ERIC Identifier: ED372355 Publication Date: 1994-04-00
Author: Juhnke, Gerald A. - Culbreth, John R. Source: ERIC
Clearinghouse on Counseling and Student Services Greensboro NC.
Clinical Supervision in Addictions Counseling: Special
Challenges and Solutions. ERIC Digest.
Since the early 1970's addictions counseling has experienced significant
growth and change. Addictions treatment has become "big business" and as a
result, there is a new consciousness for cost management and containment. Top
priorities now include reducing staff turnover, preventing employee burnout, and
maintaining credentialing to meet insurance reimbursement requirements (Powell,
1993). As the field matures, continued professional training becomes
increasingly important. Declining budgets within many agencies, however, often
prohibit participation in costly seminars designed to promote advanced clinical
skills. A solution to this dilemma is ongoing, in-house clinical supervision
In the addictions profession's infancy, supervision was often little more
than a more senior level helper telling another what to do. In addition,
directions to the junior level treatment provider were primarily based upon the
supervisor's personal recovery experience. Today, a more professional and
systematic approach to clinical supervision is warranted. A good counselor won't
necessarily be a good supervisor (Machell, 1987). Therefore, addictions
supervisors need to be well versed in both advanced supervision techniques and
Despite increased numbers of addictions treatment programs over the past
twenty years, addictions supervision has been virtually neglected. Evidence of
this is demonstrated through the limited number of journal articles written on
the topic of addictions supervision. For example, a recent search for articles
written on the topic resulted in only ten citations; of these, only four
specifically addressed the topic of providing clinical addictions supervision.
One conspicuous exception has been the work of David Powell, who has written
consistently about addictions supervision since the mid 1970s. His seminal
writings have resulted in descriptive and databased articles, culminating in the
recent publication of his second book on supervision in addictions counseling.
Powell (1993) has developed a model of clinical supervision which blends aspects
of several supervision theories. His model is developmental in nature and
addresses nine descriptive dimensions of clinical supervision issues (e.g.,
influence, therapeutic strategy, counselor in treatment, etc.). Powell also
outlines issues specific to addictions counseling and supervision. It is because
of these unique aspects of addictions counseling that attention is greatly
needed in the area of supervision.
WHAT MAKES ADDICTIONS SUPERVISION DIFFERENT?
great number of issues related to the supervision process are similar across
different types of counseling (e.g., school, mental health, family, career,
etc.), at least three supervision issues are idiosyncratic to substance abuse
counseling and deserve special attention (Powell, 1993). First, a significant
number of addictions treatment providers are paraprofessionals. Unlike
professional counselors, paraprofessionals have not fulfilled the educational
requirements for a master's degree in counseling or an allied human service
field. Paraprofessionals in some states are required to have little more than a
high school diploma or equivalent and pass a state certification examination.
They, therefore, lack formal graduate school instruction pertinent to the eight
common core areas considered rudimentary to the counseling profession (i.e.,
human growth and development, social and cultural foundations, helping
relationships, group, lifestyle and career development, appraisal, research and
evaluation, and professional orientation). Paraprofessionals also may lack the
fundamental counseling skills typically developed through participation in an
organized sequence of practica and field-practica experiences (e.g., counseling
internships) common to counselor education program graduates. The implication
for supervision is clear. Supervisors must be continually aware that
paraprofessionals lack fundamental counselor training. Therefore, the
supervision milieu must contain a strong educational component to ensure a
minimal level of skill and knowledge-based competencies. Supervisors may find
that informal lectures related to counseling theories and practice of counseling
techniques enhance clinical sophistication and promote greater treatment
effectiveness. Undoubtedly, clinical supervisors working with paraprofessionals
who lack adequate training may need to assume a greater proportion of the
responsibility for treatment planning and can help paraprofessionals learn how
to apply their existing skills with diverse clients.
