Mental Health and Supervision: Perspectives on Supervision of Graduate Students

Louise Pinkerton

[00:00:00] 

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Kate Grandbois: Hello and welcome to S L P Nerd Cast. I am here alone today without my co-host Amy Wonka, but I am not alone or lonely. I am here with a whole panel of guests. It's not often that we get to welcome multiple people here [00:02:00] for a discussion, and I'm very excited today to welcome Louise Pinkerton, Jenny Brodel, Elisa Green, and Stacey Robinson.

Welcome all. Hi everyone. Thank you. We're happy to be here. I would love to start off by having you all tell me a little bit about yourselves. Um, I'll go ahead and 

Louise Pinkerton: start first, um, I actually took the long way round to get to speech pathology. Um, I was accepted to a master's program after my undergraduate music and decided to do other things, um, specifically singing and, uh, teaching voice at universities.

But, you know, I wanted something a little more stable. And speech pathology is amazingly stable with lots of employment opportunities versus being a soprano. Um, so I did my master's in 2016 and then have worked in a variety of settings, um, outpatient, acute hospital, rehab hospital, and now I'm returning to [00:03:00] university teaching and continuing to do supervision like I did in the workplace.

But I'm an assistant professor and I run the voice team for our in-house clinic. That's wonderful. Thank you, Louise. 

Jenny Brodell: Um, so I, oh wait, I'm the opposite of Louis. I always wanted to be an S L P and I just went straight through right when I got to college. Um, I have always been interested in pediatrics and autism.

I originally worked at a nonprofit outpatient clinic where I specialized in evaluation and treatment of pediatric, um, pediatric clients with developmental, um, disorders. Now I am here at the University of Iowa and I am also a clinical assistant professor. Um, and I specialize in, um, still specialize in pediatrics and autism, but now I'm supervising graduate students regularly.

Thank you. Jenny, 

Kate Grandbois: how about you, Stacy? 

Stacy Robinson: Um, yes. So, uh, similar to [00:04:00] Jenny, I wanted to be an S L P for a long time. Went straight through. Um, I moved out to Baltimore to start my career at Kennedy Krieger Institute, um, their autism center out there. And then took a brief detour in the schools before, um, ending up in, um, Iowa, um, to supervise.

And I still specialize in pediatrics. I'm a more, a bit more generalist than, um, when I was doing autism. And then, um, I also have been developing a little bit of a specialty in literacy lately. So that's been 

Kate Grandbois: fun. Thank you. And how about you, Elisa? 

Elisa Green: I am Elisa Green and I am the clinical director at St.

Ambrose University. About 45 minutes down the road from the other three on the panel here at University of Iowa. And, um, while I'm the clinic director here, I never actually saw myself in academia. I worked in a skilled nursing facility and I worked in a rehab hospital. [00:05:00] Um, and I loved working with students in CFS while I was there.

And it was actually a student who suggested that I apply for a position at St. Ambrose. Um, they said, oh, you're so good with students and you can relate. And, um, even though students have changed and I have changed because I'm not as close to their age as I once was, um, in the last couple decades. But, um, I still love working with students.

Um, I love their energy. I love sharing our passion about our field with them. Um, my specialty is adult neurogenics and, um, I just love working with students and helping my clients and their family members. 

Kate Grandbois: I am really excited to hear more from you all today. Mental health is something that we talk about a lot on this podcast.

We've also talked about supervision on this podcast, but I don't think we've ever had an opportunity to marry these two concepts and do a little bit of a deeper dive talking about mental health in supervision, [00:06:00] particularly with graduate students. So I'm very excited to have this conversation. Before we get into all the super fun stuff, I do need to get through some housekeeping things.

So I'm gonna read our learning objectives and everyone's disclosures, and then we will kick off the conversation learning objective number one, describe practices that support the mental health needs of graduate students learning. Objective number two, describe Anderson's continuum and how feedback changes throughout the clinical education process and learning.

Objective number three, identify at least six characteristics of effective feedback. Disclosures. Louise's Financial Disclosures. Louise received an honorarium for participating in this course. She also receives a salary from University of Iowa and the University of Iowa Hospitals and clinics, Louise's Non-Financial Disclosures.

Louise is the Continuing Education Administrator for the Pan-American Ology Association, jenny's Financial [00:07:00] Disclosures. Jenny received an honorarium for participating in this course. Jenny receives a salary from University of Iowa and the University of Iowa Hospitals and Clinic Jenny's Non-Financial Disclosures. Jenny has no non-financial relationships to disclose Elisa's financial disclosures.

Elisa received an honorarium for participating in this course. Elisa receives a salary from St. Ambrose University, Elisa's Non-Financial Disclosures. Elisa has no non-financial relationships to disclose Stacey's, Stacey's financial disclosures. Stacey received an honorarium for participating in this course.

Stacey receives a salary from the University of Iowa, Stacey's non-Financial Disclosures. Stacey is a member of the Iowa Board of Speech Language Pathology and audiology. Kate, that's me. My financial disclosures. I am the owner and founder of Grand Watt Therapy and Consulting, l l c and co-founder of S L p Nerd Cast.

My non-financial disclosures, I'm a member of ASHE SIG 12 and serve on the a a C advisory group for Massachusetts Advocates for Children. I'm also a [00:08:00] member of the Berkshire Association for Behavior Analysis and Therapy. That was a lot. You all are a wonderfully experienced group of people, so thank you to everybody who sat through that with me.

Um, I would really like to kick off this conversation with a question related to what you have listed here as the modern student. So I was reviewing all of your notes that you sent in before we hit the re record button. And you have a lot of information here about the quote, modern student. What is that exactly?

I.

Elisa Green: So the modern student is actually six times more likely to experience anxiety and depression, and stress can be a cause of that. Anxiety and depression. I can see Kate's face. I was also shocked when I found out and read that research of how much more anxiety and depression is incurring with our students.

