SUPERVISION PRACTICE
Are you getting enough? – (2) Supervision models and barriers In the second o our articles, Sam Simpson and Cathy Sparkes explore supervision approaches and belies. Their two-part practical activity (box 1) is designed to help you relect on your own experience, whether you have accessed supervision or not.
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n this series we hope to introduce, develop and validate your understanding and insight into supervision practices. In our rst article we set set out to dene dene supervision supervision and demondemonstrate that it is a uid relationship encompassing a wide range o skills and techniques. Reecting on our own experiences o supervision, we can recognise the diferent styles and approaches we have received and ofered. Tese have been determined through negotiation with our respective supervisors and supervisees both at the start and at regular intervals throughout the relationship. We intend to help you to see your supervision history in relation to some o these approaches and models. In addition, we hope to enlighten you as to why sometimes it can be dicult to access supervision.
A. MODELS It is our intention to give an insight into the act that there are many ways o ofering and receiving supervision and that every relationship will benet rom an array o styles depending on who the relationship is with and at what stage o the supervisee’s journey they are accessing it. Each dyad is unique. We We have have selected selected three three models to illustrat illustratee the multidimensionality o supervision. We consider all three to be complementary and do not avour one over another. 1. A functions model of supervision Prochter (undated, in Hawkins & Shohet, 1989) describes a model that diferentiates between the three main processes o supervision: i) Formative and Educative Functions involve acilitating the supervisee to develop their skills, understanding and abilities, thereby enabling them to reect on their practice, recognise strengths and weaknesses and develop skills and knowledge ii) Restorative / Supportive Functions thereby providing the supervisee with opportunities to explore and vent eelings, address emotional responses and understand their underlying causation iii) Normative / Managerial Functions concerned with ensuring high standards o practice and that the supervisee’s work stays within the organisational objectives. In practice there is considerable overlap between the processes, and the relative contribu18
SPEECH & LANGUAGE THERAPY THERAPY IN PRACTICE
tion o each compol-r: Cathy and Sam nent will vary in each supervisory relationship and across diferent settings and time. 2. A developmental model of supervision Hawkins and Shohet (1989) report that “supervisors need to have a range o styles and approaches which are modied as the counsellor (supervisee) gains in experience and enters dierent denable developmental stages”. Teir developmental model asserts there are our levels to the supervision relationship, each with its own unique eatures. We will explain some o the key eatures o each level: Level 1 Childhood - Novice At this level the supervisee supervisee is characterised characterised by trainee dependence on the supervisor. Whilst highly-motivated, s/he oten presents as anxious, insecure about his/her role and ability and lacking in insight. Supervisees tend to lack an overview o the whole therapeutic process, are prone to theorising prematurely and exhibit over-concern with their own perormance. Stoltenberg & Delworth (1987, p.56) report that supervisees at this level “tend to ocus on specic aspects o the client’s history, current situation, or personality assessment data to the exclusion o the other relevant inormation. Grand conclusions may be based on rather discreet pieces o inormation.” In terms o the role o the supervisor, s/he “needs to provide a clearly structured environment which includes positive eedback and encouragement to the supervisees to return rom premature judgement o both the client and themselves to attending to what actually took place” (Hawkins & Shohet, 1989, p.49). Tey need to ocus on the content o the supervisee’s work with the client client and and the detail o what what haphappened in the session (attending to what is ). ). In addition, they need to support the supervisee to see the detail o individual sessions within a larger context (over time, to client’s outside lie and personal history). According to Stoltenberg & Delworth (1987, p.64), “balancing support and uncertainty is the major challenge acing supervisors o beginning therapists.” Level 2 Adolescence - Journeyman At this level the supervisee supervisee uctuates uctuates between
