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The Supervision Quarterly


Summer 2015
In this edition:

2015 Year in Review

As the summer months are ahead of us and Christmas is near, it is a good time to reflect on the year that was and to tell you about our plans for 2016. 

We have had a very busy few months:
CSS ran two ‘firsts’ in October: A Specialist Master Class in Neuropsychology led by Dr. Nicola Gates and a Specialist Master Class for School Counsellors led by Lydia Senediak. CSS is committed to providing expert training in supervision and both these workshops delivered information that was specific to the field of those psychologists attending.

We also ran a number of workshops in Sydney, Launceston and Newcastle this quarter. Next year we will increase the number of Master Classes run both in Sydney and interstate (Darwin and Perth), in accordance with requests from AHPRA to ensure there are sufficient Master Classes for psychologists needing to maintain their Supervisor Accreditation.

Courses for 2016



For the full current AHPRA approved Supervisor Training program for 2016 please download our 2016 Programs Flyer below. Further workshops will likely be offered throughout the year and advertised both on the website and via the newsletter.

Also on offer for 2016 is a four day family therapy workshop which will run monthly on a Friday starting in April 2016. This is a wonderful opportunity to update and refine your understanding of family therapy theory and practice. Group discounts apply. Download the flyer below for further information.

If you have any questions about any of the workshops please do not hesitate to contact the staff at CSS on enquries.css@optusnet.com.au
 
2016 Programs Flyer
Family Therapy Workshop

Creativity in Supervision

In this newsletter the topic of creativity in supervision will be addressed. In our modern world of technology, online learning and social media these means of communication are seen as a way to enhance the process of both therapy and supervision. Many courses are now offered online, as are some therapy services. Supervision can be offered via teleconferencing, Skype, Zoom and Fuze to name a few. In a sense, this is seen as an innovative way to reach more people and to offer a service that is more accessible.  There are other ways to be creative of course, including usual visual tools, letter writing and imagined/hypothetical dialogues and using figures and play material to describe interactions/systems to name a few. 
Supervision that uses both the left hemisphere (logic, language) and the right hemisphere (creativity) provides richness to the process and can tap into broader thinking and problem solving.  Being creative can helps to get out of loopholes, pitfalls and resistance by opening up new ways of thinking and perceiving the issues brought to supervision. 
 What is helpful in supervision is to create an environment to ‘dance to a different dance’ (Minuchin, 1974).  If supervision is always just a structured verbal account of clinical material you may miss opportunities for creative exploration of ‘news of difference’
This edition will look at how to creatively apply systems thinking in supervision: to hold in your awareness organisational factors and work collaboratively with the supervisee within their organisational context to create a space for reflection on emotions and relational factors in supervision.   It will draw on ideas from the family therapy literature and examine the importance of creating and observing feedback processes in clinical work and what is brought to the supervision room. 
In order to create new meaning and open up possibilities for differing perspectives one approach is to use different means of presenting and discussing material in supervision.  Here are a few ideas to get you started thinking about using creative means in supervision.  No doubt many of you already use some of these ideas in therapy so the transition to supervision shouldn’t be too difficult.

1. Genograms/sociograms

In a previous newsletter I have talked about the use of genograms in helping to map out a systemic understanding of the presenting problem.  Starting a supervision session with a family genogram and related sociogram (other organisations involved in the case; where the therapist is positioned in relation to the client/other family members and why) provides richness of information and can create a launch pad for discussion.  It can immediately open up a systemic discussion and generate alternate lenses for viewing and understanding the presenting problem (e.g. from the mother’s position; from the sibling’s position, teacher’s position etc,).
Here is a summary of the advantages of the genogram including:
  • Easy visual representation of family and wider system relationships
  • Can add lots of information to the picture easily and quickly when taking notes
  • Helps the family to see patterns, and therefore can be used as an intervention about change
  • When only seeing an individual, brings the wider system and family into the room
  • Can be used in supervision to map out wider system issues; aids discussion
  • Offers information on strengths and restraints (who can be recruited in the family that will aid the process of therapy; what else needs to be addressed to help the client change)
http://www.infiressources.ca/fer/Depotdocument_anglais/The_genogram_a%20means_of_enriching_the_interview_the_principles(Part1).pdf

