The Argument for Comprehensive

Supervision: Supporting Great Staff and Good

Trauma Work

Crisci & MayerToronto, Ontario, Canada

Phone (416) 480-1611 Fax (416) 480-2922

nmayer@ckmconsultation.com www.ckmconsultation.com

2011 Sexual Assault Care Conference

Nancy N. Mayer, M.S.W., R.S.W

© Crisci & Mayer 2011Disclaimer/Copywrite Information:The information being presented in this workshop is copywritten and is intended for instructional use by the participants of this workshop only. Reproduction and distribution of this material is strictly prohibited. This information cannot be distributed electronically, or duplicated in any fashion without written permission of the authors.

The Argument for Comprehensive SupervisionWorkshop Objectives:

• Be able to identify the potential difficulties that workers experience when working with sexual assault victims

• Understand how solid clinical supervision assists workers in providing good services

• Understand a two-tiered supervision model that accommodates staff needs for clinical supervision as well as creating a safe space to explore personal reactions to clients

• Recognize when to utilize external consultants to assist staff

There are significant

challenges in working with people who have been sexually

assaulted

Traumatic events result in clients being subjected to

overwhelming, uncontrollable experiences that

psychologically impact them and create feelings of

helplessness, vulnerability, loss of safety, and loss of

control

Challenges

Being able to establish safety can be difficult Developing a trusting therapeutic relationship is

hard Through the telling of the traumatic experience,

the therapist bears witness to the abuse Empathic engagement with the client makes

knowing that story more difficult Potential Involvement with justice system - Potential Impact on therapeutic alliance - Potential risks/liability to therapist Transference and counter transference Intersecting lines between therapists personal

history and life Impact of workplace politics Compassion Fatigue and Secondary Trauma

Compassion Fatigue

Compassion fatigue is a state experienced by those helping people in distress; it is an extreme state of tension and preoccupation with the suffering of those being helped to the degree that it is traumatizing for the helper.

Dr. Charles Figley

© Crisci & Mayer

Vicarious Traumatization

Vicarious Traumatization refers to the

transformation in the trauma worker’s inner experience resulting

from empathic engagement with

clients’ trauma material.

Pearlman and Saakvitne, 1995

© Crisci & Mayer

Through exposure to clients’ graphic accounts of sexual abuse experiences and to the realities of people’s intentional cruelty to one another, and through the

inevitable participation in traumatic reenactments in the therapy relationship, the therapist is vulnerable through

her empathic openness to the emotional and spiritual effects of vicarious traumatization.

Pearlman and Saakvitne, 1995

Vicarious Traumatization

© Crisci & Mayer

These effects are cumulative and

permanent, and will be evident in both

the workers professional and

personal life.

Pearlman and Saakvitne, 1995

Vicarious Traumatization

© Crisci & Mayer

It is not the responsibility of our clients, nor in any

way an indictment of them. It is an

occupational hazard that must be acknowledged

and addressed.

Pearlman and Saakvitne, 1995

Vicarious Traumatization

© Crisci & Mayer

Secondary Trauma is a process, not an

event

© Crisci & Mayer

IMPACT OF SECONDARY TRAUMA

Causes Disruptions to one’s sense of:¨ Meaning¨ Connection¨ Identity¨ World View¨ Tolerance¨ Psychological needs¨ Beliefs about self and others¨ Interpersonal relationships¨ Sensory memory¨ Spirituality

© Crisci & Mayer

CONTRIBUTING FACTORS TO VICARIOUS TRAUMATIZATION

¨ Specific Characteristics of the Therapy/Relationship and its Context

¨ Particular Characteristics and Vulnerabilities of the Listener

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CONTRIBUTING FACTORS TO SECONDARY TRAUMA

SITUATIONNature of the work

Nature of the clientele

Cumulative exposure

Organizational context

Social and cultural contextPearlman & Saakvitne, 1998

© Crisci & Mayer

CONTRIBUTING FACTORS TO SECONDARY TRAUMA

THERAPIST/LISTENER

Personal History

Personality and defensive styles

Current life context

Training and professional history

Personal TherapyPearlman & Saakvitne, 1998

© Crisci & Mayer

Very few epidemiological studies in the workplace – some with firefighters, police,

soldiers

Studies challenge previous belief that PTSD was a normal response to a

traumatic event and can occur to anyone

© Crisci & Mayer

Research suggests that those who “get” PTSD are

influenced by:

• a specific predisposition to PTSD

• a predisposition to mental illness that can be triggered by adversity

• the actual traumatic event and the meaning of that event© Crisci & Mayer

Why a Two Tiered Model

of Supervision Supports

Great Staff and Good

Trauma Work

Supervision

Is the cornerstone to sound clinical practice. It provides oversight and accountability