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dependence and autonomy, and between overcondence and being overwhelmed. S/he is less simplistic and single-ocused, but can be more reactive to their clients. Supervisees at this stage may also test out ou t their supervisor’ super visor’ss authority. “Te supervisor needs to be less structured and didactic than with level 1 trainees, but a good deal o emotional holding is necessary as the trainees may oscillate between excitement and depressive eelings o not being able to cope, or perhaps even o being in the wrong job” (Hawkins & Shohet, 1989, p.51). Level 3 Early Adulthood – Independent Craftsman Te supervisee now demonstrates a more exible approach to client management and is able to see their client in a wider context, having developed ‘helicopter skills’ (the ability to be ully present with the client in the session, but simultaneously have an overview that enables appreciation o the present content and process in the context o the total process o the therapeutic relationship, the client’s personal history and lie patterns, the client’s external lie circumstances, as well as the client’s lie stage, social context and an d ethnic background). Stoltenberg & Delworth (1987, p.20) comment that supervisees supervisee s will “show increased proessional sel-condence, with only conditional dependency on the supervisor. He or she has greater insight and shows more stable motivation.” In relation to the role o the supervisor, “supervision becomes more collegial, with sharing and exemplication augmented by proessional and personal conrontation” (Stoltenberg & Delworth, 1987, p.20). Level 4 Full Maturity – Master Craftsman Te supervisee is characterised by personal autonomy, insightul awareness, personal security, stable motivation and an awareness o the need to conront personal and proessional problems (Stoltenberg & Delworth, 1987, p.20). S/he oten becomes a supervisor at this stage, which consolidates and deepens their own learning. Now supervision is not viewed so much in terms o acquiring more knowledge, but o allowing knowledge to be deepened and integrated.
SUPERVISION PRACTICE
At this this level, level, the superviso supervisorr has has a role in listenlistening to deeper meanings and wider implications and in ocusing on paralleling, transerence and counter transerence as well as providing access to other approaches or key models. 3. A tasks model of supervision Carroll (1996) addresses the generic tasks o supervision rather than any particular ramework. His hope is that efective supervisors will select tasks appropriate to their supervisee’s learning. Te ollowing is an outline o those tasks: • eaching: enabling the integration o theory into practice. • Counselling: aims to raise awareness and understanding o the therapist’s own ‘baggage’. I personal issues are recurrent, it may be appropriate or the therapist to access counselling to address these. • Monitoring proessional / ethical issues as a susu pervision task: to ensure clear boundaries and accountability. • Evaluation: thereby encouraging sel-monitoring and challenging work that alls short o good standards. • Consultation: the attention given to process in supervision. • Administrativ Administrative: e: involving involving explorin exploringg the impliimplications o the therapist’s work in the diferent contexts that they operate, including condentiality, documentation and service cultures.
B. BARRIERS AND BLOCKS BLOCKS We We realise realise lookin lookingg back over over our career careerss that, that, in spite o good intentions and a true commitment, there have been times we have ound it more dicult to access supervision due to personal, organisational or cultural pressures. We We can both b oth identiy times when we accessed supervision less regularly than optimal due to work pressures or the gradual realisation that the current supervision set-up was no longer working as efectively. We can all be aected by external pressures or relationships. Te Sheeld Project (1992-1994) quoted by Syder & Levy (1998) is a good example that, even when the conditions seem to be right, issues around access are nevertheless apparent. As part o a pilot study, supervision was made available to all 60 speech and language therapists working in Sheeld between 1992 and 1994. Terapists were able to sel-reer or non-managerial supervision, which was not compul compulsor soryy and ofered ofered ree ree o charge. charge. Everyone was entitled to time out rom work and a range o neutral and central locations were made available. Sessions were condential and eedback was gather gathered ed rom rom those those who opted opted or superv supervisi ision on as well as rom those who declined. Reported gains or therapists who opted to take up the ofer were multiple: • ‘alking through my reasoning behind decisions and checking out what personal biases have gone into them’ • ‘Becoming more aware o my prejudices with a particular client group’ • ‘I eel less drained by work now’. However, a number o stumbling blocks were identied: • Insucient time due to other work commitments • Feelings o guilt about taking the time
