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The Supervision Quarterly

Autumn 2016

Welcome to the Autumn Edition of
The Supervision Quarterly

In this edition:

CSS News and Upcoming Training

Clinical Supervision Services is very excited about our program for the year ahead which has already started with some organisational training with two Sydney based universities and another planned with a third University in metropolitan Sydney.  It is wonderful to see that the Clinical Psychology Departments are supporting clinicians in the field with sponsored training and ongoing supports.
Upcoming training
We have some more training planned across Australia this year with both the Full Training Supervisor course and a Master Class being offered in Perth, Western Australia in May.  Later in the year a Master Class will be offered in Darwin so for any southerners who want to escape the cold winter and head up north to combine CPD training and a holiday, this workshop is planned during the school holidays! 

The workshop flyers are available below if you are interested.  Just remember that CSS offers discounted rates for keen and early bird payments AND group bookings when 3 or more participants register.
 
Perth Master Class Flyer
Darwin Master Class Flyer
Family therapy workshop series 
Beginning April, CSS is offering experiential family therapy training which includes 4 days of intensive family therapy theory and practice training.  Dr. Glenn Larner, Ron Perry and myself will lead various sessions on working with families which will provide foundational skills of interviewing whole and part family groups, assessment and family therapy interventions.  There are still a few places left so please email if you are interested or need any further information.  Again group discounts are available.
Family Therapy Workshops Flyer
New CSS website
Our other exciting news is our forthcoming new website which will hopefully be live in the next month or so.  We will continue to offer free resources and materials via our resource page and the Quarterly newsletter on all things ‘supervision related’.  Any topics or information you want covered just ask…….

Online mini courses
And one last development for 2016…..with the improvement of our new website we are currently developing a number of e-learning modules on various topics related to supervision and family therapy. Over the next few months we plan to develop a range of online mini courses in the field of psychological practice. We invite you to keep an eye open for these e-learning modules.


The CSS website has all our current workshops listed for the year but more will be added for the second half.  If you want to keep informed please ensure you subscribe to the newsletter.

The ‘Ins and Outs’ of Group Supervision


The Value of Group Supervision

Opportunities to learn are fostered by the interactions that occur among group members.  Supervision in groups provides an opportunity to share common experiences, solve complex tasks, learn new skills and share mutual support and increase insight. At the core of group supervision is the interactions of the supervisees so it is important that supervisees participate in a way that fosters good communication. Meeting in groups allows supervisees to be exposed to a variety of cases, assessment methods and interventions and if done well, allows for a depth of collaborative learning. It teaches the supervisee to interact with peers and increases mutuality between those in the group.  This Autumn newsletter is dedicated to examining the ‘ins and outs’ of group supervision, providing helpful guidelines and question sheets for those engaged in group supervision or thinking about setting up a group supervision network. 
What is group supervision?
Typically, the main focus of group supervision is didactic presentations, case conceptualization, and individual and group development.  But it can also be creative and use opportunities for role play practice and other experiential methods of learning. A well-functioning group allows all participants to contribute and learn from a presentation. 
Group supervision is:
A regular meeting with a designated supervisor for the purpose of furthering understanding of ‘self’ as a clinician, the clients with who they work and/or of the service in which they provide the clinical work.
It is a working alliance between supervisor and several others with group size varying from 5 –  8 participants.  Depending on who you ask and in which context, the optimal size of the group depends on many factors (e.g. developmental level of participants, matching of group members (e.g. backgrounds, skill level, personal needs of the group).  Some say too many (more than 6 or 7) does not allow for equal contribution by all present and others say too little (less than this number is too susceptible to disruption caused by absences or drop outs).   I have some groups that are 3 and others that are up to 10, which means that the way they are managed require different skills of the supervisor and different responsibilities on the part of the supervisee. My rule is to make sure you plan and discuss how you will manage group processes, clearly articulate group rules about attendance and contributions.
If you do this early in the contract and setting up stage, you are more likely to get a group of participants that are enthusiastic and active in their participation and attendance. I’m a bit of a stickler for group rules but I find it works and keeps all on track and focussed.

