Clinical Psychology Specialist Supervision Module for New Supervisors

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Clinical Psychology Specialist Supervision Module
for New Supervisors
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Clinical Psychology Specialist Supervision Module
For New Supervisors

• Duration
• Two days 9.30am-4.30pm
• Activities
• Small group discussion
• Plenary discussion
• Behavioural rehearsal

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Clinical Psychology Specialist Supervision Module
For New Supervisors

• Day 1
• 9.30am
• Introductions
• Expectations
• 11.00am
• Setting up the placement
• Thinking about competences
• Lunch

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Clinical Psychology Specialist Supervision Module
For New Supervisors

• Day 1
• 1.45pm
• What does the trainee know, what do they need
  to know?
• How do we help them get there?
• Contracting
• 3.30pm
• Supervision has its ups and downs!
• Review

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Would I lie to you?

• Tell the group two things about yourself
• One true
• One a lie
• Not work related (unless its funny)
• We need to guess the lie
• If you can con us more than we can guess the
  lies, we supply biscuits for break

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Introduction

• Where are we now?
• Minimum 3 years experience of being a trainee
  and receiving supervision
• Attended the 3 day GSC course
• models
• practicalities
• processes

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Introduction

• This framework conceives supervision as a formal
  but collaborative relationship which takes place
  in an organizational context, which is part of
  the overall training of practitioners and which
  is guided by some form of contract between a
  supervisor and a supervisee The expectation is
  that the supervisee offers an honest and open
  account of their work and that the supervisor
  offers feedback and guidance which has the
  primary aim of facilitating the development of
  the supervisees therapeutic competencies but
  also ensures that they practice in a manner which
  conforms to current ethical and professional
  standards.
• (Roth and Pilling 2008)

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Introduction

• An intervention that is provided by a senior
  member of a profession to a junior member....
  this relationship is evaluative, extends over
  time and has the simultaneous purposes of
  enhancing the professional functioning...,
  monitoring the quality of the professional
  services offered., and serving as a gatekeeper
  for those who are to enter the particular
  profession.
• (Bernard
  Goodyear, 1998).

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Introduction

• Where are we now?
• Minimum 3 years experience of being a trainee
  and receiving supervision
• Attended the 3 day GSC course
• models
• practicalities
• processes
• May have delivered some supervision already

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Introduction

• Where are we now?
• Making a significant transition
• Confidence in therapeutic skills growing
• New roles and responsibilities
• Shift in perspective (gatekeeper)

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Introduction

• Aims of the course
• Apply understanding of the models to supervision
  of Clinical Psychology Trainee
• Reflect on impact of role transition and
  individual difference on practice of supervision
• Apply understanding of learning theories to
  develop a positive learning environment
• Reflect on and practice some of the skills
  required in the process

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Introduction

• Our methods
• Activity based
• Discussion (small group plenary)
• Reflection
• Rehearsal
• and a bit of fun!

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Introduction

• Resources
• Shared space
• Guidelines
• Key chapters
• Journal Articles
• Evaluation tools
• Handouts
• Workbook
• Record key learning points
• Reflections
• Record of learning experience and learning needs

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Introduction

• Why do we need a Specialist Supervision Module in
  Clinical Psychology?
• What are the particular challenges?
• What characteristics are unique?
• Are there professional/cultural issues that are
  different?

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Expectations

• Small group discussion
• In light of the previous discussion, discuss your
  expectations for the next few days
• How will we know if we have achieved it?
• Individually write one Intended Learning Outcome
  for you (space in workbook)
• Feedback TWO expectations from the group

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Anxieties
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Expectations

• Take some time individually to consider 3 future
  selves
• The supervisor you MIGHT become
• The supervisor you would LIKE to be come
• The supervisor you are AFRAID you might become

• How would you behave/think/feel about the
  trainee?
• What would be the impart on the trainee?
• How would you know which one you were becoming?
• What would it feel like?
• What would it look like to others?

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Setting up the placement

• Looking back on better days (!?!?)
• What are your recollections on the first day of
  placements?
• What made things less anxiety provoking?
• What made you think this is going to be good!?
• How quickly did you make a conclusion about the
  nature of the placement?
• What prompted that conclusion?
• How much did this influence the way placement
  panned out?
• Did it impact on the way you approached
  supervision
• what you brought
• what you discussed
• what you disclosed

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Considering Competence

• Competence Framework
• Core Competencies Clinical Psychology A Guide
  (BPS 2006)
• Division of Clinical Psychology - Professional
  Practice Guidelines (BPS 1995)
• Standards of Proficiency Practitioner
  Psychologists (HPC 2009)
• Competency Framework (Roth and Pilling 2008)

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Considering Competence

• BPS domains of Competence
• 3.1 Transferable skills
• 3.2 Psychological Assessment
• 3.3 Psychological Formulation
• 3.4 Psychological Intervention
• 3.5 Evaluation
• 3.6 Research
• 3.7 Personal and professional skills
• 3.8 Communication and teaching
• 3.9 Service delivery

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Considering Competence

• 3.1 Transferable skills
• ?Deciding, using a broad evidence and knowledge
  base, how to assess, formulate and intervene
  psychologically, from a range of possible models
  and modes of intervention with clients, carers
  and service systems.
• ? Generalising and synthesising prior knowledge
  and experience in order to apply them in
  different settings and novel situations.
• ? Demonstrating self-awareness and working as a
  reflective practitioner.
• ? Ability to think critically, reflectively and
  evaluatively.

