2 2 n d A N D 2 3 t h F e b r u a r y 2 0 1 6

INTRODUCTORY SUPERVISOR WORKSHOPS (ISW)

AIMS FOR THE MORNING

•  For participants to: •  Be aware of the structure and requirements of this

training •  Complete elements of the portfolio •  Be aware of the context within which supervision is

being delivered •  Be aware of the research base regarding the

effectiveness of supervision •  Consider the importance of educational theory in

supervision •  Increase their awareness of supervisory models •  Have the opportunity to reflect on the use of the

models in their own supervisory practice

Tracey  Smith  Jan  Hughes  Fiona  Thorne  

Sue  Walsh  Katherine  Hildyard  Jo  Burrell    

Philip  Molyneux  Annette  Schlosser  Pete  Fleming  

•  2+2 days •  BPS Learning Outcomes •  Peer Supervision •  Supervision Practice and Supervised Practice •  All presentations from this residential event will be

found in various ways through the three different Universities (see pack)

ASSESSMENT STRATEGY

• Reviewed by Sarah Baxter (qualified CP) in 2012 and by Frances Corrigall (Year 3 trainee) in 2014

• Utilising Kirkpatrick’s model we were doing well at evaluating our training at: •  Level 1 (Reactions; the reaction of the learner

should be sought, i.e. what they thought about the training.)

•  Level 2 (Learning; measuring to what extent the learner has increased their knowledge or capability)

• But encouraged us to look at: •  Level 3 (Transfer; measuring to what extent what

was learned is transferred to the job.) •  Level 4 (Results; measuring whether there is an

effect on the business/environment resulting from the learner’s performance.)

• As a result, this is now our strategy....

•  Self Evaluation of Learning Outcomes Questionnaires (1 pre training and 1 post training)

•  Goal Attainment Scaling Exercise •  Peer Supervision Contract (and commentary) •  Presentation of the Problem Based Learning

Exercise

•  A reflective log containing 3 x 500 word personal accounts considering •  An issue of difference and diversity •  The relevance of a theoretical model of supervision •  An ethical aspect of supervisory practice

•  Structured feedback received from someone the participant has supervised during the course of the programme using the Supervisory Relationship Questionnaire (SRQ) developed in Oxford or the Leeds Alliance in Supervision Scale (LASS) on a minimum of 6 occasions (plus

commentary)

Portfolio of Assignments •  Feedback from your supervisor of supervision, after

Day 2 and after Day 4. This must include direct observation (live or recorded delivery of your supervision)

REVIEW OF PORTFOLIO BY COURSE

Portfolio submitted by the end of the Year Certificate issued for CPD records

THE CONTEXT OF SUPERVISION

The needs/expectations of: •  - Research •  - National •  - the Training Institution •  - the Team/Organisation •  - the Supervisor •  - the Supervisee •  - the service user

RESEARCH

•  The most recent update on the efficacy of supervision (not satisfaction with supervision) was conducted by Watkins in 2011

•  This review built on previous reviews e.g Ellis and Ladany, (1997) & Freitas (2002), Wheeler and Richards (2007).

•  There is very little evidence of the impact of supervision on client outcomes, apart from one credible study (Bambling et al., 2006).

•  This study found a significant impact of supervision on the outcomes for those working with people with major depression

THE NATIONAL CONTEXT

• DROSS/STAR/CSAG • BPS and CPD • Health and Care Professions Council • BPS accreditation criteria

•  Trainees must ‘develop skills in the provision of supervision’

• BPS Guidelines for Clinical Supervision (2010) • Agenda for Change • New Ways of Working •  IAPT

SUPERVISION COMPETENCIES

•  An IAPT supervision expert reference group was established in February 2008

•  This group was multi-disciplinary and aimed to devise a competency framework for supervision

•  This is now completes and comprises: •  - Generic supervision competencies •  - Specific supervision competencies •  - Applications of supervision to specific models/

contexts •  - Metacompetencies •  - www.ucl.ac.uk/clinical-psychology/CORE/

supervision_framework.htm

Metacompetences Competencies used by supervisors to work across all these levels and to adapt supervision to the needs of each individual supervisee

Generic Supervision Competences

used in any form of supervision

Specific Supervision competences

specific supervision tasks

Application of supervision to specific models

techniques employed to supervise in a particular modality

BPS GUIDELINES

• A very helpful (and brief) paper – PLEASE READ!

