Individual Supervision Research Articles

Practitioners’ perspectives on the use of clinical supervision in their therapeutic engagement with asylum seekers and refugee clients

ABSTRACTThe present study is the first study undertaken in Australia that seeks to explore practitioners’ perspectives on the use of clinical supervision in their therapeutic engagement with asylum seekers and refugees. We used thematic analysis to analyse extracts of interviews that were conducted with nine professionals who worked therapeutically with asylum seekers and refugees and had experience of participating in individual and peer supervision. The findings of the study suggest that supervision encouraged practitioners to develop multicultural awareness and explore therapeutic ways of working that are compatible with their clients’ frame. In addition, supervision provided the context in which practitioners explored the impact of the asylum legislative framework on their clinical work and reflected upon their feelings of powerlessness and political impotence. Implications for practice that derive from supervisory needs of practitioners who work with asylum seekers and refugees are explored.

Evaluation of a model of dissertation supervision for 3rd year B.Sc. undergraduate nursing students

All English universities now offer an all degree undergraduate nursing programme. Many currently use an individual supervision model to support final year dissertation students, but with increased numbers and limited resources new models of supervision are needed. This study evaluated a mixed (group and individual) model of dissertation supervision to determine its effectiveness for a large group of undergraduate nursing students.A sample of 3rd year students and their supervisors were selected from one large university. An evaluation survey was conducted using anonymous internet-based questionnaires and focus groups. The data was analysed using Survey Monkey, SPSS and thematic analysis. A 51% (n = 56/110) response rate (students) and 65% (n = 24/37) for supervisors was obtained. The majority of students and supervisors were satisfied with the new model. There was a mixed response to the group workshops and supervision groups. Three themes emerged from the qualitative data: engaging with the process, motivation to supervise and valuing the process. The supervision process is a struggle but both parties gained considerably from going through the process.In conclusion, a mixed model of supervision together with a range of other learning resources can be an effective approach in supporting students through the dissertation process.

Physiotherapy students' perceptions of learning in clinical practice in Sweden and India

It is reasonable to assume that conditions for learning differ between universities and countries. Increased understanding of similarities and differences of student's perceptions of learning environment can be useful in the development of the physiotherapy education as well as of the profession as such. Through international comparisons the benefits and challenges of educational programmes can be made transparent and serve as base for improvement. The objective of this study is to describe and compare physiotherapy students' perceptions of their learning environment in clinical practice in India and Sweden. A questionnaire study was performed, covering physiotherapy students' perceptions of their clinical learning environment, the physiotherapy supervisor within the clinical context, their supervisory relationship and the role of the clinical supervisor at two Universities, Luleå in Sweden and Amity in New Delhi, India. Undergraduate students at two physiotherapy programmes, in New Delhi, India and in Luleå, Sweden participated in the questionnaire study. In general, both groups had high rankings of their perceptions of the clinical learning environment. The Swedish students ranked individual supervision, participation in meetings, the supervisor as a resource, being a part of the team and giving them valuable feedback higher than the Indian group. The supervisory relationship was equally satisfying in groups, providing valuable feedback and acknowledging equality and mutuality in the relationship. The Indian group ranked the supervisor as a colleague, as a support in learning, and that he/she made them feel comfortable in meetings higher than the Swedish group. Both groups had high ratings of the supervisor and the clinical learning context Participation at meetings was higher rated in the Swedish and the supervisor as a support in learning higher rated of the Indian students.

Supervision in Nursing: Latvian Sample Study

Burnout is a work related mental health impairment comprising three dimensions: emotional exhaustion, depersonalisation and reduced personal accomplishment. Preventing and reducing work related burnout is of great importance not only with regard to the quality of life of those affected or endangered, but also for preventing the economic losses which come about as a result of absenteeism and job turnover. Supervision is known to be one of protective factors of burnout and professional effectiveness. Purpose of study was to evaluate the effectiveness of supervision of nurses practicing in mental health hospital in Latvia aimed at preventing burnout. To measure burnout we used Maslach's 22-item Burnout Inventory (MBI). It is the well-studied measurement of burnout in the literature. MBI assesses emotional exhaustion, depersonalization and the lack of personal achievement. Study sample included 60 registered and practicing mental health nurses, sample was divided in 2 groups - one who were provided with group and individual supervision (n=30), and the second - control group (n=30). The experimental group received 8 sessions of supervision. The levels of burnout were assessed 2 times for each nurse - before and after supervision sessions. The data show that there is a statistically significant difference between emotional exhaustion and depersonalization indicators within experimental group participants before and after the supervisions as well as between experimental group and control group indicators after supervisions. Supervisions reduced burnout indicators in experimental group compared to control group. Supervision also was helpful for nurses to understand better themselves, their emotions and behavioral aspects of the various work issues.

