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Spring Newsletter 2016: Recovery Oriented Supervision
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The Supervision Quarterly

IN THIS EDITION:
Spring Newsletter 2016:

Recovery Oriented Supervision

This edition will look at the role of recovery in supervision practice.  Traditionally mental health services have predominantly been medical in design and biological in practice which does not align comfortably with the concepts of a recovery focus on individual self-determination and self-management. This newsletter will provide some practical ideas in how to integrate a strengths based approach to supervision utilizing the individual and systemic resources of the client within a recovery framework.  This newsletter will also suggest ways the supervisor can embrace a recovery paradigm that emphasizes psychosocial functioning over traditional medical symptomatology. 

A quick definition

A recovery model sees recovery as a multidimensional process putting the person at its centre, with shared decision-making, choice and information on services.  Recovery supports the person to recognise and take responsibility for their mental health wellbeing.  Recovery is a journey towards a meaningful, satisfying and hopeful life alongside the limitations imposed by illness. Because it requires a holistic and person-centred approach between consumers and health professionals it is imperative that a partnership exists acknowledging and maximising the resources and expertise of both.  The recovery paradigm has many similarities with postmodern therapy theories and practices incorporating collaborative, narrative and solution-focused strengths based approaches. As such the supervisor must embrace the consumer voice as a partner alongside both the therapist AND supervisor. This collaborative positioning is foundational to this approach.
The following link provides some helpful guidelines and policies:
http://www.health.gov.au/internet/main/publishing.nsf/Content/mental-pubs-n-recovfra

The Habits of the Recovery-Oriented Supervisor
 

Jha & Jha (2012) provide a framework for mental health professionals in ways to adopt recovery principles in their everyday practice so that it becomes habitual in their practice.  The following habits have been extended to supervisors and provide some practical ideas on integrating recovery thinking and being in supporting mental health recovery.  They stress that these principles need to be internalised and not tokenistic and superficial.  They stress that mental health professionals start their journey by reflecting on their own personal growth. 

Family therapy literature (and this previous newsletter from Autumn 2015) reviewed ways of doing this through personal reflection on the use of self in therapy and awareness of personal strengths and restraints.  That is, enhancing personal understanding of one’s family of origin and life experience and how this has shaped the practitioners thinking and ways of working. 

From a supervisory perspective this would mean that the supervisor models and encourage self-awareness and openness and supports the supervisee to convey hope, share power and be open to diversity when working with clients through the change process.


If a supervisor holds this framework at the forefront of their practice, it encourages ongoing self-awareness through discussions of the practitioner’s personal and professional values, beliefs, working practices, restraints and boundaries in clinical practice. The Sainsbury Centre for Mental Health 10 top recovery-oriented reflective practices (2007) are listed below and practitioners are encouraged to reflect on their actions in relation to their work with consumers.

http://www.mymentalhealth.org.au/content/Document/recovery_toptips.pdf

 
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Recovery-oriented reflective practices

1. Active listening (how does the individual make sense of their mental health concerns?)
2. Work with the individual to identify THEIR personal goals for recovery
3. Identify the individual’s strengths and resources – including systemic resources (family/community)
4.  Identify self-experiences of ‘lived experience’ or of other service users, which can be used to inspire hope
5. Focus on strengths and goals to help the individual step out of the ‘sick role’
6. Utilise resources/connections/supports to walk alongside the individual in working towards their goals
7. Work collaboratively towards the individual’s goals and make them achievable
8. Convey and practice respect – internalise recovery oriented principles
9. Demonstrate belief in the individual’s existing strengths and resources
10. Despite expected setbacks from time to time continue to express support – maintain positive expectations and hope for the future
By adopting the above practices the health practitioner needs to adopt fundamental changes in day-to-day interactions with service users.  The supervisor must assume a position of hope, shared power and openness when thinking about the supervisee-consumer interaction and be prepared to reflect and share their own experiences which may aid understanding, promote empathy and improve ways of working form a recovery framework. 

From a systems perspective, this change reflects both first and second order change:  recovery being possible through inclusive dialogues within all systems of care (Leamy et al, 2001; Onken et al, 2007). 

A recovery oriented supervisor:
‘should endeavour to demonstrate to their (supervisees) the outcomes of the empathic assessment with the subjective needs of the (consumer)’
(Jha & Jha, 2012 p. 347).

That is, what are the goals of the individual…..what are their hopes….. have questions been asked in a way that elicits this discussion…and how does the supervisor ask questions of their supervisee to ensure that he or she incorporates in their habitual practice questions of and for the individual?