•  Selected highlights: •  - who can supervise: doesn’t always have to be a

CP but quality needs to be maintained •  - aims of the placement should be agreed within

the first two weeks •  - the supervisor should plan an induction for the

trainee •  - trainee needs shared office space, telephone

and a desk, plus secretarial and IT support

•  - supervisors have clinical and legal responsibility for their trainees

•  - supervision must be at least 1 hour (1 1/2!) per week with total contact time of 3 hours

•  - trainees and supervisors must observe each other at work

•  - there are mechanisms for monitoring the placement and for dealing with potential failed placements

•  www.bps.org.uk/system/files/documents/pact_guidelines_on_clinical_supervision.pdf

BPS GUIDELINES (CONT’D)

RAPPS

•  The Register for Applied Psychology Practice Supervisors

•  Started in 2010 •  Costs: £50 to apply, plus £35 per year •  You can apply when you have completed your

portfolio •  Membership lasts for 5 years, when you will have

to show evidence of supervisor practice and CPD •  www.bps.org.uk/what-we-do/developing-

profession/register-applied-psychology-practice-supervisors-rapps/register-app

LOCAL REGISTERS

•  The three programmes keep their own registers as a quality assurance process.

•  Information held on these varies between programmes but may include: •  Dates of introductory training •  HCPC registration •  Supervision-related CPD •  Information about preferred models of working •  Dates of placement provision

THE REGIONAL TRAINING CONTEXT

•  The three courses did some work together between 2011- 15, based on the evidence that therapists learn more effectively when they are given regular service user feedback.

•  This resulted in a change of culture where the use of outcome and sessional measures to get feedback from service users and to influence practice, has become much more prevalent

•  The Hull and Leeds programme continue to use CORE-NET as their logging system for trainees. Sheffield are now using pebble pad.

DEFINITION

} ‘An intervention provided by a more senior member of a profession to a more junior member… This relationship is evaluative, extends over time and has the simultaneous purposes of enhancing the professional functioning of the more junior person(s), monitoring the quality of professional services offered to the client(s) she, he or they see(s), and serving as gatekeeper of those who are to enter the particular profession � Bernard & Goodyear, 1998

DEFINITION

Supervision is … “what happens when people who work in the helping professions make a formal arrangement to think with another or others about their work with a view to providing the best possible service to clients, and enhancing their own personal and professional development.” (Scaife, 2009)

ROLES AND RESPONSIBILITIES

•  What are the roles and responsibilities in supervision?

ROLES IN SUPERVISION 1

•  Functions Model (Kadushin, 1992) •  - Educative

•  - Supportive

•  - Managerial

ROLES IN SUPERVISION 2

•  Inskipp and Proctor, 1993

•  - Formative

•  - Restorative

•  - Normative

ROLES IN SUPERVISION 3

•  Teacher • Monitor evaluator • Counsellor • Coach • Colleague • Boss • Expert technician • Manager of administrative relationships

•  Hawkins and Shohet, 2006

RESPONSIBILITIES IN SUPERVISION (WHICH OVERLAP WITH ROLES)

•  To the service user/public- to ensure ethical practice

•  To the supervisee •  To the employer(s) •  To the training institution •  To the profession

•  Scaife, 2009

EDUCATIONAL PRINCIPLES OF SUPERVISION

•  1. Learning is best seen as part of a cycle of activities, rather than as a one-off event

•  2. Supervisees are more likely to learn when they themselves perceive a gap between what they currently know and what they need to know

•  3. Supervisees need to be able to make the connection between any new learning and their current knowledge