Group meetings provide an opportunity for each member to discuss a clinical issue of concern and receive feedback and guidance from both the supervisor and group members. It also provides a focus for developing clinical and ethical competence and confidence. 
Advantages of group supervision

1. There is a great deal of stimulation and variety of perspectives on each supervisee’s cases.
2. There is an opportunity to learn from the ways in which fellow supervisees handle their own counselling work.
3. Supervisees have the opportunity to hear about and learn from colleagues’ work with a wide variety of clients.
4. The variety of views may act as a corrective against the single supervisor’s biases or blind-spots.
5. Group supervision may be very economical in training settings, in voluntary counselling organisations, or for those supervisees whose counselling work does not pay them very much.
6. The make-up of the group may provide useful opportunities for role-plays to be experimented with.

Disadvantages of Group Supervision

1. There may be insufficient time for each supervisees’s concerns to be addressed in any detail.
2. Supervisees may have too much opportunity to ‘hide’ or to minimize their difficulties.
3. Supervisees may consciously or unconsciously compete with or thwart each other, particularly when supervised together in a training setting.
4. The variety of perspectives on each supervisee’s cases may be experienced as a bombardment of conflicting and unhelpful views.
5. Group dynamics may become at times more distracting or interesting than the actual cases under discussion.
6. Confidentiality is somewhat less protected.
Are you a ‘good enough’ supervisor?

A good group supervisor knows how to manage group process.  The group needs to use the initial stages of getting together to determine group rules and a contract. The composition of the group is not just putting a group of fellow workers together hoping that they will find common ground.  It needs to be a conscious decision considering developmental level, experience or interpersonal compatibility.
Sometimes groups come together because the team work together and they can be very different in skills, therapeutic orientation and knowledge. Be mindful of how the work they do might impact on group discussion.

Having different perspectives can bring a wealth of information to the group and open up new territory in how the client is viewed. 
A good supervisor will formulate a contract with the organisation/team and with the group members.  A pre-group discussion clearly spells out expectations, structure, rules and methods for presentation and discussion and if followed will help minimise problems from developing.
I find that this might need to be revisited over the course of the supervision contract.  Because there is more than just the two of you (supervisor and supervisee) it means there are more opportunities for things to go astray …… reminding the group about structure ensures that you are able to stick to the routine and everyone gets to contribute.  The following article provides a clear overview of how to set up group supervision following a clear contract:
Smith, R., Cornish, J., & Riva, M. 2014. Contracting for Group Supervision, Training and Education in Professional Psychology, 8 (4), 236 – 240. 
Download full article

 
A good supervisor will facilitate ‘check ins’ throughout the session.   Questions like ‘how do you understand …..what do you think the core issues are?’ The supervisor also needs to draw in all supervisees to contribute to the discussion and acknowledge their contributions from a strengths based perspective.  Try not to shut down or criticise a contribution but rather reframe it ‘viewing things from that lens’ …are there other ways that you might consider ….?
Manage competition – no matter how well the session is structured and how often you have discussed rules of turn taking there will always be someone in the group that has a tendency to dominate.  Competition is a natural part of the group experience and when reframed it can be seen as the person being enthusiastic about their learning and wanting to share their thoughts.  Try and take away the competitive edge to the discussion!
You will find you could easily have spectators vs. co-supervisor to pseudo-supervisors in the group so it is important to identify how to draw out the quiet members and curb the more active dominant members.  This is where it is handy to refresh your ‘Group Skills Training 101’ skills to help manage group dynamics!
  • Know your group
  • Tackle issues promptly
  • Define roles and responsibilities
  • Model mentoring with clear and supportive direction.
Draw together themes and move from being only client focused to clinician focused.

Teach your supervisees to ask for what they want.  Use a case presentation form in the early stages to ensure there is some structure.
Review Topics for Case Discussion
These questions can be used in a peer or group supervision context to help facilitate reflection on case management, process issues (client-therapist) and self-issues for the therapist.
Assessment
Topic for discussion and review
What do you want help with?

Plan of action
What is your assessment and/or intervention plan?
What is your role?
What do you need to consider in order to follow this plan? (consider individual/couple/family interviews; discussion with referrer; team leader if necessary)

Administrative requirements
What administrative requirements are there? (notification processes; duty of care; documentation; file notes)

Theory and practice
What theoretical model/s are you using to guide your assessment and/or interventions
Do you have all the necessary skills and knowledge in order to be able to do this? If not, how will you get the necessary information?

Reflection on Self and therapeutic relationship
Is the work with this client ‘triggering’ anything for you? (feelings/thoughts)
If so, how are these thoughts and/or feelings impacting on your work with the client?
How can you ‘use yourself’ (your reactions) in your work with this client?

Client factors
Is the client a ‘customer’ of the service?  If not, what can you do to move the client to a position of receiving help from you?
What are the client resources that you can use to facilitate change?

