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SUPERVISION PRACTICE

Are you getting enough? – (3) The supervision process
Sam Simpson and Cathy Sparkes continue their supervision series by exploring the ‘nuts and bolts’ of roles, responsibilities and boundaries in setting up and developing a supervisory relationship.
Supervision – are you getting enough? Let us know at the AUTUMN 08 forum, http://members. speechmag.com/ forum/.

l-r: Cathy and Sam

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n this article we aim to discuss some practical considerations that will enable you to frame your supervision and to set up and maintain clear role relationships. Imagine you are about to embark on a brand new supervisory relationship as either a supervisor or a supervisee, or alternatively want to review an existing contract. We will start by outlining the overarching criteria prior to guiding you though the three parameters we believe to be the nuts and bolts of that process: roles, responsibilities and boundaries. OVERARCHING CRITERIA Discussion in the focus groups held to inform this series of articles has indicated that some speech and language therapy teams have written processes in place to frame the way each supervisory relationship is set up. Other services, in contrast, have a much looser arrangement. For both those with and those without an operational framework, the following overarching criteria may help you to focus on the key themes you and your team might want to consider prior to setting up a supervisory relationship: 1. Documentation (Is this standardised or individual? Who updates it each session? Where is it kept? Who has access to it?) 2. Guidelines for frequency of sessions and time allocation (Is it clear for different grades?) 3. Location options (Supervisee’s base? Supervisor’s base? Alternating? A neutral location?) 4. Choices around who supervises whom (Are supervisors allocated or does the supervisee have a choice?) 5. Availability of managerial and non-managerial / personal supervision (Is there a big enough body of supervisors to allow for non-managerial supervision?) 6. Options for a speech and language therapist to have a supervisor from a different profession (Could a speech and language therapist have a supervisor from occupational therapy, psychology, human resources…?) 7. Access to funding for external supervision (Can a supervisee access someone outside of the organisation or Trust?) 8. Options for changing supervisor (Is there flexibility in choice of supervisor over time as needs / interests / work roles or preferences change?) 18

9. Types of supervision available (Are a variety of supervision genres available - peer, group, oneto-one, managerial and non-managerial?) A policy that defines a department’s position in relation to these criteria gives a very explicit insight into that department’s supervision culture and philosophy. It also provides a solid basis upon which, at a micro level, supervisory relationships can be formed and, at a macro level, supervision services can be evaluated. We will now turn our attention to the three parameters we believe to be paramount in the process of supervision. We will define each of these in turn, and discuss ways in which they can be made explicit at the outset of the supervisory relationship and at regular intervals throughout.

2. Responsibilities

1. Roles

Once the supervisor and supervisee have accessed their departmental supervision framework / policy, they can meet to negotiate and define the specifics of their relationship. Each dyad or group is unique and deserves attention. Hawkins and Shohet (1989) describe the ‘supervisor’ as having a number of sub-roles, such as ‘counsellor’, ‘educator’, ‘manager’, ‘boss’, ‘expert technician or clinician’, ‘colleague’, ‘monitor evaluator’. Indeed, we can both readily reflect on the many roles we have been required to play or been placed in, in both the supervision we have given and received. It might be useful at this point for you to reflect on the role(s) you may have expected your supervisors to play over the years and the role(s) you yourself might have played in relation to your supervisees. To what degree has this been explicitly negotiated and agreed? Sometimes we may not be aware when we are expecting our supervisor to take on a certain role or behave in a certain way. It may also be that experiences you have had as a supervisee have shaped the roles you have been open to playing when you became a supervisor, such as coach or sounding board. We need to try to ensure that, when we start each new relationship, roles are clear but also negotiated and flexible. It is important not to adopt the same constellation of roles with everyone.

Many descriptions of the responsibilities of both the supervisor and the supervisee can be found in the literature. The following list is not exhaustive, but provides a range of ideas from which you can usefully draw in discussions with your supervisor / supervisee: Supervisor responsibilities: • ensure a relaxed and safe enough space for the supervisee to bring and discuss practice issues in their own way • help the supervisee explore and clarify the thinking, feelings and anxieties which underlie their practice • encourage the supervisee to conceptualise new ways to construe their clients • share experience, information and skill appropriately • challenge practice that is perceived to be unethical, unwise or incompetent • facilitate and accept feedback from the supervisee • enable the supervisee to be actively involved in the supervision process • fulfil the supervision contract to the best of your ability • initiate and organise your own supervision. Supervisee responsibilities: • identify practice issues with which you need help and ask for help • become increasingly able to share freely • identify what responses you want • be open to feedback • check your own tendencies to justify, explain or defend • develop the ability to discriminate what feedback is useful • be accountable and responsible for your own work • be proactive in organising your own supervision • fulfil supervision contract. Again it is worth considering how explicitly these responsibilities have been discussed in your past and present supervision relationships.