Quality of Supervision as an Independent Contributor to an Anesthesiologist's Individual Clinical Value.

Although the clinical (operating room) production of individual anesthesiologists has been measured in multiple related ways (e.g., hours of direct clinical care), the same is not true for the quality of that effort. In our study, we consider the quality of clinical supervision provided by anesthesiologists who are supervising anesthesia residents and nurse anesthetists. The quality of the daily supervision can be measured reliably and validly using the scale developed by de Oliveira Filho et al. If clinical production and supervisory quality were not positively correlated, then it would be important for departments to measure the quality of clinical supervision because, essentially, the clinical value provided by an anesthesiologist would be correlated with, but not necessarily proportional to, their clinical hours. Our department sends daily e-mail requests to anesthesia residents and nurse anesthetists to evaluate the supervision provided by each anesthesiologist with whom they worked the previous day in an operating room setting. We compared anesthesiologists' clinical activity (total operating room hours) and supervision scores obtained during the first (July 1, 2013 to December 31, 2013) and last (July 1, 2014 to December 31, 2014) of 3 consecutive 6-month periods. During the first 6 months, anesthesiologists received no feedback regarding the supervision scores. During the last 6 months, there was feedback to all anesthesiologists regarding their individual supervision scores and comments provided by residents (during the preceding 6 months) and nurse anesthetists (during the preceding 12 months). Anesthesiologists' mean supervision scores were not positively correlated with their total (weekly) hours of clinical activity. For the first 6 months, the correlations were r = -0.18 among scores provided by residents (P = 0.92 for positive correlation, N = 57 anesthesiologists) and r = -0.04 among scores provided by nurse anesthetists (P = 0.70, N = 61). For the last 6 months, the correlations were r = -0.28 (P = 0.98) and r = -0.10 (P = 0.79), respectively. Pairwise by anesthesiologist, the mean supervision scores provided by residents increased by 0.08 ± 0.01 points (P < 0.0001, N = 44). The mean supervision scores provided by nurse anesthetists increased by 0.28 ± 0.02 points (P < 0.0001, N = 49). When anesthesiologists supervise anesthesia residents and nurse anesthetists, the amount of clinical work performed and the quality of the supervision provided do not necessarily follow one another. Thus, faculty supervision scores serve as an independent measure of the contribution of an individual anesthesiologist to the care of the patient. Furthermore, when supervision quality is monitored and feedback is provided to anesthesiologists, quality can increase. The results suggest that anesthesiology department managers should not only be monitoring (and perhaps reporting) the quality of their departments' level of supervision, but also establishing processes so that individual anesthesiologists can learn about the quality of supervision they provide.

Disclosure—and Lack Thereof—in Individual Supervision

Disclosure is a central component of the supervision process for supervisees and may, at times, also be a vital intervention for supervisors. I review the theoretical and empirical literature on disclosure and nondisclosure in individual clinical supervision, from both supervisees’ and supervisors’ perspectives. The review is focused primarily on supervisee nondisclosure, supervisor disclosure, and supervisor nondisclosure, and concludes with implications and recommendations for practice and research.

Triadic Supervision with Practicum and Internship Counseling Students: A Peer Supervision Approach

Accreditation standards in counseling allow triadic supervision, one supervisor meeting with two supervisees simultaneously, as a substitute for individual supervision. Research, however, has indicated that triadic sessions may complement individual and group supervision by offering unique learning opportunities not present in other supervision modalities. We describe a peer supervision approach that capitalizes on these learning opportunities while addressing some of the challenges in conducting triadic supervision (e.g., helping supervisees give constructive feedback, keeping both engaged). We include structured peer review forms used with practicum and internship supervisees and describe different supervisor roles during triadic supervision with these two groups.

Psychoanalytic Teaching by Video Link and Telephone.

In this era of global connectedness, there is great interest in using distance video platforms such as Skype and VSee, as well as the telephone, for conducting psychoanalysis and psychotherapy across geographic distance. Little, however, has been written about the use of technology for psychoanalytic education. The International Psychotherapy Institute has extensive experience in the use of videoconference and telephone technology in the teaching of psychoanalysis and psychoanalytic psychotherapy, including didactic teaching, infant observation, and individual and group supervision, with individuals and groups across the United States and overseas. Use of this technology for tele-education has facilitated the spread of psychoanalytic ideas, recruitment of psychoanalytic and psychotherapeutic trainees, and ongoing training for members living at great distances from one another and from the institute. This work is in many ways similar to ordinary psychoanalytic teaching and supervision, and yet presents significant differences in technique, opportunity, and group dynamics. Further implementation and study of this methodology can greatly aid in the dissemination of psychoanalysis in the digital age.

