What is supervision?

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What is supervision?

Post by miriam » Sun Apr 15, 2007 6:55 pm

To me there are two definitions of supervision:

The commonly understood one is that the supervisor is taking responsibility for the supervisee's job performance, and is deciding what they should be doing, when and how. So in a clinical context this could mean a ward manager deciding how many cases an NA is working with, what they are expected to do in their sessions, how they record them, how they share that information, etc. This applies in all sorts of contexts.

However, in clinical psychology supervision also has a more specific function. The supervisor is not just accountable for a person's actions and managing their workload and remit, they are also helping them reflect and develop. This can cover discussion of their role, the interface between personal and professional, where their "growing edges" are, how they wish to develop, helping them to link theory and practise, to fomulate what is going on with complex cases and to be aware of the systemic context of the team, organisation, NHS. The supervisor is also sharing their experience, decision making and interpretation with the supervisee's observations, experiences and information gathering. So, for example, an AP can administer a particular test, but the supervisor will interpret it, and decide on a treatment plan that the AP can then deliver. So it is designed to be a trusting collaboration in which the supervisee can develop, and the supervisor can feel confident that work is being delivered indirectly that meets their standards and is under their guidance.

I hope that gives a bit of the flavour of it.

I should also say, supervision doesn't stop on qualification. I still meet my head of department once every three or four weeks to discuss cases, systemic issues, how I wish my role to develop, the personal impact of the work, etc. I really enjoy and value that time. We also have various forms of "peer supervision" where the definition between supervisor and supervisee is much more mobile and not heirarchical or one-to-one, and use this to discuss papers and cases and how it feels to be working in our department with all the current stresses and strains. There is also an aspect of supervision in our monthly team meetings and biannual away days. Looking after staff is important, and adequate and supportive supervision is an important part of that in our profession.

There is also some BPS guidance for supervision of trainees that can be read here

Supervision requires...
• Setting a time
• At least an hour a week
• No interruptions
• Identifying needs
• Setting agenda from this
• Evaluating if needs are being met
Supervisors must be...
• good communicators
• focused
• empathic
• approachable
Supervision should ideally include...
• informing
• supporting
• evaluating
• observing
• training
• educating

Addendum (from Hawkins and Shohet)
At any time in supervision there are many levels operating. At a minimum all supervision situations involve at least four elements; a supervisor, a therapist, a client, a work context.

Of these four, normally only the supervisor and the therapist are directly present in the supervision session, except in live supervision. However, the client and the work context are carried into the session in both the conscious awareness and the unconscious sensing of the therapist. There are many styles of managing the supervision process, here is one, known as the double matrix or seven-eyed model of supervision.

Matrix One: The therapy session is reported and reflected upon in supervision

Mode One: Reflection on the content of the therapy session
Attention is concentrated on the actual phenomena of the therapy session: how the client presented themselves, what they chose to share, which area of their life they wanted to explore, and how this session’s content might relate to content from previous sessions. The aim and goal of this form of supervision are to help the therapist pay attention to the client, the choices the client is making and the relatedness of the various aspects of the client’s life.

Mode Two: Exploration of the strategies and interventions used by the therapist
The focus here is on the choices of intervention made by the therapist – not only what interventions were used but also when and why they were used. Alternative strategies and interventions might then be developed and their consequences anticipated. The main goal of this form of supervision would be to increase the therapist’s choices and skills in intervention.

Mode Three: Exploration of the therapy process and relationship
Here particular attention will be paid to what was happening consciously and unconsciously in the therapy process: how the session started and finished; what happened around the edges; metaphors and images that emerged; and changes in voice and posture. The main goal of this form of supervision will the therapist having greater insight and understanding of the dynamics of the therapy relationship.

Matrix Two: Focus on the therapy process as it is reflected in the supervision process

Mode Four: Focus on the therapist’s countertransference
Here it is important to concentrate on whatever is still being carried by the therapist, both consciously and unconsciously, from the therapy session and the client. The countertransference may be of several different kinds.

Mode Five: Focus on the here-and-now process as a mirror or parallel of the there-and-then process
Here focus is placed on the relationship in the supervision session in order to explore how it might be unconsciously playing out or paralleling the hidden dynamics of the therapy session. Thus, if the client was covertly acting in a passive-aggressive way to the therapist, this might emerge in the supervision by the therapist’s becoming unconsciously passive-aggressive to the supervisor as they discuss that particular client.

Mode Six: Focus on the supervisor’s countertransference
Here the supervisor primarily pays attention to their own here-and-now experience in the supervision – what feelings, thoughts and images the shared therapy material stirs up in them. The supervisor uses these responses to provide reflective illumination for the therapist. The unconscious material of the therapy session which has been unheard at the conscious level by the therapist may emerge in the thoughts, feelings and images of the supervisor.

Mode Seven: Focus on the wider context
Although the six modes of focus are inclusive in so far as they include all the processes within both the therapy and supervisory matrices, the supervisory relationships also exist within wider context which impinges upon and colours the processes within it. The supervisor cannot afford to act as if the client-therapist-supervisor threesome exists on an island. There are professional codes and ethics, organisational requirements and constrictions, as well as relationships with other involved agencies. All of these need to be taken into consideration.

It would be very unusual to find a supervisor who remained entirely in one of these seven modes of supervision. In fact, good supervision must inevitably involve movement between modes.

More info here

Further reading:
(recommended by Guest23)

Fleming, I. & Steen, L. (2003). Supervision and Clinical Psychology: Theory, Practice and Perspectives. London: Brunner-Routledge.

Carroll, M. (2007). Clinical psychology supervision. Clinical Psychology Forum, 174, 35-38.

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Content checked by Will on 26/2/12.
Last modified on 26/2/12 (fixed broken link).

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