And so we can't just say, well, in my [00:09:00] time, or maybe they need to tough, you know, tough it out. I toughed it out. It is different. Our world is different. Our current students are different. Just like we treat our clients as individuals, we need to be treating our students as individuals as well. And so that'll be one great thing about learning the different kinds of feedback and information that you can provide these students because you really do need an arsenal of different supports depending on the student that you have.

Um, so not only across campuses are we seeing the trend that, um, anxiety or mental health in general. So, anxiety, depression are kind of the two that speech pathology students have the most of. But in general, mental health is becoming more and more of a problem across college campuses, and that's undergrad and grad students.

Um, but our grad students are faced with even more challenges as they enter this kind of [00:10:00] adulthood, um, phase of their life. Also, the rigor of our coursework increases. They're actually seeing real people where they are making decisions that impact these people's lives. And so it's adding to their, um, stress, which increases their anxiety and depression.

Kate Grandbois: So I, straight out of the gate, I am blown away by these statistics.

I'm not surprised, but I don't think that I had a good understanding or a good grasp on how much of a problem it was. And I really appreciate, I guess, all of you taking a moment to hold space for that because graduate school is extremely stressful in and of itself. And I think if you map on, you know, I know the, the point of this podcast episode is not to talk about the complexity of our society and our broken world right now, but there are a lot of stressors out there.

And I, I, I just really appreciate, I really [00:11:00] appreciate, um, you taking space for that. I wonder if you could tell us a little bit about, um, how that stress impacts the graduate school experience?

Elisa Green: Um, yes, I can. So we ask our students to work with clients. We ask them to meet productivity. We ask them to make quick decisions and write down exactly what they did and what they saw in a very fast paced world. And if somebody is experiencing significant, um, mental health deficits, They are going to struggle to do just the basic things, let alone what we're asking them to do clinically.

Jenny Brodell: And 

Elisa Green: so, um, we might ask them to, 

Jenny Brodell: um, 

Elisa Green: uh, you know, build a relationship with a client, [00:12:00] but somebody who is experiencing mental health disorders has challenges creating that relationship to begin with. And so those things that we're expecting and asking them to do clinically are going to be more challenging based on what we know about those who are experiencing mental health 

Jenny Brodell: deficits.

I also think we can't, you know, discount that we're not that far away from the pandemic and how that has really impacted our students. You know, something that Elise has been saying, which really rings true for the students, you know, we've seen recently is just this switch from, you know, one, like you had said, going from just sitting in a classroom to now you're in clinic and you have to actually apply everything you've been learning for years.

Um, but you know, they, this, you know, new generation of student has had so much of their learning put online and virtually [00:13:00] to where they, you know, now those interactions almost get taken out of the learning process. So it's almost like they have to have this crash course and like, what does it mean to truly collaborate with someone?

It's more than just kinda sharing a Google Doc back and forth. Um, it's more than just, you know, here read this and then you'll know how to do it. Um, I think. What we've noticed is that just some of those, um, those skills and working with other people in general, um, need a little more support because they've had this period of isolation where they haven't had as many opportunities to expand their just kind of general, um, you know, collaborative skills.

So 

Kate Grandbois: in relation to the, in relation to the statistics that you mentioned earlier about how anxiety and depression are on the rise in this age group, just in universities in general. Mm-hmm. Would you say that this problem is particularly [00:14:00] difficult for students in communication sciences and disorders when compared to other forms of student bodies or other tracks, other disciplines?

I. 

Elisa Green: That is what the research is showing us. And so there was a study that had different health sciences, um, and they compared, and speech students led the way, for lack of a better term, in signs of anxiety and depression, um, across the board. And when asked, you know, why they thought this might be some perfectionism came into play.

And so, you know, I think about my college professor, um, we were on a committee together years after I had graduated and I was saying, well, we need to do this and this and this, you know, and kind of make it the best it can be. And his remark to me was, your Type A has been driving me crazy for decades, but we're getting stuff done with it.

Right? And so I was able to use my little dose of [00:15:00] perfectionism. I'm by no means a perfectionist, but a little, a little dose of wanting to do things just right. Four positive outcomes. But if I am somebody who has perfectionism and anxiety and depression, that's gonna make adverse outcomes. I'm not gonna be able to lead my group to get things done.

I'm going to be putting things off, worrying about things, overthinking things, not sleeping at night, and just making my problems even worse. 

Kate Grandbois: It also makes me wonder about the culture within the graduate program. So, um, I mean, I, I'm hearing you say the word perfectionist. I am sure. Mm-hmm. There are many of us who bring that to the table as part of our natural personalities.

Mm-hmm. Uh, but that's not everyone. Not everyone identifies as a perfectionist. So, but if we're quote, as you said, leading the way in anxiety and depression in [00:16:00] graduate school, what does that say about our academic institutions and our professional culture? That cultivates this, this, I don't know, extra special anxiety and depression skill.

Stacy Robinson: I think part of it is just the rigor to get into graduate school in the first place. If you think about what students have to do to even be accepted into an SS l P graduate program, I mean, I'm on the admissions committee at our university and the excellence of students that just apply but are not gonna get in because they're not excellent enough.

Because there's just so many, 

Kate Grandbois: you know? I was gonna say, what contributes to that? As someone who went to graduate school almost 20 years ago, don't tell anyone. What is that like now? I mean, why is it so competitive? 

Stacy Robinson: I don't, I don't know. But I mean, it's the students that are getting [00:17:00] into top programs are, they need to have, they.

Basically a 4.0 g p a. They need to have research experience, they need to have some kind of clinical or, you know, volunteer experience. They need to show leadership capabilities. I mean, the number of things that students in their undergrad programs are doing just to be able to get into the graduate program.

