Category Archives: Supervision

Supervision keeps us awake!

I have been fortunate in my career to have some really excellent supervision, but all too often I hear from colleagues that the service they work in does not offer quality supervision. I regularly hear that for many it becomes a tick box managerial function, concentrating more on the doing of therapy rather than the being or becoming a therapist. Yes, we need to have time to check on whether we are using the right procedures, we need affirmation that we are abiding by the right policies, but this should not form the main focus of supervision sessions. I have found it helpful when supervising colleagues to devote some time in each session to the doing, i.e. the day-to-day activities of the job, but to ensure that there is enough time to talk about the being and becoming, i.e. to explore our emotional and psychological responses to our work and how the work is affecting us. Geller in Fourie (2011) rightly says that “attention to the affective and intersubjective aspects of clinical relationships has been neglected in speech-language pathology” (p. 197).

We encourage students at the Universities at Medway programme to use reflection from day 1 to explore their feelings about their experiences in becoming a therapist. We need time to explore our emotional responses and reflective writing offers a chance to do this. In professional contexts we could learn so much from colleagues in psychology about issues related to transference and countertransference. One particularly useful session I recall was where I was encouraged by an experienced supervisor to unpack the feelings that had been aroused by working with a family where there were bereavement issues, which in turn had awoken emotional responses in myself. This allowed me a safe space to reflect on my role with this family and to make me more aware of my own responses.

Nicky Weld’s book on transformative supervision for the helping professions has been very influential for me. She points to a fear of people having emotion-based conversations in supervision for fear of not being able to manage what comes forward. This lack of acknowledgement of our emotional responses can ultimately lead to a risk of burnout. In the context of ever-reducing funding, I would urge colleagues to ensure that quality supervision is provided and that time is made to attend to creating, through supervision, a safe, protected environment for learning, personal and professional development without which we will stop growing. Ryan (2004) says of supervision: “It wakes us up to what we are doing. When we are alive to what we are doing we wake up to what is, instead of falling asleep in the comfort stories of our clinical routines” (p.44). Let us stay awake and not fall asleep on the job by falling back into familiar routines. Supervision can help us unpack received wisdom.

photo-feb-2016

 

Jane Stokes
Senior Lecturer, Speech and Language Therapy
Faculty of Education and Health
University of Greenwich

 

 

 

 

See further reading:

Geller E. (2011) Using oneself as a vehicle for change in relational and reflective practice. in R. Fourie (ed) Therapeutic Process for Communication Disorders. Hove: Psychology Press, 9.195-212.

Ryan S. (2004) Vital Practice. Portland UK: Sea Change Publications

Weld N. (2012) A Practical Guide to Transformative Supervision for the Helping Professions; Amplifying Insight. London: Jessica Kingsley

There is always an alternative!

letitgobyleunigYou could call me a supervision junkie. I love it! I always have. To be honest I find it hard to understand those who don’t feel the need for it as for me it is like oxygen. It is one of life’s essentials. Essentially it keeps me, a speech and language therapist of nearly 25 years (very scary!!), breathing deeply and steadily, in the demanding and often surprisingly formidable and sometimes treacherous environments of schools of South London and Surrey. I know that if I did not have regular supervision, I would not have the stamina to continue to be fit to practice and I would have choked under the heavy pollutants of managing unrealistic expectations and negotiating the smoke screens and barriers to providing the best care for my clients. Supervision in all its forms – 1:1 with a supervisor for overview of my work; peer supervision with someone working with a similar client group; group supervision in a wider geographical area; occasional supervision with a specialist in a specific field – I access all and need each.

Supervision is like a filter, it gives an opportunity to sort out the stuff that needs sorting and provides a cleaner, more concentrated view of the contents. Over recent years, I’ve been on the two supervision courses by intandem on “Being Supervised” and “Being a Supervisor”. I have attended a practical course on Personal Construct Psychology (PCP) (Kelly) to improve my problem solving and questioning. Through the Counselling CEN, I’ve attended a Brief Solution Focussed Therapy course and have learnt a lot about active listening by being a member of an Action Learning Set. All of these opportunities have provided me with tools for ‘filtering’ my clinical and supervision work, so that I have a way of looking at things with clarity and with new ideas distilling through from the process.

