What is supervision? Is it necessary?
Being on the front line in the role of an Intermediary can be very challenging, and at times distressing. Although many of us are experienced clinicians, the effect of vicarious/secondary trauma cannot be underestimated.
“The expectation that we can be immersed in suffering and loss on a daily basis and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet.” (Green 2013)
Secondary/vicarious trauma is the effect on us which we may experience through seeing and hearing traumatising material as a result of accounts of abuse, loss, blame and shame. No matter how carefully we set our boundaries, these demanding emotions can transfer and permeate our psyche.
It is a requirement for psychotherapists to have undertaken their own therapy during their training and to be in some type of supervision arrangement. The Allied Health Professionals, which include speech and language therapists, occupational therapists, physiotherapists and some psychotherapists, are required to have regular clinical supervision.
Although there is no one all-encompassing definition of clinical supervision, the Kings Fund Centre 1994 states:
“Clinical supervision is a formal arrangement that enables . . . to discuss their work regularly with another experienced professional. Clinical supervision involves reflecting upon practice in order to learn from experience and improve competence.”
It is accepted that this reflective practice is a way to promote good, safe practice as well as providing time to address individual needs for support. This is carried out in a safe, confidential environment which can be restorative and enhances resilience. During supervision, skills are required which involve active listening, use of open questions, and the offering of practical solutions. A safe environment will offer the possibility to be authentic and self-reflective without the intrusion of forces such as competition and envy. It offers an opportunity to reflect on how events went, what could have been done differently, and the effect they have had on us.
There are various models of practice currently used, such as:
- Proctor’s three function intervention model
- Heron’s six category intervention analysis
- Padeskey’s cognitive therapy model
- Driscoll’s solution focused model
Essentially, all models focus on enabling practitioners to understand and manage emotional stress in a restorative and supportive environment. Likewise, they help skill development and enable self-monitoring of effectiveness.
How does this translate into the Intermediary world?
There is no formalised requirement for Registered Intermediaries to engage in supervision. However, some intermediaries have organised some type of supervision and many intermediaries have formed peer supervision groups. These are closed groups where a fixed number of people meet at regular intervals. The groups are run without a formal agenda. Each member can bring to the group experiences and emotions that may have arisen during a case or sometimes frustration regarding the system. Coming from caring professions, it can be shocking at times to be caught in an adversarial system.
Group supervision sessions are times when fears, frustrations and triumphs can be aired. Confidentiality is guaranteed and emotions can be allowed to flow in the safety of this ‘contained’ environment. Sessions can be both settling, energising, completing and enhancing for our work. The links created can assist in clarification of both situations and emotions.
A useful definition of a supervision group is provided by Bond and Holland (1998):
“Three or more people form a fixed membership group and have planned regular meetings in which each person gets the chance for in-depth reflection on their own practice and on the part they as individuals play in the complexities and quality of that practice, facilitated by reflection from the other group members.”
Some intermediaries have chosen to engage their own personal supervisors who they may meet on a regular basis or have phone/video supervision when required. Alternatively, others may wish to have a supervisor who facilitates/leads a supervision group.
Another powerful form of supervision is art psychotherapy, where the intermediary creates images, sculptures and other forms of artistic expression. This allows for the externalisation of inner thoughts and memories following hearing and seeing distressing accounts. It has come to be known as ‘turbo charged’ supervision as it can access feelings very deeply and rapidly. The supervisee may not have been previously aware of what they were carrying around with them. One intermediary reported that making images helped her cope with the after-effects of the horror of having seen child abuse images which had been part of a case.
No matter what style of supervision is chosen, the effect is far-reaching in helping to cope with the occupational hazards of intermediary work. This, in turn, can benefit the vulnerable people we are working with. Intermediary work is varied and involves a steep learning curve. To seek out the help afforded by supervision and to share experiences during such sessions will facilitate best practice and also, importantly, safeguard us from burn-out!
References
Bond, M and Holland, S (1998) Skills of clinical supervision for Nurses. Open University press.
Driscoll, J (2000) Practising Clinical Supervision – a reflective approach for health care professionals. Edinburg, Balliere Tindall Elsevier.
Faugier, J and Butterworth, A (1994) Clinical Supervision – a position paper. University of Manchester.
Glover, D (2000) Models of Supervision. Nursing times, 96, 6, p45-47.
Green, M (2013) BAAT Conference – Secondary Trauma and Resilience.
Heron, J (1989) Six Category Intervention analysis. Human Potential resources Group, University of Surrey
Padeskey, C (1996) Developing cognitive therapist competency: teaching and supervision models. Guildford Press
Proctor, B (1987) Supervision – a cooperative exercise in accountability. Enabling and Ensuring. Supervision in Practice. National Youth Bureau and Council for Education and Training in Youth Community Work.