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Considering Competence

• Accreditation standards tend to increase in
  number over timehowever even when criteria are
  specified, expected competence levels often
  remain elusive to both supervisors and
  supervisees
• (Bernard Goodyear 2009)

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Level 2/3
Level 2
Level 2/3
Level 2/3
Level 2/3
Level 2
Level 3
Level 1
Level 1
Level 1
Level 2
Level 1
Older Adult Placement
Adult placement
Child placement
L.D placement
Specialist placement
Specialist placement
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The complexity of the trainee experience
Public
LAT
NHS
University
Academics
Supervisors supervisor
Trainee
Supervisor
Clinical Tutor
Client
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Understanding the trainees context

• A model by Michael Carroll of
• Survival mode
• Versus
• Competency mode

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Frontal cortex thinking

• Plans for the future
• Imagination and prediction
• Self development
• Ability to reflect
• Introspection
• Ethical decisions
• Managing emotions

• Creativity and change
• Speaking
• Writing
• Reasoning
• Abstracting
• Problem solving
• (Carroll, Centre for Supervision Training, 2009)

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Survival Mode

• Fight
• Flight
• Fragment
• Freeze

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Competency Mode

• Learning is risky and occasionally dangerous,
  and creating reflective environments engenders
  disagreement and debate.
• We do create environments and relationships
  where power over is so dominant that it puts
  people into survival mode (rather than
  competency mode), which means they can only learn
  in certain restricted ways.
• It means further that we look carefully at how
  power is used in learning situations to ensure
  that power over doesnt negatively affect
  learning.

Carroll 2009
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Observation Task

• Clip 1
• Pick out areas of competence that could be
  considered
• Areas of particular strength
• Areas for development
• Into groups of three and discuss your
  observations
• The experience of observing and picking out
  strengths/weakness
• What did it feel like?
• Did you know what you were looking for?
• What level were you expecting?

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Considering Competences

• Clip 1
• First year trainee working with a woman
  experiencing low mood and relationship
  difficulties.
• Observe with checklist
• Strengths
• Areas for development
• Small group discussion
• Your observations
• The experience of observing and picking out
  strengths/weakness
• What did it feel like?
• Did you know what you were looking for?
• What level were you expecting?

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Observation Task

• Clip 2
• As before, however the trainee is more
  experienced
• In your groups discuss
• What was it like this time?
• How confident did you feel?
• How difficult was it to find areas for
  improvement?
• How close to your level do you think they were?
• How does that impact on you and the decisions you
  make?

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Considering Competences

• Clip 2
• Third year trainee working with a woman
  experiencing low mood and relationship
  difficulties.
• Observe with checklist
• Strengths
• Areas for development
• Small group discussion
• What was it like this time?
• How confident did you feel?
• How difficult was it to find areas for
  improvement?
• How close to your level do you think they were?
• How does that impact on you and the decisions you
  make?

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Kolbs Experiential Learning Cycle
Adapted from Milne Jones 2002
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Kolbs Experiential Learning Cycle
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Experiential Learning

• Observation is the key
• By supervisor
• Anxiety provoking but does convey interest
• Can be supportive
• Nature will change through placement
• Maintains Quality Assurance
• Provides evidence for both formative and
  summative evaluation
• Of Supervisor
• Provides model
• Is experienced differently through placement
• Promotes reflection (through modelling)
• Reiterates competence (and therefore confidence
  in trainee)

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Demonstrating

• What are peoples recollection of observing their
  supervisors?
• When?
• How often?
• What kind of activity?
• Why is this the pattern?
• What are the struggles for supervisors?
• What is your experience of demonstrating (ie
  observed but not evaluated)

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Experiential Learning
Observations of supervisor
Observations by supervisor
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Experiential Learning
Observations of supervisor
Observations by supervisor
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Setting Learning Objectives with Trainee

• SMART objectives are
• Specific
• Measurable
• Achievable
• Realistic
• Timely

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Setting ILOs

• Split into groups of similar type (e.g. adult,
  learning disability etc) if possible
• Think about developing some SMART ILOs for the
  placement you offer.
• What would be the specific competences they would
  expect to see developing within their placement?
• What methods do they use to nurture these
  competences in the trainee?
• What experiences doo they offer which directly
  contribute to the development of the competences?
• How do they know if the competences have been
  achieved?
• How do they review them.

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Contracting

• What are your recollections of the supervision
  contract?
• How is it generally used?
• As trainee, how did it feel?
• Was it ever revisited?
• How were boundaries set?
• Were they explicit or implicit?