Is training effective? A study of counseling psychology doctoral trainees in a psychodynamic/interpersonal training clinic.

We investigated changes over 12 to 42 months in 23 predoctoral trainees during their externship training in a psychodynamic/interpersonal psychotherapy clinic. Over time, trainees increased in client-rated working alliance and real relationship, therapist-rated working alliance, client-rated interpersonal functioning, ability to use helping skills (e.g., challenges, immediacy), higher-order functioning (e.g., conceptualization ability, countertransference management), feelings about themselves as therapists (e.g., more authentic, more self-aware), and understanding about being a therapist (e.g., theoretical orientation, curiosity about client dynamics). In contrast, trainees did not change in engaging clients (return after intake or for at least 8 sessions), judge-rated psychodynamic techniques in third and ninth sessions across clients (although trainees used more cognitive-behavioral techniques over time in third but not ninth sessions), or changes in client-rated symptomatology. Trainees primarily attributed changes to graduate training, individual and group supervision, research participation, and working with clients. Implications for training and research are discussed.

The Importance of Supervision

This article is a reflection on my extended and rewarding experience of supervision. Through having a nourishing and challenging first experience of supervision I was able to be supported in the very demanding environment of a residential therapeutic community for people who had come out of psychiatric hospital. It was not only the individual supervision I had, but the ethos of the staff team which made sure my supervision time was protected, and built in as part of team supervision (staff dynamics).

The roots of Compassion and Empathy: implementing the Francis report and the search for new models of health care.

Background: The Francis report into the catastrophic failures of care in a UK NHS hospital Trust identified lack of compassion as a major factor. Developing a ‘culture of compassion’ was emphasized in the Report, but the sources and meaning of compassion and empathy were not discussed further. In this paper we consider aspects of the scientific, theological and philosophical literature covering these key subjects. Findings and discussion: Compassion is an ancient concept found in all of the World’s major religions. Empathy is the intellectual recognition of someone suffering and the emotional response to this and compassion adds in the volition to act to relieve suffering. Karl Jaspers regarded empathic understanding as essential to psychology. Medicine is both an art and a science and as health practitioners we need to be able to view people from both interpersonal and objective perspectives. Exhausted, demoralized and threatened staff cannot sustain empathy and compassion and many UK NHS staff report such feelings. Unregulated empathy can also lead to clinician burnout and failure of compassion is indeed recognized as a symptom of burnout. Empathy shows a high heritability, it develops through the first five years, supported by responsive and consistent parenting. It is asserted that compassion needs to be deeply embedded in our characters, not least through spiritual practices such as meditation, reflection, modeling and direct teaching. In healthcare, compassion is sustained by individual supervision and group reflection.Conclusion: The need for compassion and empathy in healthcare has been highlighted repeatedly since at least 1927. Individuals need support and appropriate systems to enable compassionate care to be given. The NHS in England, UK is under severe strain and the current competitive business model has led to a culture of secrecy and ‘splitting’. In our opinion, the current system is not fit for purpose.

A comparison of individual supervision at forensic, inpatient, and college counseling internship sites.

A comparison of individual supervision at forensic, inpatient, and college counseling internship sites.

Anesthesia residents' global (departmental) evaluation of faculty anesthesiologists' supervision can be less than their average evaluations of individual anesthesiologists.

Faculty anesthesiologists' supervision of anesthesiology residents is required for both postgraduate medical education and billing compliance. Previously, using the de Oliveira Filho et al. supervision question set, De Oliveira et al. found that residents who reported mean department-wide supervision scores <3.0 ("frequent") reported a significantly more frequent occurrence of mistakes with negative consequences to patients, as well as medication errors. In our department, residents provide daily evaluations of the supervision received by individual faculty. Using a survey study, we compared relationships between residents' daily supervision scores for individual faculty anesthesiologists and residents' supervision scores for the entire department (comprised these faculty). We studied all anesthesiology residents in clinical years 1, 2, and 3 (i.e., neither in the "base year" nor in fellowship). There were daily evaluations of individual faculty supervision of operative anesthesia for 36 weeks. Residents clicked a hyperlink on the invitation e-mail taking them to a secure Web page to provide their global (departmental) assessment of faculty supervision. We calculated the ratio of each resident's global (departmental) faculty supervision score (i.e., mean among 9 questions × 1 evaluation) to the same resident's daily evaluations of individual faculty (i.e., mean among 9 questions × many evaluations). All 39 of 39 residents chose to participate. The mean departmental supervision score was significantly less (P < 0.0001) than the mean of individual faculty scores. The median ratio of scores was 86% (95% confidence interval, 83%-89%). Kendall's rank correlation between global and (mean) individual faculty scores was τb = 0.34 ± 0.11 (P = 0.0032). The ratios were uniformly distributed (P = 0.64) between the observed minimums and maximums; were not correlated with the mean value of individual faculty scores previously provided by each resident (P = 0.64); were not correlated with the number of individual faculty evaluations previously provided by each resident (P = 0.49); and did not differ among the first, second, or third year residents (P = 0.37). Residents' perceptions of overall (departmental) faculty supervision were less than overall averages of their perceptions of individual faculty supervision. This should be considered when interpreting national survey results (e.g., of patient safety), residency program evaluations, and individual faculty anesthesiologist performance.

