Using Motivational Interviewing in Clinical Supervision
Many clinical supervision models identify 3 stages of supervisee development: Beginning, Middle, and Advanced. Motivational Interviewing (MI) skills are easily adaptable to these 3 stages of supervisee development and can help to provide direction for the clinical supervisor in the supervisory sessions.
Using MI skills in clinical supervision offers an opportunity to role model a theoretical modality during the supervisory session. If both the supervisor and supervisee are familiar with MI skills then it also allows for a common language to be shared, building an alliance while increasing the confidence of the supervisee.
In the Beginning Stage of Supervisee Development the supervisee is:
Gaining basic clinical skills
Wanting to appear confident and an expert
Often feeling inadequate or identifying with imposter syndrome
Motivational Interviewing emphasizes building a relationship of empathy, curiosity, and collaboration which is at the foundation of all clinical work, including clinical supervision. Supporting a supervisee as they are beginning their clinical practice requires careful attention to their vulnerability while they present their cases and documentation for feedback and review. The skill of Engagement is the 1st of the 4 Processes of Motivational Interviewing and is a useful tool in the supervisory relationship.
The Middle Stage of Supervisee Development is often distinguished by:
Increased exploration in clinical modalities
Increased internalized confidence
Ability to recognize their own impact in the relationship with client
Willingness to admit mistakes and experiment with their own style
During this Middle Stage of Supervisee Development the supervisor is able to role model all 4 Processes of Motivational Interviewing which are Engagement, Focusing, Evoking, and Planning. An astute clinical supervisor will ask the supervisee for their solution; elicit their view; explore; and expand on the thoughts and ideas of the supervisee. Reviewing the use of these skills with the supervisee opens the door for practice, discussion, and feedback
Movement into the Advanced Stage of Supervisees Development is characterized by:
High skill acquisition and mastery in one or more clinical modalities
High confidence in various clinical roles
Comfortability with the complex nature of the clinical relationship
High autonomy and understanding of when to ask for help
The 4 core Motivational Interviewing skills, or OARS, are Open questions, Affirming, Reflecting, and Summarizing. These skills, though applicable throughout all the supervisee stages of development, are particularly useful in the Advanced Stage. Keeping clinical supervision effective as clinicians become more skilled is a challenge for many supervisors. Listening for the nuanced feelings and values of the supervisees in addition to the issues they might avoid is a complex reflection skill.
The spirit of partnership, evocation, acceptance, and compassion are fundamental to Motivational Interviewing. All of these are essential in developing an open and safe environment in supervision with the goal of the supervisee growing and evolving into a skilled clinician. Each of the skills in Motivational Interviewing are applicable when providing clinical supervision since both put the focus on change as a result of collaboration. Coupled with other supervision models, it affords the supervisor another tool in their supervisory toolbox.
Miller, W.R. & Rollnick, S. (2013) Motivational Interviewing: Helping people to change (3rd Edition). Guilford Press.
Dayna Guido, MSW, LCSW, ACSW has over 40 years of experience as clinical social worker, clinical supervisor, and trainer. She is the author of Creative Ways to Learn Ethics: An Experiential Training Manual for Helping Professionals and The Parental Tool Box: For Parents and Clinicians.
Dayna taught for 23 years in graduate programs and is in private practice in Asheville, NC specializing in providing clinical supervision and ethical consults. She currently leads virtual supervision groups for fully licensed clinicians and supervision groups for supervisors.
Using expressive arts in therapy, supervision, and training is one of the ways Dayna keeps her own skills evolving and fresh. Recently she developed The Ethical Courage Decision Making Model and is now expanding the idea of Intuitive Mindfulness and how it can be used in clinical settings.