2. Art and Play Tasks 

Art tasks can enhance both the richness of the information brought to supervision and the enjoyment of the supervision process.  Whilst enjoyment might not necessarily be a primary aim, something that is enjoyed is likely to be repeated and remembered.  Arts tasks such as ‘drawing a feeling/representation’ associated with the clinical presentation can open up alternative descriptions and as such, tap into self-exploration, transference - countertransference and new meaning. Bowman (2013) notes that using art tasks in supervision facilitates creativity in the clinical setting as therapists are introduced to new ways of working with their clients, alongside traditional evidence based ‘talk therapies’. 
 For example, an experience I had with one supervision group was a member who brought a photo to the session to represent how she was feeling about her clinical work with a refugee client. The photo was of her white water rafting.  The group enquired about the ‘therapeutic meaning’ of her choice of photo, parallels between the clinical and rafting experience and what she might be able to do to stabilise her experience of being ‘out of control’ in the clinical context and preferred ways to manage  this difficult presentation.  The session drew on personal reactions first (self-issues) and segued to intervention and treatment strategies.
http://scholar.lib.vt.edu/theses/available/etd-06272003-082400/unrestricted/rbowman6-27etd.pdf
Peabody (2015) uses material in supervision by building metaphors with Lego bricks in response to questions asked in the supervision session.  Supervisees build on their representation of the story presented in supervision to construct how they are feeling or how they might problem solve clinical issues. This kind of work is very similar to sandtray work in that the supervisee is given material to represent the situation or emotion brought to supervision and the representation is then discussed.  Whilst this kind of supervision work should not take the place of a structured and evidenced based approach to supervision, it can be used as an adjunct when the supervisee is stuck and/or when more creative means are warranted in supervision (stale processes). 

3. Sandtray Techniques

I recently ran a workshop at a mental health facility where clinicians employ an eclectic blend of therapeutic perspectives working with their client group who present with significant trauma.  Clinicians are encouraged to use a range of therapies which best suit clients at their different stages of trauma recovery. As such, a number of the clinicians have extended their clinical work using expressive therapy in the supervision room by integrating visual representations of sandtray work in supervision. 
Supervisors provide supervisees with a container filled with sand and small objects and observe how the issues are presented.  For example, the supervisor asks the supervisee to use the sandtray materials to provide a visual representation of closeness and distance in the therapeutic milieu. Discussion can be around the choice of figures and placement of figures and their meaning.  Discussion can be reflective about the meaning of the placement and choice or can be more directive where the supervisor helps the supervisee to explore structural interventions in the clinical context. Use of this mode of expression may facilitate the exploration of issues which are difficult to put into words and as such enables supervisees to take a ‘meta-position’ regarding the dynamics of the therapy session (Dean, 2001; Warr-Williams 2012).

4. Drawings, visual representations
and Whiteboard Work

Visual representations of clinical work offer multilevel means of communicating information often difficult to communicate in words.  Although a verbal description in supervision offers richness and nuance of the presenting issues and related factors, visual means of communicating information have the following advantages:
  • Can communicate complex information often more simply than a verbal description
  • Often easier to cognitively ingest
  • Can see patterns (e.g. similarity; proximity; symmetry , common boundaries, chains of reasoning, feedback loops, parallel lines of thought and actions).
Within the narrative field, visual means of presenting material in clinical and supervisory contexts is frequently used as a tool to express and map out patterns.  One technique that I often use in supervision is to ‘map out the therapy story’:  As the supervisee is talking I might draw what I have heard the supervisee describe. Usually this is done as a road with intersecting side streets (influencing factors) and then I invite the supervisee to think about how they see this map, where they would position him/herself on the map in relation the client and/or problem and what would need to happen for change to take place. Colours can be used to represent emotions. 

