Clinical supervision refers to the activity that is responsible for bringing skilled practitioners and supervisors together with the aim of reflecting upon their practices. According to Butterworth and Faugier (2013), clinical supervision (CS) is commonly used in psychotherapy, counselling, and other mental health disciplines that encompasses the collaboration and engagement of a group of people. This supervision might also be applied to practitioners in their somatic disciplines, in order to enhance the preparatory work for all service users and/or patients. In other words, supervision refers to the replacement in place of formal reflective inspection, disseminating evidence about the expertise of supervised practitioners. CS has undergone substantial enhancement and evolution in past decades and has started to encompass reflection on practise as well. The primary objective of such CS is to advance clinical practice and progress patient outcomes (American Psychological Association, 2015). Hence, implementation of CS is imperative to the profession and scope of practice of nursing. CS can also be defined as the formal provision, by permitted supervisors, of a relationship-based teaching and exercise that is focused on work. This essay will elaborate on a CS model and also illustrate its strengths and weaknesses.
Supervision models- In the words of Bernard (2014) clinical supervision refers to the individualised learning approach that is adopted by supervisees who work with their clients. This acts in the form of a systematic manner and principally comprises of three different supervision models such as, the integrated model, the developmental model, and the orientation specific model. The underlying principle of developmental models of supervision is the idea that individuals are unceasingly growing. In uniting human experience with genetic predispositions, people are able to develop their strengths and eliminate their areas of weaknesses (Kristofferzon, Mårtensson, Mamhidir&Löfmark, 2013). The primary goal of supervision from the developmental perspective is to exploit and recognise growth, required for the future. Thus, it is characteristic to be uninterruptedly identifying novel areas of development in a life-long knowledge process as a mental health practitioner (Borders et al., 2014). Owing to the fact that several psychotherapists consider themselves as “varied”, the integrated model of supervision employs manifold therapeutic orientation. The orientation specific model is usually adopted by counsellors who implement specific kinds of therapy such as, solution-focused, Adlerian, and behavioural. One major advantage of this kind of supervision model is related to the fact that the supervisor and supervisee share alike theoretical orientation and allow maximisation of the modelling.
Summary of clinical supervision session- I adopted the psychodynamic model of supervision during a session in the mental health unit. Our clinical expertise and experience in the mental wards have made us realise that CS is an essential aspect of a mental health practitioner’s job. The primary reason for adoption of the CS model was in order to enhance the clinical practice safety, and create opportunities that would allow me to develop my professional skills. Furthermore, CS also helped in ensuring that adequate support was given to the clinicians. This acted as a vital mechanism related to the provision of high clinical care quality (Diener&Mesrie, 2015). This supervision model is a category of a psychotherapy-based supervision approach that utilises psychotherapy theory for applyingalike techniques used with regulars in the supervision location.
The model places a due focus on the relationships between the client and the clinician, the clinician and the supervisor, besides their interactions (Strømme, 2014). A range of approaches to psychotherapy have been found imperative in leading to dissimilar approaches to supervision, each placing a specific focus on the management process. The primary emphasis in psychodynamic model of supervision is the reaction of the supervisee to the client. This model also elaborates on the ways by which the supervisee governs defence mechanisms, devolutions and counter transferences (Sarnat, 2016). These situations are commonly encountered in therapy situations. However, the model of supervision gets more complex by the fact that the fundamentals of counter transference, transference and numerous defence mechanisms that are present in the supervisory relationship.
Elements- The six fundamentals of clinical supervision are supervisory association, facilitative environs, supervisory methods, structural foundations, supervisory responsibilities and easing of learning experiences. The facilitative environ endorses development of the supervisee. CS helps in ensuring the presence of a safe, open and fostering environment. This in turn promotes development of mutual faith, respect and trust between the supervisor and client. The structural element lays a foundation for the implementation of supervision (Saleh, Yaacob& bin Rosli, 2015). It involves setting of duties, amplification of responsibilities and potentials, stability in supervisory conduct, suitable response, and prolific discussion between the supervisor and the supervisee. Some of the most essential skills that are imperative for CS include skilled, technical, societal, investigative, descriptive and informativeaptitudes. The easing of learning experiences is facilitated by the delivery of materials, and incorporatesuse of several demonstrations, tutorials, and sharing of knowledge. Simpson?Southward, Waller and Hardy (2017) elaborated on the interpersonal psychodynamic supervision, the prime objective of which is to generate a more experimental, sharing, and relationship-focused method of supervision that not only offersserviceable psychotherapeutic information and skills, but also eases the expressive and relational progress, vital to adorning the role of an operative psychodynamic psychotherapist, in the mental health scenario.
