Supervision for counsellors, therapists, and other helping professionals in health and social care as well as the voluntary sector.
From tunnel vision to ‘super’ vision
One day in mid February I popped out to post a letter. It had
been dull and overcast for days now so I did not feel inclined to
linger outside. As I walked along, however, there was a break in the
clouds and a ray of sunshine poured through. Suddenly everything looked
different. I noticed the raindrops glistening on tree branches and a
few snowdrops in a garden, and felt glad to be outside. The world was
the same, yet in an instant, through that ray of sunlight, my view of
it had changed completely.
Clinical supervision can be compared to that ray of sunshine that
it can help us to see things differently or more clearly. I could have
seen the snowdrops before, but I hadn’t. I needed the help of the
sun to clarify my vision. Before the sun came out I saw the world
through my own thoughts and prejudgements. I thought “It is a
dull day, there is nothing of interest.” so I did not look.
“Each one of us sees the world through the window of his thoughts”
(Chakravarty 1997:12)
The above experience made me realise that this quote is true, that we
do see the world through the ‘window’ of our thoughts, and
so need to keep that window as clean as we can. In clinical supervision
we can be helped first to become aware of our thoughts and feelings and
then, through reflection, ‘clean’ them so that we can see
what is outside the window. Now, I know that windows have the habit of
getting dirty again. I also know that the only thing to do about it is
to clean them again, since the cleaner the window, the clearer the
view. It shouldn’t be surprising that we see the world though the
window of our own thoughts, feelings, experience and knowledge –
how else would we make sense of it? The important thing is to realise
that our view is not the only one, nor is it necessarily superior to
anyone else’s. As no two people are the same, and we are all
shaped by our unique experiences, it is unlikely that any two people
will every experience the same event in exactly the same way. I have
frequently been amazed at the difference between my recollection of an
event and those of other people – sometimes it seems that we are
not even speaking about the same thing at all.
I have learnt that although each of us probably thinks that we perceive
the world ‘as it really is’ this is not the case. If we did
perceive simply ‘what is out there’ there would not be the
amount of conflict and disagreement that there obviously is. “We
see the world not as it is, but as we are … or as we are
conditioned to see it.” (Covey, 1989:228). This is true even for
those of us in the helping professions who pride ourselves on our
ability to empathise with people. In our interactions, whether with
clients or with colleagues, we have a tendency to understand things one
way rather than another. Sometimes this means that we feel stuck or
that we are missing something, or we may feel less effective than we
would like to be without knowing why.
Many of us have occasions when we find it difficult to acknowledge the
views of others, particularly if we feel strongly about something. The
trouble with such ‘tunnel vision’ is that it is very
limited. It is a wide world out there and we need to keep our vision
wide to appreciate it. The ‘facts’ of any situation have no
meaning in themselves, as it is our interpretation of them that give
them meaning. Thus the more we are aware of our habitual ways of seeing
things – our prejudgements and our assumptions, in fact our
‘map’ of our professional world – the more open we
will be to the different views of others.
If supervision works well, we are helped to become aware of our
‘maps’ or the ‘lens’ through which we see
things, so that we develop a ‘super’ vision. So supervision
is not just about unpacking what happens in our interactions; it is
also about examining the lens through which we view the interactions
themselves.
Personal experience can alter our perception
Ray, a married man with children, had taken a business degree
and now had a reasonable job at a manufacturing company. However he
became increasingly dissatisfied with his working life and wondered
whether he had chosen the right career. Then his two-year-old daughter
became very ill and had to be admitted to the local children’s
hospital. “I had no idea what nurses did,” he told me
“it is a very complex job, isn’t it? You have to be able to
cope with so many different things.” His daughter recovered and
Ray decide to retrain as a nurse, which he was able to do as his wife
earned a good salary as a computer programmer. “It will be tough
for a few years,” Ray said, “but I want to do something
that has meaning for me. Anyway they told me at the interview that
business skills are very much needed in the Health Service, so
it’s not going to be wasted.”
Ray’s example shows how new experiences can radically alter our
perception. It also indicates how a changed view can lead to actions so
different they could not even have been imagined in advance. I feel
that the only way that clinical supervision is going to become an
integral part of all helping professions is through people having the
actual experience of good supervision, as this can similarly lead to
radical changes of view and action that often can’t be envisaged
beforehand. Adequate training and preparation are therefore essential.
As far as the implementation of clinical supervision in organisations
is concerned, I would rather that people started small. I believe that
if enough people have positive experiences of supervision that make a
difference to the way they practise, a paradigm shift will occur, and
powerful change will become possible in the organisation as a whole.
General background
In the health, social care and voluntary sectors it is
increasingly realised that people like to feel valued or they may vote
with their feet. Managers in charge of teams and workers dealing
directly with clients, all need to feel that the jobs they do are
recognised as important. In addition the notion of continuous
professional development is now an accepted element of many
professions, with re-accreditation contingent on being able to
demonstrate this. At an organisational level staff development should
therefore be a priority and not regarded as something people should
solely do in their own time and at their own expense. Perhaps
paradoxically, those organisations that facilitate their staff’s
further training and professional development tend to have the lowest
levels of staff turn over
How workers are valued, supported and helped to develop will have a
direct impact on the performance of the organisation as a whole. The
concept of ‘the learning organisation’ means that there
will be a continuous improvement in the organisation’s
performance through the continuous professional development of its
staff. Supporting individual workers therefore makes sense in
organisational terms, as it ensures that the clients, who after all
constitute the primary business of the organisation, get a good deal.
