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Barriers to the clinical supervision of direct care staff in a human service organization: A case study

Philip Rich, University of Massachusetts Amherst


The study utilizes the case study approach in examining clinical supervision in a large, multi-service human service organization. It specifically examines factors impeding clinical supervision, asserting that clinical supervision is typically not practiced as a result of multiple causes. A model of clinical supervision is synthesized from existing literature and is used as the basis for the study, which was operationalized through questionnaires and interviews conducted throughout the organization, a review of organizational materials, and the observation of supervision. In addition, organizational efficiency was conceptualized as the product of the interaction between defined task, organizational employees, formal organizational arrangements, and the informal culture of the organization. The thesis presents seven propositions to support the view that clinical supervision is impeded as a result of multiple causes: (1) supervisors are not well versed in the clinical basis of direct care work, (2) supervisors are untrained in the practice of clinical supervision, (3) most supervisory tasks are considered to be administrative rather than clinical, (4) organizational structures do not adequately encourage or support the use of clinical supervision, (5) training in clinical supervision is unavailable, (6) clinical supervision is more likely to be provided in programs that have a clear "clinical" identity, than in programs that are less clearly defined, and (7) clinical supervision is reserved more for highly professional staff than for the bulk of the direct care staff that deliver agency services. Results largely support the propositions, showing that responsibility for supervision largely lies in the informal organization. There are few formal arrangements or plans for the development and use of clinical supervision, and, where practiced, supervision is far more administrative than clinical. The study also highlights the lack of conceptual sophistication in direct care supervisors in which a highly interpersonal, human relations type supervision is mistaken for clinical supervision. Clinical supervision is considered the outcome of a series of interacting parts, and a complex concept based upon both content and approach. The study concludes by describing a method for the design of clinical supervisory systems, based on generic principles identified in the literature but built around the specific needs of individual organizations.

Subject Area

Social work|School administration|Occupational psychology

Recommended Citation

Rich, Philip, "Barriers to the clinical supervision of direct care staff in a human service organization: A case study" (1992). Doctoral Dissertations Available from Proquest. AAI9233144.