Supervising a beginning clinician- The quality of the supervisory association creates a major contribution towards CS efficacy. Situations that encompass supervising a novice clinician is focused on the fact that the struggles of the beginning practitioner must be acknowledged and due attention must be placed on the supervisor-supervisee relationship. The model of psychotherapy supervision that need to be implemented in this case scenario involves enhancing the clinical competence of the clinician by displaying empathy and fostering an effective interaction (Beinart, 2013). There is a need to focus on different concepts such as parallel processing and transference. Owing to the fact that each subordinate has unique capabilities and shortcomings, the model will allow focusing on the development of the employee potential.
Supervising an experienced clinician- One of the oldest approaches of supervision will focus on the fact that accomplished psychotherapists are by default, skilled supervisors. Hence, while supervising an experienced clinician having different ideologies, their expertise in mental health units shall always be taken into consideration. The psychodynamic model of supervision will also place a due emphasis on the need of understanding the psychological functioning of the clinician. In the words of Watkins and Scaturo (2013) this will facilitate effective working with the person and foster gaining a sound understanding of the learning style that he/she possesses. Efforts will be made to refer the clinician to personal therapy, which might lead to the generation of countertransference related issues. However, use of the psychodynamic model to establish a sense of trust, mutual respect and understanding would be vital for the scenario. The areas that require attention in such situations are namely, observation of the practice of the clinician, thus gaining a detailed understanding of the clinical and interpersonal skills of the former.
Supervising a group of clinicians- The basic principles of the psychodynamic model that will be followed while supervising a clinician group focuses on deepening the understanding of the psychodynamic frame of the group. The major approach that will be adopted in this regard comprise of employing a range of interpretation techniques that will help in addressing the personal and professional capacities of the clinicians. The phenomenon of transference is not just restricted to the dominion of psychotherapy (Watkins Jr, 2013). Efforts will be made to engage in transference, intentionally or unconsciously. Unchecked transference has the potential of wreaking havoc. Thus, all the strengths of the clinicians in the group must be addressed and they should be made aware of their own feelings, needs and experiences. Providing positive feedback to the group of clinicians will be another major step in this CS scenario.
Strengths and weaknesses- Under situations where the supervisor and the supervisee share the similar orientation, the psychodynamic approach works towards maximisation of the modelling. This is usually facilitated by the supervisor’s teaching and results in the concomitant formation of a theory is additionally combined into training. However, one major weakness is the fact that when there occurs a clash of orientations, the psychodynamic theory leads to the development of parallel processes or conflicts. Additionally, supervisors who adopt a straightforward and forthright attitude might recognise the need to fine-tune their approach while overseeing a sensitive apprentice (Norberg, Axelsson, Barkman, Hamrin& Carlsson, 2016). Under situations where alteration of the supervision style does not help, issues are often raised with the supervisee and calls the need for swapping to a new supervisor. Furthermore, Hilsenroth and Diener (2017) state thatevents that make the supervisors believe that their trainee professed that they, the administrator, had somewhat valuable to deliver to them such as, abilities or a theoretical orientation, the supervisory connexion was resilient. Enhanced relationship between the supervisor and the supervisee is also built by this CS model owing to the fact that it does notdemarcate between the trainees on the basis of their race, gender, theoretical orientation, and ethnicity (unlike the feminist model).
Conclusion- To conclude, clinical supervision for mental health specialists began as apprenticeships in other arenas. It primarily focuses on the aspect that an apprentice with negligible knowledge would absorb the work by witnessing, assisting, and getting feedback from a talented associate of the identical field. It was supposed that because the supervisor is quite decent at the work, he or she would be correspondingly good at instructing and/or supervising. Despite the fact that CS and counselling have common grounds, such as, the aptitude to involve in an interpersonal relationship, the two domains also utilize distinct and discrete skills. The psychodynamic model of supervision is one such approach that draws on clinical data characteristic to a theoretical alignment.
References
American Psychological Association. (2015). Guidelines for clinical supervision in health service psychology. The American Psychologist, 70(1), 33. doi: 10.1037/a0038112.