Box 1 Your supervision journey 1. Take a ew moments to refect on the type o supervision super vision you are receiving / have received and could / would like to receive in the context o the three models in this article. Where possible refect with a colleague and share your experiences. 2. Look at your supervision journe journeyy and and consid consider er your your personal supervision belies over time. You might be pro / anti / somewhere in between be honest with yoursel. Having read the article, are your belies represented? How have your belies impacted on your commitment to accessing regular personal supervision? How do your belies compare with those o your manager / service / organisation? • Anxiety that a riendship riendship with the supervisor might interere with the process • Put of by the term ‘supervision’ • Not eeling the need to use it at this stage • Feel adequately supported by colleagues • Feeling happy with work lie, thereore supervision is superuous • Supervision is only or when things are not going well, or problem clients or or times o stress / distress at work • Supervision is a perk. Tus, in spite o having created the culture and core conditions or an entire service to have access to non-managerial supervision and having minimised the external barriers, take up was nonetheless an issue. Te power o therapists’ internal belies about and understanding o supervision became evident and heavily inuenced their perception o the useulness o supervision and their willingness to access it. Syder & Levy (1998) discuss the range o possible barriers to embracing supervision as ollows: • Reluctance to re-live the uncertainties o student clinics • Reluctance to put ourselves in a situation where either our peers or our managers managers are given licence to criticise • Feeling expected to know more than we do / to have acquired more skills than we know we possess • Uncertainty regarding boundaries (supervision, counselling, teaching) • Feeling that supervision will wear away at our authority with younger therapists • Diculty seeing what supervision can ofer
having worked or a number o years and developed a style o working with which we are content • Uncertainty regarding where to go and nd it. Hawkins & Shohet (1989) also reect on the possible barriers to access: • Previous experience o supervision • Personal inhibition • Te supervisory relationship • Organisational blocks • Practical blocks (eg. nancial, geographical, availability o suitable supervisor) • Cultural blocks within the organisation • Cultural blocks within the proession. It is indeed interesting to consider the history o supervision in counselling as compared to speech and language therapy. Counselling training has long allied itsel to an andragogic approach to learning, whereby students take responsibility or their own learning and aim to become sel-directed learners. From an andragogic perspective, learning is seen as lielong with supervision representing the major way counsellors counsellors continue their proessional proessional development ater training. In contrast, speech and language therapists have traditionally been trained in a pedagogic manner, which corresponds to the medical model strongly associated with the initial practice o the proession. Tus students were seen as empty vessels vessels that that have to be ‘lled ‘lled’,’, ‘examined’ and then ‘deemed competent to practise’ (Syder & Levy, 1998, p.259). Recent shits in student speech and language therapy training programmes show a move towards an andragogic approach, which is urther underlined by developments in reective practice and continuing proessional development postqualication. Discussions in the ocus groups we held or this series have highlighted that, whilst proessionally the importance o supervision is being increasingly recognised and embraced by younger generations o therapists, traditional attitudes still remain and can have a strong cultural inuence at a departmental, service and organisational level. We We look orward orward to hearing hearing any comments comments you have. In the next issue we will be discussing the process o supervision, roles, responsibilities SLTP and boundaries. Sam Simpson and Cathy Sparkes are specialist speech and language therapists and Cathy is also a trained counsellor. ogether ogether they t hey are www.intanwww.intandem.co.uk.
Reerences Carroll M. (1996) Counselling Supervision: Teory, Skills and Practice. London: Cassell. Hawkins, P. & Shohet, R. (1989/1993) Supervision in the Helping Professions. Milton Keynes: OUP. Stoltenberg, C. & Delworth, U. (1987) Supervising Counsellors and Terapists . Terapists . San Fransisco: Josey Bass. Syder, D. & Levy, C. (1998) ‘Supervision’, in Syder, D. (1998) Wanting to alk: Counselling Case Studies in Communication Disorders. London: Whurr, pp.256-288.
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