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SUPERVISION PRACTICE

Are you getting enough? – (2) Supervision models and barriers
In the second of four articles, Sam Simpson and Cathy Sparkes explore supervision approaches and beliefs. Their two-part practical activity (box 1) is designed to help you reflect on your own experience, whether you have accessed supervision or not.
Supervision – are you getting enough? Let us know at the Summer 08 forum, http://members. speechmag.com/ forum/.

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n this series we hope to introduce, develop and validate your understanding and insight into supervision practices. In our first article we set out to define supervision and demonstrate that it is a fluid relationship encompassing a wide range of skills and techniques. Reflecting on our own experiences of supervision, we can recognise the different styles and approaches we have received and offered. These have been determined through negotiation with our respective supervisors and supervisees both at the start and at regular intervals throughout the relationship. We intend to help you to see your supervision history in relation to some of these approaches and models. In addition, we hope to enlighten you as to why sometimes it can be difficult to access supervision.

tion of each compol-r: Cathy and Sam nent will vary in each supervisory relationship and across different settings and time. 2. A developmental model of supervision Hawkins and Shohet (1989) report that “supervisors need to have a range of styles and approaches which are modified as the counsellor (supervisee) gains in experience and enters different definable developmental stages”. Their developmental model asserts there are four levels to the supervision relationship, each with its own unique features. We will explain some of the key features of each level: Level 1 Childhood - Novice At this level the supervisee is characterised by trainee dependence on the supervisor. Whilst highly-motivated, s/he often presents as anxious, insecure about his/her role and ability and lacking in insight. Supervisees tend to lack an overview of the whole therapeutic process, are prone to theorising prematurely and exhibit over-concern with their own performance. Stoltenberg & Delworth (1987, p.56) report that supervisees at this level “tend to focus on specific aspects of the client’s history, current situation, or personality assessment data to the exclusion of the other relevant information. Grand conclusions may be based on rather discreet pieces of information.” In terms of the role of the supervisor, s/he “needs to provide a clearly structured environment which includes positive feedback and encouragement to the supervisees to return from premature judgement of both the client and themselves to attending to what actually took place” (Hawkins & Shohet, 1989, p.49). They need to focus on the content of the supervisee’s work with the client and the detail of what happened in the session (attending to what is). In addition, they need to support the supervisee to see the detail of individual sessions within a larger context (over time, to client’s outside life and personal history). According to Stoltenberg & Delworth (1987, p.64), “balancing support and uncertainty is the major challenge facing supervisors of beginning therapists.” Level 2 Adolescence - Journeyman At this level the supervisee fluctuates between

dependence and autonomy, and between overconfidence and being overwhelmed. S/he is less simplistic and single-focused, but can be more reactive to their clients. Supervisees at this stage may also test out their supervisor’s authority. “The supervisor needs to be less structured and didactic than with level 1 trainees, but a good deal of emotional holding is necessary as the trainees may oscillate between excitement and depressive feelings of not being able to cope, or perhaps even of being in the wrong job” (Hawkins & Shohet, 1989, p.51). Level 3 Early Adulthood – Independent Craftsman The supervisee now demonstrates a more flexible approach to client management and is able to see their client in a wider context, having developed ‘helicopter skills’ (the ability to be fully present with the client in the session, but simultaneously have an overview that enables appreciation of the present content and process in the context of the total process of the therapeutic relationship, the client’s personal history and life patterns, the client’s external life circumstances, as well as the client’s life stage, social context and ethnic background). Stoltenberg & Delworth (1987, p.20) comment that supervisees will “show increased professional self-confidence, with only conditional dependency on the supervisor. He or she has greater insight and shows more stable motivation.” In relation to the role of the supervisor, “supervision becomes more collegial, with sharing and exemplification augmented by professional and personal confrontation” (Stoltenberg & Delworth, 1987, p.20). Level 4 Full Maturity – Master Craftsman The supervisee is characterised by personal autonomy, insightful awareness, personal security, stable motivation and an awareness of the need to confront personal and professional problems (Stoltenberg & Delworth, 1987, p.20). S/he often becomes a supervisor at this stage, which consolidates and deepens their own learning. Now supervision is not viewed so much in terms of acquiring more knowledge, but of allowing knowledge to be deepened and integrated.

A. MODELS

It is our intention to give an insight into the fact that there are many ways of offering and receiving supervision and that every relationship will benefit from an array of styles depending on who the relationship is with and at what stage of the supervisee’s journey they are accessing it. Each dyad is unique. We have selected three models to illustrate the multidimensionality of supervision. We consider all three to be complementary and do not favour one over another. 1. A functions model of supervision Prochter (undated, in Hawkins & Shohet, 1989) describes a model that differentiates between the three main processes of supervision: i) Formative and Educative Functions involve facilitating the supervisee to develop their skills, understanding and abilities, thereby enabling them to reflect on their practice, recognise strengths and weaknesses and develop skills and knowledge ii) Restorative / Supportive Functions thereby providing the supervisee with opportunities to explore and vent feelings, address emotional responses and understand their underlying causation iii) Normative / Managerial Functions concerned with ensuring high standards of practice and that the supervisee’s work stays within the organisational objectives. In practice there is considerable overlap between the processes, and the relative contribu18

SPEECH & LANGUAGE THERAPY IN PRACTICE SUMMER 2008

SUPERVISION PRACTICE At this level, the supervisor has a role in listening to deeper meanings and wider implications and in focusing on paralleling, transference and counter transference as well as providing access to other approaches or key models. 3. A tasks model of supervision Carroll (1996) addresses the generic tasks of supervision rather than any particular framework. His hope is that effective supervisors will select tasks appropriate to their supervisee’s learning. The following is an outline of those tasks: • Teaching: enabling the integration of theory into practice. • Counselling: aims to raise awareness and understanding of the therapist’s own ‘baggage’. If personal issues are recurrent, it may be appropriate for the therapist to access counselling to address these. • Monitoring professional / ethical issues as a supervision task: to ensure clear boundaries and accountability. • Evaluation: thereby encouraging self-monitoring and challenging work that falls short of good standards. • Consultation: the attention given to process in supervision. • Administrative: involving exploring the implications of the therapist’s work in the different contexts that they operate, including confidentiality, documentation and service cultures.

