Clinical supervision

On Supervision – a blog for Practitioners

I have worked as a Clinical Supervisor with a range of supervisees over the last 7 years, in groups of three and four as well as one-to-one, with supervisees in training, and more experienced counsellors.

In supervision the relationship created with the supervisee is key, just as the relationship between client and counsellor is of central focus to the movement of the therapeutic work. When a counsellor comes to supervision they may be feeling anxious, stressed, confused or afraid. It is important to create a space where it feels safe enough to talk about difficult feelings without fearing judgement and to be able to acknowledge and discuss them.

‘The task of the supervisor is to help the supervisee feel received, valued, understood on the assumption that only then will he feel safe enough and open enough to review and challenge himself, as well as to value himself and his own abilities.’ (Hawkins and Shohet; 1989, 36)

Supervisors can all too easily be experienced as in a position of power and this can bring out a defensiveness in the supervisee who wants to prove to their supervisor and themselves that they are doing a good job.

‘Transference difficulties, usually the projecting of critical or uncontaining parental images are often there, just as in therapy, but less easy to recognize.’ (Hawkins and Shohet; 1989, 22)

In short, I need to hold a balance between genuine warmth and the need to challenge thought processes and practice. An acknowledgement Our relationship can act as a useful reflection of the client/counsellor that there is no one way to interpret information and that our purpose is co-operative rather than from above’ with a respect for the role of boundaries. This is encapsulated by the following quote:

‘…an integrated style of supervision. We are not only advocating integration of the educative, supportive and managerial roles, but also a supervisory approach which is relationship based’.
(Hawkins and Shohet; 1989, 5)

My view of good supervision is that it focuses predominantly on the client. The dynamics of the supervisee will come into the process but the exploration of this will be with the client in mind. We examine the issues brought by the client in order to move the work forward in his or her best interests. It is as if part of the work of the supervisor is to ‘speak the unspoken’, not to be ‘mesmerized’ by the supervisee or the client. (Houston; 1990,38)

Hawkins and Shohet draw together the qualities of a good supervisor as follows: ‘empathy, understanding, unconditional positive regard, congruence, genuineness (Rogers 1957), warmth and self-disclosure (Coche 1977), flexibility, concern, attention, investment, curiosity and openness (Albott 1984; Aldridge 1982; Gittermann and Millier 1977; Hess 1980.) 

I use the various definitions and recommendations from the different modalities on the basis that they work, suit my style of relating, suit the environment in which I find myself and all are there ultimately to promote healing in the client via their encounter with my supervisee.

The difference between Supervision and Therapy
Supervision uses the same set of skills as client work, but the supervisor must be clear about how it is different in content, focus and boundaries. The supervisory relationship is more collaborative, more of a partnership, more equal, depending upon the needs of the supervisee.

Therapy is a place where social limitations are removed, we nudge the client forward, challenging them, supporting them and taking them to a place they have not been or do not know how to get to. This in turn is reflected in the supervision process where the supervisee is challenged to better serve the client. In therapy we ask our client, are we talking about the right thing?  In supervision we ask the supervisee what is it that this client wants from counselling? We hold this in mind.

‘Therapy is essentially about healing, the healing of wounds, and this healing will only take place if the therapist is willing to take the risk of meeting, which Martin Buber (1958) calls the ‘I-thou’ relationship. When this willingness for meeting is present, this very possibility for meeting creates the quality of relationship in which healing can occur.’
(Jacobs; 1996, 64)

In supervision there is generally more open dialogue and essentially more challenge.  In essence if it’s ‘coming up’ for the supervisor then it is useful to say it. (Houston 1990)                                       

By contrast, in therapy it may be more appropriate to hold the thought but not verbalize it. In supervision we discuss transference, counter-transference and the parallel process overtly.  A definition of the parallel process is neatly described by Michael Jacobs:

‘Whereby it is thought that the dynamics of the therapy relationship can be replicated within the supervisory relationship.’ (Jacobs; 1996,2)
Nicky Mark

As an example, a supervisee may come over in a completely different way when talking about a particular client, inadvertently ‘demonstrating’ the client with great accuracy.

                                   ^  ^

Client                        :   :            supervisee

Counsellor              :   :             supervisor              parallel process (echo)

As supervisors we work with one foot in and one foot out of the supervisory relationship with the supervisee. We keep a ‘birds eye view’, using ‘helicopter ability’ to be able to focus on the client being described, whilst being able to switch perspectives and focus on the supervisee and their process., and also our own. (Hawkins and Shohet; 1989, 37)

We keep a third eye on the work in order not to get pulled in by the supervisee. (Houston 1990; 36)

What are the crucial tasks of supervision?
‘The supervisor’s role is not just to reassure the worker, but to allow the emotional disturbance to be felt within the safer setting of the supervisory relationship, where it can be survived, reflected upon and learnt from. Supervision thus provides a container that holds the helping relationship within the ‘therapeutic triad’: supervisor; supervisee; client.’ 
(Hawkins and Shohet ;1989, 3)

A supervisee needs to be able to trust their supervisor in order to be able to talk about ruptures in the work, stuck points, transference and countertransference. These are all crucial tasks of supervision, the bringing of issues that are not going well.

It is important to have a truly non-judgemental stance which enables supervisees to be honest about their difficulties with their clients. This is fundamental because supervisees can so easily feel judged or incompetent when the client’s circumstances or their own response is challenging or ambivalent. The danger is the tendency to underplay or not reveal these rather than seeing that it is in our difficulties that we learn. In turn, I need to be open and honest in order to foster trust in supervisees.

Supervision needs to strike the balance between an informal and a structured approach as it is important that supervisees feel comfortable and safe enough to raise anything that is a concern to them, but, as outlined above, supervision has a clear purpose and focus – the client.

When working for an agency, supervision needs to be ‘owned’ by both the organization and the individual; a supervision policy will lay out the purpose, frequency and format of supervision so that it maximizes professional development in addition to checking the quantity and quality of work.

My own style of supervising.
Development in my role as a supervisor includes the development of my personal supervisory style. I would describe myself as being open, spontaneous, having a sense of humour and an ease with supervisees.

I encourage the collaborative nature of the supervisory relationship, both one-to-one and in a group and find it refreshing that it is my responsibility to ensure that the group is challenging in a way that moves the work to a deeper level, both within the room and then subsequently with the client.

Part of my style is to be open to feedback. I believe that if I am prepared to be open about my flaws then a supervisee is more likely to be able to discuss their anxieties or fears.  I want a new supervisee, or a supervisee with a new client to be able to share any difficulties and not clam up for fear that they may get it ‘wrong’ or will not be able to find the ‘right thing to say’.

I incorporate elements of my current supervisor’s style into how I work. We wonder and are curious together. I remind myself to be quiet, sit back, listen, wait before entering into a dialogue. I also have to remind myself not to reassure or rescue. If a new supervisee is too grateful or too apologetic, I question this and what it means.

I bear in mind the need to heed my internal supervisor. As I listen to the presentations I ask myself, what is happening here? How am I feeling? What are my body responses?  What is my intuition telling me?

I reflect more than I pose questions. Statements are often more honest than requests for answers and allow for a more reflective response. I also do my best to respect difference in terms of different styles of working and discuss this openly. As well as discussion, I find it useful to use role play and two chair work.

This can be particularly useful if a supervisee seems to be having difficulty in relating to a client. The responses from other members of the group are also valuable and model the need for close observation of body language, timbre of voice and choice of language itself. The immediacy of the Gestalt approach is very effective in promoting a deep bodily understanding of what is happening both within the supervision group and within the client/counsellor dynamic.

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