Professional development through clinical supervision
Clinical supervision is increasingly seen as one of the ways in which
organisations can demonstrate to their staff that they matter. If an
organisation is willing to spend adequate resources on the
implementation of clinical supervision it gives its workers the message
that they are important. Indeed, the way in which supervision is
implemented in terms of how, when, where and how often it takes place
says a great deal about the importance placed upon it by the
organisation (Hawkins and Shohet, 2000:168). As a worker said recently,
“The fact that my employer thinks that I am important enough to
have someone spend time with me on a regular basis to look at how am
doing makes me feel valued.”
It seems that supervision, whether clinical, case or managerial, is now
a well-known concept in the health, social care and counselling
sectors. However, from my meetings with people from a wide range of
occupations throughout the country it is becoming increasingly clear
that many lack a clear understanding of the nature and purpose of
supervision, or the most effective way to practise. Training for
supervision is often very short to non-existent, with the consequence
that people often lack a model or framework of what to do and how to do
it. It is therefore not surprising that much supervision is not as
effective as it could be, which from an organisational point of view
this is not a good way of investing resources.
Although supervision is much more established in the world of
counselling, many counsellors find themselves in the position of having
to take the role of supervisor before they have had a chance to
undertake any supervision training. In a way the current situation is
an interim stage, although more and more institutions now offer courses
in supervision, there are not enough trained supervisors around yet to
satisfy the demand.
Personal history
For many years I wore two hats, the hat of general nursing and
the hat of counselling. When I wore my counselling hat, clinical
supervision was an integral part of my practice, I do not think that I
could have function effectively without it. Where would I take the
stresses and uncertainties, where would I go to be challenged on how I
work, if not to supervision? Indeed the British Association of
Counselling and Psychotherapy (BACP) has long regarded it as unethical
for any counsellor to practise without adequate supervision. As far as
healthcare is concerned, however, I had never come across any reference
to clinical supervision until the early 1990s, when it became
increasingly widely debated within nursing as well as other professions
allied to medicine. I found out that hitherto clinical supervision had
been practised here and there in mental health nursing and that
midwives too had a form of supervision. This greatly excited me.
“At last,” I thought, “a recognition of the emotional
labour involved in healthcare and a realisation that those engaged in
any kind of helping profession need to be supported if they are to
maintain quality and best practice.”
At the time I was already involved with providing supervision for
counsellors, both within an agency and privately and quickly extended
this to nursing and related professions. The experience of providing
supervision as well as workshops and courses on the topic for nurses
and other health professionals led to the publication of my book
“Clinical Supervision: a practical guide” in 2000. This
focussed to a large extent on the preparation needed for supervisees
and supervisors alike; as for many health care professionals
supervision was still a very new concept. The book also included a
model, the Double Helix Model of Supervision, which I developed in
order to clarify the whole concept of supervision, encompassing an
individual as well as an organisational perspective.
I admit that I love doing supervision and have a real passion for it,
whether as a supervisor, a supervisee or a trainer. For me supervision
provides the opportunity to really look at what is going on in
someone’s practice in detail, which can be immensely stimulating
both professionally and personally. Of course I am not saying that it
is never uncomfortable, all good supervision should be challenging us
to look at our work honestly so that we can grow and develop. As a
supervisee it is wonderful to be able to off load and be helped to
reflect on what is happening. When I wear the hat of the supervisor it
is the frisson of not knowing what will be brought that I enjoy (as
well as fear, to be honest). Frequently, when someone brings what
concerns them to supervision I think “well, I have no idea
what’s going on and I have even less of a sense what to suggest
that may be helpful.” However, over the years I have learnt to,
as they say, “trust in the process.” Giving it time,
attention and consideration, without rushing to find an answer, helping
the supervisee to really reflect on what might be going on, is in
itself tremendously helpful.
Three steps to starting, doing and evaluating supervision
I decided to call my way of working “The 3Step
Method”. Basically it comprises three steps, the beginning of a
session, the middle and the end. In the book each of the steps is
unpacked to show what needs to happen, and what skills or techniques
may be helpful. As the 3Step Method provides a simple structure, and is
not based on any particular theory, it can be integrated with other
supervision models. I will make clear when I am doing this and why so
that you, the reader, can choose whether or not this is appropriate for
you. Of course, what I present in this book is my personal integration
and readers are therefore encouraged to take from it what seems useful
and appropriate and to change or alter what does not. In any case, the
way in which I work is by no means set in tablets of stone, and I aim
to continue learning and developing and add to the choices available to
me. The tools and techniques I present in the book are a result of what
I have accumulated over the years. Some methods are my own creation,
some I have adapted from others, whereas with others I no longer know
where they originally came from. However, wherever possible I will
credit the original source.
The examples and case studies in the book are all based on my own
experience of practising, teaching and discussing supervision. Where
actual bits of transcript are included, permission has been sought and
granted from those involved. Other examples are an amalgam of several
people and issues, in order to ensure anonymity and confidentiality.
The main focus of the book is the 3Step Method of conducting a
supervision session. However, the 3Step Method can also be used as a
framework for the setting up of supervision – whether for
individuals or groups, or within an organisation – evaluating
supervision, or writing notes of supervision sessions. As far as its
use in the actual practice of supervision, the 3Step Method can
incorporate other models, theories or approaches. Also, because of its
simple structure it lends itself well to adaptation to different
professional contexts.
Excerpt taken from van Ooijen, E (2003) Clinical Supervision Made Easy. Edinburgh: Churchill Livingstone – Available from
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