For example, the abbreviated image below (Picture A) comes from a recent session where the supervisee described the client’s past story; both strengths and restraints; where the client was now and what would need to happen in terms of change.  Outside the supervision session, this picture was then elaborated on in the clinical setting where the client was able to further expand the picture and look at what was needed to create change.
Picture B was drawn collaboratively by the supervisor with the supervisee to represent the description offered by the supervisee of the challenges she was experiencing working with a young man with significant psychotic and depressive symptoms and the challenges she was facing working with the father and the psychiatrist, the later whom she clashed with regarding treatment.  She found herself ‘blurring boundaries’ and working hard for the young man because she felt ‘no one else did’.  When asked to map out where she positioned herself and where she positioned the psychiatrist she was able to see that she was taking over care for fear that he would kill himself under her case management.  Intervention clearly indicated that she needed to manage her own reactions and work more collaboratively with the psychiatrist and family to activate protective factors.
Picture A
Picture B
Grant & Usher (2011) note that mapping out a therapeutic story, or using pictures on a whiteboard etc., enhances collaborative practice. That is the ‘client – therapist’, or in the case of supervision, ‘supervisee- supervisor’ position themselves together to examine/observe what is put up on the Board. The whiteboard then becomes an effective externalised medium for the supervisee to position him/herself as observer of the problem.  ‘Whiteboarding’ encourages a rich, energetic and exacting collaboration between the supervisee and supervisor offering opportunities to observe the current story and offer observations of what is going on and possible ways of deconstructing and offering new information to the change process (Usher, 2011). 

5. Role Play, Video/Audio Recordings
and Live Supervision 

Observation of clinical practice is considered an integral part of the supervisory process to accurately investigate supervisee competencies and focus attention on the behaviour of the clinician, their reactions to the client and process issues. 
Interestingly supervision is still largely reliant on verbal case presentation which often fails to pick up on the subtle nuances of the therapist-client relationship. 
Without observational methods (live supervision, audio-video recordings or role play) the supervisor simply is unable to accurately assess the supervisee’s knowledge and skills.  Evidence indicates that supervisees both knowingly and unknowingly withhold information in supervision including clinical mistakes and negative reactions to the client (Hill et al, 2015). 
By introducing role play and live supervision in the supervision session the supervisee learns to feel more comfortable to talk about their reactions to the client, possible self-issues, identify different and improved ways of interviewing and delivery interventions.  Observational methods offer information for specific, targeted and corrective feedback and are essential for the supervision.   It also lends itself for integrating reflective practice questioning ‘purposeful critical analysis of knowledge and experience’ (Mann, 2009) because the supervisor can target specific questions to the therapeutic dialogue being reviewed. My suggestion is to put it into your contract and model how live supervision and/or recordings/role play can be integrated into the everyday session.  If you make it part of your ongoing process it isn’t a big deal and it doesn’t solely become an evaluative and fearful experience.  
So, give it a go to introduce different methods in supervision which might help create more energy and different perspectives in the supervisory conversation. 
I hope that you have enjoyed the Summer Edition of the Supervision Quarterly and some of the ideas have sparked your interest to work more creatively in supervision. 

Feel free to contact me if you would like to explore these ideas further.  

If you found this newsletter interesting please pass it onto a colleague. Clinical Supervision Services wishes everyone a restful and a happy Christmas, 

Christine

References


Barney, C., & Shea, S. 2007. The Art of Effectively Teaching Clinical Interviewing skills using role playing: A Primer, Psychiatric Clinics of North America, c31-c50.

Dean, J. E. (2001). Sandtray consultation: A method of supervision applied to couple’s therapy. The Arts in Psychotherapy, 28, 175-180.

Grant, L., & Usher, R. (2011). The whiteboard as a co-therapist: Narrative conversations in a generalist counselling setting, The International Journal of Narrative Therapy and Community Work, 4. 9-15.
 
Hill, H., & Crowe, T., & Gonsalvez, C. (2015). Reflective dialogue in clinical supervision: A pilot study involving collaborative review of supervision videos, Psychotherapy Research, DOI: 10.1080/10503307.2014.996795

Peabody, M. 2015. Building with Purpose: Using Lego Serious Play in Play therapy supervision, International Journal of Play Therapy, 24, 30-40.

Purswell, K., & Stulmaker, H. (2015). Expressive Arts in Supervision: choosing Developmental Appropriate Interventions, International Journal of Play Therapy, 24, 103-117.

http://www.lianalowenstein.com/articleFamilyTherapy.pdf

Warr-Williams, J. (2012) Conversations in the Sand: Advanced sandtray therapy training curriculum for masters level clinicians, Doctorate in social Work Dissertations, University of Pennsylvania.

Clinical Supervision Services

www.clinicalsupervisionservices.com.au

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