VISTAS articles are made available for historical reference only and are presented "as is." ACA does not guarantee or represent that the information is current, accurate or indicative of the original or intended quality. These materials are not maintained or updated and may contain outdated or incomplete information. Readers should exercise discretion and verify information independently before relying on it. We assume no responsibility for the use or interpretation of this content.

Article 38

Intentionality in Supervision

Supervising Play Therapy Interns and Practitioners

Denis’ A. Thomas

Download PDF

The process of supervision is used in nearly every helping profession as a part of training both students and beginning professionals to develop clinical and professional skills (Haynes, Corey, & Moulton, 2003). Nearly every state requires supervision to become a fully licensed professional counselor, and most doctoral programs in counseling, psychology, and social work require a supervision training course (Fall, Drew, Chute & More, 2007). Experienced practitioners and educators use the supervision process to guide those with less professional experience and to support and challenge supervisees (VanderGast, Culbreth, & Flowers, 2010). In fact, clinical supervision has been called the “signature pedagogy” of the mental health professions (Bernard & Goodyear, 2004, p. 2). Supervision that is growth-promoting and skill enhancing must consider four aspects: the purpose of supervision, a philosophical approach, utilizing parallel process, and planning/ preparation.

Purpose of Supervision

According to Haynes et al. (2003), “Supervision is a unique relationship between a supervisor, a supervisee, and the clients they serve. This relationship changes over time and with experience” (p. 2). While the American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct (2010) mentions supervision in sections 7.06 and 7.07, the American Counseling Association’s Code of Ethics (2014) has devoted section F in the newly revised code to supervision, training, and teaching. Included are 11 subsections: 1) counselor supervision and client welfare, 2) counselor supervision competence, 3) supervisory relationship, 4) supervisor responsibilities, 5) student and supervisee responsibilities, 6) counseling supervision, evaluation, remediation, and endorsement, 7) responsibilities of counselor educators, 8) student welfare, 9) evaluation and remediation, 10) roles and relationships between counselor educators and students, and 11) multicultural/diversity competence in counselor education and training programs. This speaks to the importance that the profession places on quality supervision.

The supervision relationship, according to Bernard and Goodyear (2004), is hierarchical and evaluative, extends over time, and enhances the professional functioning of the supervisee. The supervisor monitors the quality of professional services offered to the supervisee’s clients and serves as a gatekeeper for the profession. Therefore, supervision has four goals (Haynes et al., 2003).

• Promoting supervisee growth and development through teaching

• Protecting the welfare of the client

• Monitoring supervisee performance and gatekeeping for the profession

• Empowering the supervisee to self-supervise and carry out goals

Philosophical Approach

While the purpose of supervision is consistent across helping professions, the philosophical approaches may be quite different. One example is supervision in the specific area of play therapy. Play therapy is defined as a dynamic interpersonal relationship between a client and therapist using selected play materials and facilitating a safe relationship for the client to express and explore feelings, thoughts, experiences, and behaviors through play (Landreth, 2012). However, within play therapy, supervision approaches may vary by theoretical orientation, level of directedness, and supervision models, among other variables. The important aspect is to have a clearly defined approach that the supervisor can and does articulate to supervisees.

Practitioners prefer supervision within the area of their practice. In one study (VanderGast et al., 2010), researchers surveyed members of the Association for Play Therapy, and the 559 survey respondents indicated that while 86% preferred to receive supervision from a supervisor professionally identified as a play therapist, only 51% currently identified their supervisor as a play therapist. Their preference for supervision goals included improvement of skills and techniques, professional support, and an increase in self-awareness. Respondents also preferred the supervision topics of identifying play themes and case conceptualization. Clearly, what practicing play therapists desire is supervision from one with expertise in the philosophical approach of play therapy.

One possible philosophical approach to play therapy supervision is to use the same philosophy with supervisees that is used with clients, modeling a supervisor’s approach to play therapy in supervision consistently. Play therapy has specific philosophical underpinnings. For example, child-centered play therapy upholds that: 1) clients have an inherent push toward discovery, development, and growth; 2) the therapeutic conditions for growth are genuineness, warm caring and acceptance, and empathy; and 3) the relationship is the therapy (Landreth, 2012). While students and new professionals may understand these and other tenets of play therapy within the context of their clients, in child-centered play therapy supervision, it also defines how the supervisor frames work with the supervisee. This approach is rooted in the person-centered theoretical orientation, but also uses play to facilitate growth in supervision, albeit in a more directive manner. In a large survey of play therapists, only 43% responded that they received play therapy specific supervision, and of those, 40% did not meet the criteria of a registered play therapist supervisor (Ryan, Gomory, & Lacasse, 2002). This means that most practitioners using play therapy have not been supervised specifically in the practice, and of the 43% from this study who reported they had, most of the supervisors were not credentialed to supervise in play therapy. In these circumstances, it is highly unlikely that supervisees experience the modeling provided from supervisors demonstrating their philosophy of play therapy.

