Supervision: More questions than answers?

Dean Spruce | 13 Dec 2018 | 0 | Clinical Supervision, reflective practice | Web Log

Supervision: More questions than answers?

Steve Freeman, Solution Focused Practitioner. www.stevefreeman.org.uk

This article is late to press. It’s very, very late. I could claim that this is due to pressure of work, putting family first and any number of other reasons. The truth, however, is that the topic is overwhelming. This is the latest of several attempts that I’ve made at writing about supervision. And even now as the article is ready to submit I haven’t entirely succeeded.

I’m the first to recognise that I should know better. I’ve been using, providing and researching supervision for decades. And yet…..when it comes to summarising the available information I’ve been stumped.

For this reason I’ve decided to give a personal overview of the topic based on my reflective practice portfolio. This is produced as part of my nursing registration process. The contains a few references and other anchor points and observations of what works well. These are based on observation and feedback from both people that I’ve supervised and colleagues who work as supervisors.

It’s worth considering what ‘supervision’ means. It isn’t ‘clinical supervision’ as described in much of the health related literature and yet it has common factors with it. Definitions of supervision vary greatly. For many practitioners supervision is an all encompassing activity carried out by their manager. It includes all aspects of their work from ‘management supervision’ (timekeeping, performance review etc) to clinical or caseload supervision discussing direct work with people accessing services. For others these functions are very separate. My experience and preference has been to keep the two aspects of supervision separate. I have acted as supplementary support for people using the joint approach and the amount of compromise required by both parties’ means that the managerial aspect almost always prevails. At best it has a significant influence. After all managers are there to manage. Been there done that!

Most literature on the topic focuses on people in paid employment and usually in some professional role. Social workers, care workers and clinicians. This article aims to be more inclusive. Anyone who engages in conversations with the aim of helping others is, in effect, a practitioner. To that end when I have worked with teams and organisations looking at models of supervision I have insisted that it should be offered to every person there. Every person from the start to end of my visit to any team should have access to supervision and the ability to reflect on their work as an individual and a member of the team.

Supervision serves many functions for some it is simply a place to ‘vent’ or ‘offload’ and for others it is a place to examine how they are working with people. These people may be customers, colleagues or both. For others it is simply a safe space; some very positive feedback has been provided by people who appreciate the hour or so to relax and catch their breath away from the Bedlam of work. This isn’t supervision per se but is a great way to open a session. A whole session of venting would suggest that the supervisor isn’t doing their job. There has to be an intervention. Otherwise the supervisor could be replaced with a ‘shrieking tree’ as found in traditional Chinese gardens. Respectful curiosity works well for me in this situation. Getting as much detail as possible about the experience being described enables the supervisee to explain the ‘issue’ to themselves alongside the supervisor. This reduces the time that it takes to reach the reflective and action stages of the conversation. Other useful questions derived from solution focused practice would include scaling, exceptions, preferred future and ‘what would have to happen…..?’ On a personal and professional note I wouldn’t be delving into past experience and psychodynamic explanations of their impact. Past experience is valuable and should always be recognised and validated. It should also be seen as a springboard to future success rather than an anchor holding people back.

The wide range of models informing supervision reflects the breadth of approaches to practice. Many of these models have their basis in therapeutic modalities. Interestingly the preferred models of the two parties don’t have to be the same. As a solution focused practitioner I have acted as supervisor for CBT therapists, psychodynamic psychotherapists and ‘generalists’ who mix and match elements of several models. Equally I know solution focused practitioners who have supervisors from other schools and using other models. There really are no rules.

When I began working with Voices and Expert Citizens my supervisor asked if I had an approach in mind and if there was a specific or alternative model for the new venture; “you won’t be using the same models as in nursing and medicine will you?” My supervisor is great and yet this question shocked me. Why would I need a different model? In solution focused practice the aim is to recognise and work with the expertise of the individual; they are inherently competent and are experts in their own lives. My ‘expertise’ (if any) is in asking the right questions and listening very intently to the person’s narrative.

Whilst models of therapy have influenced supervision it is important to state that supervision is explicitly not therapy. It may be ‘therapeutic’ in that people feel better as a result of supervision. It has a positive effect on how people view work. This is regardless of reported levels of job satisfaction. It can have an influence on self esteem and hence relationships with self and others. And yet despite all this it is not therapy. The skill in both parties is to recognise not only the boundaries of the supervision relationship but their own limits. I’m fortunate in having qualifications and insurance as a therapist and still have to be very aware of how far the boundaries are pushed and stretched in all my work. It’s a great topic for supervision and I’m occasionally asked by my supervisor “So what is it we’re discussing? Supervision, therapy or just a chat?”

