Group Supervision: Case Study

Group Supervision: Case Study

Scenario:

The following scenario is a demonstration of a group supervision experience in which the group observes a portion of a counseling session conducted by a fellow supervisee. The supervisor leads a discussion with the supervisees in order to enhance their utilization of an Evidence Based Practice – Motivational Interviewing. The client has been seeking to utilize mediation as part of her relapse prevention plan but is finding it difficult to fit it into her busy schedule.

S1 = Supervisee 1 & Clinician for the counseling session

S2 = Supervisee 2

S3 = Supervisee 3

C = Client

Sup = Supervisor

Counseling Tape Starts

S1: Hello Sarah, what would you like to talk about?

C: I would really like to incorporate more meditation in my day.

S1: How do you define meditation?

C: Oh, being able to read, just be quiet for awhile and clear my mind.

S1: So you have meditated in the past. What was that like for you?

Counseling Tape Stops

Sup: Let’s pause here for a moment, you made a simple reflection and then followed up with an open ended question. What are you hoping to accomplish with this question?

S1: Well, I am getting the impression that she is having a difficult time fitting meditation into her schedule. She kind of defined meditation as alone time that helps her; I wanted to give her a chance to say out loud some of the ways she has benefitted from it in the past.

Sup: Supervisee 2, what do you think about the open ended question that Supervisee 1 used?

S2: Ummm, could you repeat the question?

Sup: Please comment on the open ended question that Supervisee 1 used with his client.

S2: Oh, well, it a, it gave the client a chance to talk about the pros of meditation and reinforce why she wants to do it. It seems like it could increase her motivation if she knows it is a good thing.

Sup: Okay, let’s resume our observation of the session.

Counseling Tape Starts

C: Good. If I do it in the morning it is kind of cleansing for my day. It helps me be clear headed and ready for the day. I guess it takes away anxieties or pressures. In the evening it helps me relax and get ready for bed, I guess.

Counseling Tape Stops

Sup: Excuse me, Supervisee 2, is there something else more important to you than participating in this group exercise? You appear to be distracted and I can hear you typing on your keyboard.

S2: Ummmm, no, nothing more important.

Sup: Good. Let’s start again. I will go back just a little bit to make sure we didn’t miss anything.

Counseling Tape Starts

S1: So you have meditated in the past. What was that like for you?

S1: So you have done both, you have meditated in both the morning and the evening.

C: Mmhmmm.

S1: And if you meditate in the morning it helps you get your thoughts and feelings organized for the day. If you do it in the evening it helps you to relax and process the events of the day.

C: Yeah. Kind of clear out the day; I get stressed and need to do something to relax. I would normally start drinking once I got home but I want to do something else to relax instead of drink.

S1: Clear out the day so that you will be able to rest and relax at night without having to rely on drinking alcohol. You have found meditation to be very helpful.

Counseling Tape Stops

Sup: Good job. You used open ended questions to learn the dimensions of her experience. You used some simple reflections to demonstrate that you hear her. You may have known at the time or maybe recognize now that you are using your simple reflections to capture her reasons to meditate. In some ways you are reinforcing her change talk.

S3: The summary seems sort of short and simple. Would it have been better to include more in the summary in order to really reinforce her change talk?

Sup: How would you have summarized at this point?

S3: Maybe, something like, you have successfully used meditation in the past to help yourself both mentally and emotionally. It sounds like you have even found that if you take the time to meditate, you feel like you are more efficient, you do a better job at home and at work and you are able to choose to do something beneficial rather than drink alcohol.

Sup: What do you think Supervisee 1?

S1: Since the client was already moving in a direction toward discrepancy, I thought it would be better to keep my comment short so that she could keep going with her own change talk.

Sup: Okay, well, Supervisee 1, if you wanted to be a step ahead of the sustained talk, with a target behavior like increasing meditation for the purpose of coping with use triggers, like stress, than time is pretty reliably the reason they can’t do it. (There is a faint sound of music in the background but the supervisor continues with remarks) I noticed that when you summarized the change talk, including all the benefits she gets from meditation, she goes to the other side of her ambivalence, which is the time.

