Top tips for fostering successful clinical supervision
Top tips for fostering successful clinical supervision
How to work towards giving and receiving gold standard supervision
I have expanded my list to include 10 tips because I think if you follow these gold standard rules you set up solid supervision practices and create an environment for ongoing monitoring and review.
Supervision when done well is both supportive and educative and can transform practitioner’s theoretical knowledge into meaningful practice and develop confidence in working with a range of presentations across the lifespan. Often supervisors assume that supervisees come with a preconceived understanding of what supervision is and how it should be done. That is far from the truth in many cases, especially when past supervision has not been a good experience.
- AHPRA Core competencies for psychologists provide the seven core components of what supervision should entail for psychology supervision
[http://www.psychologyboard.gov.au/Standards-and-Guidelines/Codes-Guidelines-Policies.aspx]
- Nursing and midwifery, physiotherapy, medical
[http://www.ahpra.gov.au/Search.aspx?q=supervision] - Social work
[https://www.aasw.asn.au/practitioner-resources/supervision-standards-and-professional-supervisor-] - Drug and alcohol
[http://www1.health.nsw.gov.au/pds/ActivePDSDocuments/GL2006_009.pdf]
Supervision practice needs to be grounded in competency standards and engage the supervisee in reflective practice couched within a strong supervisory relationship with assessment and feedback methods that can account for skills development. Supervisors should be knowledgeable on the evidence based literature on supervisory standards of practice. It should be a place where there is established trust so if there are problems in clinical practice, or if the supervisee is not travelling well and this is impacting on their clinical work, he or she can come and talk about it in supervision and get back on track and where needed seek counselling outside the supervisory context.
Falender and Shafranske (2004) state that supervision should be a lifelong cumulative process that pays close attention to diversity considering legal and ethical issues, personal and professional factors and be self and peer assessed [Falender and Shafranske (2004). Clinical Supervision: A Competency-based Approach, American Psychological Association].
A tall order…so here are some reflections on my top 10 tips for fostering successful clinical supervision – for both the supervisor and supervisee AND the wider system:
Tip No. 1: Assume nothing! Ask questions and invite a collaborative partnership
You wouldn’t assume you know a client on first presentation before you begin treatment so why assume that beginning work with a supervisee you don’t need to cover the same groundwork to get to know who you are working with.
Good clinical supervision requires:
1. An assessment of learning needs
2. Background information exploration
3. Expectations (supervisor/ee) and
4. The resources the supervisee brings to the supervisory context (baseline theoretical and clinical skills).
Even if you know the person who is seeking supervision ensure that you go through the basics and ASK QUESTIONS. Don’t assume you know the service that s/he work in (because you work in the same service or did in the past); don’t assume having worked with him/her you know their style, skills etc., and don’t assume that they will know how to use supervision effectively. This is a trap……you will find you will be more likely to engage in a semi-structured conversation rather than a structured supervision session.
Tip No 2: Pre-supervision meeting and the Working Alliance
A good idea is to send out a list of possible questions that can be canvassed at the meeting:
- What do you see is the purpose of supervision?
- What have you done so far in your training/work?
- What style of supervision have you experienced – what works and doesn’t work for you?
- What are your goals for this placement/contract –If I were to ask you at the end of this period what would you like to achieve….? What do you think you would say?
- What are the expectations of the supervision? (of me as your supervisor? For you as the supervisee? Share expectations and see if they are mutually compatible
- What practical issues do we need to talk about? – timing of sessions, venue, format of presentations, note taking/record keeping, confidentiality/reporting responsibilities
- What is your understanding of reflective practice and how we can use in supervision? Use of a diary/reflective journal.
- Theoretical orientation? (of both supervisor/ee and context of workplace)
- Any system issues that we need to think about (workplace issues)?
- Discuss evaluation processes and how feedback can be delivered collaboratively – be clear about processes
- Determine possible review dates and evaluation processes
- Add any other questions you think might be relevant to your workplace context; personal preferred style of supervision.
Tip No. 3: Establish a contract with learning goals that are reviewed regularly
Contracts provide clarity of roles, expectations and processes. A contract is in place so that everyone is on the same page (including workplace/s)… often a contract is not in the forefront of everyone’s mind UNTIL something goes wrong… Contracts provide a solid foundation to the supervisory process and when used wisely create boundaries in practice, clarify roles and promote an agreement of how the supervisor and supervisee will work together. There are NOT helpful if they are only initiated for the sake of having a working document never to be looked at again…
Here are some links to contract examples: [https://www.health.qld.gov.au/__data/assets/pdf_file/0029/371288/c_super_agreement.pdf]
[http://www.med.monash.edu.au/assets/docs/scs/psychiatry/acmhn-documenting-clinical-supervision.pdf]
Be sure to include:
- Who the contract is between
- Goals/Expectations/roles/responsibilities (management of any dual obligations – administrative and clinical responsibilities)
- Reporting lines of communication
- Structure of supervision (frequency, duration, location, fees)
- Any preparation required (e.g. case presentation form); documentation for registration
- Availability between sessions (and management of crises)
- How supervision will be evaluated
- Limits to confidentiality (management of ethical or professional issues)
- Supervision records (storage of notes).