Building with purpose: Using LEGO SERIOUS PLAY in play therapy supervision.

LEGO SERIOUS PLAY is an innovative facilitated methodology, using brick building and metaphoric storytelling that has been successfully utilized in business, training, educational, family, and mentor contexts. This article explores a modifica- tion of the established LEGO SERIOUS PLAY (LSP) process as an expressive tool for use in individual and group supervision, with a targeted focus on play therapist professional identity. The article provides an overview of the LSP methodology and process, adaptations, case examples, implications for practice, and suggests areas for future research within the play therapy of practice. Slowing down, reflecting, and receiving lie at the nexus of clinical play therapy supervision. A core aim of supervision is to create an experience that encourages the development of clinical competencies, professional values, the- ory integration, and professional identity (Bernard & Goodyear, 2004). Profes- sional identity development is defined as the successful integration of personal attributes and professional training in the context of a professional community (Gibson, Dollarhide, & Moss, 2010, pp. 23-24) and is central to counseling professionals' ethical practice (Corey, Corey, & Callanan, 2010; Granello & Young, 2012). Therefore, it is in reflective play therapy supervision that devel- opment of a distinctive identity as a play therapist becomes integrated into clinical practice. The Association for Play Therapy (2014) confers the Registered Play Therapist (RPT) and Registered Play Therapist-Supervisor (RPT-S) credentials upon li- censed mental health professionals to help consumers easily identify those who have specialized experience and training in play therapy. The RPT credentialing process encourages specific supervision with a registered play therapist-supervisor (RPT-S), for clinicians seeking or maintaining the RPT credential. Recent research by Hughes-Bise (2012) posited effective supervision by a RPT-S played a vital role in furthering the professional identity of clinicians specializing in play therapy. Several authors in the play therapy supervision literature espouse the use of playful supervision techniques (Drewes & Mullen, 2008; Guiffrida, Jordan, Saiz, & Barnes, 2007; Robert & Kelly, 2010). Drewes and Mullen (2008) gathered a cross-section of experts in child and play therapy to share both knowledge and

Type of supervision does not affect attendance or physical fitness in an 8-week workplace exercise intervention

Introduction: Low cardiorespiratory fitness (CRF) and muscular strength are significant metabolic, cardiovascular andmortality risk factors. The workplace has become a key setting for physical activity promotion; however attrition rates up to 75% in workplace exercise interventions have been reported. Therefore, this study investigated the effect of providing different types of supervision in a university workplace exercise intervention on attendance and fitness levels. Methods: This pilot randomised controlled trial allocated 46 university staff (mean± SD; 37 female; aged 42.5±11 yrs; BMI 25.7±4.0 kgm−2;waist circumference84.7±12.7 cm) toeither1:1 supervised (SUP;N=22) or indirectly supervised (IND;N=24) exercise groups. The 1:1 SUP group received individual supervision each exercise session, while the IND group received supervision for safety only, with assistance provided if requested or required. Each participant completed an 8-week individually tailored moderateto-high intensity aerobic and resistance exercise program at an onsite gymnasium, based on American College of Sports Medicine guidelines. Participants were required to attend at least once a week but had the opportunity to complete up to five training sessions perweek. Total attendance (total number of exercise sessions performed), total aerobic training volume (METmin), and total resistance training load (sets× reps×weight) were calculated. Cardiorespiratory fitness was predicted using a progressive submaximal cycle test (Monark 828E, Sweden), while maximal knee flexion and extension strength were measured at 60degrees s−1 with a Biodex (Biodex Medical Systems, USA) before and after the intervention. Results: Independent sample t-tests found no significant differences between groups for age, BMI, waist circumference, CRF or muscle strength prior to the intervention (p>0.05); nor any significant differences between groups for total attendance (p=0.94), total aerobic volume (METmin) completed (p=0.73) or total resistance load completed (p=0.88) over the 8-week intervention. One-way repeatedmeasures ANOVA revealed significant improvements in CRF (p<0.001), absolute and relative kneeflexion strength (p<0.05) as well as absolute and relative knee extension strength (p<0.01). No between-group differences were found for any variable. Discussion: This study found that CRF and lower body strength improved with a short workplace exercise intervention, irrespective of the type of supervision. The supervision type did not affect exercise session attendance, or exercise dose completed. Therefore, providing 1:1 exercise supervision was not more advantageous than indirect supervision for CRF or muscular strength in a university workplace exercise intervention.