Here are the top 5 ‘gems’ which I have learnt so far that help me in my role as a supervisor and as a person needing supervision:

  • There is always an alternative way of doing things (Kelly, PCP)
  • If someone has a problem, ask them what they think could help. It is often easy to forget to do this! (Kelly, PCP)
  • Supervision comes in lots of forms, but the 1:1 face-to-face session is the most powerful. To be listened to, properly, without interruption and with the full attention of another person, allows the person being listened to, to think more clearly than you would ever expect. Give this to your supervisees and clients and they will be very grateful. (Action Learning)
  • We are what we do! Always find out what sort of supervision history people have had in the past and what they have done. Asking them to draw a timeline of this can be very useful. (intandem courses)
  • “What else?” This is a very useful question to ask and opens up a million and one possibilities that might not have come to mind if the question had not been posed (Brief Solution Focussed Therapy)

Final thought: No one likes to be told what to do. Supervision should not be about being told what to do. It can be a very rich and fertile opportunity to grow and be nurtured and do things a different way. I challenge you to give it a try.

Ann-M Farquhar

B App Sc (Speech Pathology), MSc (Human Communication)

Speech and Language Therapist in Independent Practice

Interests in: Language Disorder, Social Communication and Supervision of Speech and Language Therapy Colleagues.

See my YouTube     https://youtu.be/5rZwG7IAzhg

 

Supervision at the fork in the road

image1We all start out with dreams and ideas about how our careers will go. It’s hard to foresee when, where or why the forks in the road will come, but it is almost certain that they will. This blog post explores two key ways in which supervision helped me to negotiate a fork in the path, keep hold of my dreams and step into independent practice.

Seventeen years ago, I embarked on a career in Speech and Language Therapy, with a dream to become a neuro rehab therapist. In the early stages of my career I was fortunate to have some great supervisors (also my managers), who nurtured my enthusiasm for neuro rehab.

In 2008, I took a senior post in a small department without access to clinical supervision within the organisation. I was holding a complex caseload, but for the first time also dealing with wider departmental and organisational issues. I felt the need for external supervision to develop my practice and take care of myself as I entered a more challenging stage of my career.

My line manager continued to oversee my work in post, particularly supporting my CPD, and helping me develop the SLT department. The separation of my clinical supervision to another time and place enabled me to attend to the needs of my clients, as well as my own needs, within this increasingly challenging work context. Through external clinical supervision, I had the freedom to reflect on the needs of my clients more deeply and my own journey more broadly.

Hawkins and Shohet (2007) discuss self-care as an important aspect of clinical supervision. Drawing an analogy between the ‘good enough helping professional ‘ and Donald Winnacott’s concept of the ‘good enough mother’. The ‘good enough mother’ may struggle to cope with the rigours of motherhood without the help and support of another adult, just as the helping professional may struggle to cope without the support of a supervisor. At this point in my career, I was faced daily with the devastating reality of people’s lives following brain injury. I was starting to develop quite strong ideas about addressing these needs with clients but also felt frustrated by the difficulties of achieving gains for my clients. I could easily have been worn down by these frustrations, but with wise and meaningful supervision, these difficult experiences ‘….. were survived, reflected upon and learnt from’ (Hawkins and Shohet, 2007). Through supervision, I became much more conscious of my concern to address my client’s ability to participate in their chosen life roles and started to think about how I could facilitate this for them.

It was at this time that my own personal circumstances changed. With a young family I was keen to be as present at home as much as possible without completely losing connection with my profession. I started to explore how to manage this change in my life and find a way to continue working within my chosen specialism.

Cathy and Sam have written about the changing role of supervision which ‘….. has now extended to one that supports and facilitates emotional resilience, opens up possibilities where there seem to be very few and fosters an individual’s personal/ professional resources to manage change’ (Bulletin, February 2013).

With this changing picture, refined by my professional interest and constrained by my personal circumstances, my supervisor helped me to consider diverse options as I stood at this fork in the road. I don’t remember who initiated the idea of independent practice, but I know that this path seemed daunting, much less travelled and insecure. I didn’t know how to begin walking away from the security of paid employment.

The supervisory relationship was a place of safety that allowed me to: test out ideas, evaluate the pros and cons of working independently, make plans and connections, review early steps and ask silly questions. I saw my first independent client in 2009, nearly six years ago. The transition to independent practice has been necessarily slow as I have been at home with my family, but this has brought with it opportunity to reflect on each small step in supervision and build slowly in confidence. With my supervisor’s support this process has been much smoother and more satisfying than it might have been as early ideas have come to fruition.

