Routledge Handbook of Clinical Supervision

Fundamental International Themes

John R. Cutcliffe, Kristiina Hyrkas, John Fowler, John R. Cutcliffe, Kristiina Hyrkas, John Fowler

• Publisher: Routledge
• Year: 2010
• ISBN:
  9781136912795
• Edition: 1
• Topic: Medizin
• Subtopic: Gesundheitswesen, Verwaltung & Pflege

The Routledge Handbook of Clinical Supervision provides a global 'state of the art' overview of clinical supervision, presenting and examining the most comprehensive, robust empirical evidence upon which to base practice.

This authoritative volume builds on a previous volume, Fundamental Themes in Clinical Supervision, whilst greatly expanding its coverage. It contains nine updated and 25 entirely new chapters, focusing on both areas of contemporary interest and hitherto under-examined issues. Divided into five parts, it discusses:

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• Education and training

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• Implementation and development

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• Experiences and practice

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• Research activity

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• International perspectives.

Containing chapters on Europe, the US, Canada, and Australasia, the Routledge Handbook of Clinical Supervision has a multi-disciplinary approach to clinical supervision and includes chapters relevant to nurses, doctors, psychologists, psychiatrists and counsellors. It will be of interest to students, researchers and practitioners of clinical supervision in a range of health professions.

PART I Education, training and approaches to clinical supervision

DOI: 10.4324/9780203843437-3

3 Training for the supervision alliance

Attitude, Skills and Intention

Brigid Proctor

DOI: 10.4324/9780203843437-4

This chapter focuses on the ‘supervision alliance model’. It was originally presented in Fundamental Themes in Clinical Supervision (Proctor 2001: 25–46) and in this book we offer an edited version of the chapter. It now offers a brief description of the key components of the model, and then explores the training process the author uses and the open learning structure. Brigid Proctor’s model is perhaps the most commonly used clinical supervision model within health care. It is based on very important and seminal works and is, therefore, a classic and timeless model. For those interested in the development of the model, its antecedents and a detailed discussion of its foundational elements, it is well worthwhile to refer to the author’s exposition in Fundamental Themes in Clinical Supervision.

We believe that this is an important chapter for any practitioner interested in clinical supervision. Because the model has been very popular, not all representations of it are fair or accurate. It is then, very interesting to note that Brigid herself highlights that the principal function of her model is its supportive function. Effective supervision requires a supportive underpinning as the foundation upon which the formative and normative aspects of supervision are built.

A model geared to practice

Practitioners – of supervision and health care – need support and help in ‘seeking virtue and embracing wisdom’ in a complex and multi-cultural world. One way they can get this is by being offered regular space to reflect on their moment-to-moment practice. The picture in Figure 3.1 sketches the outline of the supervision alliance model transposed into health care settings. Editors’ comment: These values and assumptions have been discussed in detail in Fundamental Themes in Clinical Supervision (Proctor 2001: 25–46).

Contracts and agreements

The overall contract

The model emphasises that clinical supervision always involves more than two stakeholders. All have a right to be respected in the process of clinical supervision. However, the central figures are, first, the recipient of the supervision – the practitioner. In the world out there, he or she is the channel through which the service is offered – the public face of the service and a person in his or her own right. Second, there is the supervisor who is responsible for creating a climate and a relationship in which the practitioner can reflect on his or her practice within clear boundaries of freedom and responsibility.

Figure 3.1Supervision: alliance towards reflective practice.

Box 3.1 Values and assumptions of the Supervision Alliance Model

It assumes that practitioners are usually keen to work well, and to be self-monitoring, if they are brought to professional maturity in a learning environment which sufficiently values, supports and challenges them.

It values the ability to reflect on experience and practice as a major resource for life and learning.

It presumes that reflective practice can be learned – taught even – but that learners require a trusting and safe environment if they are to share their experience and practice honestly with themselves or others.

It views supervision as a co-operative enterprise between colleagues – who may (or may not) be unevenly matched in work experience or age, but who share a common humanity and common professional interests, ethics and, often, ideals.

Those clear boundaries are first set by the contract that the employer makes with the supervisor and practitioner as to the purpose and manner of clinical supervision in a particular context. This will necessarily be bounded by guidelines or codes regarding wider professional ethics and practice.

The working agreement

Within the overall contract, I suggest that a working agreement for a particular supervision alliance is made between supervisor and practitioner. At one level, its clarification and negotiation is practical, idenjpgying such key matters as responsibilities and roles, contextual factors, administrative arrangements, supervisor’s methods of working in supervision, practitioner’s developmental needs and learning goals, preferred learning styles, and supervisor and practitioner resources. At another level, it is a shared process of clarification and negotiation that begins to establish the degree of trust, safety or wariness there may be in this relationship and to shape a suitable working climate.

A working relationship

The contract and the working agreement are not seen as bureaucratic devices, but as a means of establishing sufficient safety and challenge. The overall contract signals continuing accountability to the other stakeholders in the supervision enterprise – this is both opportunity and responsibility to mature in practice and offer a better service. The working agreement signals the co-operative nature of the enterprise and the complementary roles of each party. The process of discussing and establishing the alliance is the vehicle through which an intentional and unique relationship is initiated between this particular practitioner and this particular supervisor, in this particular context.