We realise looking back over our careers that, in spite of good intentions and a true commitment, there have been times we have found it more difficult to access supervision due to personal, organisational or cultural pressures. We can both identify times when we accessed supervision less regularly than optimal due to work pressures or the gradual realisation that the current supervision set-up was no longer working as effectively. We can all be affected by external pressures or relationships. The Sheffield Project (1992-1994) quoted by Syder & Levy (1998) is a good example that, even when the conditions seem to be right, issues around access are nevertheless apparent. As part of a pilot study, supervision was made available to all 60 speech and language therapists working in Sheffield between 1992 and 1994. Therapists were able to self-refer for non-managerial supervision, which was not compulsory and offered free of charge. Everyone was entitled to time out from work and a range of neutral and central locations were made available. Sessions were confidential and feedback was gathered from those who opted for supervision as well as from those who declined. Reported gains for therapists who opted to take up the offer were multiple: • ‘Talking through my reasoning behind decisions and checking out what personal biases have gone into them’ • ‘Becoming more aware of my prejudices with a particular client group’ • ‘I feel less drained by work now’. However, a number of stumbling blocks were identified: • Insufficient time due to other work commitments • Feelings of guilt about taking the time

B. BARRIERS AND BLOCKS

Box 1 Your supervision journey 1. Take a few moments to reflect on the type of supervision you are receiving / have received and could / would like to receive in the context of the three models in this article. Where possible reflect with a colleague and share your experiences. 2. Look at your supervision journey and consider your personal supervision beliefs over time. You might be pro / anti / somewhere in between – be honest with yourself. Having read the article, are your beliefs represented? How have your beliefs impacted on your commitment to accessing regular personal supervision? How do your beliefs compare with those of your manager / service / organisation?
• Anxiety that a friendship with the supervisor might interfere with the process • Put off by the term ‘supervision’ • Not feeling the need to use it at this stage • Feel adequately supported by colleagues • Feeling happy with work life, therefore supervision is superfluous • Supervision is only for when things are not going well, for problem clients or for times of stress / distress at work • Supervision is a perk. Thus, in spite of having created the culture and core conditions for an entire service to have access to non-managerial supervision and having minimised the external barriers, take up was nonetheless an issue. The power of therapists’ internal beliefs about and understanding of supervision became evident and heavily influenced their perception of the usefulness of supervision and their willingness to access it. Syder & Levy (1998) discuss the range of possible barriers to embracing supervision as follows: • Reluctance to re-live the uncertainties of student clinics • Reluctance to put ourselves in a situation where either our peers or our managers are given licence to criticise • Feeling expected to know more than we do / to have acquired more skills than we know we possess • Uncertainty regarding boundaries (supervision, counselling, teaching) • Feeling that supervision will wear away at our authority with younger therapists • Difficulty seeing what supervision can offer

having worked for a number of years and developed a style of working with which we are content • Uncertainty regarding where to go and find it. Hawkins & Shohet (1989) also reflect on the possible barriers to access: • Previous experience of supervision • Personal inhibition • The supervisory relationship • Organisational blocks • Practical blocks (eg. financial, geographical, availability of suitable supervisor) • Cultural blocks within the organisation • Cultural blocks within the profession. It is indeed interesting to consider the history of supervision in counselling as compared to speech and language therapy. Counselling training has long allied itself to an andragogic approach to learning, whereby students take responsibility for their own learning and aim to become self-directed learners. From an andragogic perspective, learning is seen as lifelong with supervision representing the major way counsellors continue their professional development after training. In contrast, speech and language therapists have traditionally been trained in a pedagogic manner, which corresponds to the medical model strongly associated with the initial practice of the profession. Thus students were seen as empty vessels that have to be ‘filled’, ‘examined’ and then ‘deemed competent to practise’ (Syder & Levy, 1998, p.259). Recent shifts in student speech and language therapy training programmes show a move towards an andragogic approach, which is further underlined by developments in reflective practice and continuing professional development postqualification. Discussions in the focus groups we held for this series have highlighted that, whilst professionally the importance of supervision is being increasingly recognised and embraced by younger generations of therapists, traditional attitudes still remain and can have a strong cultural influence at a departmental, service and organisational level. We look forward to hearing any comments you have. In the next issue we will be discussing the process of supervision, roles, responsibilities SLTP and boundaries. Sam Simpson and Cathy Sparkes are specialist speech and language therapists and Cathy is also a trained counsellor. Together they are www.intandem.co.uk.

References

Carroll M. (1996) Counselling Supervision: Theory, Skills and Practice. London: Cassell. Hawkins, P. & Shohet, R. (1989/1993) Supervision in the Helping Professions. Milton Keynes: OUP. Stoltenberg, C. & Delworth, U. (1987) Supervising Counsellors and Therapists. San Fransisco: Josey Bass. Syder, D. & Levy, C. (1998) ‘Supervision’, in Syder, D. (1998) Wanting to Talk: Counselling Case Studies in Communication Disorders. London: Whurr, pp.256-288. 19

SPEECH & LANGUAGE THERAPY IN PRACTICE SUMMER 2008