Work is not how I envisaged it seventeen years ago, but it does really work for me in the context of my life now. However, I could so easily have missed this path if I had not been able to access great supervision at the fork in the road.

Mary Ganpatsingh
www.communicationchanges.co.uk
@Comm_Changes

References
Supervision in the Helping Professions, 3rd edition (2007), Hawkins, P. and Shohet, R.
Supporting robust supervision practice, Sparkes, C. and Simpson, S. (February, 2013) Bulletin

Putting the Relationship in Supervision

images-9Supervision. The word invokes many different thoughts for me. The many supervisors I have had, and the many people I have supervised. And the formality of the word. I got a bit stuck when trying to move past this, so I read through multiple blog posts about having one’s communication shaped, ‘therapyed’ or embraced. These posts brought to my mind the way that we as Speech and Language Therapists (SLTs) advocate for all of this communication, in whatever form is successful or possible for each individual, yet when it comes to shaping my own supervision, the same rules just don’t apply. I turn up to therapy sessions with clients. But at times, have found it hard to access my own unique communication space (which will help in those therapy sessions I turn up to), why is that? We want our accountants to be au fait with current tax law, our mechanics to put the right parts in our car, yet for some reason there are times when we turn up to sessions not having invested in our knowledge space, which is essential to providing therapy. Why do we not seek it out if we don’t have what we need or want?

Reasons I have not accessed supervision include that I have worked outside of the NHS and just haven’t got round to getting any, I have had managers who haven’t seen its benefits (I have also had managers who have ‘over-supervised’!), and I have had supervisors where their style of supervision is just not my cup of tea. There have also been times when I’ve not been linked into a neat network of Speech and Language Therapists. At times I have craved this ‘simple’ structure of one senior SLT supervises me, and then I supervise an SLT below me. But currently that isn’t an option available to me. I am an overseas trained SLT, who has spent some time as a permanent staff member in the NHS, a wee stint working privately and am currently working as a locum in the NHS. My life is soon changing as I am looking to return home.

Right now, I am lucky, especially as a locum. I have regular supervision. I also give regular supervision. I have a clinical team leader (CTL) who is not an SLT, but who always has an open ear, and filing cabinet full of ideas, especially around complex issues such as safeguarding and setting up a service. But, we have both wondered on occasion, if she was an SLT, would we come up with the answer to a curly clinical quandary more quickly?

I also have, until recently, received private supervision from an SLT. On writing this I reflected about what brought me to private supervision, and it struck me that I was looking for that ‘simple’ hierarchical structure that I mentioned above. However, what came out was something different. I had the freedom to discuss anything as my supervisor was able to look at my thoughts and issues through a different lens, removed from the need to be managerial. Someone who was intrigued to help me find the balance in relationships, who did not have a stake in the outcome and, therefore, was able to challenge me in order to help me create boundaries within my work. In her removed position, she was able to help me understand what areas to drive forward clinically. However, this separation from my day-to-day work existence, meant at times I would need to go back to my CTL to float the ideas discussed.

It took me a while to access private clinical supervision. I would often go to my sessions with the anxiety that one has when the ‘to do’ list takes up three sides of paper. But when I would leave it was like a weight had been lifted off my shoulders – the exact same feeling that I have when I meet with my CTL. Although both of my supervisors are interested in serving the same purpose – making sure I don’t burn out – they come at it from differing perspectives.

The biggest thing I will be taking from my recent supervision experience is that it is all about relationships. The relationship with the supervisor and myself, but mostly the content of discussion is how I am relating to others. I have sated my need for the neat little SLT supervision structure. It is not a necessity to be supervised by your own discipline or receive clinical support from your own workplace. A perfectly excellent job can be achieved outside of these arrangements, as long as your supervisor knows what kinds of questions to ask, and is humble enough to say “Hmmm, is this what that looks like? If not, tell me more…” I can feel myself now asking similar-structured questions to the Occupational Therapists and Physiotherapists, who ask me how they should manage a particular situation. I pride myself on my ability to relate to my colleagues, clients and wider community as an SLT, but I need to leave my guilt at the supervision door because if I am not showing up to my own unique communication space then the relationships in my work just won’t work.