And a lot of times I have to tell our students, Hey, you've already shown us that you are excellent. And they're still trying to prove it to us, and they're still putting that same level of pressure on themselves that they did to get to this place. 

Jenny Brodell: I do think another, um, you know, roadblock to is that we just, you know, we're limited in.

I say we as you know, the collective we and how many programs there are out there and how many students, you know, are coming through undergraduate to graduate programs. And you know, this is an issue we talk [00:18:00] about in-house all the time is just that we, we really struggle to take on more students because of the type of experiences we want them to get clinical or otherwise.

And we don't have enough faculty to take on more students. And so I think there's just issues at all levels that really create roadblocks and then, you know, increase this, this stress surrounding just getting into the program. This 

Kate Grandbois: is wild. I mean, you hear about things being stressful, but this is just remarkable.

Louise Pinkerton: Yeah, and I'll, I'll run back to, they've gone through all that stress just to get into the program and we do a lot of talking to people about, we're a collaborative group now. It's not competitive. You're working together. And that is a huge mindset shift. And I know I've had lots of discussion with students, especially the last couple years about being excellent or being [00:19:00] competent and what the differences are and that it's okay to be a competent clinician.

That's our baseline, that's our bottom line. That's good. And just determining that, you know, not every session has to be peak. Excellent. Every session has to be good and solid and show progress in their skills and help their client. And that's a really hard thing for our students to get used to because not perfect is bad.

So then what is competent? 'cause competence not perfect. Competence what ASHA asks for and competent is what we ask for, and so it's a real change. 

Jenny Brodell: That kind of gets into the, the issue of changing from just classroom, like coursework to clinic where in classroom, like Louise was saying, competent is an A or an a plus.

That's in their mind is what competent is because that's what they need, you know, to be at the top of their [00:20:00] class to get into graduate school. Now you get into this world of gray that is clinic and like Louise said, what is competence? They think it means I must know everything. I have to know how to do everything before I do it.

Um, and I think that again leads to so much stress and we really have to, you know, kind of keep telling them over and over again, like, we don't know what we're doing. A lot of the time it's okay to not know a humongous part of our job is going on that search for more information, not. Knowing everything ahead of time because that's impossible.

Elisa Green: And then if you take to Jenny's point, we're expecting them to have clinical inquiry and see what happens and try things out. But if you are somebody who is already lacking self-confidence and having anxiety, you aren't going [00:21:00] to feel comfortable and you aren't maybe going to try those things that we expect our students to do.

And so I, I had a student sitting in my office and they were telling me right after the dysphasia test, all of the stages of the swallowing, all the anatomy involved, everything with it, what you would do to assess it, what you would look for on the swallow study. And I said, so what'd you write for your test?

Nothing. She wrote nothing down. She said she got there and her head just went completely blank. And she has significant anxiety and she has accommodations for test anxiety. If nothing's coming to your mind, she couldn't share her knowledge. And we're expecting our students on internship or our CFS to share their knowledge, to try new things to explore and their mental health may impact what we're seeing.

Kate Grandbois: Well, and it's making me think about what science says about learning. The science of learning is [00:22:00] operating on the fringes of your competency. It requires vulnerability, it requires discomfort and anxiety. Just shuts all those things right down. I I am, I am shocked. I'm wondering if you could tell us a little bit about what this looks like.

Are there signs and symptoms for anybody out there listening? I and I, we mentioned this before we hit the record button, but I suppose it's, it begs, you know, it's worth saying. This applies not just to graduate students, but to anybody else that you're supervising, fully certified SLPs individuals in their clinical fellowship.

Anyone who's new-ish to the field. Um, I think we're, we are living in a sort of perilous time. Identifying signs and symptoms of anxiety and depression in our supervisees and our colleagues and our coworkers is, is really important. What can you tell us about signs and symptoms? Um, to be on the [00:23:00] lookout for, in a workplace?

So 

Elisa Green: it's an individual I. Kind of thing. And so you might want to get to know yourself if you have anxiety or depression, but also your student. Um, I work with my students all the time on what are your symptoms, what are your signs to try to catch things beforehand. Um, but in general, irritability would be noted.

Maybe difficulty controlling your emotions, like having extreme worrying about something, maybe constantly seeming like they're on the edge. Um, exhaustion can be a big one. You know, they always seem tired and sometimes I. Um, supervisors will say they don't wanna be here. They don't seem like they wanna be here.

They're yawning. They seem disinterested. Those things might manifest. Um, the students might feel guilt, like they're not giving their best to this client, this actual human that's sitting across from them, that they are, quote, in charge of, [00:24:00] um, 

Jenny Brodell: helping, um, 

Elisa Green: feeling low about their, you know, low self-esteem, about their own worth.

Um, there could actually be physical manifestations, so like physical pain or headaches, you know, those, those kinds of things without known causes. Um, it's also worth noting that the signs and symptoms and anxiety and depression in general occur more often in women. Which our profession has a lot of, 

Jenny Brodell: but 

Elisa Green: also in those gender non-conforming individuals as well.

And so those two, um, types of people, um, are where we're gonna see those anxiety and depression in increase the most. And we have a lot 

Jenny Brodell: in our field. Um, from that.

Elisa, I 

Louise Pinkerton: was gonna say, I know you have some really good ideas for then how to deal with these in the clinical setting. We've, the four of us have done some presentations [00:25:00] together, and I know in particular there, there were some acronyms that I wanna be sharing with my students, and I was wondering if you could tell us about those.

Elisa Green: I can, so they're actually from the ASHA leader in 2017. Um, their, their acronyms, I love them. I think because of me, they're like memory strategies and easy to remember. Um, so the first one they talked about was the surf model, and that's really, um, you know, self-care understanding, so like seeking to understand someone else's perspective.

Um, relationships, there's so much with just relationships, having a relationship with the client, having a relationship with the student, having a relationship with the university so that you can get that, that kind of support. So, um, and then the f is for focus, like a clear focus. And so many of our students now are asking for clear expectations.

