‘Psychologically Informed Supervision — Creating constructive, containing and reflective spaces in a PIE…’
05.03.2021: For this week’s blog as the Lead for Psychologically Informed Environments (PIE) at the national youth homeless charity: Centrepoint, I have been reflecting on relationships again and their key importance within a PIE. However, rather than reflecting on relationships between our staff and the homeless young people we support, I have been thinking about the importance of supportive relationships between staff. Specifically, over the past few weeks as part of the development of our new PIE informed ‘Housing Operational Model’ (HOMES) to be launched next month (more details to follow soon — watch this space!), I have been working with senior housing staff to review the Monthly 1:1 Review Forms or ‘Supervision’ recording forms. In particular, I have been considering how we can ensure that these forms, as well as the wider process of supervision across the organisation is psychologically informed.
‘Supervision’ is a somewhat loaded word for many professionals working in the Health and Social Care sectors. In the Oxford English Dictionary, it is defined as “a process of overseeing, directing, inspecting and controlling”, which if we adopt this definition, can quite understandably lead to feelings of dread or anxiety on the part of the supervisee (the junior member of staff receiving it) as well as to some extent on the part of the supervisor (the senior member of staff providing it). It gives the impression of something that is ‘done to’ rather than ‘done with’ and takes out the relational elements of the process. I therefore much prefer Bond & Holland’s (1998) description of supervision as “regular protected time for facilitated, in-depth reflection on clinical practice aimed to enable the supervisee to achieve, sustain and creatively develop a high quality of practice through the means of focused support and development”. Or indeed Inskipp & Proctor’s (1988) definition of supervision is a more helpful summary; “Supervision is a working alliance between a supervisor and a worker, or workers in which the worker can reflect on herself in her working situation by giving an account of her work and receiving feedback and where appropriate guidance and appraisal. The object of this alliance is to maximise the competence of the worker in providing a helping service”.
Both these definitions, as per a PIE, focus on the importance of the relationship within a supervision or 1:1 review session. Moreover, they view the process as beneficial to the supervisee (in terms of learning, development and support to undertake their role to the best of their abilities) as well as the supervisor (in terms of the provision of appropriate supportive guidance to their staff reducing burnout and staff attrition or absence). As we were reviewing the actual forms used to record the process recently, I highlighted the need for these forms to not only provide some prompts to support reflective discussion (e.g. psychological well-being, reflection on practice and key elements of an individuals’ role) but most importantly to be ‘user friendly’. It is essential that these forms did not overly define or restrict the process and were not laborious to staff, who may avoid supervision if the process is too onerous or difficult. I hope this is what has been achieved, and look forward to receiving further staff feedback in the future on the process as it embeds across the organisation.
So what does psychologically informed supervision look like and why is it important? As a psychologist supervision has been a key part of my training and continuing professional development for over two decades. If I am honest, some of those experiences have been more difficult or challenging than others, and I feel I am still developing and learning as to ‘what works’ both as a supervisor and as a supervisee. On reflection, I have not always ‘connected’ with my supervisor and sometimes, especially early on in my career, I felt very anxious about coming to a supervision session. I feared that I would be judged and that all the things that I did not know or the mistakes that I might have made since the last session would be highlighted. In my clinical training when I worked with certain client groups that I found particularly challenging or had less experience with, these supervision sessions were often more about me trying to learn how to do something, rather than creating a space for reflection or feeling safe to bring worries or concerns about my role, or the impact that the work was having on me personally. However, I have also had some excellent supervision in the past (and including my current supervisor!), where I have felt safe and secure, and have enjoyed supervision sessions that have felt perhaps more like a ‘conversation’ and a space to have constructive reflections on my practice, rather than a way of ‘being reviewed’.
In line with my some of own reflections, Scaife (2001; p9–10) helpfully outlines what ‘psychologically informed’ supervision, whatever your professional background or level of experience and expertise, should look like. She notes that supervision is first and foremost ‘supportive’ and ‘takes place in the context of a facilitative relationship’. It is also ‘safe’ as it is a confidential space, and ‘provides an opportunity to ventilate emotion without comeback’, which I would argue is very important because of the nature of much of the work we undertake in the homeless sector being emotionally challenging and at times distressing and stressful. Consequently, supervision is a space that ‘provides us with the chance to talk about difficult areas of work’ so being honest and open in the space is most beneficial, and however hard it might be, it is important that we feel able to admit our mistakes or concerns (supervisee) or the limits of our own support and advice (supervisor). It can also be helpful to be aware of and reflect upon the concept of transference (how a young person might be perceiving the staff member as someone from their past such as a parental figure and consequently reacting towards them) as well as countertransference (the way in which the staff member feels indicating perhaps how the young person might also be feeling) in a supervision setting.
However, supervision can also be ‘challenging’ and we may need to be ‘brave’ because we are encouraged to talk about the realities of our daily working practice, and take a constructive and realistic approach to what we have done well, and perhaps what we might need some extra support or assistance with. It is therefore helpful if the supervisee spends a few moments before supervision preparing, by considering what they would like to discuss and bringing with them anything that is required to facilitate that discussion (e.g. notes) in order to structure their discussion and ensure that they don’t ‘forget’ anything they want to raise. Moreover, it can be just as helpful if the supervisor reviews past session notes to determine what actions have been previously agreed in order to follow these up in the next session to ensure any learning, development or support needs of their supervisee are being met.