Blanco, Muro, and Stickley (2014) outlined using the concept of genuineness in teaching techniques and supervision practice of play therapy through Stoltenberg’s developmental model. The authors argued that, “instruction based upon child-centered play therapy principles should primarily focus on the impact of a therapeutic relationship that is facilitated by a warm, caring, and honest adult who is focused primarily on fostering growth” (p. 53). They suggested that a merging of skill-building and genuineness-training is imperative throughout the training of new play therapists.

Traditional supervision models do not, according to Allen, Folger, and Pehrsson (2007), consistently meet the needs of supervisors for effective supervision of interns in play therapy because they do not easily cross the barriers of non-verbal clients, projective manipulation of objects, and the adult-child client power differential. These authors created a three-step model to use with beginning play therapy interns, clearly outlining their philosophical approach. Step one was “Contact: Relationship Building by Attending,” and in this step, novice interns were encouraged to practice reflection with clients. Step two was “Alliance: Relationship and Therapeutic Partnership,” emphasizing advanced reflections and identifying emotional responses. The authors coined step three as “Insight: Discovering Personal Meaning,” in which interns verbalize direct feeling reflections to the client. While this model provides a framework for the educational portion of supervision, it does not address how to bring the philosophical tenets of play therapy into the supervisory relationship.

Ray (2011) wrote that play therapy supervisors should possess the knowledge, skill, and experiences of an advanced practitioner, but also have the qualifications of congruence, unconditional positive regard, empathic understanding, supervision education, theory and practice education, supervision of supervision, play therapy experience, and ongoing play therapy experience. Combining play therapy and a developmental supervision model, Ray outlined a four-step process of supervision:

1. Skill-focused—focus on skill development while communicating empathy, unconditional positive regard, and genuineness

2. Experimentation and questioning—explore supervisees’ thoughts about the philosophy of play therapy and congruence

3. Philosophical decision making transformed into practice—supervisee adopts a philosophical approach to play therapy and supervision becomes more collaborative

4. Person of play therapist emerges as professional—supervision becomes consultation, often initiated by the supervisee to explore the self in relationship to play therapy

In Ray’s (2011) process, the supervisor’s attitudinal qualities were based on the child- centered philosophy of play therapy (i.e., unconditional positive regard, empathy, and congruence). Ray’s approach provides a model for skill enhancement as well as incorporating the unique philosophical approach of play therapy into supervision.

Parallel Process

The concept of parallel process bridges the divide between the purpose of supervision and the philosophical approach. Parallel process is defined as one dyad of the supervision relationship (e.g., client-supervisee) reenacting in another dyad of the supervision relationship (e.g., supervisee-supervisor; Bernard & Goodyear, 2004). For example, as supervisees struggle to express challenges in their clinical case conceptualizations, a supervisor may use advanced reflection to facilitate supervisee self- awareness and then use the process to illustrate how the supervisee could use that skill with the client. The site supervisor or agency system may also be a part of a dyad. Traditionally, parallel process has been viewed as originating with the client-supervisee dyad, but the supervisor may intentionally initiate a dynamic that is played out in the supervisee’s therapy, since parallel processes are bidirectional (Bernard & Goodyear, 2004).

Mullen, Luke, and Drewes (2007) argued that just as children use toys to express themselves in play therapy, sometimes in lieu of words, supervisees could use play therapy techniques when words are inadequate to express their experience or client understanding. Sand tray, drawing techniques, journaling, movement, and other play techniques help meet the goals of supervision, within the philosophy of play therapy, using parallel process.