A second complicating factor related to addictions supervision is that many
professional counselors and paraprofessionals facilitating addictions treatment
strongly believe that one must be in recovery to provide effective treatment
(Powell, 1993). Treatment providers espousing such a "recovery-only" position
may be highly resistant to supervision from non-recovering persons. Direct
inquiry by the supervisor can be helpful in understanding the counselor's
position on this matter. For example, the supervisor may find it helpful to ask
the supervisee, "How will my not being in recovery effect our supervision
relationship?" Whatever the response indicated by the supervisee, the supervisor
will need to follow-up by asking, "How can we effectively work together so our
clients receive the best possible treatment?" Such directness is typically
prized within the substance abuse community and encourages supervisee honesty.
Failure to address this important topic can result in pseudo-supervision, which
wastes valuable time and inevitably impedes client progress. Even the most
adamant helper who believes one needs to be in recovery to facilitate effective
addictions treatment, will typically recognize the benefits of supervision when
the emphasis is placed upon working together for the sake of the client.
Finally, it should be noted that to some degree all treatment providers are
influenced by personal issues. In an attempt to be helpful, however, recovering
helpers may be particularly vulnerable to imposing their personal experiences
and unconscious beliefs on a client (e.g., what worked for me will work for
you). A client's relapse also may provoke unconscious responses in the
recovering helper (i.e., loss of empathy, reduction in patience, etc.) which may
negatively effect the counseling relationship. Therefore, the supervisor's
attentiveness to these possible issues is critical. Encouraging recovering
helpers to embark on a "recovery expedition" can be helpful. Here, helpers ask
others how they initiated their recovery experience and what things they find
helpful to maintain chemical abstinence. Participation in the recovery
expedition teaches helpers that there exists no single method in which people
initiate or maintain the recovery process. Helper behaviors, cognitions and
feelings resulting from a client's relapse or a client's unwillingness to commit
to the abstinence process can be discussed within small group experiences. Such
small group experiences can promote effective ways of dealing with anger,
frustration, and fear related to the helper's own recovery.
OTHER INGREDIENTS VITAL TO THE SUPERVISION PROCESS
supervision has been neglected within many addictions agencies, basic
supervision practices are often foreign to addictions helpers. Therefore, it is
critically important for addictions supervisors, as it is for all supervisors,
to establish supervision practices in a nondemeaning manner which emphasizes
client benefits. To secure such practices, it is imperative that addictions
supervisors: 1) establish a solid working relationship with the supervisee, 2)
assess the supervisee's counseling skills, 3) agree to contract for the conduct
of supervisory sessions, and 4) establish learning goals with the supervisee
(Borders & Leddick, 1987). Mutually agreed upon goals for supervision need
to be concrete, attainable, and specific. Together, both the supervisor and the
supervisee need to determine methods for attaining these goals and ways to
evaluate progress in each area (Bradley & Boyd, 1989).
Effective supervision principles include consistent meeting times and a
collegial atmosphere, both of which contribute to a working relationship
vis-a-vis a structured hierarchy in which the supervisor dictates counseling
interventions. This promotes the supervisee's "ownership" of the case. As both
supervisor and supervisee become more familiar with the working relationship,
professionalism grows and clients benefit. This typically leads to increased
supervisee effectiveness and satisfaction.
A number of factors endemic to the addictions
field make supervision within this community both challenging and rewarding.
Effective supervision requires developing the skills of front-line staff at all
levels and addressing possible supervisee concerns related to non-recovering
treatment providers. When these issues are adequately addressed within the
supervision process, the promotion of professionalism and professional identity
Borders, L., & Leddick, G. (1987). Handbook
of clinical supervision. Alexandria, VA: American Association of Counseling and
Bradley, L. J., & Boyd, J. D. (1989). Counselor supervision: Principles,
process and practice. Muncie IN: Accelerated Development (ERIC Document
Reproduction Service No. ED 345 128).
Machell, D. F. (1987). Obligations of a clinical supervisor. Alcoholism
Treatment Quarterly, 4, 105-108.
Powell, D. J. (1991). Supervision: Profile of a clinical supervisor.
Alcoholism Treatment Quarterly, 8(1), 69-86.
Powell, D. J. (1993). Clinical supervision in alcohol and drug abuse
counseling. New York: Lexington Books.