Supervision of Clincial Practice: Models and Methods of Delivery in a Developing Context

Dr Bridie Gallagher presented this talk at the Chab Dai Social Work Conference in Phnom Penh in 2013,for a summary read on…

What is clinical supervision?

  • – ‘The act of overseeing; inspection; superintendence; oversight.’
  • – “Teaching and learning process that gives particular emphasis to the relationships between and among service user, professional, and supervisor and the processes that interplay among them”.
  • – “Provides supervisees withfeedback about their performance; offers them guidance in what to do in times of confusion and need; allows them the opportunity to getalternate views and perspectives…”
  • – “Supervision is an intensive, interpersonally focused one-to-one relationship in which one person is designated to facilitate the development of competence in the other person”
  • – “…to achieve, sustain, and creatively develop a high quality of practice through the means of focused support and development.

 

Supervision has three main aims:

  • 1. Formative: Educate or train, to help the professional to develop.
  • 2. Normative: To manage and evaluate performance and ensure ethical, quality services.
  • 3. Restorative: To support and allow those who work in difficult settings with people in distress to share the personal impact.

 

Why is it important?

– Burn out. Reduces Staff turnover in stressful settings (Medland, Howard-Reuben, and Whitaker, 2004)

– Supervision encourages self awareness and reflection (Rice et al. 2007).  Without reflection we can respond to people based on our own feelings and experiences rather than on their needs – become abusive, oppressive, or ineffectual.

– Evidence shows increased satisfaction of both staff (Hyrkas, 2005; Ohlson & Arvidsson, 2005) and service users (Leiter, Harvie, and Frizzell, 1998) when staff receive adequate supervision.

– To challenge assumptions, prejudice, and develop services to meet the needs of the service users.

 

Who provides it?

Ideally…

– Someone more experienced and knowledgeable professional (for appraisal often needs to be a manager)

who has a clear understanding of the demands of the role and organisation.

– has training and experience of teaching/training, supporting, and constructive evaluation and feedback.

– Someone receiving their own clinical supervision

 

Supervision in the Cambodian Context

Supervision is becoming more widely acknowledged as a need for many reasons, not only because it is good practice:

1. Stressful working environments –

– Wide range of helping professionals working in many areas.

– Vulnerable groups are prevalent

– Systems are under-resourced and under funding threats

SUPPORT (RESTORATIVE)

2. Need for staff education and development –

– Staff often lack formal and ongoing education and training opportunities.

– High caseloads and demands mean limited time for development of staff or ambivalence about investing in staff who are likely to leave.

– PROFESSIONAL DEVELOPMENT (FORMATIVE)

3. Lack of regulatory bodies and systems to ensure quality services –

– Confusion around professional roles (e.g. counsellor/psychologist)

– Anxiety for managers is increased and so the normative functions of supervision become important.

– MANAGEMENT (NORMATIVE)

 

Identified Issues

– Staff can feel scrutinised rather than supported. Not a safe place to share concerns or weaknesses.

– Supervision provided by foreign staff with Western models and influences.  Often not trained in providing supervision.

– Supervision is seen as a place to offload, not facilitated/productive so participants cannot develop and learn.

– Lack of attention to supervisory processes within social work and psychology training.

– Ambivalence from senior management regarding their own supervisory needs.

 

Our Role at Indigo as Supervisors

– “Experts” in psychological processes, team dynamics, learning models.

– Clear training and models to draw upon.

– Experience providing supervision to social workers, support staff, carers, nurses.

 

HOWEVER…

– Models of supervision are often closely aligned with psychological models (learning, developmental, and therapeutic models).

– These models have inherent biases and assumptions within them about distress, normal behaviour and relationships.

– There are, therefore, considerable issues with simply importing Western models of supervision into the Cambodian context.

– Patel (2004) – Supervision is a primary way in which ideas and values about human relationships and distress are communicated and disseminated to professionals.

– Back door colonisation.

– Need for supervisor to have an awareness and acknowledgement of transcultural issues and power imbalances.

– Throw out the models! New locally tailored models need developing.

 

Common Responses

– Colour blindness – it is not a problem I treat and respect all my supervisees the same no matter what ethnic or cultural background they come from.

– Colour conscious – every issue or difficulty is attributed to cultural differences.

– Denial – the way in which I work is not affected by differences in culture as it is open and so can accommodate all different beliefs and approaches.

– Pragmatist – There is too much to do in supervision and not enough time I cannot address every issue…

 

Working with Difference

– Addressing power imbalances and cultural differences is vital to making a safe space and for effective supervision in any context.

– Discussing other experiences of supervision and/or evaluation

– Discussing experiences of oppression or powerlessness

– The supervisor must be able to challenge the supervisees assumptions without fear.

– The supervisees must also be able to challenge the supervisors assumptions and prejudices.

– Address differences in gender, ethnicity, role up front

– Agree a shared language for talking about difference.

– Develop strong skills in encouraging reflection.

 

Indigo and Supervision

– Clinical psychologists supervise Cambodian colleagues in both direct therapeutic work and in providing supervision

– We supervise foreign staff in a variety of roles in Phnom Penh.

– Our Cambodian psychologist offers supervision – as a counsellor he offers a supportive function, as a psychologist he can offer teaching or advice in a wide range of areas including managing distress, encouraging positive behaviour in parents, carers, individuals, and supporting the development of a strong team.

– Encouraging staff to reflect upon their own practice, develop alternative perspectives, and be creative in their responses to problems or challenges. (Interested to hear your feedback on these very Western ideas of “good” supervision.)

 

References and Further Reading

  • Hawkins, P. (1985) Humanistic Psychotherapy supervision: a conceptual framework. Self and Society: Journal of Humanistic Psychology, 13, 69-79.Hubble, M.A,. Duncan, B. L ., & Miller, S. D. (1999). The heart and soul of change: What works in therapy. Washington DC: American Psychological Association.
  • Hyrkas, K. (2005) Clinical Supervision, burnout, and job satisfaction among mental health and psychiatric nurses in Finland.  Issues in Mental Health Nursing, 26, 531-556
  • Leiter, M. P., Harvie, P., & Frizzell, C. (1998) The correspondence of patient satisfaction and nurse burnout.  Social Science and Medicine, 47, 1611-1617.
  • Mannix et al (2006) Effectiveness of brief training in Cognitive Behaviour Therapy techniques for palliative care practitioners. Palliative Medicine 20: 579-584
  • Maslach, C. (1976) Burned-out.Human Behaviour, 5, 16-22.
  • Medland, J., Howard-Reuben, J., & Whitaker, E. (2004).  Fostering psychosocial wellness in oncology nurses: Addressing burnout and social support in the workplace.  Oncology Nursing Forum, 31, 47-54
  • Ohlson, E., & Arvidsson, B. (2005) The nurses conception of how clinical supervision can promote their mental health. Nursing Science and Research in the Nordic Countries, 25, 32-35.
  • Patel, N. (2004), Difference and Power in Supervision: The Case of Culture Racism, in I. Fleming, & L. Steen (eds). Supervision and Clinical Psychology. Hove: Brunner-Routledge, pp.108-134
  • Rice, F., Cullen, P., McKenna, H., Kelly, B., Keeney, S., & Richey, R. (2007) Clinical supervision for mental health nurses in Northern Ireland: formulating best practical guidelines.  Journal of Psychiatric and Mental Health Nursing, 14, 516-521

 

Leave a Reply

Your email address will not be published. Required fields are marked *