Systems issues
Are there parallel processes occurring? Is what is being brought to supervision mirroring what is happening for the supervisee and/or supervisor? How does this impact your work?
What do you need to do in order to ‘use’ this experience in a helpful way? (i.e. bring to the attention of the supervisee and discuss ways to manage in the clinical context)
Does anything else need to happen either outside or inside the session to manage systems issues?

Supervisory relationship
What is helpful and unhelpful in this discussion? What else is needed? Is there anything that needs to be discussed (brought to the table/made explicit) that isn’t being addressed?

Keep to time for each person presenting and for the discussion time…..
it is frustrating for all when the last person gets the least time because ‘time has run out’……
Use the expertise in the room before you add your summary or analysis.  The more reflection you can facilitate and nurture the more independent and confident your supervisees will become. 

Balance challenge and support - too much cosy and positive affirmations may make the supervisee feel good in the short term but after a awhile it runs pretty thin. A good supervisor will teach supervisees how to ask reflective questions that invite the presenter to consider alternative ways of thinking and working with the client.

Supervision that is critical will mean that supervisees simple won’t volunteer to present if they feel they are going to be criticised in a group forum.  An easy way to teach your supervisees how to be facilitative is to model this early in the supervision process.  For example, ‘from your perspective you have noted…..how else can you help X (the presenter) to consider ………

Use your personal responses with the group as this can lead to a greater depth of analysis and model reflective practice and awareness of the ‘self in therapy’.  What is your reaction telling you about the group process, the client, the wider system?
Be creative – just because you are meeting in a group doesn’t mean you can’t use role play, sculpting, visual whiteboard work or other creative means to enhance exploration of the therapeutic process.  Creative means like this (especially whiteboard work) and role play brings the issues alive in the room and allows a ‘bigger picture’ to be portrayed in relation to the case (see Summer 2015 Newsletter).
Consider what format of supervision you are providing:

Supervisor led supervision – where the supervisor leads the discussion (more educative when learning something new)

Participative group supervision – where the supervisor supervisors and members are taught how to and encouraged to participate

Co-operative group supervision – the supervisor facilitates the group in learning to supervise each other (more reflective and independent focused)
Peer group supervision– no clear leadership and there is sharing of all roles.  Whilst there may be no clear leadership if set up the same way with clear rules and guidelines the peers in the dyad or small group can act efficiently.
Advantages of Peer Groups
  • Sharing of roles so ‘expert’ role is minimized
  • Participants can organize supervision meetings at their own convenience.
  • Payment can be avoided.
  • Participants tend to have a good understanding and support for each other’s developmental stage and needs as they are often work colleagues.
Disadvantages of peer groups
  • No one has any final authority or clear mandate to offer final direction (for example to follow report any unprofessional behaviour).
  • If a notification or professional practice issues need to be raised the ‘peer’ may feel reluctant to point out and follow through
  • Participants may avoid confronting each other when it is necessary to do so
  • Participants may lack elements of necessary experience and expertise
  • Participants may either collude with each other or lack the structure and skills to offer emotional containment to each other.
Possible roles within group peer supervision

Moderator The person who oversees the group process and is timekeeper.
Asks the PRESENTER to present their question/s for the presentation. This will be the focus for the group. 
Invites the group to offer their feedback and moderates the discussion. The moderator should also ensure that ‘solutions’ are not offered but rather the questions asked are reflective and guides the PRESENTER to explore options and their reactions to the material presented.
 
Case presenter – The person/s who present the case or issue for discussion.  This needs to be presented in a clear format, preferably with a genogram/sociogram/ecogram (using a structured case presentation format) is helpful.
 
Consultants – The remainder of the group who contribute their ideas and discuss the case.  The consultants provide ideas, support, alternative lens for viewing the case/issue
The aim is to facilitate discussion and reflection on the many aspects of the case at hand. 

Conclusion to peer consultation:
The Case Presenter is guided to drawing together the ideas presented and what they will take from the discussion. The Moderator closes the discussion and may help debrief the group if needed. 
 