Supervision should also be ‘regular’ (at least monthly, maybe more or less depending on resources and our need or the stage in our professional development), that takes place throughout our careers ‘in a protected time’ and confidential space. It is also noted that supervision ‘is an invitation to be self-monitoring’ and ‘is concerned with learning to be reflective and becoming a reflective practitioner’. However, although supervision is a place to reflect, is it not just line management nor is it personal therapy (although well-being issues should be regularly discussed, and the supervisee signposted for further support if needed). Finally, and most importantly, it should always be ‘centred on developing best practices for service users’, in order words the focus remains on ensuring that we are always trying to strive towards improving ourselves in order to improve outcomes for the home young people we are working with.
Our individual supervision is also important because as noted above, alongside team reflective practice groups, it can give us space to process the emotional consequences of the work or ‘vicarious trauma’ common in the homeless sector (Waegemakers Schiff et al, 2019). It is also time dedicated to just us within our working day that can help us process events and re-charge ourselves ready to face the next challenge! This can help reduce staff attrition and ‘burnout’, and manage the emotional climate of our work (Scaife, 2001) as well as improve our practice. For example, there is now increasing psychological research evidence that notes the positive effects of supervision on staff well-being and job satisfaction as well as on actual clinical outcomes (e.g. Bambling et al, 2006; Berg et al, 1994; Bradshaw et al, 2007; Kellet et al, 2014). Of note, these research studies do not suggest that one particular model or type of supervision is more effective than another model; hence I have not focused on outlining specific psychological supervision models within this blog.
Rather, it is the quality of the supervisory relationship, again as per a PIE’s focus on the central role of relationships, which is actually the most important factor. The relationship between supervisor and supervisee is strongly associated with supervisees’ satisfaction with supervision, and their willingness to be open about practice, which in turn maximises the effectiveness of the process (Ladany et al, 1996; Beinart & Clohessy, 2017). Consequently, as per any of our work with homeless young people, the relationships or ‘therapeutic alliance’ that is built between supervisor and supervisee is critical. Norcross (2011) for example, notes the important of collaborative working between both parties and the need for supervisors to be ‘responsive’ to their supervisees. Therefore, perhaps trauma informed principles such as ‘safety’, ‘choice’, ‘collaboration’, ‘empowerment’ and ‘trust’ can be helpful to hold in mind not just when we are working with homeless young people, but also when working with and supervising our colleagues. Supervision should not be a ‘re-traumatising’ process to engage in (or indeed facilitate)!
Moreover, a good supervisory relationship creates ‘psychological safety’, a concept that has developed over recent decades in some high-risk industries such as aviation, as a way of developing effective feedback mechanisms and reducing errors (Edmondson & Verdin, 2018). However, as it occurs within the context of relationships, it is a continuous live process that naturally varies over time. We are all human; sometimes we will feel more ‘safe’ in supervision than at other times. It is inevitable that talking about our practice in detail may make us feel exposed, which is why a supervisor should be sensitive to their supervisee and what they may need from that particular session (e.g. space to reflect to develop their own solutions versus more directive guidance and support on a particular issue). However, the safer that staff feel to air problems and report mistakes to senior colleagues (and not just amongst their peers), then the more able an organisation is to listen and to act on information to improve systems and processes. This creates an organisational culture that allows staff to think collaboratively about the work they do (not just in supervision but also in reflective practice and other meetings), learn from mistakes or challenges and ultimately deal with issues and improve outcomes for staff and young people.
Finally, a psychologically informed organisation needs to support and value the supervision at all levels. The wider systemic impact on the 1:1 supervision process cannot be ignored, not just in terms of the paperwork required to complete but also in the broadest sense of attitudes and priorities. If supervision is viewed solely as a way of monitoring staff performance and appraising them, it can be viewed as punitive and staff will avoid it, which as noted above, has a negative impact on a variety of outcomes for both staff and service users. Both supervision and reflective practice can put staff in touch with how they are feeling, encourage them to explore challenges and look to colleagues for support and guidance (Kurtz, 2020). If a service or organisation is not PIE informed with a focus on the importance of relationships and the psychological well-being of those within it, instead focusing on just ‘through put’, outcomes or Key Performance Indicators (KPIs), then supervision (and indeed reflective practice) won’t be prioritised and can in fact be viewed as unnecessary and /or an interference. Consequently, I would argue that all staff within an organisation, whatever their level, need ‘supervision’ in the psychologically informed definition as noted above rather than in the ‘monitoring sense’, in order to create an atmosphere of trust and safety, that allows constructive, containing and reflective practice to flourish and be shared. Let’s not fear ‘supervision’, rather lets aim to create positive psychologically informed supervision spaces that not only help ourselves and those we supervise to become ‘the best we/they can be’, but also enables us to support our homeless young people to do similar…