•  ‘The zone of proximal development’ •  4. This is an adult learner model

EXPERIENTIAL LEARNING CYCLE KOLB, 1984

Experience

Abstract Conceptualisation

Reflection Active experimentation

MODELS OF SUPERVISION

•  Functions Model- Kadushin (1992), Inskipp and Proctor (1993)

•  Developmental Model- Stoltenberg & Delworth (1987)

•  Key Issues Model- Gilbert & Clarkson (1991) •  Systems Approach Model- Holloway (1995) •  General Supervision Framework, Scaife & Scaife

(1996) •  Process Model- Hawkins & Shohet (1988, 2000) •  Therapy specific models- e.g. CBT (e.g. Armstrong

and Freeston, 2006) •  Etc, etc…

DEVELOPMENTAL APPROACH: (STOLTENBERG & DELWORTH, 1987)

•  Level 1: self centred (novice) • Characterised by anxiety, dependency and

high motivation. •  Supervisors need to provide structure and to make

prescriptive interventions: Needs patience •  ‘can I make this work’?

DEVELOPMENTAL APPROACH (CONT’D)

•  Level 2: Client centred (journeyman) • Characterised by fluctuation between

dependence and autonomy and uncertainty about role

•  Supervisors need to provide support, clarify ambivalence and provide modelling: Needs flexibility •  ‘can I help this client make it?’

DEVELOPMENTAL APPROACH (CONT’D)

•  Level 3: Process centred (independent craftsman)

• Characterised by being able to move between their own responses and client awareness

•  Supervisor needs to provide enough stimulation for supervisees to continue to develop: Needs wisdom •  ‘how are we relating together?’

DEVELOPMENTAL APPROACH (CONT’D)

•  Level 4: Process in context centred (master craftsman)

• Characterised by personal autonomy, insightful awareness, personal security and knowledge being deepened and integrated •  ‘how do processes interpenetrate?’

KEY ISSUES MODEL (GILBERT & CLARKSON, 1991)

• 1. Reduction of Harm • 2. Ethics/professional practice • 3. Skills/techniques • 4. Conceptual framework • 5. Transference/countertransference • 6. Developmental • 7. Personal Issues • 8. Treatment goals/stages • 9. Assessment

A SYSTEMS APPROACH (HOLLOWAY, 1995)

•  The model takes into account a number of contextual factors and provides a matrix of supervision tasks and supervisor functions

•  Supervision tasks are: •  counselling skill, case conceptualisation, professional role,

emotional awareness, self-evaluation

•  Supervisor functions are: •  monitoring/evaluating, advising/instructing, modelling,

consulting, supporting/sharing

PROCESS MODEL (HAWKINS & SHOHET 1989, 2000, 2006)

•  Mode 1: Content of the Supervision Session •  Mode 2: Strategies and Interventions •  Mode 3: Therapy Relationship •  Mode 4: Therapist’s Process •  Mode 5: Supervisory Relationship •  Mode 6: Supervisor’s Own Process •  Mode 7: Wider Context

MODE 1

•  Focus on the client- what and how they present •  Helping the supervisee be rather than do

MODE 2

•  Exploration of the strategies and interventions used by the supervisee •  - ‘if the only tool you have is a hammer you will tend to treat

everything as if it is a nail’

MODE 3

•  Focusing on the relationship between the client and the supervisee •  - attending to the client’s transference •  - learning from the patient

MODE 4

•  Focus on the supervisee •  - the internal processes of the supervisee and how they may

be affecting the work

MODE 5

•  Focus on the supervisory relationship •  - parallel process

MODE 6

•  The supervisor focusing on their own process •  - the client and therapist relationship can invade and be

mirrored in the supervisory relationship

•  6A- supervisor-client relationship

MODE 7

•  Focus on the wider context •  7.1 Context of the client •  7.2 supervisee’s intervention in the context of their

profession and organisation •  7.3 Context of the supervisee-client relationship •  7.4 Wider world of the supervisee •  7.5 Context of the supervisory relationship •  7.6 Context of the supervisor

CRITIQUES OF THE PROCESS MODEL

•  The model is hierarchical •  The model if based on one orientation (and not

integrative) •  Mode 7 should be contained within the other 6

LIMITATIONS OF SUPERVISION MODELS

•  Too simplistic •  Too prescriptive • Do not provide ‘the answers’! • All supervisees are different • Research seems to be suggesting two

themes •  In a crisis we all need structure •  The most important factor in effective supervision is the

relationship

EXPERIENCES OF SUPERVISION

•  Consider your experiences of supervision •  What models have you used? •  Is it possible to integrate aspects of the models?

