Supervision vs Consultation

Have you ever wondered about the invisible threads that guide a therapist's journey to mastery? We're peeling back the curtain to reveal the critical roles of consultation and supervision in shaping mental health professionals. Our latest episode delves into the intriguing dynamics of these two realms, contrasting the responsibilities and impacts they have on counseling practices. Supervisors serve as the profession's gatekeepers, wielding legal responsibility and guiding the evaluation of a therapist's work. On the flip side, consultants, equipped with niche expertise, offer case-specific advice without the same level of authority. Through a captivating case study, we illustrate how therapists weave consultant insights into their practice, highlighting the delicate dance of maintaining professional autonomy.

Turning the spotlight to the foundational mental health consultation models pioneered by Kaplan, we dissect the four methodologies that are transforming therapeutic services at individual and systemic levels. Whether it's the Client-centered case consultation that focuses on improving client outcomes, or the Consultee-centered case consultation that hones in on the personal growth of the therapist, these models offer a roadmap for development. We also explore the strategic facets of Program-centered Administrative Consultation and Consultee-centered administrative consultation, which both aim to enhance organizational performance. This episode is not just a deep dive—it's an invaluable resource for anyone in the mental health field seeking to understand the nuanced mechanisms that refine and elevate their craft.

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Transcript

Eric Twachtman: 0:06

What's the difference between consultation and supervision? To answer this question, let's review a few definitions. In the counseling world, a clinical supervisor oversees a therapist's course of treatment for a client. This includes such things as being privy to details of cases, helping with interventions, monitoring client progress, addressing ethical issues and assessing clients' overall quality of care in therapy. A consultant is a professional who assists a therapist by providing feedback and suggestions regarding a particular case. A consultant usually has a field of expertise and is hired to problem-solve a particular case. A consultant usually has a field of expertise and is hired to problem-solve a specific issue. The main differences between the two are Problem Identification A supervisor helps to identify a supervisee's problems.

Eric Twachtman: 1:05

A consultant is hired after a problem has been identified. Roles A supervisor wears a few different hats and performs administrative, educational and supportive functions. A consultant only plays an educational role. Authority A supervisor has administrative authority over the supervisee and can enforce the supervisee's compliance with procedures. A consultant has no administrative authority over the therapist, so the therapist can choose to disregard the consultant's feedback or suggestions. Legal liability A supervisor is legally responsible for the supervisee's actions. A consultant is not legally liable for the therapist's actions.

Eric Twachtman: 1:58

Focus and responsibility A supervisor is responsible for the supervisee's overall work performance and professional development. A consultant is hired to provide feedback about a specific issue. Supervision is geared toward training and supporting new therapists in an effort to control the quality of service that clients receive in therapy. Supervisors play a variety of roles. In their administrative role, supervisors provide supervisees with work structure and resources that allow them to be successful in their practice. In their educational role, supervisors provide training to their supervisees in order to increase their knowledge and skill set and, ultimately, ability to perform their jobs effectively and independently. In their supportive role, supervisors ensure that supervisees have appropriate psychological and interpersonal resources available to them so they can perform their jobs effectively. On an emotional level on an emotional level, while undergoing supervision, a therapist must notify all clients that his or her supervisor has access to all client records. This is part of the informed consent process. The client must also be provided with information related to the supervisor's qualifications, the supervisor's and supervisee's objectives, approach to treatment, responsibility and limits to confidentiality.

Eric Twachtman: 3:36

Gatekeeper Issues vs Transitory Issues. A supervisor acts as a gatekeeper to the counseling profession. This means that it's their ethical responsibility to monitor and evaluate a supervisee's knowledge, skills and professional qualities and prevent individuals from becoming therapists when they lack the necessary professional competence to perform in that role. A supervisor may identify transitory issues when overseeing a supervisee. These are not as serious as gatekeeper issues. These can be resolved through education and discussion with the supervisee.

Eric Twachtman: 4:20

Consultation is the model or process by which one professional seeks out the advice and recommendations of another. Consultants are often retained by experienced therapists for their specific expertise in a particular area and develop an ongoing relationship for case review and consultation. There are a few goals that a consultant consistently works toward Assisting the therapist in understanding the current problem at hand and improving the therapist's knowledge and skill in resolving the problem. Equipping the therapist with knowledge and skills to deal with similar future problems that may arise, with similar future problems that may arise Remaining focused on the therapist's work performance, not acting as a source of emotional support. It's important to note that a consultee is under no obligation to accept the suggestions offered by a consultant. Let's take a look at an example.

Eric Twachtman: 5:23

Connie was hired by the Children's Center to consult with their counseling department. She is an expert in cognitive behavioral techniques with children and has pioneered a new protocol for dealing with behavioral problems in the school setting. The counseling staff has experience in a variety of techniques and appreciates the opportunity to learn different ways to deal with challenging and complex cases. Jennifer presented a case. Sarah, age seven, has difficulty with her schoolwork, following directions both at school and home, violent outbursts with family members and physical altercations with peers and authority figures at school. Jennifer is trained in play therapy but still has great difficulty drawing Sarah out.

Eric Twachtman: 6:12

In session, connie made recommendations specific to her new proven protocol. Jennifer attempted to follow the recommendations but had little success. In the following four sessions. But had little success in the following four sessions. She returned to her treatment format, in which she was comfortable, knowledgeable and accomplished in her interventions, but did make some alterations based on the group's consultative feedback. In this example, jennifer sought the consultation of Connie in the departmental group. She did not have success and returned to what was familiar and consistent with her training, but did integrate some of the new ideas into her style. Jennifer is an experienced therapist and is not bound by a consultant to alter her treatment methods. However, she can enrich her practice by learning new techniques and her clients will likely benefit from her expanded knowledge base.

Eric Twachtman: 7:14

In this model outlined by Edgar Schein, a consultant would not be called in to fix problems, instead to help the consultee learn how to identify and fix the issues themselves, so there will be no dependence on outsiders to have to be called in to save the day. In Schein's model, consultants encourage self-sufficiency by helping the original issues get resolved and teaching the consultee the how-tos for handling future issues. Shine postulated seven stages in process consultation Communication process building and maintaining a group. Group problem-solving and decision-making, group norms and culture. Leading and influencing, appraising performance, inter-group process. Gerald Kaplan laid out his model, which is grounded in psychodynamic theory, as the consultant helping the consultee find and identify the issues, stressing that the consultee must actively participate in the process. He placed high priority on confidentiality, not only from consultant to consultee but also with upper management, therefore building a foundation of trust to help reveal and address the issues without fear of recrimination.

Eric Twachtman: 8:44

Kaplan described four models of mental health consultation Client-centered case consultation A consultee needs help assessing or diagnosing a client and needs to consult a specialist to assess the client and offer suggestions to the consultee. Consultee-centered case consultation A consultee who has a difficult client needs help due to their own professional shortcomings, for example, lack of knowledge, lack of objectivity, lack of self-confidence, etc. Program-centered Administrative Consultation Similar to Client-Centered but deals with developing and implementing programs at the administrative organizational level. And Consultee-centered administrative consultation. The consultant deals with the administrative level, discovering shortcomings and other issues to guide them to discover ways to improve their organizational standards. It's in there.