of individuals relapse after treatment.  Moreover, according to statistics reported in 2019 by the National Institute on Drug Abuse (NIDA) the recidivism rate among individuals living in California was approximately 46.5 percent. These numbers are staggering and begs the question: Is there a nexus between quality of care and recidivism?  In other words, is recidivism a result of poor quality of care?  It is commonly known that recidivism is a part of the disease process; however, we also know that a number of other elements play a significant role in relapse.  Delineating each element is beyond the scope of this article and it is not the intended purpose of the article.  Thus, we will focus on the role of supervision in ensuring quality of care and best-practice interventions in mitigating or reducing recidivism.

In the introduction I mentioned that the role of a clinical supervisor is to pass on new knowledge to junior counselors.  What does this mean?  These professionals interpret and impart information and skills-based knowledge to newly assigned subordinates.  This knowledge is passed on through experience or education and is the theoretical or practical understanding of a subject.  Experienced clinical supervisors are better equipped to interpret and translate theory/evidence-based knowledge into clinical best practice for addiction counselors who are new to the field.  This does not imply that more experienced SUD professionals do not require continued training and supervision to enhance their professional skills.  In fact, client retention, decreased recidivism, and overall program success depends on a cadre of well-trained individuals.

Helping Clinical Supervisors

Clinical supervision is a daunting task and therefore those performing such duties require nurturing.  Prioritizing training and supporting the people who are the teacher-coach-mentor-consultants to newly assigned staff requires a concerted effort by everyone involved in the process. We can begin by understanding and implementing the following: 1) Clinical supervision and administrative supervision are very distinct processes.  2) While administrative supervisors further the organization’s mission and vision, clinical supervisors integrate program goals with evidence-based clinical skills to further clinical practice.  3) Clinical supervisors sharpen their ethical decision-making skills in order to address ethical dilemmas that arise in course of providing counseling.  4) Supervision and staff development are a must if you are a new clinical supervisor 5) Supervisors provide mentorship to others and should also receive mentoring.

In conclusion, clinical supervision is at the heart of providing quality care for individuals suffering from addiction.  Creating a pathway to ensure appropriate provision of care begins by placing properly trained clinicians in positions of supervision. Organizations that invest in current and future clinical supervisors will ensure a return on their investment in the following ways:

  1. Better quality of  treatment interventions
  2. More tools to appropriately measure outcomes
  3. Professional, succinct, evidence-based and accurate clinical documentation 
  4. Proper risk management to mitigate potential harm to client
  5. Decreased recidivism and increased successful program completion

Dr. Jessica Rodriguez
LAADC-S, ICAADC, MAC, SUDCCIV-CS, BSP, CTRTC, CIP, CTP, CTS, FSS

Dr. Rodriguez was named the Executive Director of Gateway Corp in 2012.  Gateway Corp was developed as a non-profit, public charity and founded October 27, 2011. November 2014, she developed a clinical hub for Gateway Corp called OnSite Strategies. OnSite is also a United States Trademark.

She has held the position of CEO, Clinical Director, Lead Educator and Clinical Trainer as well as the Clinical Business Developer. She has fulfilled the roles of a clinical consultant, professional development consultant and has clinically supervised many SUD/addiction counselors, mental health professionals and addiction and family interventionists for over 12 years.

She has been active in the mental health field since 1995. She has also clinically trained throughout the US and provides clinical oversight for several organizations in California.

Dr. Rodriguez released her first book, “When the Rainbow Ends a Shadow from Heaven Appears” in 2017.” Her newest book, “The Cart, From Adversity to Collateral Beauty” is scheduled to be released in the Fall of 2022.

Dr. Rodriguez is currently a writer for Rapporteur Magazine. Her focus is about Mental Wellness also covered topics to include ACE’s, trauma, anxiety, and Systemic Racism.

Adriana Popescu, Ph.D.

Dr. Adriana Popescu is a licensed clinical psychologist and empowerment coach with over 25 years of experience in the mental health field. She specializes in treating addictions and trauma, and has directed a number of treatment programs in the San Francisco Bay Area. She is the Founder and CEO of Firebird Healing, a trauma healing program, and the Clinical Director at Avery Lane, an innovative and holistic treatment program for women with co-occurring addiction and mental health disorders and trauma.