What do you expect of them? I'll [00:26:00] tell my students, I can't expect something from you if I, you know, you don't know about it. And so trying to be as clear as possible in what it is that you are expecting of them. 

Kate Grandbois: Another note that I see here is that there's some evidence in the research that those who report symptoms of anxiety and depression also report multiple issues with supervisors.

Yeah. So there's a relationship between the supervisee and the supervisor relationship. Can you tell us a little bit about that? Um, yeah, 

Elisa Green: so about half of the people who have some kind of disclosed mental health issue report that they felt unsupported, their supervisor didn't care about them, they didn't provide any, um, good feedback, which again, is gonna be so wonderful to hear about.

Ways to provide good feedback and support. Um, and they just in general, Don't feel that we have as supervisors [00:27:00] provided that support for them, um, which is why it's important to know what feedback to 

Kate Grandbois: give.

You mentioned acronyms. Do you have more acronyms for me? I love a good acronym. 

Elisa Green: Well, just one more. And as much as we might try to provide them feedback, you know, your question was how do we support people and when they report that they're not feeling supported or cared about, um, It can still go wrong, right?

So we think we're providing great support. We think we're providing great feedback. We've used all the tricks that we have in our supervision bucket and it's not working. And so then the last acronym is dare uh, again, this is from the Asher leader in 2017, um, from Rice, I believe. And it's, you know, Des the D is design your mindset carefully.

So really assume positive intent from the people that you are talking to, um, and supervising. And then the A is for [00:28:00] approaching yourself, but also others with compassion. As a supervisor. Don't forget to breathe. Take a deep breath. Their future is not entirely on your shoulders. And I think we as supervisors sometimes feel that way, but it is not.

You are one piece. A very important piece, but one piece of their, their future. Um, and then going on with the acronym, the R in DARE is for requesting feedback from others. I only know what, I know other people have had different experiences and they can maybe shed light or think of something from a different perspective than what I thought.

And then finally, um, for the e it's about expectations. Um, expectations and relationships are gonna drive our outcomes in clinical settings. And so letting others know what you expect of them, and then also having [00:29:00] that relationship with them so that they may feel more comfortable to try things, they may feel comfortable to disclose to you that they have, um, some anxiety or depression or other kinds of mental health so that you can support 

Louise Pinkerton: them.

I wanna add to the expectations. It's also that we need to work on learning how other people understand our expectations. 'cause there are many times where I feel like I've been very clear and I've laid it out and I've given step-by-step. Or maybe I didn't write it out, but we did it verbally and I thought people understood, but I find out after the fact that they were missing key points or there wasn't follow through or the, the format I had chosen to share it just did not get through.

So it's not, it's important to have the expectations and to communicate them, but also make sure that communication's been received, which I think is kind of a tenant of the whole idea of communication. It's not talking, it's being [00:30:00] understood.

Kate Grandbois: Thank you for that delineation. And I'm, I'm thinking about everyone listening who now feels a tremendous responsibility to mitigate all of these factors, not only for a graduate student that you might be supervising, but a CF that's you're supervising, um, or, you know, feedback that you wanna give to your own supervisor who's creating maybe a more toxic environment than is necessary if this feels really overwhelming for people as supervisors.

I'm just moving ahead to our next learning objective 'cause I love a good framework. Are there any, are there any structured approaches that we could take to improve. Our ability to move through this and support graduate students. 

Jenny Brodell: Yeah. And I, I love Kate how earlier you had mentioned just like what's, what are general processes for learning?

Because those are, um, definitely things we look to when we think about how do we support people, how do we support their learning in general? [00:31:00] One that we use a lot, um, at the University of Iowa, and I know this has been adopted many places, is Jean Anderson's Continuum of Supervision, which has three main steps.

One is, you know, an evaluation feedback step, and that's one we're, we're really giving lots of direct and consistent feedback to a learner. Then we kind of move into a transitional stage where our student is gaining more independence, they're needing less direct feedback. We become more collaborative in nature until we move into the last step of the framework, which is self supervision, where the student is able to.

Um, you know, really just use us as a consult where they're engaging in independent learning, they're motivated to make changes, they have more tools to support themselves and to reflect themselves. And what's really nice about thinking about a framework like this is that we can [00:32:00] individualize it not only to each individual student, but to each individual learning opportunity that they have.

You know, the, the goal is not that every student should be starting in the evaluation feedback stage and needing much more support until they move along the continuum to self supervision. It's that we as supervisors need to take a little bit of time to figure out, you know, where this student falls within this particular learning episode.

Um, so maybe we have a student who has. Worked as a camp counselor before. They have lots of experience with kids. They were a teacher previously and they're coming back. So they already know a lot of, you know, different learning strategies in general and working with children. So maybe they're starting in this continuum and the Andersons continuum a little farther down on, on the scale.

They're in the transitional stage. They're almost to self supervision, but you know, we have to look [00:33:00] at. A different situation in a different way. Let's say they get to the hospital and they're now gonna be working with a patient with dysphagia, and they might be in that evaluation feedback stage where they need more support.

Um, we, we really just kinda like this framework because they think it makes us slow down and think about each student as an individual. And considering that they're not gonna know everything as none of us do, um, they're gonna feel more comfortable and more knowledgeable and competent in cer certain situations.

Um, so we need to kind of take the time to just recognize that and think through, okay, what do they know? It's my job to kind of figure that out, set up the relationship so we can kind of get that information and then use the support that's necessary within each of those different situations. And I 

Stacy Robinson: think that.

Not only is that framework really helpful for us as supervisors, but I think it's [00:34:00] also incredibly helpful for the students. Mm-hmm. So we share this continuum with students. I have my students Mark, where they think they are on the continuum when they start a placement with me, um, to see what their perspective is of their own learning and what they are gonna feel comfortable with.

