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Current ideas in supervision theory and practice
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The Supervision Quarterly

 

Winter 2014

Welcome
Welcome to the first Supervision Quarterly, scheduled as a quarterly newsletter focussing on current ideas in the practice of supervision theory and practice.  The intention of the newsletter is to offer ideas on supervision and clinical practice offering downloadable handouts and resources for anyone interested in improving the practice of supervision, either as a participant of supervision, educator or as a supervisor.  I hope to also dabble in some of my other interests in clinical work and mental health….. hopefully there will be something for everyone with an interest in supervision and clinical practice.  My supervisees continue to inspire me so no doubt I will reflect on their questions and raise some of these in the Quarterly as well in future editions.

I hope you find the newsletter worthwhile and I welcome any comments or ideas on what else you might like covered in forthcoming newsletters.  From time to time, I will feature excerpts from books or articles I think you might find useful and invite guest contributors on special feature topics.  

So, if you would like anything specific covered or have any burning questions you want answered related to supervision and clinical practice feel free to write in.  If I can’t answer it I will endeavour to find an expert in the field who can help out…

If you like the newsletter, make sure you subscribe online and please forward to a colleague if you think they might also be interested.  You can unsubscribe at any time and your privacy will always be respected and not shared or displayed at any time. I hope you enjoy the first edition of the Supervision Quarterly.

Christine Senediak
The delicate balance
of support in supervision
I am drawn to the work of Proctor who categorised core tasks of supervision into three main areas as noted below: normative skills (professional accountability), formative skills (skills and knowledge development) and restorative (colleague/social support). By keeping these core tasks in mind the supervisor is able to holistically guide the supervisee in their personal and professional development. 

Summarised below are some of the core tasks of each domain and you are invited to consider others that you might add to each domain.
 
Normative:  Professional Accountability
Problem solving
Professional identity
Improving clinical practice
Job satisfaction
Awareness of role
 
Formative:  Skill and knowledge development
New learning
Professional development
Self-confidence and self-awareness
Professional development and skills development
Insight into therapeutic use of self in clinical practice
Competence and creativity
Improved knowledge and related skills in applying new skills in clinical practice
 
Restorative: Colleague/social support
Improved capacity to handle work stressors
Job satisfaction self-understanding
Improved relationships
Personal development
Engagement within the workplace
Increased interest  and enthusiasm in the workplace
Improved self-care
 
Proctor, B.  (2009) Group supervision. A guide to creative practice. Sage Publications, London.
I invite you to think about what tasks focus most strongly in the supervision you provide and/or the supervision you receive.  Has this changed over time and can you think about what has influenced this change?  How do you invite your supervisee to think about the various tasks of supervision?  How relevant do you think they are in your everyday work in clinical practice, within your organisation and in your supervision?

[Article by Christine Senediak. Copyright Clinical Supervision Services 2014]
On being
a supervisor
Being a supervisor is a privilege.  Every week I learn something new from my supervisees and they keep me on my toes! I have a diverse group of supervisees ranging from those new in their field to those that have even more years’ experience than I do. I need to be up to date with my readings, knowledge on policies and procedures and clinical approaches for a diverse range of mental health problems that might be presented in the course of the supervision session. It doesn’t necessarily mean that I have to know it all, but that I can mindfully navigate the discussion and help the supervisee come to a better understanding on the reasons why they present their issue/s and how they might be better able to handle this situation once exiting the supervision room.

My approach to supervision is to be open to what might come my way in the course of the supervision session, whether it is related to how the supervisee manages interpersonal relationships in the workplace (colleagues and clients), or working with difficult clients or dealing with change or stress in the workplace.

I like to approach supervision first and foremost by inviting the supervisee to think about the reason they are presenting the issue or issues for supervision.  Once a starting point is determined then the session is structured with supervisor, supervisee (and group) focused on the goal/s for that presentation and session. When working with a group a goal is to also invite the other members who are not presenting to consider how they might handle such a situation should it arise in their clinical practice.  Overriding this always however, is the focus on process and relationships within the therapy room.

I encourage the use of a structured Case Presentation form, which provides a framework for the presentation. This is particularly useful for a supervisee who might need some help in formalising their thinking around the presenting concerns.  A structured template allows the supervisee to target the issues they need addressed in supervision, especially when new to the supervisory process. Over time supervisees find the way that suits best them in presenting their issues for supervision, which may or may not involve using a formalised process such as a form.

I have found over the years that supervisees use their supervision time in different ways.  Some come really prepared with a list of questions they want answered, some with just thoughts about a particular issue and others arrive at the supervision meeting with already consolidated ‘themes’ identified in their clinical work.  This is often dependent on both the level of experience the supervisee has and what their past experiences of supervision has been (directive vs. reflective). Supervisees need guidance to develop reflective thinking which should be nurtured early on in the supervisory relationship. Many of my groups that I have worked with for years apply systemic and reflective thinking automatically and at times pull me up when I am being to content rather than process focused!

I start by asking – ‘what have we got for today?’  The question can be phrased in a number of different ways but generally my aim is to point the supervisee to think about their issue/s either before they come to supervision or at the very least in the early stages of the supervisory hour so that by the time they walk out the door they feel more empowered, knowledgeable and confident in dealing with the issue that brought them to supervision.  It’s a little like a good counselling session – you want the supervisee to feel more confident in managing their situation.  The reflective supervision and self-supervision handouts available from the resource page of the website provide some guidelines in how to do this.