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Beginning Contracting

• Wish List

• Making concrete

• Which of these could you contract for?
• What would it look like?
• What would be the challenges
• What might the impact on the relationship be?

• What is important for you in supervision?
• My image of successful supervision is..
• What I fear happening in supervision is.
• Write down some responses to these questions
• As a supervisee
• As a supervisor

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Why Contract?

• Scaife (2001/2009) gives a number of reasons to
  contract including the following
• To clarify the expectations of both parties
• To set a context of openness and negotiation
• To set a context of shared responsibility
• To encourage supervisees to think about the
  conditions that help them learn
• To model exploring process and content
• To clarify the evaluative role
• The identify the context (e.g. training) within
  which the supervision will occur

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Contracting

• In contracting a new supervision relationship you
  may want to consider the following
• The developmental stage of the Supervisee
• The interpersonal style of the Supervisee
• The Supervisees needs within supervision
• The Supervisees previous experience of
  supervision

• Individual session contracting
• responsibility, number of clients/issues to be
  discussed, etc.
• Clarity about the reduction of harm as paramount
  and my need to act if necessary
• Ways of developing mutual trust (e.g., My image
  of successful supervision is.., What I fear
  happening in supervision is.)

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Contracting

• Ways of constructively challenging when
  appropriate
• Transference and countertransference issues- how
  we can deal with personal issues that arise (for
  both of us)
• Confidentiality boundaries
• Working with difference
• System for review and feedback
• Negotiation regarding the use of the parallel
  process practicalities

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Helpful events Factors which might contribute
to effective supervision Hirons and Velleman
(1993) Clinical Psychology Forum 5711-13

• Joint problem solving
• Guidance on clinical work (including observation
  of supervisor and guided discovery)
• Theory/practice linking
• Reassurance
• Soliciting views from the trainee
• Reflection on parallel process between therapy
  and supervision
• Being available and reactive to trainee needs
• Sensitivity to impact of personal issues on
  ability to carry out certain types of clinical
  work
• Discussion of feelings

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Unhelpful events

• Lack of direction in therapy
• Trainee being talked to like a client
• Non-genuine reassurance
• Lack of direct guidance when needed
• Supervisor telling the trainee what to do
• Anxious supervisor-unclear advice
• Unreliable supervisor
• Global, unclear criticism
• Lack of balance between ve and -ve feedback
• Expected to know what to do

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Cushway Knibbs (2004)

• Helpful Aspects
• Rapport Safety
• e.g. affirming safe, emotional support,
  supervisor qualities, supervisor self-disclosure
• Client Focus and Challenge
• e.g. challenge and direction, introducing new
  ideas, reflection, direct learning

• Unhelpful Aspects
• Unbalanced
• Developmentally inappropriate
• Intolerant of differences
• Poor model of personal/professional attributes
• Professionally apathetic

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Role model

• Supervisor perceived as
• Skilled and knowledgeable
• Respectful of clients
• Respectful of colleagues
• Respectful of trainee
• Viewed as possessing special knowledge,
  credibility and integrity

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The supervisory relationship over time (Frost, K.
2004)

• IPA study of 4 supervisory dyads over 3 time
  points
• Beginning Supervisee adjusting, seeking
  guidance, striving for acceptance. Supervisor
  influence and guidance , nurturance and
  commitment.
• Middle Supervisee expanding learning and
  understanding. Supervisor exploring ideas,
  settling into a sense of security, trusting the
  trainee.
• End Supervisee resolution and empowerment.
  Supervisor satisfaction and collaboration,
  evaluation and endings.

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Contracting

• Behavioural Rehearsal
• Trainee
• Supervisor
• Observer
• Observe and feedback, commenting on issues of
• Power
• Modelling
• Negotiation
• In washup connect with trainee/supervisors
  reflective experience

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The Supervisory Alliance

• The content of supervision is not explored by
  two impartial objective observers looking at
  various areas of the supervisees working life,
  it is in the context of the live and changing
  interaction of the supervisory relationship.
• Hawkins (1982)

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The Supervisory Alliance

• You and the trainee are approaching a lift on the
  way to a meeting. Consider what happens next
• Who presses the lift button when outside the
  lift?
• How would you feel if the trainee pressed the
  button?
• Who goes in the lift first?
• Where do you stand?
• Who presses button inside?
• How was it being in the lift?
• What did you discuss (if anything!)?
• How would it look for each of your future
  selves
• How might you be?
• How would you like to be?
• How are you afraid you could be?

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The Supervisory Alliance

• One floor later someone else gets on. It turns
  out its
• Your supervisor
• The trainees line manger
• The clinical tutor
• A client!
• How does this impact on the activity on the lift?
• How does the relationship between you and the
  trainee change?
• Who presses the button now!

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Context for the Relationship
Public
NHS
University
Academics
Supervisors supervisor
Trainee
Supervisor
Clinical Tutor
Client