Beinart, H. (2013). Models of supervision and the supervisory relationship. In Supervision and clinical psychology (pp. 63-78). Routledge. Retrieved from https://www.taylorfrancis.com/books/e/9781136650727/chapters/10.4324%2F9780203805817-10
Bernard, J. M. (2014). Tracing the development of clinical supervision. In Supervision in Counseling (pp. 11-30). Routledge. Retrieved from https://www.taylorfrancis.com/books/e/9781317717683/chapters/10.4324%2F9781315785493-6
Borders, L. D., Glosoff, H. L., Welfare, L. E., Hays, D. G., DeKruyf, L., Fernando, D. M., & Page, B. (2014). Best practices in clinical supervision: Evolution of a counseling specialty. The Clinical Supervisor, 33(1), 26-44. https://doi.org/10.1080/07325223.2014.905225
Butterworth, T., &Faugier, J. (2013). Clinical supervision and mentorship in nursing. Springer. Retrieved from https://books.google.co.in/books?hl=en&lr=&id=j1H2BwAAQBAJ&oi=fnd&pg=PP7&dq=clinical+supervision&ots=wpcZYW0woU&sig=01PMbnlrBlT6YB2INwP0KLMwsI8#v=onepage&q=clinical%20supervision&f=false
Diener, M. J., &Mesrie, V. (2015). Supervisory process from a supportive–expressive relational psychodynamic approach. Psychotherapy, 52(2), 153. https://psycnet.apa.org/doi/10.1037/a0038085
Hilsenroth, M., & Diener, M. (2017). Some effective strategies for the supervision of psychodynamic psychotherapy. T., Rousmaniere, R., Goodyear, S., Miller, B. Wampold,(Eds.), The cycle of excellence: Using deliberate practice to improve supervision and training, 163-188. https://books.google.co.in/books?hl=en&lr=&id=Ka2hDgAAQBAJ&oi=fnd&pg=PA163&dq=psychodynamic+supervision+clinical+supervisor&ots=QXVUHsQVqg&sig=GO6TxSW49cUUBFwPUz31daegdVc#v=onepage&q=psychodynamic%20supervision%20clinical%20supervisor&f=false
Kristofferzon, M. L., Mårtensson, G., Mamhidir, A. G., &Löfmark, A. (2013). Nursing students’ perceptions of clinical supervision: The contributions of preceptors, head preceptors and clinical lecturers. Nurse education today, 33(10), 1252-1257. https://doi.org/10.1016/j.nedt.2012.08.017
Norberg, J., Axelsson, H., Barkman, N., Hamrin, M., & Carlsson, J. (2016). What psychodynamic supervisors say about supervision: Freedom within limits. The Clinical Supervisor, 35(2), 268-286. https://doi.org/10.1080/07325223.2016.1219896
Saleh, N. S., Yaacob, H. F., & bin Rosli, M. S. (2015). Developing Items Using by Pilot Test, Confirmatory Factor Analysis Statistical in Literacy for Communication and Supervision Clinical Elements Provider. Mediterranean Journal of Social Sciences, 6(2), 202. DOI: 10.5901/mjss.2015.v6n2p202
Sarnat, J. E. (2016). Supervision essentials for psychodynamic psychotherapies. American Psychological Association. https://psycnet.apa.org/doi/10.1037/14802-000
Simpson?Southward, C., Waller, G., & Hardy, G. E. (2017). How do we know what makes for “best practice” in clinical supervision for psychological therapists? A content analysis of supervisory models and approaches. Clinical psychology & psychotherapy, 24(6), 1228-1245. https://doi.org/10.1002/cpp.2084
Strømme, H. (2014). A bad and a better supervision process; actualized relational scenarios in trainees: A longitudinal study of nondisclosure in psychodynamic supervision. Psychoanalytic Inquiry, 34(6), 584-605. https://doi.org/10.1080/07351690.2014.924372
Watkins, C. E. (2013). The contemporary practice of effective psychoanalytic supervision. Psychoanalytic Psychology, 30(2), 300. https://psycnet.apa.org/doi/10.1037/a0030896
Watkins, C. E., &Scaturo, D. J. (2013). Toward an integrative, learning-based model of psychotherapy supervision: Supervisory alliance, educational interventions, and supervisee learning/relearning. Journal of Psychotherapy Integration, 23(1), 75. Retrieved from https://psycnet.apa.org/buy/2013-06973-005
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