Um, and just like Elisa was talking about, that helps create an expectation of this is what we're kind of looking at across this next semester or even across this specific evaluation that we're preparing for, or something like that. Um, because I think we mentioned this earlier, students sometimes think that they need to be able to do everything perfectly the first time.

Um, and so even if, you know, I have a student who's pretty independent in their treatment sessions that they've been doing every week, well then we get to an evaluation and I. Suddenly, I think they sometimes have the perspective that I'm gonna be just as uninvolved in that evaluation as I have been in their treatment sessions.

And it's important to tell them, oh no, I'm gonna be in it [00:35:00] with you because I recognize that this is a different, um, stage of your learning and I don't expect from you in this situation what I have maybe come to learn that you can do and now expect from you in another situation.

Elisa Green: And I, I love that idea, Stacy, of having them mark where they think that they're at in the continuum. You know, self-assessment, self-evaluation is a skill that we really want our students to develop and that I think will help them, but it could also help them to see that they have shown progress, and then it leads to those great conversations where you're being supportive and you're telling them, I don't expect you to be way over here in the continuum with this kind of client.

And helps them to see that you have different expectations based on different clients because of their 

Jenny Brodell: different experience levels. Right. That really brings us to, you know, one of the most important feedback strategies if we're kind of keeping this framework for supervision in mind is that it's [00:36:00] really essential that.

You know, you set up these expectations and you set up this environment that's really accepting of what the learning process is. The student has to know, again, that this is much different than just, I'm gonna tell you information and you will memorize it, which is what they know thus far before they get to clinic.

That's what coursework is. Um, hopefully it's a little more than that, but you know. It's just different. Um, so just letting them know like, Hey, we're all gonna make mistakes together. Me, myself included, as a supervisor, we are all on this journey of continuous learning. We expect questions. We want you to ask questions.

We do not expect that you know everything, and that is okay. You don't have to know everything. And I feel like I constantly want to remind my students like I do not know everything. I have to go on this [00:37:00] continuous journey of learning with you. I do not know it all. 

Louise Pinkerton: I think some of the best learning opportunities for my students have been when the treatment protocol we decided to do for voice therapy wasn't a good match.

'cause we had a client that came in with an advanced neurological condition I was less familiar with. We were doing the things that should have worked theoretically, research-wise, evidence-based, but they just weren't a match for the client. They didn't fit her. And so for them to see that, frankly, we crashed and burned and had to completely reevaluate and find a different approach that would, was still evidence-based but would get her where she needed to be, was I think an incredible process to go through because I'm the one that guided them to make those choices in the beginning.

And then we had to reevaluate and really start over. And I think it's exactly what would've happened if I was treating the client on my own. Because I [00:38:00] started with the tried and true and it was great how those students could see, again, that process and how you reassess and how you maintain a relationship with a client when you're having trouble with them.

Seeing that we are not perfect. Yeah. Very, very good point. 

Kate Grandbois: It reminds me of my, one of my favorite quotes that I say to myself privately, quietly, in my mind all the time, failure is data. Mm-hmm. That's all it is. It's in more information for us to reconsider our goals, reconsider our approach, tweak, rinse, repeat.

I love 

Stacy Robinson: that. I love that. Yeah, I love that too. I'm gonna start using that with. Um, I think it's also important for us to, kinda like what Louise was saying, like she guided them on that treatment path. Um, and it wasn't their quote unquote mistake because I have so many students that do exactly what I tell them to do and it doesn't [00:39:00] work, and then they feel like they've messed up.

And so part of creating that environment is being really honest and saying, no, you did everything I told you to do. I wouldn't have expected you to do anything else. It just didn't work. And I now, you know, now we together can come up with a new strategy, but even just to kind of help ease some of that stress, sometimes it helps for me to just go ahead and take the lead and say in owning up to like, Hey, that was what I told you to do and it didn't work.

But that's okay. 

Jenny Brodell: Yeah, and I think that really kind of. Bridges into this. Next point I wanna make, we're, we're kind of getting into some more evidence-based feedback strategies from this paper by Laura Mogenson and Markins from 2016. Um, I was talking about creating and accepting environment. One is definitely, we wanna normalize mistakes, but then also discussing what is feedback and discussing that process upfront because that is another area where [00:40:00] before I was a supervisor, I don't think I even thought about it.

Um, it was just, I remember having a meeting with my students and offhandedly saying I take written feedback 'cause I'm old school. I don't, I don't like to type. I write by hand. Um, um, and I just remember someone had said, some had commented on the length of my written feedback and I had said to the group, you know, it's the length of my notes has.

Usually has nothing to do with what you are doing in a session and has everything to do with what I am paying attention to, to what I am thinking about. It's not, if you have a full page of feedback, it's not a mark of failure. It may be just meant I was in your session for longer, or I, you know, we were doing something newer that day.

Um, and they were like, no one has ever told us that before. And since that moment I'm like, I really need to [00:41:00] dedicate. You know, so more, much more time to talking about what is feedback, what can it look like, what does it mean? And that is part of creating this accepting environment and getting students to understand, again, this new way of learning, because they don't get constant feedback again in classrooms, they might get a note here or there.

They might see a minus one or a letter grade on a paper. But in clinic, man, we're watching them, we're writing down notes. We're sending them things. We're putting in long comments in their clinical documentation. And so just letting them know, here is the expectation. Here is what my feedback will look like.

Here is what it means. It's a tool for learning. It's a tool to help you think a little more critically. It is not a mark of failure. Where, you know, unlike, again, in, in your different learning [00:42:00] experiences, having more notes does not mean, oh, this is a failure. It just means, wow, there's lots of learning opportunities here.