Tasks and Tension of Clinical Supervision

This brings us to the best known feature of the model – the complementary but sometimes contradictory tasks of clinical supervision – normative, formative and restorative. In health care contexts, the constituent tasks of supervision should probably be transposed. The supervisor has responsibility for making clear his or her own criteria of good practice, and comparing that with the practitioner’s perspective. She/he may nevertheless have to decide to take things further if they consider or suspect that the practitioner continues to practice unwisely or unethically. So, for both practitioner and supervisor, clinical supervision will always be a forum where normative issues are addressed and engaged with and the supervisor may, very occasionally, become a whistle-blower (see Cutcliffe et al. 1998a, 1998b).

• Clinical supervision will be a major opportunity for professional and, hopefully, personal refreshment so the restorative task in these stressful times should, I think, be placed first. If supervision is not experienced as restorative, the other tasks will not be well done.
• Second, the opportunity to become increasingly reflective on practice, and to learn from one’s own experience and the experience of another qualifies clinical supervision as a uniquely formative process.
• Whereas in counselling contexts supervision may be the major forum of professional accountability, in most health settings there will be other places where account is rendered. Nevertheless, there will necessarily be self-monitoring elements to the work, for the practitioner. At best, clinical supervision is the safe enough setting where he or she can share and talk about practice and ethical dilemmas without jeopardising him- or herself.

By whatever means clinical supervision is distinguished and detached from formal managerial assessment procedures, this element of monitoring will be present and both practitioner and supervisor will need to recognise the tension between the restorative and the normative tasks. In training, most supervisors and supervisees find it difficult to develop the ability to manage this tension skilfully and with integrity within a single role relationship.

Role flexibility

Each task carries attendant informal roles, which will be reciprocal for practitioner and supervisor. It can be helpful for both to recognise this, because it allows them to ‘play’ at relating flexibly and appropriately to the task they are engaged in at any one time. Figure 3.1 suggests a number of complementary roles, and we have already seen that aspects of the ‘preceptor-initiate’ and the ‘mentor-evolving practitioner’ dialogue may also find a place in supervision (Morton-Cooper and Palmer 2000).

However, the overall role responsibilities are those of supervisor and supervisee (or practitioner-in-supervision) as negotiated in the working agreement for the supervision. Any settling down into a single set of roles (for instance, taking only restorative roles or falling regularly into a teacher-learner dyad) will not be fulfilling the working agreement.

Attitudes

Attitudes are the outward expression of what we value and understand. We engage in tasks with certain attitudes towards them, based on the values we consciously or unawarely espouse, and also on the understanding we have about them. A supervisor who uses this model needs to understand the underlying values of working in alliance (as opposed to hierarchically) and be prepared, at least, to test these values out in his attitude to the task. For instance, he needs to believe that agreements are co-operative, and act on that. He has to assume that the practitioner he is supervising has good will to her work, at least until he has clear evidence to the contrary. He has to understand that clarity of roles and responsibilities is a safeguard against oppressive supervisor (or supervisee) behaviour. He has to ‘act in’ to the understanding that this is a human relationship between two (or more) adult practitioners, rather than, say, a pedagogic relationship between master and pupil. A human relationship implies that either party may feel, and be, vulnerable within the relationship from time to time, so attitudes towards vulnerability need to be accepting and helpful, for the well-being of both participants and for the furtherance of the task of supervision.

The practitioner coming for supervision, in turn, has to develop certain attitudes to the task if she is to make good use of her opportunity for reflection and learning. These attitudes may be unfamiliar and countercultural. The title ‘supervisor’ has strong hierarchical connotations. A practitioner new to this kind of clinical supervision may have well-founded scepticism of being apparently trusted and valued as an equal contributor. The first initiation in clinical supervision will be crucial in allowing practitioners to get a feel for the potential of this unfamiliar process.

Interpersonal communication and reflective skill

These are examples of implications of the model’s values for appropriate attitudes. But even if supervisor and supervisee idenjpgy with those values and have a similar understanding of the tasks they are engaged in, their lack of skill in communicating in this rather unusual interpersonal arena may still defeat their intentions. Attitudes are what the ‘receiver’ sees, hears and imagines, not necessarily what the ‘protagonist’ intends or imagines. So the final strand to this model is the spelling out of specific jobs which need to be done within the o...

Table of contents

• Cover Page
• Half-Title Page
• Title Page
• Copyright Page
• Dedication
• Table Of Contents
• List of illustrations
• Editors and contributing authors
• Foreword
• Foreword
• Preface
• PART I Education, training and approaches to clinical supervision
• PART II Introducing, implementing and developing clinical supervision
• PART III The practice and experience of clinical supervision
• PART IV Contemporary research activity on clinical supervision
• PART V International perspectives and developments in the state of the science of clinical supervision
• Index