The Supervisory Relationship

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The Supervisory Relationship

• Kerry Smith 2007

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Supervision and relationships

• In psychology, supervision considers the work
  occurring between clients and therapists in the
  context of their therapeutic relationship
• It also consists of a relationship in itself
• What is clear from all models of supervision,
  however is the primacy of the supervision
  relationship, and its centrality to the outcome
  of supervision. (Holloway 1995).

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Integrate knowledge from supervision models

• Draw on your knowledge of how to establish
  relationships in therapy
• But be aware of what is different
• Pay attention to all aspects of the supervision
  process
• Pay attention to the clarification of
  professional roles and boundaries (contracting)
• Pay attention to the developmental level of the
  trainee
• Ask for feedback from your supervisee

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Aims of supervision

• To facilitate your development as a clinician and
  as a professional
• To protect the public/ to evaluate your
  performance
• Provides constructive feedback and advice
• An opportunity to reflect
• An opportunity to discuss your reactions (to your
  client, to your supervisor, to the service)
• An opportunity to talk through wider
  professional and organizational issues

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Supervision

• Weekly (60-90 minutes) plus informal contact.
• Same time if possible.
• Booked in advance.
• Uninterrupted.
• Take supervision notes/record in case notes if
  relevant.
• Use tape recorded material where possible

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Responsibilities of supervisor

• Provide regular, uninterrupted time and a safe
  space for reflection
• To protect the client and be accountability for
  therapeutic work
• To keep a record of supervision sessions
• To evaluate trainees competence and flag up any
  concerns in a constructive manner. To stop
  incompetent or dangerous practice.
• To provide constructive feedback, information etc
  to shape behaviour.To guide trainees professional
  development through discussion of experiences on
  placement
• To ask trainees about their personal reactions
  within and to therapeutic work
• To provide relevant reading material
• To ensure safety/security of placement and to
  meet any relevant legal requirements
• To make trainees aware of local policies
• To provide formative feedback to the university
  course regarding the development of competence

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Responsibilities of supervisee

• To prepare for supervision beforehand
• To keep a written record of supervision,
  especially actions to be taken
• To commit themselves to a reflective supervisory
  process as a developing professional
• To reflect on work and be open with supervisor
  about aspects they are happy or not so happy with
• To act on supervision in clinical practice
• To bring casenotes, letters, sections of tapes
  for supervisor to see
• To be prepared to talk about the impact of
  personal issues on professional practice
• To take responsibility for proactively seeking a
  range of experiences on placement to ensure you
  gain the competencies required
• To regular review progress on developing
  competencies
• To flag up any difficulties with your placement
  or obtaining regular supervision as soon as
  possible with your placement visitor

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Preparation/structure of supervision

• Lay aside time to go over case notes and clarify
  thinking prior to session
• Decide how you want to use the session
• Take case notes with you.
• Negotiate an agenda (supervisor may have items to
  bring or ideas about structure)
• Stick to agenda and manage time appropriately

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Supervision content

• Request for advice or information to supplement
  or clarify reading
• Coherent presentation of dilemmas/progress
• Putting together formulations
• Discussion of personal reactions
• Receiving feedback
• Adult/adult interaction

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Factors which might contribute to effective
supervision Hirons and Velleman (1993) Clinical
Psychology Forum 5711-13

• HELPFUL EVENTS
• Direct guidance on clinical work
• Joint problem solving
• Reassurance
• Theory-practice linking
• Soliciting ideas from trainee

• UNHELPFUL EVENTS
• Telling the trainee what to do
• Lack of direction in therapy
• Talking to trainee as though they are client

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Helpful events (course attenders)

• Joint problem solving
• Guidance on clinical work (including observation
  of supervisor and guided discovery)
• Theory/practice linking
• Reassurance
• Soliciting views from the trainee
• Reflection on parallel process between therapy
  and supervision
• Being available and reactive to trainee needs
• Sensitivity to impact of personal issues on
  ability to carry out certain types of clinical
  work
• Discussion of feelings

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Unhelpful events (course attenders)

• Lack of direction in therapy
• Trainee being talked to like a client
• Non-genuine reassurance
• Lack of direct guidance when needed
• Supervisor telling the trainee what to do
• Anxious supervisor-unclear advice
• Unreliable supervisor
• Global, unclear criticism
• Lack of balance between ve and -ve feedback
• Expected to know what to do