Psychoanalytic Supervision in a Heterogeneous Theoretical Context: Benefits and Complications

This paper explores the influences of a heterogeneous psychoanalytic training setting, such as the Israel Psychoanalytic Institute, on the individual supervision of trainees. While this kind of institute reduces the dangers of submission, uniformity and indoctrination, it creates its own difficulties, “the perils of diversity.” The examples offered include the impact of divergent views of analyzability; aspirations encouraged by certain theoretical models, which may be frustrated in a supervision guided by different views; and controversies regarding psychoanalytic technique, which may confuse a candidate and create inconsistency vis-à-vis the analysand. The open joint exploration of such issues, and of their influence on the supervisory process, is strongly recommended.

“Common-Fate”: Therapists’ Benefits and Perils in Conducting Child Therapy Following the Shared Traumatic Reality of War

In this study we examine the experiences of 70 therapists who treated children identified as suffering from posttraumatic distress following the shared traumatic reality of war (the Second Lebanon War between Israel and Hezbollah). The data are based mainly on qualitative research methods: focus groups, therapy narratives, and “member-checking” interviews, supplemented by quantitative data from questionnaires. Nearly all the therapists reported being affected by the war and half of them reported additional vicarious traumatization resulting from exposure to the children’s experiences. Therapy work with children was experienced as particularly challenging, yet involving high levels of work satisfaction. The perception of an intergenerational and concurrent “common-fate” between the therapists and the children contributed to increased empathy and the forming of an emotionally intense and care-giving relationship with the children. The therapy focused mostly on emphasizing the children’s strengths and building strategies for coping, and provided the therapists with a sense of agency and helpfulness. It also allowed the therapists an opportunity to rework their own traumatic childhood memories that tended to emerge unexpectedly during the sessions. Concurrently, posttraumatic distress experienced by the therapists seemed to present a potential barrier for their therapeutic availability and to lead to a defensive avoidance of the children’s painful memories. Therapists found the work itself, in addition to the use of individual psychotherapy, supervision, and peer-support to be helpful in coping with their primary and secondary traumatic reactions.

How to teach a psychiatry trainee: Individual and team supervision

Individual and group supervision of psychiatry residents are a critical vehicle to develop core competences of medical knowledge, clinical care, interpersonal communication, professionalism, practice-based learning and improvement, and systems-based practice. Effective trainee supervision involves setting clear goals, timely, specific and constructive feedback with follow-up, and a graduated approach to move the trainee from direct supervision toward autonomy.

Building Connections Through Teletechnologies to Augment Resident Training in Psychodynamic Psychotherapy

This report describes the utilization of teletechnologies for training in psychodynamic psychotherapy in a residency training program. This includes the development of a unique psychodynamic psychotherapy case conference for residents, education in a particular model of short-term dynamic psychotherapy through distance education, and the use of web-based technologies to provide individual case supervision. Evaluation forms and verbal feedback from trainees have been used as a preliminary evaluation of this program. Experience with educational models using web-based technologies have greatly enhanced the learning experience for residents beginning training in psychodynamic psychotherapy Web-based technologies can be used effectively to augment resources in a residency training program and might be considered to link programs to share resources.

Is this bank ill? The diagnosis of doctor TARGET2

We develop indicators for signs of liquidity shortages and potential financial problems of banks by studying transaction data of the Dutch part of the European real time gross settlement system and collateral management data. The indicators give information on 1) overall liquidity position, 2) the interbank money market, 3) the timing of payment flows, 4) the collateral's amount and use and 5) bank run signs. This information can be used both for monitoring the TARGET2 payment system and for individual banks' supervision. By studying these data before, during and after stressful events in the crisis, banks' reaction patterns are identified. These patterns are translated into a set of behavioural rules, which can be used in payment systems' stress scenario analyses, such as e.g. simulations and network topology. In the literature behaviour and reaction patterns in simulations are either ignored or very static. To perform realistic payment system simulations it is crucial to understand how banks react to shocks.