Adriana has contributed to a number of books, including TJ Woodward’s Conscious Being Workbook, the Conscious Recovery for Addiction and Conscious Recovery for Mental Health Workbooks, and the Conscious Creation Workbook, all of which she co-authored with him.

She has a private practice in San Francisco and travels around the world speaking, coaching, and facilitating transformational and empowering workshops. She also hosts a fascinating podcast called Kaleidoscope of Possibilities – Alternative Perspectives on Mental Health.

Adriana loves to bring the most innovative and effective tools to her work, empowering people to overcome their imagined limitations, release their self-judgments, and discover the brilliance within – creating a life of infinite possibilities.

Her first book, “What If You’re Not as F*cked Up As You Think”, was released in October.

Aven Armstrong-Sutton, Ph.D(c), RSW

Clinical Services Manager at Kinark Child and Family Services

Aven L. Armstrong-Sutton has been a practicing licensed social worker for over a decade. With diverse experience in settings such as health promotion, foster care, youth homelessness, outpatient mental health & addictions, and student support services, Aven currently serves as a Clinical Services Manager at Kinark Child and Family Services, managing a Live-In-Treatment Program and three outpatient treatment programs. Maintaining a part-time private practice, Aven’s multidisciplinary and integrative approach focuses on trauma and resilience among under-served communities.

June Price Tangney, Ph.D

Dr. Tangney received her Ph.D. in clinical psychology from UCLA. She is currently University Professor and Professor of Psychology at George Mason. She is a Recipient of International Society for Self and Identity’s Distinguished Lifetime Career Award and Fellow of the Association of Psychological Science and of APA’s Division of Personality and Social Psychology.

Dr. Tangney is coauthor (with Ronda Dearing) of Shame and Guilt, coeditor (with Ronda Dearing) of Shame in the Therapy Hour, coeditor (with Jess Tracy and Richard Robins) of The self-conscious emotions: Theory and research, and coeditor (with Mark Leary) of the Handbook of Self and Identity. She has served as Associate Editor for Self and Identity, Consulting Editor for Journal of Personality and Social Psychology, Personality and Social Psychology Bulletin, Psychological Assessment, Journal of Social and Clinical Psychology, and Journal of Personality, and is currently Associate Editor of American Psychologist.

Her research on the development and implications of moral emotions has been funded by NIDA, NICHD, NSF, and the John Templeton Foundation. Currently, her work focuses on moral emotions among incarcerated offenders. She draws on theory and research in psychology and criminology to develop novel interventions that leverage inmates’ moral emotions and prosocial values. A recipient of GMU’s Teaching Excellence Award, Dr. Tangney strives to integrate service, teaching and clinically-relevant research in both the classroom and her lab.

Christina Veselak, MS, LMFT, CN

Founder and Director of the Academy for Addiction and Mental Health Nutrition

Christina T. Veselak, MS, LMFT, CN, is the founder and director of the Academy for Addiction and Mental Health Nutrition, which teaches practitioners around the world how to use diet, along with amino acid and nutrient therapy, to help prevent cravings and recurrent drug use. She has been a licensed psychotherapist working in the SUD treatment field since 1985 and a certified nutritionist specializing in mental health and addiction recovery since 1993.

Sean Bezdek, LMFT, MBA

Sean is a licensed Marriage and Family Therapist with over 25 years of experience working in mental health and substance abuse settings, in inpatient, PHP, and private practice. He holds b a master’s degree in Marital and Family Therapy from Philips Institute and an MBA from Baker College.

Sean’s clinical practice has specialized in working with Personality Disorders, Couples, Adolescents, and individual suffering from chronic mental illness. As a clinician Sean enjoys working with clients who can be resistant to traditional treatment and believes in the philosophy of “You can lead a horse to water, but you can’t make them drink. BUT you can feed them saltines to make them thirsty!”

Sean is the Program Director for Akua Mind Body’s Sacramento inpatient mental health program. His prior leadership experience includes oversight of acute inpatient, utilization management, hospice/palliative care, home health and skilled nursing. Sean’s approach to management is to ensure the work that needs to get done gets done. “Our job is patient care. This include everything from making coffee to running groups. There is not one person who is more important that the other when it comes to providing exceptional care to the clients we serve.”