3. Boundaries

The more we have been involved with supervision (from both sides) the more important the concept of boundaries has become. This is not in a rigid way, but in terms of the delineating

SPEECH & LANGUAGE THERAPY IN PRACTICE autumn 2008

SUPERVISION PRACTICE aspects of each relationship we encounter and ensuring we give transparency the highest importance at all levels. The following are examples of areas within the relationship where we believe attention to boundaries is needed: • Frequency (amount vs. quality: would you rather see someone less regularly and get better quality supervision as opposed to seeing someone more frequently who can only partially meet your needs?) • Duration (perhaps 1–1½ hours, thereby allowing sufficient time to discuss 1-3 issues in depth) • Location (accessibility, neutrality, safety, confidentiality) • Timing (beginning and ending at agreed times) • Interruptions (such as mobile phone, bleep, other staff) • Evaluation / review (for example every 4-6 sessions) • Confidentiality • How cases are chosen (for instance by supervisee / supervisor, by difficulty, randomly, themed, in terms of positive outcomes?) • Balance within and across sessions (such as personal issues versus professional concerns; management versus clinical issues; range of topic areas brought for discussion) • Process time (for example allocate 10 minutes at the end of every session to reflect on the session, recurrent themes, changes in thinking / beliefs observed throughout the course of the session, what was most / least helpful and what the supervisee will be taking away) • Supervisor’s awareness of their skills and limitations (may include onward referral to counsellor or GP). IN PRACTICE: BEING EXPLICIT To conclude we will consider how the three key parameters of roles, responsibilities and boundaries can be negotiated at the start of a supervisory relationship and in an ongoing capacity throughout the supervisory experience. Our thoughts are: • Introductory session How much time do you allocate in the initial session to negotiating respective responsibilities, roles, boundaries and drawing up a clear supervision contract? Is this documented and, if so, who has access to it? Do you agree a timeframe following which this is reviewed and renegotiated if needed? • Supervisee history, views and preferences How much time is allocated at the beginning of the relationship to discussing and reflecting on helpful / unhelpful past experiences of supervision in order to determine the supervisee’s wants, needs and views in relation to the roles and responsibilities they would like their supervisor to take? • Supervisor and supervisee history and styles In how much depth are your histories (supervisor’s and supervisee’s) and preferred style(s) discussed as well as the responsibilities each is willing to take and roles they are prepared to play? • Pre-existing relationship with each other How explicitly would the roles and responsibilities you already have in relation to each other be discussed? How might these differ or conflict with the supervisory relationship you

Box 1 Practical activities 1. Take this article to your next supervision session and reflect with your supervisee / supervisor on the 3 key parameters (roles, responsibilities, boundaries) using the points and questions as a springboard for discussion. 2. Share this article with your team in order to explore these ideas in relation to your local policy and supervision pathway.
want to establish? What boundaries may need to be re-enforced? • Regular / ongoing review How frequently would you review how you are working together and whether the roles, responsibilities, and boundaries you have contracted together are being met or are still desired? • Predicted changes in roles and responsibilities How often would you review whether the range of roles and responsibilities evident in supervision is sufficient or needs to be broadened or developed in different ways? • Qualities / skills of supervisor / supervisee How openly do you discuss the qualities and skills both parties bring to the supervisory relationship, what is working well and what needs further re-negotiation? • Mechanism for when boundaries are being disrespected To what extent do you negotiate the steps that need to be taken when the contract is not being adhered to? • Feelings associated with any / all of the above What space is given to both parties openly sharing how they feel they are working together and checking out any issues / conflicts or concerns in relation to their roles, responsibilities and boundaries? How openly would you discuss other options if the relationship proved not to be satisfactory to either party? We look forward to hearing any comments you have in relation to this article and the practical activities in box 1. In our final article we will be discussing the transition from supervisee to supervisor and ways of developing the integral skills needed. Sam Simpson and Cathy Sparkes are specialist speech and language therapists. Cathy is also a trained counsellor and Sam in currently in training. Together they are www.intandem.co.uk.

Revised training standards

news extra

The Health Professions Council, which regulates 13 professions in the UK including speech and language therapy, is consulting on its revised standards for education and training. The Council uses these standards to assess all the undergraduate programmes which lead to a speech and language therapy qualification through approval visits and annual checks. A student who successfully completes a programme which meets the standards is then eligible to apply to the Health Professions Council for registration. The standards of education and training are designed to be applicable to all professions regulated by the Council as well as those it is likely to regulate in future. The consultation runs until 14th November 2008 at www.hpc-uk.org/aboutus/consultations/index.asp?id=70. Meanwhile, Health Professions Council President Anna van der Gaag has been re-elected unopposed as a Council member for speech and language therapy. In future the Council will be appointed rather than elected. Details of the recruitment process will be in the national press and on www.appointments.org.uk. www.hpc-uk.org

Stroke reading service expands

The InterAct Reading Service for people who have had a stroke has awarded its first writer in residency position. The charity supports stroke recovery through using professional actors to provide a live reading service for stroke clubs and people in hospital who have had a stroke. The charity says it specialises in delivering witty and inspiring short stories designed to speed recovery by improving mood, stimulating the brain and providing much needed entertainment. Alan McCormick won the short story competition with The Sacred Elephant, inspired by an argument overheard at a restaurant. His year’s residency will involve visiting hospitals and meeting people who have had a stroke to discuss with them what type of genre they would like added to the service’s library. www.interactreading.org

Auditory training

References Resource

Hawkins, P . & Shohet, R. (1989/1993) Supervision in the Helping Professions. Milton Keynes: OUP . Sparkes, C. & Simpson, S. (2007) Are you getting enough? Developing an understanding of supervision theories, models and practice in a range of environments. Intandem course materials. SLTP

Training can improve the ability to understand speech in background noise, according to a Deafness Research UK report on ongoing work at the Institute of Hearing Research in Southampton. The charity says that work with a group of normal hearing adults trained to discriminate speech sounds embedded in noise played to the right ear points to a mechanism in the brainsteam that may, in some people, be responsible for trouble understanding speech in background noise. Importantly, auditory training may be of benefit. The charity adds, “This could be particularly relevant for children with language-based learning problems, who are thought to have brainstem-related difficulty in understanding speech in noise. www.deafnessresearch.org.uk

SPEECH & LANGUAGE THERAPY IN PRACTICE autumn 2008

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