REFERENCES

•  Falender, C.A. & Shafranske, P. (2004). Clinical Supervision: A Competency Based Approach. Washington, APA

•  Fleming, I. & Steen, L. (2011). Supervision & Clinical Psychology 2nd edition. Hove, Bruner-Routledge

•  Hawkins, P. & Shohet, R. (2006). Supervision in the Helping Professions. 3rd edition. Buckingham, Open University

•  Hughes, J. (2011). Practical aspects of supervision. In I. Fleming & L. Steen. Supervision & Clinical Psychology. Hove, Bruner-Routledge

•  Scaife, J. (2009). Supervision in Clinical Practice. A Practitioner’s Guide. Hove, Bruner-Routledge

•  Watkins, C. E. (2011). Does psychotherapy supervision contribute to patients’ outcomes: Thirty years of research. The Clinical Supervisor, Vol 30 (2), 235-256.

Ethics in supervision Katherine Hildyard

ISW day 1 February 2016

Exercise 1 � What do you mean by the word ethics?

� What does being unethical mean to you?

� Discuss in small groups and feedback

� http://youtube/27XAhBu4XjE

�  Of course, indifference can be tempting - more than that seductive. It is so much easier to look away. It is so much easier to avoid such rude interruptions to our work, our dreams, our hopes. It is after all, awkward, troublesome, to be involved in another person’s pain and despair. Yet for the person who is indifferent, his or her neighbours are of no consequence. And therefore their lives are meaningless.

�  Elie Wiesel taken from Barker (2011) ’ Mental Health Ethics: The Human Context’. (p5)

‘Workers are accountable to their clients, their colleagues, employers and to society.  Each worker has a responsibility to determine where his or her ultimate responsibility rests.  Within these constraints, many workers will decide that they are, ultimately, responsible to themselves, and will operate according to a personal ethical code’.  

Baldwin and Barker (1997)

Thinking about ethics and supervisory practice (taken from Scaife 2009)

�  General principles of ethical decision making �  Kant absolute duty �  Consequentialist theories �  Virtue theory

�  Adopted by medicine in 1920’s/ 30’s led to a framework of a professional community guiding their own professional action

Ethical Principles (taken from Scaife, 2008)

Can be used as a framework to understand ethical dilemmas within supervision

Autonomy

�  The principle that individuals have rights to freedom of

action and choice.

�  Eg the developmental model of supervision emphasises the right to more autonomy of supervisees as they become more experienced practitioners

Beneficence �  The principle that the actions taken should do good,

using knowledge to promote human welfare.

�  The application of this principle needs to take account of who judges what is for the good and for whom it is judged to be good.  In determining what is judged to be for the good in supervision, the participants will need to bear in mind the welfare of the supervisee, the client and involved others.

Fidelity �  Being faithful to promises made and to ‘right’/ proper

practices

�  Attention to this principle helps supervisors to think carefully about what they can reasonably promise to supervisees during the contracting process with care taken not to go beyond what is possible.  Eg. confidentiality

Justice �  Ensuring that people are treated fairly

‘fair-opportunity rule’ requires that the supervisee be provided with sufficient assistance to overcome any disadvantaging conditions resulting from her or his learning abilities or difficulties, or social context. Eg. providing more supervision to a struggling supervisee versus equity to all; no discrimination.

Non-maleficence �  Striving to prevent harm

�  The needs of one person or group may be privileged over another, eg children and families

Codes of Conduct �  NHS and the culture of increased governance and litigation

�  “All professionals make mistakes. What is important is that people do their best in the knowledge of principles of ethics, codes of conduct and legal precedents” p130 Scaife, J. (2001).