Another area where parallel process has benefits in play therapy supervision is in exploring multicultural concerns when the supervisee and client are from different ethnicities. Research from one study suggests that while most play therapists are Caucasian females, they serve a large number of children (47%) from racial minority groups (Ceballos, Parikh, & Post, 2012). In this study, researchers found that the higher the number of minority children served, the more supervision time is spent addressing multicultural concerns. They assert that clinical supervision can be used to allow mental health professionals to engage in self-awareness regarding their own attitudes, beliefs, and comfort toward social justice and advocacy and also enhance play therapists’ self- awareness regarding their racial identity, cultural biases, and prejudicial attitudes. Play therapy supervisees’ level of comfort with social justice attitudes has a direct impact on their willingness to advocate. This, too, can be explored through parallel process.

Planning and Preparation

Practical strategies to achieve the purposes of supervision are essential. Supervision is more effective when it is intentional. Below are a few practical suggestions to help.

Promoting supervisee growth and development through teaching.

• Check-in with a toy, colored pencil, or object. This sets the tone for play-focused supervision, but also brings the benefits of communication with more than words.

• Teach advanced reflective responses through modeling and use a concrete scale to assess the level of the supervisee’s response (See Garza, Falls, & Bruhn, 2009). Encourage supervisees to verbalize alternative responses. Move towards facilitating the supervisee to assess their responses unprompted as skills advance.

• Serve as a role model in supervision group discussions, individual meetings, and demonstrations. One important aspect of this is for the supervisor to demonstrate openness and empathy in giving and receiving feedback, creating a safe environment where the supervisee can risk sharing hidden parts of self (Kranz & Lund, 1994). In other words, allow supervisees to see the supervisor practicing the core conditions of empathy, genuineness, and unconditional positive regard. Lead supervisees through an expressive technique, such as sculpting a client relationship with craft dough, so they can experience it first, then be more equipped to use the technique with a client.

Protecting the welfare of the client.

• Use storytelling as a technique in case conceptualization, especially in cases of client neglect and abuse. One study (Mullen, 2002) found that a play therapist’s frame of reference for understanding children and the children’s culture was best explained through the concept of stories. They also found that play therapists chose to fill in the blanks in the clients’ stories. This process made the play therapist a co-author of the child’s narrative and helped them understand the world of the child.

• Using a magnet board with a variety of magnetic words, ask the supervisee to select the words that describe their emotions about making a report to a child welfare agency. The purpose of the exercise is to separate the supervisee fears, expectations, and concerns from the client needs.

Monitoring supervisee performance and gatekeeping for the profession.

• Explore countertransference through art techniques. Give supervisees a piece of blank paper and drawing materials. Ask them to sketch themselves in relation to the client’s therapeutic work. Notice where countertransference may be evident and facilitate supervisee awareness. See Gil and Rubin (2005) for more examples of both directive and nondirective art techniques.

• Sandtray can be a powerful experience in supervision. Although personal issues as they relate to professional practice may be explored, keep parameters around the supervision aspect to avoid dual relationships. Ask supervisees, if willing, to create a supervision scenario in the sand that is difficult to articulate.

Empowering the supervisee to self-supervise and carry out goals.

• By creating a safe environment for supervisees to practice skills, express concerns, and stretch their knowledge, supervisees can learn to self-supervise, seeking consultation when needed. Later in the supervision relationship, transfer most decision-making to the supervisees (structure, leadership, and facilitation), with encouragement.

• Use journaling in a less traditional manner. Instead of writing based on a prompt, try creating a collage, watercolor painting, or a combination of writing and illustrations. Facilitate in-supervision journaling.

Conclusion

Intentional supervision that is carefully planned and prepared, exemplifying the supervisor’s philosophical approach and utilizing parallel process, helps students and new professionals hone their skills and develop their own philosophical approaches (see Figure 1). However, the current research on play therapy supervision is sparse. Empirical validation is needed for this model, and more empirical studies are needed to examine other supervision approaches besides child-centered play therapy. In addition, research is needed that examines supervisor created parallel process within play therapy supervision.

Play therapy is an evidence-based approach. In a meta-analysis of 93 play therapy outcome research studies, the data revealed a large treatment effect for children receiving play therapy intervention when compared to children receiving no treatment or a non- play therapy intervention (Bratton, Ray, Rhine, & Jones, 2005). Because of this success, play therapy practitioners are on the rise. Membership in the Association for Play Therapy has increased by 55% since 1998 (Association for Play Therapy, n.d.). However, to preserve the integrity of the profession, more play therapy specific supervision is required.

Figure 1

Example Model of Child-Centered Play Therapy Supervision