Giving Difficult Feedback


Giving Difficult Feedback

Written By: Samia Estrada

As graduate students, we need to prepare for our role as psychologists, which will entail wearing many hats, one of them is that of a supervisor.  Being a supervisor will require, among various skills, the ability to provide difficult feedback. Research tells us that many supervisors avoid giving difficult feedback, yet trainees crave it (Hoffman et al., 2005; Ladany, Hill, Corbett, & Nutt, 1996). What is this discrepancy all about?

In an effort to better understand the matter at hand, it would be helpful to first understand: What is feedback? Hoffman and colleagues (2005) define it as “information that supervisors give to their supervisees about aspects of their skills, attitudes, behavior, and appearance that may influence their performance with clients or effect the supervisory relationship.” Hoffman and colleagues (2005) added that feedback could be given directly (e.g. “You were not very empathetic right here”) or indirectly (e.g. “I wonder how you feel about how empathetic you were right here?”).

Having defined feedback, we can now move on to see what research tells us about how feedback is used, or not used, and what some of the reasons may be. According to Ladany and Melincoff (1999), 98% of supervisors admitted that, at some point in time, they have withheld feedback from their supervisees, especially difficult feedback. Additionally, according to Hoffman and colleagues, (2005), most of the feedback given by supervisors tends to be positive and global, focusing mostly on client concerns.

In an exploration of why supervisors are withholding difficult feedback, various reasons predominated. Supervisors are afraid of crossing into therapy territory, they worry that an already fragile bond between supervisor and supervisee may weaken even more, and, simply, the supervisor is uncomfortable giving difficult feedback (Hoffman et al., 2005; Bernard & Goodyear, 2014). Supervisors worry about the ways in which the difficult feedback will affect the supervisee, as well as how it will affect themselves.

Giving feedback becomes even more complex when there are cultural differences between supervisee and supervisor.  Supervisors can find it even more difficult to give feedback to a supervisee when the supervisee is not doing what is in the best interest of the client due to the supervisee’s own cultural beliefs. The supervisor is caught between behaving in a culturally sensitive way toward the supervisee and making sure the client’s best interest is met (Burkard, Knox, Clarke, Phelps, & Inman, 2014). The cultural differences between the triad; supervisor, supervisee, and client, further adds complexity to an already difficult situation.

In a study of feedback in the presence of cultural differences by Burkard and colleagues (2014), 17 supervisors from across the United States responded to questions that addressed how culture differences influenced supervision feedback with a supervisee who was culturally different than the participant and feedback in a cross-ethnic/racial supervisory relationship when the focus was on multicultural concerns. All supervisors reported having prevalent multicultural discussions starting early in the supervisory relationship and noticing that trainees generally had difficulty relating to their culturally different clients. The research also found that supervisees had a difficult time talking about cultural concerns in supervision.

Supervisors reported that it was difficult to give feedback to the supervisee in regards to how their “lack of sensitivity to cultural issues was negatively affecting their clinical work” (Burkard et al., 2014). Interestingly, there were differences in the issues that supervisors addressed in supervision based on their own cultural background. European American Supervisors (EASRs) reported expressing concerns to their supervisees about their counselling skills (i.e., being too directive, unassertive/overly quiet), while Supervisors of Color (SRCs) reported addressing concerns about their cultural sensitivity.

Supervisors and trainees were asked about feedback and had very different ways of conceptualizing how the feedback would affect the relationship. Supervisors reported that feedback was difficult due to their concern about imposing their own culture onto the trainee (i.e., basing it on White cultural values), feeling like they were imposing their perspective on the trainee, and being afraid that the difficult feedback would be hurtful to the trainee (Burkard et al., 2014). The trainee’s reactions to feedback varied; most EASRs reported a more mutual and open supervisory relationship after the feedback, while some reported an impasse in the relationship. Most SRCs reported an impasse while some reported learning more about each other and being more willing to look at race and culture. The supervisors’ reactions to feedback also varied; EASRs typically felt uncomfortable delivering difficult feedback, while SRCs typically felt uncomfortable or disturbed by the supervisee’s reactions to feedback (Burkard et al., 2014).

Although the sample size is small, it serves as an example of the complexities that form a part of the difficult feedback issue.  Supervisors had numerous reasons for withholding feedback based on their cultural identity and trainees responded in varied ways as well; but what is it that trainees want from supervisors generally?  Studies show that supervisees actually want corrective feedback and find it helpful. Burkard and colleagues (2014) concluded that trainees want specific critical feedback. Trainees who do not get clear corrective feedback tend to have “diminished feelings regarding the value of supervision.” Supervisees described their supervisor as someone who “wanted to be nice rather than frank and honest” when corrective feedback was limited or withheld (Burkard et al., 2014).

In another study on “The Process and Outcome of giving Feedback”, conducted by Hoffman and colleagues (2005), 15 supervisors reported on their experiences with 15 supervisees on overall view of supervision, easy versus difficult feedback, and experiences with the supervisee. They found that easy feedback was typically about clinical problems and generally given directly. The immediate trainee reactions were mostly positive with typically positive outcomes. Difficult feedback varied according to clinical problems, professional concerns, and problems in the supervisory relationship and typically given indirectly. The trainee’s immediate reactions were mostly positive and had typically positive outcomes. However, when no feedback was given, it was normally about professional concerns and typically had negative outcomes. In other words, feedback was withheld when it was of great importance and withholding it hurt the supervisory relationship.

