Clinical Supervision Handbook - CAMH Knowledge Exchange ..

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Ongoing Clinical Supervision reflecting on the barriers that clients experience, speaking about what prevents them from being able to follow through on using their plans, and helping clients process their resistance as opposed to getting into a power struggle with them. Role playing After the clinician describes a challenge he or she is encountering with a client, the clinical supervisor can suggest a role play where the clinician and clinical supervisor act out the situation where the clinician had trouble. For example, if the clinician plays the role of the client, the clinical supervisor can show the clinician other ways of responding to what the client is saying. The roles can be reversed, with the supervisor taking on the client role. This variation requires that the supervisor has enough information about the client’s responses to be able to respond meaningfully. The supervisor can see how the clinician responded to the situation in question and then give feedback. Reviewing taped sessions The clinician is asked to either audio- or videotape the session or sessions with a client. The clinician must ensure that the client understands that this is being done to help the clinician provide optimal care. After this has been explained, the clinician must obtain written consent from the client. The clinician reviews the tape and marks the segment that he or she would like to discuss with his or her supervisor. The clinician plays this segment during the session and the clinician and clinical supervisor discuss their observations. The clinician may first be asked to talk about what he or she was thinking and feeling at the time and how these thoughts and feelings contributed to what he or she did or did not say. CULTURAL COMPETENCE AND DIVERSITY Influence of privilege and oppression in the therapeutic relationship Skilled clinicians possess knowledge and understanding about how oppression, racism, discrimination and stereotyping affect them both personally as well as in their work. They are knowledgeable about how sociopolitical influences impinge on the lives of 41
Clinical Supervision Handbook people who are marginalized because of race, culture, gender, sexuality, age, language, religion and abilities. Without this awareness, clinicians can respond to their clients with a range of feelings such as anger, defensiveness, sadness and powerlessness, and miss opportunities to explore how these life experiences have contributed to the client’s mental health and addictions. The Wheel of Intersecting Axes of Privilege, Domination and Oppression (see Figure 1, p. 43) is a tool that can be used to help clinicians raise their awareness in this area as they plot themselves along the various axes and consider where their clients are located as well. This helps to identify where there might be tensions in the clinician-client relationship due to meanings that either person may attribute to specific incidents within the relationship based on life experience. This tool also facilitates the exploration of contextual factors that are important to consider as the clinician assists the client in his or her recovery. For example, a client is not open about her sexual identity as a lesbian. Keeping this hidden influences her relationships with others resulting in shame, guilt, depression and anxiety. She drinks to cope. The clinician assumes the client is heterosexual and thus misses a key issue that has contributed to the client’s mental health. Using the tool Introduce the tool to clinicians by explaining the rationale for its use, as described above. Then ask the clinicians to take some time and put an “X” on each axis at the point that represents where they see themselves. If this exercise is done in group clinical supervision, tell the clinicians that they are not required to share the details with the group. After they have completed the exercise, ask them what they noticed—did anything in particular jump out for them? Many people are surprised at the number of axes and how they experience greater privilege in some areas as opposed to others. Next, ask the clinicians to think about the clients they currently see and to place them on all of the axes based on what they know about them. Then ask how they think their experiences and those of their clients might influence their relationship with one another. For example, the clinician is a Caucasian, well-educated woman, middle class, married, with two children. Her client is a single, black woman, making enough money to pay her bills, raising three young children on her own. She did not complete high school. She has been involved in the sex trade as her main source of income to support herself and her children. She uses alcohol and marijuana to cope with her feelings, and the experience of having been sexually abused in childhood by her father. Based on the clinician’s experience and biases, she or he may not raise questions about how racism and childhood sexual abuse may have contributed to dropping out of school, having limited employment opportunities due to discrimination and an overall poor sense of self. 42
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Core Clinical Practice Competencies
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A Pan American Health Organization
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