Home Clinical Psychology & Psychotherapy The Supervisory Context: Building Confidence in Practice-Based Decision-Making

The Supervisory Context: Building Confidence in Practice-Based Decision-Making

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Have you ever been asked by a practice or clinical supervisor at the commencement of your session, ‘What do you want to talk about today?’ And in that moment has the question left you scratching your head, or wondering if your supervisor is really prepared? In a way it says, ‘I’m just here to listen’. I have been asked that question — many times. It’s fine as an opener. But the question doesn’t address the normative dimensions of the practitioner’s needs for professional development. Such a question can take more time to answer with less time to structure goal objectives.

‘What do you want to achieve by the end of our session today?’ This demonstrates a skilled capacity to not only encourage structure through alliance — but also links supervisory interventions to practitioner goals. This now becomes a collaborative effort: taking the clinical supervisor from just listening and reflecting, to actively selecting a model of supervision to facilitate the session. The question also permits an openness to receiving informal feedback at the end of the session. Of course this is an opportunity for the clinical supervisor to check-in on any goals met, and to self-evaluate continuing qualities in delivering their own clinical and practice supervision. When new practitioners become “stuck” on specific case presentations and are unable to decipher clinical dilemma they often seek the quickest route to a supervisor for the quickest answer. From a contextual perspective if the supervisor provides instant solutions, and if used too often — this approach can be more about maintaining dependence and self as “keeper” of clinical information. Rather than self as “facilitator” which leads to building confidence in reflective and mindful-based skills.

Certainly the quick solution is an easy format that keeps work productive, but places sole ownership of decision-making on the supervisor. In turn, I find that supervisors who allow for this (perhaps unintentionally) invalidate the practitioner’s own capacity for learning cognitive and contextual processes when considering a range of ethical decision making. Or as I refer to, building capacity and confidence in mindful clinical mapping. Using a coaching approach in clinical supervision and/or practice line management isn’t based on handing out quick solutions. Although there is a place for that approach ,  in crisis and emergency situations. The practitioner has a quick answer and follows through. Yet this approach is void of teaching which is a higher element of supervision. Based on relational frame theory applying language as intervention considers shaping the practitioner’s capacity for effective decisions in clinical practice. It is also a meaningful way for becoming the one who can “think on one’s feet”.

The coaching style in terms of leadership resonates more with building longer term capabilities across teams. And modelling a collaborative reflection-in-action style, while using language as intervention teaches the practitioner to make autonomous and well-considered decisions. There is something to be said for those who have years of human service and mental health experience — for example in the psychology, counselling, family therapy and social work fields. It is common for “good workers” to be promoted into supervisory positions with the assumption that they have the requisite skills to provide professional clinical supervision. However, clinical supervisors do need a different role orientation toward both programmes and client goals, with a knowledge base to complement a new set of skills.

While working for Relationships Australia between 2012–2015, I was seconded to an extended section of the Family Relationships Advice Line, which is a national service responding to families, relationships, separated parents with co-parenting and children’s matters. That section dealt with mediation services in a family law context where I held the position of Practice Coordinator. I had a large team of 17 family mediators’ work to oversee. With several of those practitioners located in other parts of the state of Queensland. Given limited resources on practice supervision, my presence was to say the least , a much needed resource. Initially I was struck by mediator’s ways of seeking advice and direction, and as such they were surprised when I wouldn’t give a quick answer to their queries or problems. A yes or no, or “this is what you do” type response. This was somewhat unsettling for me, but also unsettling for them , given what they had been accustomed to. In contrast, the previous line and practice manager had a pacesetter and command style which meant there was an expectation that I too would have a similar style.

Rather I’d commence by inviting the practitioner to sit, relax, and take a breath. The mere invitation to alter one’s physical position by awareness of a simple set of behaviours , begins to shape language as intervention. Asking contextual- and systems-oriented questions, meant the practitioner became a better part of the decision-making process. While the practitioner has the case information in mind and understands the presenting needs, this on-the-spot coaching style gave these practitioners permission to hop off the trundle in a fast-paced environment, by experiencing short bursts of learning while gathering tools to take away and try out.

NB: The material presented here is for informational purposes only and is not intended to be a substitute for professional advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a psychological or psychiatric condition. Never disregard professional medical advice or delay seeking it because of something you have read on the Internet.Read the full disclaimer here

Deborah Forbes is a clinical supervisor and women’s mental health therapist. Since 1995 Deborah has served in frontline and leadership practice in the child protection sector, addiction and mental health, relationships and family sensitive practice, and therapeutic mediation. Accepted into the Masters in Mental Health programme, School of Medicine at the University of Queensland, Deborah has also worked with forensic populations transitioning from tertiary mental health care to community living. Through her work in that field as a family mediation consultant, she developed several intervention programmes to address the impacts on children post separation. @DeborahJForbes



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