�  HCPC Standards of Performance, Conduct and Ethics (2008)

�  Who’s Values? A workbook of values based practice for mental health (2004) Fulford and Woodbridge

�  The Ten Essential Shared Capabilities for Mental Health Practice (2004)

Mandatory training �  Safeguarding children and adults

�  Clinical risk/legality

�  Conflict resolution

�  Governance

�  Health and safety

�  Diversity

The Francis Report 2010/2013 The Mid Staffs Public Inquiry

�  Evidence of appalling patient suffering

�  NHS system of checks and balances did not prevent serious systemic failure

�  Causes of this failure include- a culture focused on business not on patients, an over-reliance on positive information about the service, measuring standards and compliance which did not focus on the effect of the service to patients, a toleration of poor standards, a failure to communicate between agencies, that performance monitoring was someone else’s problem, a failure to build a positive culture, the result of repeated re-organisation and disruption

Francis Report 2013

�  A FOCUS ON FINANCIAL AND GOVERNANCE ISSUES AND NOT CLINICAL STANDARDS

Ethical and legal issues in supervision

�  Confidentiality

�  Vicarious responsibility

�  Responsibility to clients/ensuring standards

�  ‘Due process’

�  Supervisor competence/accountability/power

�  Colleagues

Everyday ethics? �  Nurses can feel ‘moral distress’ and low job satisfaction when

there is a clash between what they feel they should be doing, their moral ‘values’, and what they are being asked to do (Severinsson & Hummelvoll, 2001)

�  Clinical supervision can help provide a space to reflect upon such issues as the potential conflict between core professional and personal values and organisational constraints or the system ‘rules’, enabling clinicians to feel better able to make decisions about their work, clarify their personal values, take more personal responsibility for their provision of care and focus upon the core relationship with their clients (Berggren et al 2006).

Small group work �  Consider an ethical issue that has emerged

in the context of your supervisory work

� What are the blocks to responding ethically? How did you respond? Would you do anything differently now? Why?

Practising ethically can be difficult

�  Follow due process

�  Organisational framework/ role of whistleblowers/ duty of candour

�  Do not hide

�  Deal with the emotion

�  Documentation and clarity- the small things

�  Need support and courage

(see Kish-Gephart, J.J. (2010). Bad apples, bad cases and bad barrels: Meta-analytic evidence about sources of unethical decisions at work. Journal of Applied Psychology, 95(1); 1-31.)

Supervising groups: A focus on the practical

Sue Walsh Katherine Hildyard ISW 2016

Goals of the session

n To focus on the practice of supervising groups

n To reflect on group theory and process

n To establish what you would find useful to know about supervising groups

Forming groups

n Find your peer group n Spend 15 minutes discussing your

experience of groups

More specifically-

n  What are your views about groups?

n  Think about your experience of either being supervised in a group or supervising a group.

n  Did anything go wrong? What was the most

difficult aspect of this kind of supervision? What were the positive aspects of this form of supervision?

The Building Blocks of Group Supervision

Supervising groups:the practical

n  Two broad areas that you will need to reflect on when setting up group supervision

–  Creating the practical building blocks that help to support

group learning –  Your theoretical emphasis

–  CLARITY AND PREPARATION UNDERPINS SUCCESSFUL GROUP WORKING

(Taken from Scaife 2010, Proctor and Inskipp 2001)

The hidden beginning

n  What is the real contract of work- are people sent to you , do they like psychology etc. What is the anxiety? Managing regression

n  What is the organisational milieu of the group?