Recovery-Oriented Supervisors

The recovery oriented supervisor needs to model recovery beliefs and actions that will empower supervisees to similarly internalise a habitual recovery paradigm in their day to day interactions with service users and their families, supports and carers. Rapp et al (2014) state there are parallels between recovery oriented supervision and strengths based supervision: working with identifying the consumer’s goal/s AND what the practitioner needs to do to help the consumer achieve their goal.  Adapting Jha & Jha’s seven habits of recovery –oriented practice to habits of supervisors the following list provides examples of the questions that can be used to elicit a recovery client-focused exploration: 
1. Be proactive and foster self-awareness of the supervisee (personal strengths/restraints) and how these resources can be used in clinical practice
  • Reflect on your personal experiences and how might these inform your beliefs, thoughts, feelings in working therapeutically.
  • How does your personal experience hinder/help your work?
  • What might you need to do/learn/change in order to be open to working more collaboratively and effectively within the mental health system where you work with this consumer and/or their peers/ /carers/family?
2. Begin with the end in mind: Help the supervisee to develop a recovery paradigm
  • What further information/resources does the supervisee need to become a recovery practitioner? 
  • What steps are needed to be taken to develop personal and interpersonal effectiveness? Who can you/they recruit to make this change?
  • What changes need to occur with their system?
3. Put first things first
  • Encourage the supervisee to be mindful of their values and how these might both be helpful and unhelpful when working with the individual.  Be prepared for an open discussion of values and share these in supervision.  If in a group context elicit a discussion about values and how these can be extended to the consumer’s wider system
  • Ask questions such as ‘what informs your thinking? your practice?
4. Think win/win
  • An effort should be made to discuss how the team works to enhance interdependent practitioner-consumer skills.
  • Is there flexibility and allowance for difference? 
  • Is it supported from the top-down? If not, how might the supervisee create change within their workplace?  What might your role be as the supervisor in this process?
5. Seek first to understand then to be understood
  • Has the supervisee really understood and communicated to the consumer their understanding of personal recovery goals? Have you the supervisor really understood?
  • What questions might you ask in supervision to ensure you have adequately explored this understanding?  (i.e. what are the specific skills and techniques used in practice?  Encourage leadership and support the supervisee to enthusiastically apply  a recovery philosophy everyday both in personal and professional contexts
6. Synergise
  • How do you value difference in the supervision discussion and reflection?
  • How does this allow and encourage the supervisee to ‘go the extra’ distance in working together in partnership with the consumer? 
  • What questions can be asked in supervision that will foster self-determination and resilience toward recovery for each individual?  Ensure a strengths-based framework is applied.
 
7. Sharpen the saw
  • Encourage critical analysis in supervision within a strengths/solutions and individually focused approach to recovery?
  • Be clear in exploring the supervisee and consumer goal – clearly ask the supervisee what they want help with in working to towards the consumer’s goal. 
  • Ask about and explore alternative paradigms in mental health practice to ensure continuous critical personal and professional development. The consumer’s goal should take centre stage in the supervision discussion and serves as the organising framework for the supervision session (Rapp et al, 2014).  The consumer should be offered feedback about the discussion and asked for their feedback and response – this will inform future practice.
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In conclusion

The role of the supervisor is critical to the success application of a recovery model in practice.  The supervisor is facilitator, resource person and mentor and at all times must model the contextual elements of a recovery paradigm in practice. The supervisor needs to promote openness and expression of values even if these are challenging as without openness learning cannot take place.  Supervisees need to explore their personal restraints when working with individuals with mental health concerns and trust that he or she can use the supervision context to reflect on their experience.

Next newsletter

Our next newsletter will provide the dates for the 2017 program which will offer some new family therapy training options and ongoing PsyBA supervision workshops.

Please feel free to contact me at any time for information on training.


-- Christine

References

Gehart, D. (2012). The mental health recovery movement and family therapy, Part 11: A collaborative, appreciate approach for supporting mental health recovery, Journal of Marital and Family Therapy, 38, 443 – 457.

Jha, A., & Jha, M. (2012). The seven habits of recovery-oriented psychiatrists: a non-clinical guide for personal growth and development, The Psychiatrist, 36, 345 – 348.

Leamy, M. Bird, V, Le Boutillier, C., Williams, J., Slade, M. (2011).  Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis, The British Journal of Psychiatry, 199, 445-452.

Rapp, C., Goscha, R.,& Fukui, S. (2014). Enhance Consumer Goal Achievement Through Strengths-Based Group Supervision, Psychiatric Rehabilitation Journal, 38, 268-272

Shephard, G., Boardman, J., Slade, M. (2008). Making Recovery a Reality, Sainsbury Centre for Mental Health.
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