And really, once I've seen students. Kinda grasp that. And I, you know, I feel like those have been the most successful, um, partnerships I've had with students is when we, I present, I make it more clear what this learning relationship will look like, and they kind of understand that, and then it, it kind of helps 'em feel a little more free and in asking questions and saying they don't know something and trying to write something in their documentation and then putting a little note and saying, I don't really know how to say this.

Let's brainstorm. And I feel like those are the best learning partnerships where we can, you know, both be vulnerable with each other because we know the expectations. We know that part of it is figuring it out together, not knowing at all, and recognizing that feedback is not punitive. It's a learning tool.

[00:43:00] I also just 

Kate Grandbois: wanna point out as I'm listening to you talk, That when you take this approach, it sounds like you are modeling humility, you're modeling a lot of professional humility. You're modeling a lot of vulnerability, right? Mm-hmm. And we know that these are the things, this is the environment. This is the culture that is required to operate on that fringe of competency and take those risks and feel uncomfortable and sit in your discomfort.

Um, and I love the idea of harnessing that as the supervisor to shift that culture through providing it as a model 

Jenny Brodell: yourself. Right. And I don't, you know, maybe it's, uh, probably a lot of this is generational, but I just remember thinking back, you know, when I was in, in undergrad and graduate, like, gosh, those professors know so much.

Those are the smartest people I've ever known in my whole life. And they probably were, but I never thought, oh, they [00:44:00] must make mistakes. They don't know it all. They have to continuously learn until you're the one working and you realize like, yep, we're all just, we're all having to figure it out day by day.

We, there's new research coming out. There are different. Client or patient or student presentations that I need to, um, you know, do more research in or I've never seen this type of patient before. And I think it's so important to let students know that that's not just their expectation as a student.

That's the expectation as a working clinician is that you never know at all. Your job is to continuously learn and to always be thinking about, you know, is there new research? Do I need to, um, you know, compile different approaches, reconfigure what I am doing rather than just. Looking at the learner in the situation when you're the clinician, which is your patient, and saying like, oh, it's them.

They need to do something different. It's [00:45:00] us. We, we usually need to do something different. Yeah. 

Elisa Green: And Jenny, I love that like lifelong learner approach. That's what we all have to do. And I know when I started my very first student supervising, the advice I got was, do not try to teach them everything. You know, because it took you all these years to learn that information and you can't shove it into their head in a very short amount of 

Louise Pinkerton: time.

I am gonna jump right of that off of that Alisa, because two of the points we wanna make later about effective feedback, or maybe we'll make those points now, is about appropriate amount and self-directed learning and starting with the self-directed learning and that lifelong learning part. I'm finding that's a really difficult one right now that a lot of my students need a little bit of a push or an impetus to take control of what they wanna learn, make decisions about what [00:46:00] directions they're gonna go actually go look things up.

Um, I was kind of surprised about that in a couple situations. It's like I said, go look at this website, read these three pages. They're like, yeah, I opened the page. Well wait a second. You're the one that has to see this client. Here's all this information that you could use. So getting people to, to take ownership over that and become those lifelong learners that we know they have to be to be good SLPs and a good s l p again, is a competent s l P, not an excellent SS l p I suppose.

They're both, um, and the appropriate amount part. I love what you said about that because in the beginning I kept thinking, you know, I have all this stuff I've learned through my clinical work and through my prior profession, and it's just like, I wanna download it into their brains and I can't do it.

And I remember the situation where we were rearranging a clinic room and I thought, well, why don't I explain the logic behind why we're rearranging this and how I wanted the [00:47:00] client and how I wanted them. And then I got into the idea that, well, you know, you always should make sure you have a way out of the room, which is something you really push in medical settings and in hospitals and in psych wards.

And then all of a sudden the students are just staring and looking at me and going. Are those concerns for our client? It's like, no, wait, no, your client's fine. We're, we're not worried about behavior, we're not worried about needing to escape. I was just giving them too much. Um, and so I think that idea of appropriate amount and yeah, we took a lot of time to learn this and they'll learn that lesson when they're in that setting.

I don't have to tell them that we're putting the table this way. So I always have a door or the client's never between me and a door that can come later. 

Stacy Robinson: I love those, uh, lessons that we get as supervisors too. Um, that makes me think also, Louise, of being really specific in your feedback. [00:48:00] Um, Because a lot of times, you know, I know what I'm thinking when I wrote something down, but maybe the student doesn't understand what I was thinking.

Um, so oftentimes I just try really hard to be very specific. I, even, the way I take feedback, I separate it by activity in the session so that the students know like, oh, I'm talking about this point while you were reading a book with them so they can like think back maybe to the exact moment when I wrote that piece of feedback.

Um, And then I also try to use a lot of like rationale and examples when I'm being specific. So explaining to them why I'm telling them that. Like in your example, Louise, like, Hey, I'm telling you this because I just thought of it, not because, um, I actually think it's a concern for our patient or giving them an example.

You know, if I tell a student that, um, I'd like them to phrase something differently or that their language is too complex, I'll often try to take an example of something they said that was too complex for that [00:49:00] client, and then give an example of what they could do to change that. Um, and I think that really helps increase the clear communication between the supervisor and supervisee, um, which is so important for, again, that relationship that's gonna support good supervision and good mental health, um, 

Jenny Brodell: in your students.

Just piggybacking off of that idea of. You know what can kind of support their mental health. Another thing to keep in mind with feedback is that it really helps to focus your feedback on, you know, this is in line with being specific, but focus it on that behavior that you're seeing, not making statements about the individual.

So instead of saying, you did this, you did that, those are just. Ringers for, you know, for people to take personally as we all would, right? If someone wrote like, [00:50:00] you didn't do this. Now I'm thinking, oh my goodness, I did a bad job. I'm in trouble. I, I have to do it differently next time, which may be effective, but that does nothing for, for my positive, you know, my, my kind of, um, self-esteem that makes me feel terrible.