Hoffman and colleagues (2005) found that there were some facilitating factors and hindering factors that contributed to feedback based on the type of feedback.  For easy feedback, the facilitating factor was supervisee openness; no hindering factor was reported. For difficult feedback, the facilitating factors were that trainees were open to feedback, that supervisors felt they had expertise to impart, that they had a strong supervision relationship, that the timing was good for giving feedback, that there was a clear need for feedback, and that the supervisors had outside support (i.e., support of the agency or clinic) to give feedback. The hindering factor for difficult feedback and no-feedback was the trainee’s lack of openness. The results of this research suggest that: “any conceptualization of feedback in supervision must take into account the focus of the feedback, the openness of the supervisee, the supervisory relationship, and contextual issues” (Hoffman et al., 2005).

How do we more successfully provide difficult feedback? Kaslow and colleagues (2007) suggest making the following seven considerations:

  1. Start long before the difficult feedback is needed by establishing benchmarks for performance. Begin by delineating what the goals will be and clearly explain how they will be measured.
  2. Categorize the interference in functioning. Keep in mind the origin of the problem (i.e. situational, developmental, interpersonal, etc.), the severity, the chronicity, the potential for remediation, and the manifestation.
  3. Prepare the system. Make sure you have policies in place that state what the assessment process will be and how the results will be communicated (clear expectations, no surprises). Policies should also include information on how problems of professional competence are handled.
  4. Encourage self-assessment, which develops/increases insight.
  5. Remediation plans should be structured to help the supervisee gain the level of competence expected.
  6. Include diversity. Having an open supervisor, who inquires about and supports diversity issues, tends to lead to enhanced supervision relationships.
  7. Consider confidentiality. Identifying and communicating privacy and confidentiality maximizes transparency in supervision.

These steps are one way in which a supervisor can move toward a supervisory relationship that is more open and that creates an atmosphere where difficult feedback can happen with more ease. Hicks (2011) adds that difficult feedback should describe a behavior, not the supervisee’s intentions, as we cannot possibly know them. Difficult feedback should also be specific, should avoid labels such as “you are inconsiderate”, should be timely (given immediately after the behavior whenever possible), and should be focused on a behavior that can be changed, rather than a personal style (Hicks, 2011). Lastly, he warns that difficult feedback should never be given when angry as it will generally be futile and cause the supervisee to become defensive.

Additionally, Jacobs and colleagues (2011) suggest it may be helpful to think about the following key points in regards to giving feedback:

  • Best feedback conversations happen in supportive environments
  • It is essential to prepare for your feedback session
  • Be clear about what you are addressing and how it will be measured
  • Be sure the supervisee has all the information they need
  • “Set ground rules”
  • “Communicate thoughtfully”
  • Be sensitive to supervisee’s feelings
  • Have follow-up conversations to process feelings after feedback
  • Summarize and set next steps
  • Evaluate the process

Giving difficult feedback can cause discomfort and, at times, can appear to be damaging to the trainee, however, trainees have reported time and again that they desire clear, precise, and timely feedback (Hoffman et al., 2005; Ladany, Hill, Corbett, & Nutt, 1996). Although it may seem contradictory, giving difficult feedback has been reported to improve the supervisory relationship.  An important thing to remember is that the manner in which we give difficult feedback is important, but simply put, actually giving the difficult feedback is what is most important.

 

References

Bernard, J., & Goodyear, R. (2014). Fundamentals of Clinical Supervision. New Jersey: Pearson Education.

Burkard, A. W., Knox, S., Clarke, R. D., Phelps, D. L., & Inman, A. G. (2014). Supervisors’ experiences of providing difficult feedback in cross-ethnic/racial supervision. The Counseling Psychologist, 42(3), 314-344. http://dx.doi.org/10.1177/0011000012461157

Hicks, R. (2011). How to Give Difficult Feedback. Physician Executive, 37(3), 84-87.

Hoffman, M. A., Hill, C. E., Holmes, S. E., & Freitas, G. F. (2005). Supervisor Perspective on the Process and Outcome of Giving Easy, Difficult, or No Feedback to Supervisees. Journal of Counseling Psychology, 52(1), 3-13.

Jacobs, S. C., Huprich, S. K., Grus, C. L., Cage, E. A., Elman, N. S., Forrest, L., . . . Kaslow, N. J. (2011). Trainees with professional competency problems: Preparing trainers for difficult but necessary conversations. Training and Education in Professional Psychology, 5(3), 175-184. http://dx.doi.org/10.1037/a0024656

Kaslow, N. J., Rubin, N. J., Forrest, L., Elman, N. S., Van Horne, B. A., Jacobs, S. C., . . . Thorn, B. E. (2007). Recognizing, assessing, and intervening with problems of professional competence. Professional Psychology: Research and Practice, 38(5), 479-492. http://dx.doi.org/10.1037/0735-7028.38.5.479

Ladany, N., Hill, C. E., Corbett, M. M., & Nutt, E. A. (1996). Nature, extent, and importance of what psychotherapy trainees do not disclose to their supervisors. Journal of Counseling Psychology, 43(1), 10-24. http://dx.doi.org/10.1037/0022-0167.43.1.10

Ladany, N., & Melincoff, D. S. (1999). The nature of counselor supervisor nondisclosure. Counselor Education & Supervision, 38(3), 161.

Milan, F. B., Parish, S. J., & Reichgott, M. J. (2006). A Model for Educational Feedback Based on Clinical Communication Skills Strategies: Beyond the “Feedback Sandwich”. Teaching & Learning in Medicine, 18(1), 42-47. http://dx.doi.org/10.1207/s15328015tlm1801_9

Prochaska, J. O., DiClemente, C. C., & Norcross, J. C. (1992). In search of how people change: Applications to addictive behaviors. American Psychologist, 47(9), 1102-1114. http://dx.doi.org/10.1037/0003-066X.47.9.1102

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