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My blog for health care providers using MI about the process of change!

High Stakes: Using MI-Based Clinical Supervision to Motivate Clinical Supervisees to Change

Over the years, I have noticed that many workshop attendees are interested in learning more about Motivational Interviewing (MI)-based clinical supervision. I certainly enjoy discussing MI-based clinical supervision strategies with supervisors, especially as it relates to decreasing supervisee reluctance to change or parallel process in supervision…so it’s a perfect match! 
Like clients or patients, supervisees can be ambivalent about change. Many providers wonder, “How do I motivate my supervisee to change her reaction to client avoidance?” or “How can I help my supervisee to increase his awareness of countertransference (or transference in supervision)?”
These are certainly difficult discussions to have with supervisees. It’s hard to predict how the supervisee will respond, especially as supervision is an evaluative relationship. Plus, it is so easy for supervisors to lose grip of empathy when we feel frustrated with our supervisee’s reluctance to change (especially when they’re practicing under our license!) or when an impasse occurs in supervision. The stakes are high!
Research has documented your struggle, supervisors. Supervisees often have difficulty listening to feedback even when it is constructive (Sobell, Manor, Sobell & Dum, 2008). Like clients, supervisees need a supportive and reassuring climate to accept and eventually assimilate feedback (Ladany, Friedlander, & Nelson, 2016).
MI-based clinical supervision has been shown to decrease supervisee “resistance” or reluctance to change, especially when there is a discrepancy between the supervisee’s observed and self-assessed skills (Sobell, et al., 2008). Like MI practice with our clients/patients, MI-based clinical supervision honors the supervisee’s capacity for growth and self-direction. This method emphasizes the supervisee’s strengths and efforts to change.
This supervision model also acknowledges that the supervisee ultimately decides whether or not to incorporate feedback from the supervisor. One way I use MI-based clinical supervision is to create an atmosphere that makes it more likely for the supervisee to be open to change using a supportive, empathic, and collaborative way of being, and by strengthening change talk.
Here are some examples of how to use open questions to elicit supervisees’ change talk:

  1. Tell me about a previous time when you found yourself feeling as powerless as the client/patient. How did that feeling affect you? How did you address this in supervision? How were you able to work through this feeling to help the client/patient? These open questions are designed to: 1) elicit responses from the supervisee; 2) increase the supervisee’s awareness of strengths; 3) strengthen the supervisee’s confidence to change.

  2. If you choose to do nothing about these feelings toward the client/patient, where do you think that might lead you? This open question is designed to: 1) develop discrepancy for a supervisee who is in the Pre-contemplation stage of change; 2) tip ambivalence about countertransference in therapy toward change.

  3. How would you know when it was time to manage these feelings in a different kind of way? Another open question to develop discrepancy for a supervisee who is reluctant to change countertransference in therapy or transference in supervision.
Of course, it is also important to use these questions with a nice balance of empathic reflections to convey understanding (MI benchmark: 2-3 Reflections to every questions and no more than 3 questions in a row).
I hope this has generated some ideas about how you might integrate MI into your supervision style. Try it out as an experiment and see what happens!
Ladany, N., Friedlander, M. L., & Nelson, M. L. (2016). The critical events in psychotherapy supervision model. Washington, DC: APA.
Sobell, L. C., Manor, H. L., Sobell, M. B., & Dum, M. (2008). Self-critiques of audiotaped therapy sessions: A motivational procedure for facilitating feedback during supervision. Training and Education in Professional Psychology, 2, 151-155.


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