Supervision

Supervision has both a good reputation and a not so good – for me it’s been a mixed blessing because I have rarely had effective supervision from an occupational therapist (with the exception of my current occupational therapy supervisor!), and in fact the majority of my clinical supervision has been from psychologists.

I’ve posted much more about supervision in the Occupational Therapists Only section of my blog – there are some specific issues for occupational therapists that I want to grapple with – but here are some general thoughts on how supervision works for me, both as a supervisee and a supervisor.

Supervison for me entails someone else to challenge my thinking – I know I have cognitive biases that I am not aware of (we all do), and I need someone to challenge me in case I’m working an assumption that I’m not aware of.

Supervision also involves the process of talking which can help with formulating the information that is flying around in my head. By selecting and and putting together pieces of information to transmit my thoughts, I am actively processing in a different way from when I’m documenting assessment findings, or therapy process. The talking part involves me clarifying by using the clinical model that helps to explain what I’m seeing.

Supervision for me isn’t typically about me talking about my personal responses to a given clinical situation (as in, how do I feel about the therapy with this person, how am I coping). That aspect is something I prefer to deal with abstractly using music, dance, art, photography. I’m not sure that talking about how frustrated I am with someone, or how disappointed I am with someone does anything for me apart from encourage me to invest expectations in the person – when it’s their choice as to what they want to do next.

Supervision can be a form of therapist control. I’ve experienced this in the past where a therapist used supervision as an opportunity to rein in and dictate therapy practice, and discourage exploring issues. ‘Do it this way’ was the motto, with little encouragement to reflect, and most importantly for me, no evidence that ‘this way’ was any more effective than any other way.

Hawkins and Shohet, quoted by Smith, M. K. (1996, 2005) ‘The functions of supervision’, the encyclopedia of informal education, Last update: December 28, 2007, suggests the following foci for supervision.

The primary foci of supervision (after Hawkins and Shohet 1989)
1	To provide a regular space for the supervisees to reflect upon the content and process of their work	Educational
2	To develop understanding and skills within the work	Educational
3	To receive information and another perspective concerning one’s work	Educational/Supportive
4	To receive both content and process feedback	Educational/Supportive
5	To be validated and supported both as a person and as a worker	Supportive
6	To ensure that as a person and as a worker one is not left to carry unnecessarily difficulties, problems and projections alone	Supportive
7	To have space to explore and express personal distress, restimulation, transference or counter-transference that may be brought up by the work	Administrative
8	To plan and utilize their personal and professional resources better	Administrative
9	To be pro-active rather than re-active	Administrative
10	To ensure quality of work	Administrative/Supportive

Clinical supervision is seen as a sub-set of ‘educational’ supervision. I think it might be important that the three components of supervision are openly discussed and for some people, to have different supervisors for each component. It’s tough being open and honest with someone as a supervisor who may also be responsible for assessing performance and pay!

When I’m providing supervision, I really try to use the motivational model to help the therapist decide on:

(1) his or her values (what is important in his or her practice)

(2) various options and the consequences of those options

(3) how to reconcile ambivalence about making a choice as to which option is most aligned with his or her values as a therapist

This process requires extensive use of active listening skills, particularly levels of reflective listening. A potential area of conflict could be me trying to impose my own therapy values onto the person I’m supervising. I want to avoid this, because I believe it’s important for therapists to develop trust in their own internal radar.

I also provide loads of information leads. Sometimes supervision is simply about technical information.

Above all, supervision with me is confidential. I treat supervision as just another therapeutic session, subject to the same ethics as any other therapy. That is, I don’t expect to share content without the permission of the person. The only exception I make is the same exception I make clinically – personal safety and the safety of others.

For me, clinical supervision is all about the person being supervised. What he or she needs and wants from supervision is paramount. If ‘control’ is what supervision is about, it’s not really supervision, it’s management.

A couple of references for you:
This one is from Mark Smith who is part of infed. This site has a good number of thought-provoking articles on life-long education. Well worth a look.

The ERIC digest has an older article Models of Clinical Supervision that explores a number of different models for supervision.

Victoria’s Mental Health Services has a good pdf document Clinical Supervision Guidelines as well as information in that link. Great to download the guidelines if you’re thinking of developing your own thoughts on the issues.

And the final one is a paper about ethics and supervision, suggesting that if Guidelines for Supervision are in their infancy, so too are ethics in supervision.