Anna Childs (nee Wivell)

Who or what helps us make the changes we strive for? (1/2)

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As we step into 2014, we may have exciting new projects ahead. The weather is starting to change, there may be a spring in our step and our goals for the year may seem more possible. New growth feels achievable! So how do we each go about attempting to make the changes we are striving for? Do we launch into the new adventure with planning and preparation? Do we consider who or what we might need to set up the new experiment and how we might sustain the changes? This month we hear from three colleagues who share their experiences of embarking on a change. Next month we hear the voice of our clients. What emerges from these stories is the unique and different ways people approach change, using a combination of personal knowledge & resources and the process of reaching out to others for help to start out on a new path.

Sarah reflects on how she set up a change to her life recently. Sarah starts with turning to others: ‘Doing it with another person e.g. spouse, who wants to make the same change for the same reason; doing it together can make all the difference. Having others around me who have made this change or a similar one and seeing the benefits it has brought them can be inspiring. Also, being confident and assured that those who may be supporting me in change are well equipped, be it in terms of qualifications, emotionally, intellectually etc.’ And then looking to her own resources: ‘I have found taking smaller regular steps is more likely to result in lasting and actual change. Seeing benefits (albeit small) can spur me on and be very motivating. Being flexible and open to adjusting my expectations or goals in light of new information can keep the momentum of change and stop me from going backwards. I often think of the wheel of change we sometimes use in therapy and how easy it is to slip backwards if new habits aren’t maintained!’

Nic knows what works for her: ‘My projects usually start as an idea while I’m cooking tea for my 3 kids. In between peeling, stirring and then usually overcooking, I brainstorm ideas on the pile of scrap paper I keep in the kitchen for this very purpose. The next step is to talk to my trusted, enthusiastic, inspiring, always encouraging colleagues and my service manager who generally tell me to ‘go for it’. I must then set myself a strict deadline to ensure the idea is not squeezed out by the pressure for face to face clinical contacts.’

Mark: ‘In my experience support for ‘new growth’ comes from clinical supervision, sharing of ideas and projects with supportive and motivated colleagues, good team dynamics, and a supportive line manager. I found the opportunity to talk through the situation in relation to a big job change recently really helpful, especially my feelings related to it. It felt invaluable to do this with someone unconnected to the situation in any way (in private clinical supervision), as their distance and impartiality, not to mention enormous skill in listening and hearing the real issues, really helped me to see what was happening and to tease out why I was feeling such mixed emotions.’

New growth depends on many factors, including reaching out to a variety of people (both those within and outside a situation), being flexible enough to adjust expectations, setting useful deadlines and knowing what works for you as an individual. We invite you to email us with your stories of change and growth. What helped or hindered you to move in the direction you wanted? What lessons have you learned that you are carrying forward into your next innovation?

Thanks to everyone for their contributions so far!

Cathy

Collaboration

“Coming together is a beginning, staying together is progress, and working together is success” Henry Ford

2014 marks intandem‘s 10-year anniversary. Throughout this time, collaboration has been at the heart of all our work – both with each other and with others. 2013 was a year of experiments and we worked hard to establish even more connections and links within and outside our professional groups, using a range of approaches. As a result our networks and those we have reached and influenced have increased considerably. Here are some highlights from 2013 and some aspirations for 2014…

Twitter: @_intandem
One of our new ventures in 2013 was setting up a twitter account. We have written over 100 tweets and now have over 70 followers – including clients, therapists, counsellors, researchers, organisations, charities, students, and projects. We are using twitter to let people know what we are up to as well as signposting other events and ideas. Twitter offers a different way of interacting with individuals and groups and one that we hope we are getting better at with practice. We are starting to build a community of collaborators, which we consider a positive way forward.

Blog: www.intandem.co.uk/blog
2013 also saw the start of our monthly blog. Together with a range of guest bloggers, we have been able to use this as a regular platform to share ideas, reflections and insights as well as to signpost projects. Topics have included: different group experiences, vulnerability, acceptance, community & celebration, supervision and last, but not least, the launch of Stammering Therapy from the Inside: New Perspectives on Working with Young People and Adults. We have had a very positive response to each blog post and look forward to welcoming a range of new collaborators throughout 2014. Watch this space!

