SENTIO SUPERVISION MODEL (SSM)
Steps Brief description Example
Step 1. Check trainee’s outcome data If outcome data is available, focus the supervision on the client whose outcomes signal that they are the most distressed or at risk of clinical deterioration. Mary and her supervisor notice that her client “Joe” is flagged by an outcome measure as being particularly at risk of deterioration. Because of this, they choose to focus on this client for supervision.
Step 2. Review Supervision Preparation Form Trainees complete a Preparation Form prior to each supervision that elicits preliminary ideas from the trainee on what the focus of supervision could be. Mary wrote in her preparation form that her client Joe tends to get angry at her when she asks about his feelings. She says she doesn’t know how to address this.
Step 3. Identify a Client Challenge At this stage, supervisor and supervisee collaborate to agree on a challenging and observable client behavior that needs to be more effectively addressed in session. As Mary and her supervisor look at her therapy recording, they indeed notice that Joe is getting angry after being asked about his feelings. They agree to focus supervision, at least for now, on addressing this challenge.
Step 4. Identify a Therapist Deficit After identifying a client challenge, the supervisor helps the trainee see what they are doing in session that is not working or keeping therapy stuck. The supervisor noticed and reflected back to Mary that when her client Joe gets angry in session, she looks anxious and quickly changes the subject. The supervisor points out that this therapist behavior in session is part of what might be keeping therapy stuck.
Step 5. Identify a Learning Goal The supervisor and trainee collaborate to identify a concrete clinical skill to more effectively address the identified client challenge. Mary’s supervisor proposes to address the identified client challenge by doing an alliance repair intervention. Especifically, Mary could point out that she notices her client’s frustration and, instead of quickly changing the subject, she could nonjudgmentally invite the client to elaborate on his frustration.
Step 6. Behavioral Rehearsal The supervisor guides the trainee to repeatedly practice the identified skill in vivo. For each round of rehearsal, the supervisor provides brief, actionable feedback to refine the trainee’s intervention. The supervisor asks Mary to imagine she is in front of her angry client right now, and invites her to try intervening with the proposed alliance repair skill. With each of her attempts, the supervisor provides feedback on how to better her intervention.
Step 7. Assign Deliberate Practice Homework The supervisor proposes a solitary practice homework, if possible using a video recording of the client challenge to repeatedly keep practicing the same skill that was practiced during supervision Mary’s supervisor ends the supervision session saying: “Use the therapy recording with Joe to repeat the same exercise we just did for at least 10-minutes until your next session with this client or our next supervisor.”