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Parallel process in supervision
" The parallel process should be suspected
whenever the supervisee appears to have reached
an impasse in a treatment that does not yield to
the usual exploration of case dynamics. It's
detection requires considerable alertness on the
part of the supervisor, who must be able to
identify as parallel process what may at first
appear to be inconsistencies or omissions in the
supervisee's presentation or behaviour or an
emotional strain in the relationship with the
supervisor." (E. Kahn (1979) Journal of
Contemporary Social Work)
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• GOALS OF THERAPY
• improved coping
• personal growth
• capacity to function in life situation
• amelioration of symptoms

• GOALS OF SUPERVISION
• technical skill acquisition
• professional growth
• attainment of stable professional identity
• evaluation of competence

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Vignette 1

• Carol is a first year trainee on her first
  clinical placement with you. You are aware that
  there doesnt seem to be a very comfortable
  supervisory relationship between you yet though
  Carol works extremely hard and always does as
  shes told in supervision. You also work hard to
  give her very detailed feedback in supervision
  from your specialist therapy perspective which
  you are keen to develop with Carol. You have
  listened to a number of tapes of sessions with
  her already and commented on her formulations.
  She doesnt seems to respond positively to this
  which is frustrating for you as you consider are
  working really hard to help her.
• In pairs a) Discuss what the potential issues
  may be and b) Role play any ideas for resolving
  the situation.

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Vignette 2

• Rena is a first year trainee on her first
  clinical placement with you. You are aware that
  there doesnt seem to be a very comfortable
  supervisory relationship between you yet. Rena is
  quiet and passive in supervision she doesnt seem
  to be developing any ideas about what to do with
  clients. She tends to bring information about
  clients and then wait for a response from you.
  You feel uncomfortable about this as you dont
  want to dent her confidence further by being too
  active as a supervisor.
• In pairs a) Discuss what the potential issues
  may be and b) Role play any ideas for resolving
  the situation.

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Vignette 3

• Bob is a second year trainee on placement with
  you. You are aware that there doesnt seem to be
  a very comfortable supervisory relationship
  between you yet. Bob is at least 10 years older
  than you and has worked as a psychiatric nurse
  prior to clinical training. He also has a young
  family and sometimes seems to need to take time
  off which is inconvenient in placement terms. You
  are a little irritated by this but have not
  addressed the issue in supervision.
• In pairs a) Discuss what the potential issues
  may be and b) Role play any ideas for resolving
  the situation.

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Vignette 4

• Ron is a second year trainee on placement with
  you. You are aware that there doesnt seem to be
  a very comfortable supervisory relationship
  between you at present. Supervision seemed to get
  off to a very good start and you both got on
  well, so thing seem to have changed. You are
  aware that Ron has been stressed recently with
  academic demands and you think he may have had
  some personal issues to deal with connected to
  his partner but this has only been mentioned in
  passing. Ron seems to be a very competent trainee
  and you have no concerned about his work.
• In pairs a) Discuss what the potential issues
  may be and b) Role play any ideas for resolving
  the situation.

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Some references

• Aveline M.( 1997) The use of audio tapes in
  Supervision of Psychotherapy in Shipton G eds
  Supervision of Psychotherapy and Counselling
• Brocklehurst N. (1999) An Evaluation Study of
  Clinical Supervision in Six NHS Trusts.
  Unpublished PhD Thesis, University of Birmingham
• Driscoll J.(1999) Getting the most from clinical
  supervision.Part onethe supervisee Mental
  Health Practice 2 6 pp28-35
• Dye, H. A. (1987). ACES attitudes Supervisor
  competencies and a national certification
  program. ERIC/CAPS Resources in Education,
  Document No. ED 283 098.
• Faugier J. Butterworth T. (1993) Clinical
  Supervision - A Position paper. School of Nursing
  Studies. University of Manchester. Manchester.
• Fowler, J. (1996) 'The organisation of clinical
  supervision within the nursing profession A
  review of the literature' Journal of Advanced
  Nursing, 23, 471-478.
• Hawkins P Shohet R (2000). Supervision in the
  helping professions. Bucks, England OU Press.
• Holloway, E. (1995) Clinical supervision A
  systems approach. Sage. 41-55.
• Page S Wosket V (1994). Supervising the
  counsellor A cyclical model. London Routledge.
  
• Shainberg D. Teaching therapists how to be with
  their clients. Awakening the heart, Chapter 15,
  pg 163-175.
• Stoltenberg, C. D., Delworth, U. (1987)
  Supervising counselors and therapists. San
  Francisco, CA Jossey-Bass.