Tip No 4: Know who you are working with…..
Work out your supervisee’s preferred style of working in their context of practice. All supervisees, just as supervisors, will have their preferred strengths, deficits and areas of need. In addition, personality factors and workplace systemic issues will influence their work practice. Spend some time to get to know who you have sitting in front of you.
A good way of doing this is to engage in a discussion (usually done early in the supervisory relationship) where you have a discussion about exactly that
- Strengths – knowledge, skills, relational
- Area of deficits (problem areas to work on) and
- Their needs – (what s/he wants to work on in supervision).
Use the supervisees’ strengths to work on any problem areas …and this becomes the learning goals in the contract which is then also evaluated (Tip No 6)
A strengths based framework of supervision provides a lens to view how the supervisee uses current knowledge and skills in their work.
[https://innovativeresources.org/strengths-based-supervision]
As Davys and Beddoe (2010) note within a strengths-based supervisory context it is important for supervisors to reflect on the following:
• Notices what the supervisee is already doing well
• Uses language that is strengths oriented to build on problem areas
• Notices exceptions to problems
• Invites feedback from supervisees and responds to it
Davys and Beddoe (2010).
[Best Practice in Professional Supervision: A Guide for the Helping Professions, Jessica Kingsley Publishers, London]
Tip No 5: Use a reflective practice framework
Being reflective means that the supervisee is practising mindfully, aware of their strengths and limitation, aware of the cognitions, affect and behaviour impacting on the clinical context, and therefore better placed to react in a mindful and meaningful way.
[http://www.counsellingconnection.com/wp-content/uploads/2009/10/report-4-reflective-practice-supervision-self-care.pdf
https://www.unlv.edu/sites/default/files/24/SocialWork-QuestionsReflectiveSupervisionFieldEducation.pdf]
Consider these questions:
- What factors contributed to my experience?
- What part should I focus on now?
- What was I feeling and thinking about this context? Why are these feelings/thoughts important to me (e.g. past experience)? How are they influencing my actions in the moment?
- Why did I act/say what I did?
- What are my hypotheses about what is happening; my reactions?
- What would I have liked to done differently?
- If I could change the way I handled the situation what would I do differently?
- How has this reflection helped me to understand my reaction?
- How will it inform my current and future behaviour? Senediak (2015)[https://www.clinicalsupervisionservices.com.au/client_images/1775769.pdf]
Tip No 6: Ensure ongoing feedback and evaluation is provided within a competency based framework
Supervisees need ongoing feedback and evaluation in order to develop their clinical skills. A number of favourable conditions need to be established to foster trust and openness within this learning context:
- Make the position of power explicit and how your position as an evaluator may influence the relational context of practice. Once explicit this facilitates openness and trust
- If the supervisee is anxious/defensive/angry etc., deal with it……. don’t wish it will go away if you don’t talk about it ….it will just make the situation worse and probably lead to more anxiety/defensiveness and anger
- Ensure the feedback and evaluation processes are understood
- Involve the supervisee in a collaborative discussion about feedback and evaluation – get them to evaluate supervision – what more does the supervisee need from you? INVITE feedback
- Ensure that the supervisory relationship remains professional, positive, supportive and trusting – it is for the supervisee’s benefit
- Have evidence for your feedback and evaluation - -> use video/audio recordings and invite a collaborative review of skills; do role plays
- Make sure the feedback and evaluation is ongoing – don’t wait until the issue becomes a problem!
- Use your contract if you need to take further action.
Tip No 7: Know your limits Don’t take on more that you can handle at any one time.
Good supervision requires time for planning, thinking about the person, context, material presented, wider systems issues and any parallel processes that exist within the supervision relationship.
Tip No 8: Be systemic and creative
Be creative to make supervision an enjoyable learning experience.
Use different mediums and processes to engage the supervisee. Check how best your supervisee learns (visual, auditory, kinaesthetic)
Tip No 9: Get ‘supervision of supervision’
It is important for the supervision to have a reflective space to think about the practice of supervision being delivered.
It is a principle of good practice, mindful and reflective practice and accountability. This can be in the form of individual sessions, group sessions or a reserved space within a clinical supervision session to reflect on just the practice of ‘supervision of supervision’.
Tip No 10: Always remember your boundaries and employ self-care
And lastly – ensure you practice self-care and model professional practice at all times.
2. Create space in the working day for mindful reflection
3. Tune-in and tune-out……..(learn how to switch off)
4. Have some quick fixes when the pressure is on…… (i.e. breathing and stretching exercises).
Hopefully you are already practising all or at least some of these top tips and as a result find the journey as a supervisor both stimulating and rewarding. Thanks to the participant in training who asked the question and to remind us of what facilitates our role as a supervisor.
- Christine Senediak
Director, Clinical Supervision Services and Sydney Family Therapy Training Institute
March 2022
Christine can be contacted through her website at:
www.clinicalsupervisionservices.com.au