Having others examine the work we do with clients gives us the opportunity to become knowledgeable about issues outside our awareness

Getting feedback and another point of view can improve effectiveness

It’s a Professional Thing to Do All mental health workers will be

affected by the work they do It is professional behaviour to

acknowledge these feelings and examine them to ensure no harm comes to clients

Not to do so can result in unprofessional behaviour and potential professional misconduct and error

Kadushin’s Definition of Supervision

A supervisor is an agency administrative staff member to whom authority is delegated to direct, coordinate, enhance, and evaluate on-the-job performance of the supervisees for whose work she/he is held accountable. In implementing this responsibility the supervisor performs administrative, educational, and supportive functions in interaction with the supervisee in the context of a positive relationship.

The supervisor’s ultimate objective is to deliver to agency clients the best possible service, both quantitative and qualitative, in accordance with agency policies and procedures.

© Crisci & Mayer, 2003

It is management’s job to manage and ensure implementation of the goals,

missions, policies and procedures of an organization.

Staff are accountable to their managers, the managers to the executive director

and the executive director to the Board.

The board is accountable to the funders and the wider community

Community

Board

E.D.

CL W

Human Service Organizations

Focus of this Model

Administrative - the promotion and maintenance of good standards of work, co-ordination of practice with policies of administration, the lines of accountability are clearEducational - the educational development of each individual worker on the staff in keeping with the organizations mission, policies and proceduresSupportive - the maintenance of a positive working relationship focused on providing the best possible service to the client’s

Limitations of Internal Supervision

Client’s needs are paramount – which may limit Organizational accountability issues and the

supervisors role in performance appraisal and discipline issues can negatively effect – trust with personal information

Need to maintain boundaries – supervisors should not become “therapists” to their staff

Potential issues when supervisee’s therapists do supervision

Case for Ongoing Supervision

Allows ongoing evaluation and feedback

Mechanism for contact and accountability

Tool to contain anxiety and problem-solve

Educational opportunity

Promotes fair work evaluation

Supports good casework

Vehicle for Support

Case for Two Tiered Model of Supervision

Internal supervision allows for ongoing evaluation of staff and accountability to the organization and its mission

Since organization assumes liability, it should be responsible for setting case direction and making major case decisions

The addition of a second form of supervision conducted by an external supervisor with groups of staff allows the staff to deal with the intersecting issues between casework and their personal life in private and without potential repercussions by organization (when the issues are not potentially libelous)

Case for Group Supervision External

Supervisor Group supervision allows staff to normalize that personal issues can effect the professional work if not monitored

Allows staff to learn from each other

Is cost effective. Conducting these sessions in groups makes the cost possible for most organizations

Will promote staff cohesion

Issues with Use of External Consultants for

OrganizationsExternal consultant has a responsibility to the client

and the organization to report issues that come up that could lead to liability for the organization and/or harm to the client

There should be a written contract between the external supervisor with the organization and the staff that states the above

The staff when ever possible will be encouraged to “report” themselves to their organization with the consultants support if necessary

Examples: sexual exploitation of clients, staff impairment that would harm client

In Summary

Our experience has shown that the commonly used model of supervision with an internal supervisor has limitations, especially for trauma workThe addition of group supervision with an external supervisor with clinical knowledge of trauma better addresses the issues raised in the literature about secondary trauma and compassion fatigueTogether, both approaches provide the necessary resources to ensure good clinical work and support of good staff

In 1997, we started Crisci & Mayer, Consultation Counselling and Training, to provide services to professionals in the human services field. With our combined expertise and knowledge this partnership has been successfully offering counselling services to people seeking help for themselves or their family members and offering training to the professional community.

We also provide consultation to professionals, both on an individual and an organizational basis.

We are committed to improving the lives of people who have experienced trauma or who are struggling with individual, couple or family problems and to bringing innovative perspectives to our training and practice, based on the latest research and knowledge.    

                      

Geraldine Crisci, M.S.W. Nancy N Mayer, M.S.W., R.S.W.© Crisci & Mayer 2006

Disclaimer/Copyright Information:The information being presented in this workshop is copy written and is intended for instructional use by the participants of this workshop only. Reproduction and distribution of this material is strictly prohibited. This information cannot be distributed electronically, or duplicated in any

fashion without written permission of the authors.

Crisci & Mayer

55 Eglinton Avenue East, Suite 506Toronto Ontario Canada M4P 1G8

www.ckmconsultation.com(416) 480-1611

www.ckmconsultation.com

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