Possible issues to consider:
Be clear about purpose, content and specific objective of the group
Develop a contract
Trust and confidentiality needs to be established and maintained and the group needs to be mindful of an appreciation for mutual esteem and openness
Build in a review process
Manage group size and consider membership based on compatibility, practical issues (distance to travel, time) and developmental level
Determine group rules (consider closed verses open groups)
Meeting should be once a month – 6 weekly at the most and should run for a minimum of 1.5 hours (2 hours maximum)
A review of professional ethical guidelines should take place.
Some helpful questions to consider as a supervisee
  • What are the practical issues I need to consider to make sure that I can attend supervision regularly?
  • What do I want to learn?
  • What are my personal learning goals?
  • How do I learn best?
  • Do I learn best by reading theory, practical application, discussion, reflection, role play practice etc.,
  • What has been my experience of supervision in the past?
  • What aspects did I like and not like? How might these factors contribute to planning for current and future supervision?
  • What do I perceive my role is in supervision and what do I see as the role of the supervisor?
  • How can I make this explicit to the supervisor?
  • What sort of person am I looking for as my supervisor? (i.e. gender, orientation, experience, theoretical framework?)
  • What are the expectations of the organisation of me?
  • Are there reporting requirements? Where are notes kept?
  • What are my professional needs?
  • Clearly think about what you want to achieve? Does my professional needs ‘cross over’ my personal needs?
  • How will I communicate to my supervisor what I need from supervision and the progress of supervision?  (written, feedback at the end of the session)
  • How will we evaluate the process of supervision?
Hindrances to group process
Physical and environmental problems – room size, temperature, noise
Absent peer members – disruptions for follow up reviews; group size changing
Time constraints – not enough time to process; members dominating discussion
Distraction – self issues
Managing group cohesion – conflicts/feeling unsafe

Ethical issues
Ensuring confidentiality and trust
How much or how little do the members of the group reveal about themselves.  Because supervision is both supportive and evaluative it is important to discuss confidentiality and group rules around self-disclosure.  It can be very helpful for the supervisee and other members to openly talk about personal struggles, professional mishaps or ‘red lights’ in order to help manage and improve clinical competence. 
Similarly it is important to ensure confidentiality regarding client matters. First names or initials should be used – I find pseudonyms are often forgotten and the supervisee usually slips into the real name very quickly.  It is best to make it very clear that client confidentiality needs to be maintained and only the identifying information that needs to be given should be provided. 

The literature also states that it is important that clients know that you undertake professional supervision to oversee your work and client issues may be discussed.  You need to be clear about how you discuss this with your supervisee and the advantages of your supervision to overall professional development and clinical practice.

Manage safety – feeling safe to disclose vulnerabilities with group members is part of the process of self-reflection and development. 
Be mindful of multiple relationships

If you do plan to offer both individual supervision and group supervision to the same person you will need to make this explicit to the group but be mindful about the decision to offer both.  It is best if individual supervision is offered a clear contract is articulated which is for different reasons to what is provided in the group context (e.g. registrar program; for accreditation for specialist skills). 

Also you may need to be aware that some group members know each other outside this context and as such will have a multiple relationship (e.g. group supervision member, team member).  Discuss and make explicit to the group.
Finally, the supervisor needs to allow time to promote safety for learning by…
  • Ensuring group cohesion
  • Discussing group processes openly and frequently reflect on these from a strengths based perspective (how the group manages differences)
  • Modelling and discussing ‘openness to supervision’ and expression of vulnerability (Fleming, Glass, Fujisaki & Toner, 2010).
I hope you have found this newsletter informative and that the discussion about group and peer supervision will help you consider improved ways of delivering or participating in supervision. As always, email me if you have any questions or would like to provide feedback.
 
Christine 
References and Resources
 
http://www.cyc-net.org/cyc-online/cycol-0501-supervision.html
 
http://www.peer-supervision.com/
 
http://www.psychotherapy.com.au/fileadmin/site_files/pdfs/GroupSupervision1.pdf
 
http://www.vivianbaruch.com/wp-content/uploads/2011/01/Supervision-Groups-in-Private-Practice.pdf
 
http://www.dartmouth.edu/~charky1/page40/page165/page166/files/se-supervisors-toolbox-group-supervision.pdf
 
Smith, R., & Riva, M., & Cornish, J. 2012. The Ethical Practice of Group Supervision: A National Survey, Teaching and Education in Professional Psychology, 8 (4), 238 – 248.
 
Thomas, M., & Collins, V. 2003. A comprehensive Review of a Cross-Disciplinary, Case-Based Peer Supervision Model, Families, systems and Health,  21(3), 305 – 319.
 
Fleming, L., Glass, J., Fujisaki, S., & Toner, S., 2010.  Group Process and Learning: A Grounded Theory Model of Group Supervision, Training and Education in Professional Psychology, 4(3), 194 – 203.
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