[Article by Christine Senediak. Copyright Clinical Supervision Services 2014]

Hints for the supervisee on preparing for supervision

First and foremost your supervisee needs to be a ‘customer’ of supervision.  This means that the supervisee needs to:
 
  1. Take responsibility for their own learning
  2. Be enthusiastic about attending supervision
  3. Be prepared to learn and work on issues that come up in supervision (which might be ‘self’ issues)
  4. Be organised in their thinking about what they want to discuss
  5. Come prepared for supervision – be in a’ head space’ to think about clinical issues arising from the workplace
 
Here are some of my ideas in helping your supervisee develop skills to maximise their learning in the supervisory context. I set aside some time in the first meeting to discuss the best way to proceed should a supervision contract be negotiated.  In this meeting we discuss expectations of supervision, previous experiences of supervision, how they have used supervision in the past, best ways of learning, ways to present material for supervision, strengths and areas for future focus and development.  It is really important that there is a good fit between supervisor and supervisee and while this might come naturally for some, for most it requires that both parties discuss how they can work well together.  It is important the supervisee be proactive in setting up the kind of supervision they want – no good whining some months into the process that it isn’t working and it wasn’t what was expected from the outset.
 
So here is my summary for the supervisee setting up good supervision.
  1. Be proactive
  2. Ask questions of your supervisor
  3. Identify the type of supervision that you want – and it can change over time…..
  4. Discuss your goals
 
Once you have negotiated your contract for supervision
  1. Prepare for supervision beforehand
  2. Review documentation from any previous sessions
  3. Think about what you want to discuss
  4. Give yourself time to get to the meeting place – sounds simple but running late can interrupt the supervisory process if you are part of a group
  5. Offer feedback to your supervisor – they need to know if supervision is working well or if there are gaps.  Your supervisor should be able to handle it and discuss with you openly
  6. Check out how you are feeling in and after supervision – are there any issues that are going on for you that could be reviewed in supervision? Do you need to let your supervisor know for future sessions?
  7. Be prepared to extend yourself in supervision and explore possibilities?  Be prepared as the supervisor to be extended
 
Here are some beginning ideas about opening up the practice story in supervision
  1. Something that went well for me since we last met was…
  2. I really felt frustrated when…
  3. Something that bothered me about the client was…
  4. I need help with…
  5. I wish I could…
  6. I felt that I could have handled… differently…
  7. I feel uncomfortable when…
  8. I felt good about…
  9. I’m noticing that…
  10. I want to take away from supervision some ideas about…

[Article by Christine Senediak. Copyright Clinical Supervision Services 2014]
From the Supervision Room
I hope to make this a regular section on my experiences and reflections from the supervision room.  This section will touch on global core themes that have arisen from supervision sessions, from discussions with my supervisees and from my reflections on the supervisory process.  The aim is to help both supervisees get the most out of supervision and to help supervisors reflect on common issues that arise from supervision.
Evaluation: At the end of each year I ask my supervisees to reflect on the supervisory process and for my group participants, to complete an anonymous evaluation form, which I use as the foundation for a report back to management who have contracted my supervisory services. 
This process is in addition to the ongoing feedback and discussions that I have with my supervisees about supervision at each session.  Typically I might ask the question, ‘what will you take from supervision today….how has this discussion helped you in handling the issue that you brought to supervision today’ – or something similar to this kind of question.  
By asking about the process at each session, it attunes both the supervisor and supervisee to be aware of what is working in supervision and what might need to be altered.  It helps me as a supervisor analyse what has worked in the session, how the supervisee learns best and how they use the information shared in the meeting.  By offering this question at the end of the session, it also orients the supervisee to think specifically about whether the goals of supervision have been met and what further questions might need to be explored in relation to this issue, or any other  related issues that arose from the discussion.  
Last year when I reviewed both the content and process of supervision I noticed that a number of core themes arose from my meetings.  I can separate the content of supervision sessions into 5 main areas.  That is, supervisees that came to me for supervision tended to present issues related to:
  1. Client-therapist relationship issues (dealing specifically with transference and countertransference in the therapy room)
  2. Questions related to clinical formulation, assessment and treatment issues
  3. Self-issues (e.g. professional development, stress related issues)
  4. Specific issues related to therapies
  5. Workplace and change management concerns
 
Many of you might say – ‘well that just about covers everything anyway, so what’s the big deal’?  For me, I notice that I spend a lot of time in supervision reflecting on the therapist-client relationship, attuning the supervisee to the therapeutic relationship and empowering them to consider the changes they need to make in working with the issue at hand, rather than me giving the answers.
 
It is very interesting in reflecting on my experiences in supervision to think about the influence my orientation has on process.  For example, I am very influenced by systems thinking so presentations typically include genograms, a systems perspective and strengths based questioning.  Genograms help by locating the client in the wider system which can also include the therapist, other agencies and significant factors that might impact on the client’s presenting concerns.  Genograms help shift to an interactional focus, incorporating the individual, family and wider system.  It can open up new understanding, providing new information on client/family narrative and information on ‘stuckness’, resources and strengths. I like to use Bateson’s (1972) phrase ‘ the map is not the territory’ – so in supervision my aim is to help the supervisee explore beyond what they might already know and see.  Using reflective questioning techniques, genograms, and systemic questioning incorporating the wider system can open up new understanding of the presenting concerns for the client within their system and in relation to the therapeutic process.

I encourage you to think about your way of ‘being’ as a supervisor: what works for you, the kinds of questions you ask in supervision and the impact these questions have in opening up the practice story  and what you have observed in the way you work in supervision and respond to supervisees.  
 
I welcome any feedback from the first edition of this newsletter and please let me know if you would like me to focus on anything specific in future editions.  Until next time,

Cheers,
Christine 
 
The Supervision Quarterly is brought to you by
Christine Senediak of Clinical Supervision Services (CSS).

Email: clinicalsupervisionservices@gmail.com
Web: www.clinicalsupervisionservices.com 
Copyright © 2014 Clinical Supervision Services, All rights reserved.


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