Typology of supervision groups

n Authoritative n Participative n Co-operative n Peer group

Proctor and Inskipp (2001), Scaife (2001, 2010)

Skills for supervisors in groups

n Active leadership n Clarity- defining the task and how to do

it n Preparation- taking responsibility for

what is negotiated and how n Skilled use of frameworks n Purpose and preference stating n Receptivity, imbalance and assertion

Supervisor roles and tasks 1

n  Role –  Manager

–  Supervisor

–  Inductor/trainer

n  Task –  Managing time, ‘the

housework’ –  Normative, formative

and restorative –  Providing info,

encouragment within supervision

Supervisor roles and tasks 2

n  Role –  Group manners –  Group leader

n  Task –  Modelling good

group manners –  Creating a culture

conducive to learning –  Prioritise the task

Supervisee roles and tasks 1

n  Role –  Supervisee

–  Practitioner

n  Task –  To prepare work

publically,use time –  Identify own

personal/ professional needs

Supervisee roles and tasks 2

n  Role –  Group member

–  Co-supervisor

n  Task –  Develop good group

manners –  Develop skills of a

supervisor

Some useful theory and process

n  Tuckman (1965) forming, storming, norming, performing, mourning

n  Bion’s model of unconscious process (1961) -Ba dependence, Ba pairing, Ba fight/flight

n  Balint- The Doctor, his Patient and the Illness (1957)

n  Schwartz (Boston Globe 1995) Understanding/ managing primitive feelings/

making sense of hurt

Bion and Groups

n  Working and being in groups is often overwhelming and can broadly be understood as an emerging tension of the longing to be connected vs the longing to be an individual

n  Bion’s writing in this area provides useful insight is key to- Ba’s; his writing about thinking and development; and application in organisational settings

n  Work group mentality and the basic assumption mentality- either working on a primary task or evasion of reality through avoiding the task by meeting the unconscious needs of the members by reducing anxiety Stokes (2011) in The Unconscious at work. A.

Obholzer and V.Z. Roberts. Eds. Routledge (with help from Paddy Howes)

Group exercise

n Each group will consist of: n  - a Leader/ timekeeper n  - 1 presenter n  - 3 additional group members

The task

n  Allocate your roles. The presenter choose an important issue to discuss from work setting

n  Work as a supervision group for 20 mins n  Each person observe the process and

content and or structure n  Come together and discuss your learning to

the larger group

What did you notice?

n What worked well and why? n What was challenging to yourself and

others? n What made the difference? n What do you need to know about

supervising groups to facilitate your own practice?

Peer supervision

Planning for effective group work Sue Walsh and Katherine Hildyard ISW 2016

Roles in Peer supervision

n Supervisee n Practitioner n Group member n Co-supervisor (from Proctor and Inskipp, 2001)

Levels of agreement and alliances Proctor and Inskipp (2001) n  The professional contract n  The group working agreement (agreements

that need to be negotiated to forge a working alliance)

n  Session agenda (the specific agreement at the beginning of each session)

n  Mini contract for a particular piece of supervision

The professional contract

n  What accountability is expected of participants?

n  Code of ethics and code of practice n  Confidentiality in context n  Overall ration of supervision to contact hours n  Participant’s rights, responsibilities, and lines

of communication with all employers

Agreement and alliances

n  The group working agreement –  The working arrangements (time allocation,

method of presenting, pattern of sessions, review) –  Ground rules –  Individual responsibility of participants to identify

their learning needs and what helps them

Session agenda

n Agreement made at the beginning of each session about what will be covered in time available guided but not constrained by the group working agreement

What happens within the session

n  Up for negotiation-supervision of supervision n  Influenced by your orientation/context/aims n  As informal/formal as the group finds helpful n  May wish to experiment n  Contract/PBL must be included over duration

of the group

Mini contract for a particular piece of supervision n The agreement about what each

supervisee wants from a piece of supervision and how they want to do it

n The Russian dolls

The task today

n To split into your peer groups n To discuss these ‘arrangements’ and

the issues we have covered n To begin to make a group supervision

contract n This contract should be completed at

second peer group meeting and copy kept for your portfolio

A word about your PBL exercise

n You could fill all your time as a peer group working to meet the demands of the exercise

n But…this means that you won’t really be functioning as a supervisory peer group

n So we want you to put limits around your input.

Further meetings

n  It is suggested that you meet your peer groups approx 4 times prior to Day 4

n To integrate both the PBL exercise and to experience supervising as a groups

n Day 4 and beyond?