Like, oh, I failed. So instead of phrasing statements about the individual, keeping it, about that, that behavior, that action, that was great or that maybe needs a little more thought for the next session. So this, this activity was really successful because X, Y, Z or when this type of a statement was used, the client was, you know, that supported the clients.

Whatever skill you're working on versus you did this, you did not do that. And I think sometimes 

Stacy Robinson: the standards that we have set up for students can [00:51:00] help us focus on those behaviors. 'cause it's almost like a list of behaviors that you should hopefully be looking for and cultivating in your students. So at the grad student level, you have the cost of competencies.

Um, some of those are delineated by Asha At our university. We also have other things that we're looking for and a lot of times I try to revisit those, um, competencies. We do it minimally twice a semester in the middle and at the end. But I try to revisit it more than that because that also sometimes helps me give more summative feedback.

A lot of times I can give a ton of specific feedback and then the students still won't really have a sense of whether or not they're doing well. So taking that moment to focus on the standards that you have for them and discuss how well they're doing to meet those standards can really help decrease some of that anxiety as well.

Because a lot of times we think that we're being clear in our, you know, day-to-day feedback. Um, but students don't really know [00:52:00] what we're thinking in a more summative 

Jenny Brodell: sense. I know Louise is going to talk about this strategy soon about your, your own self-reflection and collecting your own feedback. But that point about reminding students about standards is something I have to actively work at.

I forget because I just have those casa competencies stamped in my mind because it's what I do all the time. Um, but a once a student asks me in a meeting, kind of like you just said, Stacy, so how am I doing? Am I, am I gonna pass this clinical rotation? And I was thinking like I. Well, yeah. All I write is positive feedback in every, after every single session and every single note.

But I'm like, oh, I haven't, we haven't done our midterm yet. I haven't, you know, this is your first semester, so I need to give you a detailed discussion of these are the specific skills I'm looking at. Because feedback that you give for weekly sessions or weekly documentation [00:53:00] is much different than the evaluative feedback you give when you're grading someone or doing a performance review.

So just keeping that in mind is so powerful and recognizing like, I have a different thought process than this person I'm working with. 

Louise Pinkerton: Yeah, absolutely. And I think that communication is really important and that feeds in to creating that open and honest environment that's really helpful for mental health and helpful for communicating.

And it's a really important part of requesting feedback, what you were just referencing that I will touch on now. Um, but as a supervisor, it's very important that we get feedback. I. From the people we're working with. And we all know that we are never a finished product. We will be working on our clinical skills and our clinical knowledge and our supervision skills and our personal relationships until the end of our career and probably beyond that.[00:54:00] 

And part of that needs to be informed by the people we're working with. I think of evidence-based practice and you know, we've got the research, we've got our own experience, and then we've got the client preferences. We need to include the student preferences almost in our evidence-based practice triangle for supervision.

Um, and that open and honest environment is essential. Um, and also opportunity. I find that students say a lot of things to other students, but if we don't give them the opportunity to share it with us, we don't hear about it. And I often end my supervision sessions with, what else do you need? An open-ended question and.

Hopefully they understand it's an opportunity to say, I need to know more about this technique. I really don't understand why we're doing this. Um, I'm horribly stressed and need to, it's just an open opportunity to, to share what they're needing at the moment. And we usually start with an open-ended question about how things are going, [00:55:00] but, but it can lead us different directions and let them actually direct our supervision session.

Um, but some of the things we certainly wanna do is model receiving feedback. Well, um, if we get feedback from students and don't take it well and become defensive, we've kind of defeated the purpose. I do find my students have a hard time with the difference between things under my control and things not under my control.

I'm gonna start being more speci specific about, you know, there are things I can and will change and they're not a big deal that I'm glad to flex on. There are things I can't change. I cannot change Casa Casa requirements. I can't change a Asha ethics. I can't make your clients show up when they're canceling.

Um, you know, I appreciate the feedback, but there's very little under my control. And then there's another group of things that I won't change because I know that this is good educational practice and as uncomfortable it [00:56:00] is for a student to sit in, in those, um, desirable difficulties as it doesn't matter that they don't like it, they're still learning from it.

I am finding I need to do some more clarifying of what I can change for the students. Um, and also one of the things I found the last couple semesters, and I think this relates to some of the things with Covid and what Elisa was mentioning about the modern student being different, is that I'm doing the things that have created an open, honest environment in the past.

And I've been doing collegiate teaching since 2000. So I have a lot of experience with it. But what I'm finding is students will sit with me, we have a problem, we figure it out, we create a solution, we develop a plan, we agree on it. And then I am skewered in my final anonymous course evaluations. And I think this is part and parcel of learning how to communicate and not having [00:57:00] some of those fundamental experiences where you disagree with people.

And just the whole idea of, you know, we need people to understand. They can tell us. That this doesn't work. You know, I wouldn't have had a problem with any of the things that were said. What I have a problem with is that some of the students agree to one thing when they really want something else. Um, and so it makes that feedback really important and I've been doing a lot of reflecting on that and how I am gonna find a way for these students to feel comfortable.

It's a challenge. 

Stacy Robinson: Yeah. That is so difficult. And I think it goes back to what you're talking about, Louise, about creating those opportunities for feedback. Um, you know, that's hard to do on both sides of the equation, you know? So there's so much that we're often talking about in our individual meetings that's just, okay, how are we gonna get to through the next session?

Um, but spending some of that time you have with your student, whether that's in [00:58:00] scheduled meetings or between sessions, whatever, I. Setting you're in and what that allows for, to give them an opportunity to let you know how you, how they think things are going. Um, I often. At least at midterm, uh, require my students to give me, um, non-anonymous feedback because I always tell them, I'm like, this feedback is for you.

