Thoughts on Reflection in Clinical Supervision
We went back through our archives and found this significant piece by Felicity Quirk, a psychologist who used to work with us at the ACT Group.
She highlights the importance of supervision in all lines of work and how it can be a vital safeguard against vicarious trauma and burn-out.
Regular reflection in supervision has allowed me to maintain longevity in my chosen field.
The majority of my work over the last 15 years has been with children, young people, adults and families who have experienced significant abuse and neglect. Early in my career, when working as a sexual abuse counsellor, reflection in supervision provided me with a space to consolidate my thinking, develop helpful frameworks for intervention, learn how I may be best placed to assist the people I was working with, take time to reflect on the impact of this work on me personally and prioritise self care.
In this role, I remember a specific instance when I was exposed to some information which began to impact on me personally. As I was new to the field, I thought that if I told my supervisor she might not think that I was able to manage the work. I eventually discussed this in supervision. My supervisor was understanding, normalised the impact given the material, provided a framework for understanding why this had impacted and assisted me to develop a plan to address this.
Along with the main purposes of supervision – development of expertise and skills; assisting sustainability of the work within a supportive setting; and ensuring maintenance of professional standards, when working with young people in particular – it often includes components of: Confidentiality vs. Duty of Care (particularly when ethical issues arise, for example recreational alcohol use); discussion regarding Gillick Competence (is the young person deemed to have the capacity to consent to intervention without their parental guardian’s knowledge?); and inclusion of the parents/schools/other systems in the therapy vs. the young person’s growing autonomy. I see supervision as a safe space where clinicians are able to consider, process and integrate these sometimes conflicting components and determine an appropriate course of action in light of their legal, ethical and practice considerations.
Clinical supervision also provides a helpful space to reflect on the issues a person is presenting with and how their behaviour fits within the realms of “normal” development. Particularly when working with young people who have experienced developmental trauma, I use supervision to consider not only a young person’s chronological but also their developmental age – and this assists me to tailor intervention accordingly.
“Good” supervision provides a safe space to ask the “dumb” questions (there is no such thing as a dumb question), to discuss clinical uncertainties and personal responses/impacts of the work. It is a space to ensure practice remains informed by theory, is evidence based, utilises practice wisdom and is not being influenced by personal factors. “Good” supervision has clear guidelines regarding role expectation and boundary setting – along with a way to manage any problems/issues should they arise. Supervision contracts (with timeframes for specified review) can assist with this process. A supervision contract may cover expectations of both the supervisor and the supervisee regarding: goals of supervision, expected outcomes, mutual obligations, structure, agenda, resources, preparation, records, confidentiality and how problems may be dealt with.
I find it important to be supervised by somebody I can learn from and who is able to guide me in extending my professional development. As a supervisor, I think it is imperative to ensure supervision is meeting the needs of the supervisee. It may also be helpful to offer the opportunity for clinicians to experience other models of reflective practice. For example, at the Australian Childhood Trauma Group we [now use] Balint Group supervision session for the team in order to offer clinicians different experiences/learnings in undertaking reflective practice.
As workers in the field, many of us hear about or know of vicarious trauma (also referred to as secondary stress, burnout, compassion fatigue etc). When the demands of our roles become too great, supervision can often be one of the first things to slip. It is at these times that it should be our priority to maintain it as it is then that we need it most. It is important, not only for ourselves but for our clients and the agencies within which we work, that supervision is prioritised, that uninterrupted time is provided, that it is considered a sanctuary space.
Felicity Quirk – Clinical Psychologist