Culture Club
Another new intandem project for 2013 involved setting up a group opportunity for people with experience of stroke, tumour, head injury or brain surgery who are interested in music, film, theatre, comedy and art (Read here for more information). This open group of men and women meet every two months in the comfort of a local hotel café. Feedback to date has been resoundingly positive with a shared enjoyment of events, new ideas, humour and support. We plan to continue with this group throughout 2014 – check out the dates on our website here.

Relationship Group
Working with young people with experience of brain injury, who want to develop new friendships and relationships, has brought intandem to experimenting with a new group. We are looking forward to collaborating with Flame Introductions, a personal introduction agency who specialise in supporting people with mild disabilities and who you may have seen on the TV programme The Undateables. Our first joint meeting will be in March. Do get in touch if you are interested, as we are keen to open this group up to others.

Stammering Open Space
This open group has gone from strength to strength over the course of 2013 and now has a well-established core membership. (Read here for more information). Again feedback has been highly positive with a shared appreciation of the support and challenge, lively debate and exchange of ideas that the group offers. 2014 dates can be found here.

Courses
In our continued attempt to raise the profile of supervision within the profession we ran regular RCSLT registered Supervision 1 & 2 courses in England and Wales throughout the year. 2013 also saw us collaborating with UCL to offer a bespoke supervision course for new graduates. We recognise the unique needs of those entering the profession in the current climate. Through the course, we aimed to equip the students with the knowledge and skills to reach out for good support and supervision throughout their careers. Our shared commitment to offering support and training to therapists, coaches and other healthcare professionals interested in developing their counselling skills, resulted in our running a number of training days across the year, both independently and in collaboration with the Personal Construct Psychology Association and City Lit. intandem was also involved in organising a day of talks at City Lit to mark the publication of ‘Stammering Therapy from the Inside’, as well as co-ordinating a local book launch. Our 2014 programme of courses can be found here. Do check out what is new and let us know if you are interested in taking part.

We have enjoyed a year of experimentation and collaboration. Thanks to everyone we have worked with and met along the way! Here’s to 2014 – as we reach out to new possibilities ahead.

Cathy & Sam
January 2014

intandem’s first blog!

Welcome to intandem’s first blog!

It is a testimony to how far we have come since we first entered the independent sector 8 years ago – and the advance of social media!

We have embarked on 2013 with setting up a Twitter account @_intandem. Through it we hope to develop a community of like-minded people – colleagues, clients, family members, students – in order to open up a dialogue about topics close to our hearts. We are also very keen to create forums, debates and share knowledge with people we know and people we have not reached before.

In the spirit of experimentation, we are starting 2013 with a number of new ventures relevant to both professionals and clients.

  • Raising the profile of supervision within the profession is high on our agenda for the year. Having been commissioned by the Association for Speech and Language Therapists in Independent Practice to update the supervision section on their website, this has now gone live for members. Do have a look and let us know what you think.
  • Our article on the newly revised RCSLT supervision guidelines in the RCSLT Bulletin is also just out. We very much enjoyed this opportunity to share our thoughts on supervision more publically and have been pleasantly surprised by the number of positive comments we have already received. Several therapists are planning to use the article as a springboard for discussions with their managers about the adequacy of their supervisory relationships and as a vehicle to help change attitudes towards supervision within their departments. We wish them all well.

Do get in touch if you have a view on supervision in the current climate or the 2012 RCSLT supervision guidelines. We would also love to hear from you if you are interested in getting involved in setting up training opportunities and supervision networks in your area.

Some of our clients have been avidly followly the latest series of The Undateables, a programme recently shown on Channel 4 . The first episode featured a young woman with aphasia, which has promoted a lot of interesting discussions around the opportunities and challenges of meeting new people and beginning new friendships.

We start 2013 with two new group ventures for people with experience of brain injury:

  • The first is a bi-monthly Culture Club which will offer an opportunity to meet and share ideas with others interested in music, film, theatre, comedy and art. Our first event is on 5th March 2013 if you are free.
  • The second is a new group forum for people who specifically want to address issues around dating and relationships. We are beginning to gather together the names of people who are interested in meeting up for an exploratory session.

Do get in touch if you are interested in either group. Contact: info@intandem.co.uk

That’s it for this month. We very much look forward to hearing from you.

Here’s to an exciting 2013 full of tweets and hashtags!

Cathy and Sam