Bringing Micro to the Macro

Adapting Clinical Interventions for Supervision and Management

Ruth Supranovich, Richard Newmyer

• Publisher: Routledge
• Year: 2020
• Print ISBN: 9781138349551
• eBook ISBN: 9780429790461
• Topic: Social Sciences
• Subtopic: Social Science Research & Methodology
• Index: Social Sciences

The field of human services is filled with clinicians turned managers. Many of these managers have not studied business and lack leadership and management experience. Bringing Micro to the Macro: Adapting Clinical Interventions for Supervision and Management shows social workers and other human service professionals how to adapt their clinical and direct practice skills to be effective supervisors and managers.

The book demonstrates the parallels between the micro process of client work and the macro process of staff supervision and management. It also shows managers how to properly adapt and employ their micro practice skills to engage, motivate, and guide their staff to achieve maximum impact and productivity. The first four parts are based on the four phases of service delivery in social work: Engagement, Assessment, Intervention, and Evaluation and Termination. The book concludes with a part on Self-Care, as this is important if you want to have longevity in this field.

Bringing Micro to the Macro is a user-friendly book that can be a tool that new supervisors or managers in social work and human services can reach for when they wonder how to work with staff instead of clients.

Part One
Engagement

Engagement is the first stage of treatment and a critical step when starting in a new position as a supervisor or manager and beginning to work with a new staff person or workgroup. The following three chapters will discuss how building a strong therapeutic alliance is similar to building a strong supervisory working alliance (Chapter 1); explore how the tools and processes used to set expectations for clinical work have their equivalents in the supervisory context (Chapter 2); and consider how orienting an employee to the workplace is similar to how a clinician prepares a client to receive services (Chapter 3). These three areas of practice come together to establish the rules of engagement and create a trusting partnership between supervisor and supervisee.

1
Establishing a Working Alliance

Once Upon a Time

At the tender age of 25, I was hired as a home visitor by a child abuse prevention agency. The job entailed going into the homes of complete strangers and teaching them parenting skills. I was uniquely qualified for the job with my bachelor’s degree in psychology, VW camper van, and utter lack of experience. On the plus side, I had no children of my own, am the youngest in my family, and had never even worked as a babysitter. After securing the job, I had to ask, “Why did you hire me?” My new boss replied, “Because, if you knocked on the door of my house, I would let you in. The rest we can teach you.” She went on to explain that I came across as warm, interested, and friendly. I was likeable, and that was something she could not teach. I heard a very similar remark when I was hired for my first management job ten years later. The director who hired me said, “I think the staff are going to like you and I can send you to management training to learn the other stuff.” When it was my turn to hire supervisors and managers for my organization, I never underestimated the importance of likeability.

While human services work is not a popularity contest, the reality is that your staff will be more inclined to talk with you and work on goals if they like you and believe you like them. The relationship you establish in your first meeting together provides the foundation for everything to come after.

Overture

Whether providing direct services to clients or supervision or management as an administrator, the term “social work” says it all! Our work is social – we use our social skills to connect with others to get things done. There is no manual, as you would have for a machine, with directions on how to use it, that works every time. The lack of predictability in human services requires social flexibility, and you really have to enjoy people to embrace this world of work. Whether it be an individual or a group, our work is to engage socially and build relationships, improve the social experiences of others, and ultimately to improve society. Whether doing clinical work or management, it is all about relationships. The talents, skills, and experience you have developed in relationship building as a direct service provider are what will make you a great supervisor and manager – with a few adaptations. This first challenge of building a strong working alliance with your employees is a great place to examine the transferability of your direct practice skill set.

The Micro Arena

The helping professional’s relationship with his or her client, often referred to as the “therapeutic alliance” in the psychotherapy and counseling literature, is generally regarded as a crucial factor in the success of the encounter (Meissner, 1996; Safran, 2010). The therapeutic alliance is one of the most widely researched variables, with several meta-analyses showing clear linkages between the quality of the therapeutic alliance and treatment outcomes (Safran, 2010). Research has also shown that a strong therapeutic alliance can mediate suicidal behaviors, demonstrating just how critical it is to clinical outcomes (Dunster-Page, Berry, Wainwright, & Haddock, 2017). An effective therapeutic alliance can literally save lives.

The literature has described factors that can enhance this alliance, such as empathic attunement (Meissner, 1996); rapport, trust, and caring (Shulman, 2012); as well as agreement to work on tasks together and a process of negotiation (Safran, 2010). Two groups of researchers working in the area of children’s mental health studied which engagement methods were most effective in creating a working alliance with children and families (e.g., assessment, accessibility, and psychoeducation) and how and when to employ them (Becker et al., 2013; Lindsay, Proulx, Scott, & Thomson, 2013). Engagement and establishing the trust needed to build a strong and effective therapeutic alliance is the foundation of good social work practice.

The Macro Arena

Correlates between the therapeutic and the supervisory alliance can be found throughout the literature on supervision of counselors and psychotherapists. This crossover was initially a psychoanalytic framework (Bordin, 1983), with subsequent research confirming that a strong emotional bond between the supervisor and supervisee positively impacted employee satisfaction (Ladany, Ellis, & Friedlander, 1999) and helped to moderate workplace stressors and prevent burnout (Sterner, 2009). The qualities of a positive supervisory working alliance include familiar concepts to those providing direct services on a daily basis: non-judgment, empathy, validation, exploration, and normalization of anxiety and tension (Sterner, 2009). The behaviors listed as obstacles to building this supervisory working alliance will again be familiar to those working with clients: being critical, disrespectful, unsupportive, inattentive, and lacking trust, openness, praise, and encouragement (Sterner, 2009).