Counseling Tape Starts

C: I think a lot of the challenge is finding the time.

S1: So, when you get up in the morning you are immediately rushing.

C: Yeah. Ha ha

Counseling Tape Stops

Sup: (The background music has persisted and increased in volume) Excuse me. Is someone listening to music? Please turn off the music so that we can all focus on the task at hand. (Silent pause and the music stops) Thank you.

Counseling Tape Starts

C: I think a lot of the challenge is finding the time.

S1: So, when you get up in the morning you are immediately rushing.

C: Yeah. Ha ha

S1: No time to gather your thoughts so that you can help yourself be more efficient with your day.

C: Mmhmm, right.

S1: And you feel pressured.

C: Yeah, it would just be so helpful to have that time. I’m not a very good waker upper , I’m just so groggy and want to hide under the covers.

S1: So you hit snooze…

C: Yes! Like 5 or 6 times.

S1: And after the 5 or 6 snoozes, now you are panicked.

C: Yes! Now I am late. I have to get my kids going and to school or the people at the school will be calling, I can’t be late for work again…I have to get going and its rush, rush, rush.

S1: Instead of being peaceful because you have meditated, now you are panicked. And it’s that time issue. So at night, what happens, you are simply exhausted and too tired to meditate.

C: Yes, very much so, I have two small children, my husband works evenings so I am home with them. Ya know, homework, dinner, bath, bed… I really just want to sit down and have some wine.

S1: They need you and you want to disappear.

Counseling Tape Stops

Sup: Okay, let’s hear some comments at this point, Supervisee 3?

S3: Oh, okay, well, Supervisee 1 continues to demonstrate the MI spirit, using reflections to communicate empathy and understanding. It seems like the client is moving back toward ambivalence. She had been looking at the ways meditation could help her remain sober but now she is talking about not having enough time and that she would rather just drink because it’s easier.

Sup: Good. Supervisee 2, do you have any suggestions for Supervisee 1 as the client seems to be reinforcing her ambivalence?

Sup: (Silence and the picture on the monitor indicate that Supervisee 2 is not attending. Supervisor sends a chat message to Supervisee 2. Supervisee 2’s head appears to be moving up and down rhythmically) Private chat to Supervisee 2, is your audio on and working? (More silence, no apparent visible response from Supervisee 2)

Sup: Supervisee 1, do you have any thoughts about Supervisee 3’s comments?

S1: Uh, yeah. As I listen to the session and hear Supervisee 3’s comments, I think it would have been a good time to use the readiness ruler. I think the client wants to change her behaviors; she doesn’t like the pattern or the consequences of her drinking. I could have used the ruler to assess her level of confidence in making the changes.

Counseling Tape Starts

C: Yes. 8:30 rolls around and they are finally in bed but that is when my husband comes in the door and wants his dinner. So then it is just like, forget it, and just veg in front of the TV, have another glass of wine, until I drag myself upstairs to go to bed at 11 or 11:30 to just start the day again at 5 the next morning. It’s exhausting.

S1: And frustrating, maybe even thinking when you are going to bed at 11, why am I going to bed so late? Why did I drink so much again?

C: Exactly!

S1: So everybody needs something from you. You mention that your children need something from you, your husband needs something from you, your clients need something from you, everybody needs something from you; and it sounds like you are not doing anything to take care of yourself.

Counseling Tape Stops

Sup: I am going to summarize, so now you have some complex reflections in here, you are taking some guesses as to what the next steps might be; the next thing she might say and the interview is really moving along here. You’ve kind of got an amplified reflection when you say, “she is not doing anything to take care of herself.” She agrees with that statement and you are pulling for her and therefore helping her articulate change talk again.

Sup: Next up is Supervisee 2 and his tape. Are you ready? Hello?