The concept of ‘drift’ is important here. It is all too easy for a conversation to drift into supervision and supervision to drift into management of practice based issues and from here to amateur therapy. Awareness is the key in these conversations. The emphasis on listening closely and narrative assessment is crucial for both parties. When both parties are aware of drift and manage it appropriately all’s well. When the boundaries are flexed (and they will be) it is the close attention to language, content and narrative which will avoid getting into dangerous and potentially damaging territory.

Up to this point the emphasis has been on 1:1 work. What about group supervision? People have suggested that extra training is required for group supervision. This may be true. Former employers have invested heavily in this on my behalf. Whether further training is needed is an individual choice for the supervisor and their commissioner. It will also depend on the model to which they subscribe. From a pathological, problem focused perspective more people means more problems and complexity. More difficulties, tensions and issues making the expert supervisor work harder. If, however, all members of the group are viewed as inherently competent life becomes far easier. When resistance is viewed as co-operation and everyone in the room is looking for the ‘difference that makes a difference’ for the team no more training is needed beyond listening, asking, listening, noticing, asking ad infinitum. This approach enhances team cohesion and helps them to identify common factors, common resources and common goals. Doing more of the things that work well will displace the ‘tensions, problems and complexities’ reported by some experts.

All well and good but why bother with supervision? Really, truthfully is it necessary? The most common reasons for supervision not being accessed are; “I don’t have time”, “I/we don’t need it as we have a close team who look after each other”, “I don’t need therapy” and “I don’t have problems to discuss.” Therapy is dealt with above. Time poverty is interesting; if someone doesn’t have time for supervision it almost certainly shows that they need it. Good supervision leaves people more efficient and with lower levels of work based stress. There is an irony in people taking time away from work to wait for workers to do a job on their house and yet can’t take time for self maintenance. The ‘self healing team’ notion has some merit and yet doesn’t stand up to scrutiny. Supportive colleagues are valuable and not to be underestimated. And yet there is also value in discussing our work with someone not directly involved in it. An outside view is useful. A curiosity based narrative from an outsider avoids confirmation bias (a natural tendency to seek opinions and data that support what we already believe) and will develop a very different form of reflection on our work. Not having problems to discuss is an equally flawed reason to avoid supervision. Reflecting on what’s gone well and how that happened is a first step to ‘doing more of what works’ as noted above. Discussing success is not a way of avoiding discussing problems. At worst it is a case of both/and; discussing problems in the context of success and resilience. At best discussing what has worked well will displace difficulties, put them in context and provide a basis for future best practice.

Supervision is also an organisational necessity. Managers, directors and CEOs may have absolute faith in their staff. They still have to ask how they know that staff and people accessing services are safe. How can they be more confident that no one is being damaged by the service for which they are responsible? Supervision is part of this ‘safety net’. Whilst supervision is confidential there are circumstances in which concerns have to be discussed with managers by either or both parties. Equally it is possible that themes emerging from supervision may need to be raised; safety issues, lack of adequate support and safeguarding are all examples that I have come across over the years. These factors mean that supervision is not only the responsibility of the practitioner but also an element of an organisations governance structure.

In truth the term supervision is a little passé. Supervision suggests a level of control of one person by another. “Children must be supervised” as the signs say. The nursing and medical fields have been using the term ‘reflective practice’ more and more over the past decade. Reflective practice as a term and as a descriptor is one of the answers to my difficulty in writing this article. Shifting my thinking to reflective practice is much more productive. The term supervision is so embedded, however, that it may take a while for it to fade away. Many articles and policies refer to ‘reflective supervision.’ Perhaps this is a bridge between the two ideas.

Reflective practice embodies the best elements of supervision as described above. It is a hosted conversation which supports people in reflecting on their experiences and how they are more or less useful in influencing practice. The ‘supervisors’ role is that of host rather than expert and their role is to ask only questions which support reflection, change and competence.

In group contexts reflective practice depends on questions and support from the group members as well as the conversation host.

This approach is more likely to support and develop systems change than a traditional supervision approach.

So where does this leave my thinking on supervision and reflective practice? For practitioners of all types (paid, volunteers, mentors and others) any conversation which helps people to work with people and minimise harm to both parties has to be a good thing. When the conversation is focused on present and future successes and competence all the better. When past experiences are validated and reframed as resources and lived experience is seen as a resource then even better. And so long as the conversations take place….who cares what it’s called?