As in the early stages of the therapeutic relationship, the supervisory relationship helps address motivation. In this case, examples include exploring the employee’s level of motivation, the possible causes for low motivation, and instilling hope and inspiration for a better future. Knowing their supervisor is interested in discussing their concerns – regardless of whether an immediate solution emerges – will help solidify the working alliance, which will bode well for future meetings and likely result in a boost in enthusiasm until further discussions can occur. As with therapy, the goal is not only for the employee to come back for another appointment, but also to begin to contemplate the benefits of engaging in a relationship with their assigned supervisor. Later in this book, we will go into more detail about the use of Motivational Interviewing (MI) techniques in supervision and management, but the basic communication skills of asking open-ended questions, using affirmations, reflection, and summarization (OARS), are an essential part of the supervisor-supervisee meeting just as they are with the clinician-client encounter.

Motivation has been addressed extensively in the management literature and is identified as the most frequent cause of performance problems (Clark & Estes, 2008). With over 80% of workers admitting they could work harder at their job and almost 50% stating they do the bare minimum to keep their jobs (Spitzer, 1995), creating a strong working alliance that enhances an employee’s motivation to engage in his or her work can have a significant impact on the organization and ultimately better serve customers, clients, or patients. Most of us working in the helping professions do so because we want to make a difference in the lives of those struggling with addiction, abuse, poverty, mental illness, and any other number of social ills. As a supervisor or manager, if you can effectively engage and motivate your employees to perform even 20% better, consider how you can potentially make a positive difference in the lives of so many more people through them.

Leader-Member Exchange (LMX) is an example of a management theory that focuses on the dyadic relationship between a manager and a worker (Northouse, 2013). There are two main types of relationships: in-group and out-group. In-group relationships (i.e., high-quality LMX) are characterized by healthy communication, trust, and mutual respect; in contrast, out-group relationships (i.e., low-quality LMX) are characterized by formal communication, lack of trust, and individual self-interest. An in-group dyad is a true relationship, while an out-group dyad is more of a transaction. In-group dyads have been linked to a range of positive outcomes, including improved performance, job satisfaction, and retention (Breevaart, Bakker, Demerouti, & van den Heuvel, 2015; Hopkins, 2002; Masterson, Lewis, Goldman, & Taylor, 2000; Wayne, Shore, & Liden, 1997).

Perceived Organizational Support (POS) refers to the employee’s perception of the extent to which the organization values his or her contribution and cares about him or her as a person (Eisenberger, Huntington, Hutchison, & Sowa, 1986). When employees believe they are valued and cared for, they usually reciprocate it. POS is correlated with improved job performance, greater worker satisfaction, and reduced turnover intention (Kurtessis et al., 2015). Establishing a high-quality LMX dyad with each direct report will help you build the foundation for high POS. As a result, your staff will feel appreciated, valued, and respected – bringing their “A” game to the organization and the clients and community you serve.

Same but Different

Despite the similarities between the therapeutic working alliance and the supervisory working alliance, it is important to know the limits of your new role; you are the supervisor and not the therapist. Even when looking at the parallels between counseling and supervising, you do not treat each staff meeting as a therapy session. At the same time, you should not turn into an emotionally inaccessible, authoritarian boss. Working in the gray areas and managing relationships is another skill set you already possess. As a clinician or case manager, you know how to set boundaries, define your role, and adhere to ethical guidelines related to conflicts of interest. As with direct practice, you may need to seek guidance and regular consultation to navigate the relationship and the inevitable ethical dilemmas that will arise.

For example, it can be challenging to supervise someone you suspect is suffering from depression. You may be one of the best Cognitive Behavioral Therapy (CBT) clinicians around and know some of the best psychiatrists when it comes to treating depression, but you are not your employee’s therapist. Does this mean you cannot acknowledge their symptoms and share helpful resources? If you ignore the obvious signs, how will they feel cared about and how might that impact your working alliance? These are good questions, often resulting in the supervisor taking one of two extremes: either becoming the staff therapist or reacting in the opposite direction and initiating severe discipline processes. As a supervisor, you will need to engage your tolerance for ambiguity and abstruseness, just as you did as a direct service practitioner.

This Is How We Do It

The thread that ties everything together is the importance of relationship building and communication between you and your staff. As a new manager (or even as an experienced manager), your primary vehicle for doing so is spending time with your direct reports. The process is not complicated – the key is doing it intentionally and consistently. The following table includes key aspects of your role as supervisor, as well as the “what” and “why” behind each action.

Table 1.1

Component	What to Do	Purpose
Schedule individual time	Meet regularly with each of your direct reports Avoid canceling or rescheduling Eliminate or minimize interruptions Provide a safe space for honest conversations	Making time for the people who are important to us Having regular meetings ensures we go beyond status reports and putting out fires
Ask good questions	Be curious Listen genuinely Ask follow-up questions Pay attention to nonverbal communication	When we care about people, we want to know more about them We learn more by asking questions than giving directives
Keep notes	Build on past discussions Show you are listening and care about what they have to say	Do not risk forgetting what was discussed We strengthen rapport by building on past discussions

Case Study

When José, a supervisor of case managers, met with a new employee, Shari, he enquired about her prior work experience. Shari told him that in her prior job she felt undervalued because she was never given challenging assignments and felt micro-managed. José noticed Shari became agitated when describing her prior manager. José was vaguely familiar with Shari’s prior supervisor and had a positive impression of this individual, so he became curious about Shari’s experience. José had been a clinician prior to his promotion to supervisor and he found himself wondering about Shari’s childhood and whether her parents were overly protective, whether she successfully resolved the autonomy versus sh...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Contents
• Acknowledgments
• Introduction
• Part One Engagement
• Part Two Assessment
• Part Three Intervention
• Part Four Evaluation & Termination
• Part Five Self-Care
• Index