The feedback you give me at the end of the semester doesn't help you because you're going to a new supervisor, but the feedback in the middle could help you as an individual. Um, so I really try to encourage that for them. Um, but then it's also important to make sure we're creating opportunities for us to give feedback to the students, um, and making sure that that feedback is timely.

You know, some students myself include, well, really myself, so people in general, um, just to have short memories and they might not remember what happened two days ago. So if the student does a session and we don't get them their feedback for a couple of days about that specific session. [00:59:00] They might not really remember what we were talking about.

And sometimes a student will ask me a question about feedback that I gave them a week ago, and I have to say I don't really remember what was happening in that session. Um, which is why being specific can be helpful. 'cause then that usually triggers my memory better. Um, but yeah, but finding times to be timely with your feedback.

So whether that's something that you have to do in the moment, in the middle of the session because it's impacting the client's care or if it's something that you need to say right after the session so that it's fresh in both of your memories. Um, or if it's that more summative feedback that I was talking about before and maybe that only happens once a week or once every couple of weeks.

Um, all of those things are important to take into consideration when you're giving students feedback. And again, if we pull back to that mental health piece, if you have a student that has a lot of anxiety, They just finished the session and they're not hearing anything from you that can real, just the, the [01:00:00] not knowing of how the supervisor thought that went can really increase anxiety.

So a lot of times I'm running from one session to another. I don't have time to do a long verbal debrief with a student, but I'll at least say like, Hey, that went really well, or, oh yeah, he had a hard time with that. You know, your client had a hard time with that. We'll make sure to talk about that in your meeting.

So they at least get something from me before they go to read my, uh, 

Kate Grandbois: written feedback. And I have to assume that in those situations, you know, kindness and a smile go a long way, even if it was a really rough session or even if, even if, regardless of the situation. Um, being a graduate student is so you, you're so vulnerable.

I remember that feeling of being looked at through the one way mirror. Oh my Lord. And it was very uncomfortable. You're just being creepily, like, just observed, you know? It's, it's really uncomfortable. So I have to imagine that just the [01:01:00] delivery, embracing a little bit of kindness and a smile, and even, even commenting on one praise you.

This went really well. The other parts, well, let's talk about it at your meeting. You know, I just, I I have to imagine that that really, you know, counts. 

Louise Pinkerton: Absolutely. I remember one session where the clinician mentioned to me right at the end as we were all wrapping up and the client had left, well, that was a dumpster fire.

And I'm like, no, actually, it was exactly what I expected, and it was exactly where we needed to be. We were co clinician together. You did, you did everything. That you were capable of doing at this moment. Um, so it, that can be so important for that client not to have lived with their dumpster fire. 

Kate Grandbois: You all have shared so much with us today. We've talked about workplace culture, components of mental health, everything as a supervisor you can do to improve this journey for graduate students. You've brought a framework to the table.

We've [01:02:00] talked about how you can model things. You've shared so much knowledge. Do you have any parting words of wisdom for our audience or words of advice for anyone who is listening who is currently supervising a graduate student or thinking about supervising a 

Louise Pinkerton: graduate student? Yeah, I will take this one.

Um, the first thing is don't do it all at once. Um, take some time, reflect on what you're doing, acknowledge yourself for what you are doing well, and then think about some small achievable changes you can fit into your practice and your setting and your situation. So maybe if there are one or two ideas from this that you think would make meaningful changes, implement those.

See how it goes. And then reflect again, do I wanna continue doing these? Do I wanna add another one? Have I made these a habit enough? I've got the mental space to add something new. And I think it's just a process of wash, rinse, and repeat. Um, keep doing this as you go and adding [01:03:00] and dropping strategies as you find that they do and don't work for you.

But, you know, one to two at a time is plenty to try and change in the moment. Um, The next idea is that good super supervision is fundamentally about collaboration and communication. Uh, I am very used to a model where all the knowledge comes from the teacher. This needs to be a collaborative process with the students these days, and it gives us the opportunities to hear what they need.

Um, and it's a chance for us to continue to get feedback and grow and develop and meet these students where they need to be. Um, the last one I wanted to add here is that, you know, we can't manage our supervisees mental health.

Most of that is things they need to be dealing with and they need to be working with professionals on and developing their own strategies for. But what we can do is create an environment that doesn't make it worse at a minimum, um, and actually help support them. [01:04:00] To, to be more proactive and, you know, the things that help us with our mental health and managing burnout and, and all of that are probably good for our students too.

So making those connections between what we do for ourselves and and helping support them. And then the very last thing I wanna say is, uh, the four of us have two virtual presentations at ASHA this November. So if you wanna join us for a more lecture style, uh, information, we're gonna be talking about mental health and Anderson's continuum and these feedback strategies in more detail.

And then at the University of Iowa Communication Sciences and Disorders YouTube channel, we have a webinar that Stacy, Jenny, and I did on again, Anderson's, uh, continuum and the feedback strategies that you're welcome to watch anytime. And we'll make sure you have that web page for the show notes. 

Kate Grandbois: Thank you so much for [01:05:00] sharing those resources.

Yes. We will link everything in the show notes. You've also sent this beautiful reference list, so anybody who would like to do some additional reading or learning, we have many places for you to go. Thank you all so much for being here. This was really wonderful. I really appreciate it. 

Louise Pinkerton: Thank you, Kate. It was great to be here too.

Stacy Robinson: Yeah, thanks for having us. Thank you.

Sponsor 2Outro

Kate Grandbois: Thank you so much for joining us in today's episode, as always, you can use this episode for ASHA CEUs. You can also potentially use this episode for other credits, depending on the regulations of your governing body. To determine if this episode will count towards professional development in your area of study.

Please check in with your governing bodies or you can go to our website, www.slpnerdcast.com all of the references and information listed throughout the course of the episode will be listed in the show notes. And as always, if you have any questions, please email us at info@slpnerdcast.com

thank you so much for joining us and we hope to welcome you back here again soon.[01:06:00] 

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