Supervision Workshop

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Supervision Workshop
Deborah Ford Addenbrookes Hospital

• CHCC Conference
• July 2009

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Supervision

• Introduction
• Where are we coming from?
• Hopes/expectations from this workshop?
• Outline of workshop
• Why supervision?
• What is it? What does it involve?
• Supervision in relation to the Health Care
  Setting
• Particular issues in working with trauma
• Practicalities Information about finding a
  supervisor /or training in supervision

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• What is supervision? Its a way of reflecting
  together with someone about your pastoral care
  and work its about a relationship of trust,
  where you can explore and learn together about
  some of the people and situations you encounter
  someone who helps you to see and think about
  what's going on before God and to hold it with
  you.
• Form of practice first developed amongst other
  disciplines within the Caring Professions
• Whys it taken so long in the Church?!
• Think of all the different 'supervisory'
  relationships in the Bible Moses and Jethro
  Elijah and Elisha Samuel and David Isaiah and
  Hezekiah.... not to mention Wisdom herself (and
  that's just a few from the Old Testament).
• Your experiences of supervision? Contexts?
• We all have different personalities and come from
  different settings, faiths, and stages in our
  journeys and professional lives, but perhaps its
  helpful to think honestly about what works for
  us stretches us challenges us (beyond our
  comfort zones) helps us to learn, grow, and be
  creative in our work Jesus said I have come
  that you may have life life in all its
  fullness.

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• Who and what is it that helps you to sustain
  yourself and to really grow in your pastoral
  work, care and practice?
• Think about what it is that nurtures and enlivens
  you? Deep down? When does the Spirit in you
  really come alive?
• What was the last conversation you had when you
  really came alive? And who was it with? Make sure
  you spend time with those people! (John
  ODonohue)
• Thats what good supervision should be like!
• Is that how youd describe yours?

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• What do we mean by supervision ?
• The emphasis here and the term used for
  supervision in the pastoral context (as
  contrasted to clinical) is Pastoral
  Supervision.
• There are all sorts of different understandings,
  definitions and metaphors
• Sight (Latin super over/above videre to
  see) better sight higher/deeper vision
  overseeing.
• Space a safe, boundaried, contained space
  for mutual learning, interaction and growth.
• Witness someone who is present through
  listening, seeing, hearing (to the silences and
  what is not spoken, as well as what is.
• Play- a space and relationship within which to
  play, explore and envision.
• Educational process creating a facilitating
  environment where learning/growth can happen
  together.

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• A safety net- a hammock
• Gaining perspective listening and letting a
  situation/encounter speak to reveal its
  different levels of meaning.
• A place of sharing and mutual learning- not
  necessarily about having/finding the answers
• A safety net- a hammock
• An Oasis
• Apprenticeship
• A master class
• Advocate
• Free-floating attentiveness

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• Towards a working definition
• Supervision is primarily about a relationship of
  trust and accountability before God where
  confidential material can be explored, held and
  understood. It is a contained facilitating
  environment where creativity, play and
  envisioning can happen as things are thought
  about and made sense of together where the
  perspective of another can shed new light on
  otherwise unconscious processes or levels of
  communication (by definition we are unable to see
  our own blind spots). Its aim is to help the
  supervisee to recognise and acknowledge his or
  her own part (motives, gifts and wounds) in
  order to be there primarily in/for the service
  and healing of the other (in the context of
  health care chaplaincy, the patient) and to ask
  Who is God and what are Gods purposes here?

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• What would your metaphor be?
• Do you see it as more of an art or a science?

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• It's such a gift to have a regular space to be
  myself to be honest about the good things as
  well as the things I might be finding really
  difficult to be challenged and encouraged to
  be helped to see what's going on - and to develop
  different parts of myself as fully as I can in
  order to be able to be there primarily for the
  'other' in whatever context that might be. What
  does it mean for me to be a priest in this
  situation or relationship? That's the main
  difference between Supervision and Spiritual
  Direction they're both about who God is and how
  he's at work (here), but in supervision, the
  emphasis is on the well-being of those on the
  'receiving end' of my priesthood and what
  contributes to that it's more work-centred. It's
  a place where sometimes I cry and let off steam
  but we also think and imagine and laugh a great
  deal and I always come away feeling fuller and
  better about myself and my work and God (even
  when they're going really well!). I am ministered
  to in my role as minister.

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• Supervision takes place in all sorts of
  different contexts and disciplines, which (by
  definition) influence its shape, style, and its
  primary emphasis
• Different modes of supervision (Inskip and
  Proctor Making the Most of Supervision 1995)
• Normative management issues (competency,
  ethics, procedures, policies).
• Formative through guidance, teaching,
  sharing, understanding and increasing
  self-awareness challenging, encouraging growth
  and development.
• Restorative support, encouragement, feedback,
  opportunity to let off steam and recharge
  energy, ideas, creative play, imagining,
  dreaming dreams.
• (If possible, business/management issues are
  better kept separate they easily dominate and
  prevent the supervision space being creative
  especially in a culture so shaped by management
  and production)

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• Possible tasks involved in supervision
  (adapted from Michael Carroll Counselling
  Supervision Theory, Skills and Practice (Cassell
  1996)

Monitoring administrative aspects conflicts of
role /or interest, boundaries overlapping
relationships
Consulting 2-way process How are things
going? may include exploring ways to
negotiate change
Teaching or Coaching modelling by
practice encouraging, learning, teaching,
challenging
Monitoring professional/ethical issues
accountability/ fitness- to -practice issues
(consequences named)
God
Evaluating ongoing feedback not colluding
possible report writing
Exploring and Envisioning playing, imagining,
recovering initial sense of calling/vision
Thinking and Reflecting on the dynamics of the
pastoral encounter/situation of the processes at
work and asking Who is God and what are Gods
purposes here? (Prayer?)
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• Think of the different people (groups and/or
  individuals) you supervise and are (or have been)
  supervised by and the different contexts and
  emphases in those different relationships.
• What are the key dimensions and elements for you?
• What are the advantages / disadvantages of
  in-house and/or external supervision?
• Is the provision of supervision part of your
  contract?
• Is it paid for by your employer?
• How often is it provided/recommended?

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• At the heart of all supervision is the
  relationship between the supervisor and the
  supervisee - it is unique and particular to who
  each of you are and what happens (sparks)
  between you.
• Think of Jesus and the different disciples.. and
  how he relates to them and to each of us.

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• Differentiating between
• Supervision
• Spiritual Accompaniment
• Counselling/Therapy
• (given that of course there are overlaps)
• Supervision is primarily work-centred its
  emphasis is on helping me to develop my gifts in
  order to be there as fully as possible in the
  service of the other person.
• Spiritual Accompaniment focuses on my
  relationship with God and Gods purposes in and
  through me. E.g.
• Counselling/Psychotherapy takes different forms,
  but is concerned with helping me to understand
  and grow in awareness of my self and my stuff
  my own patterns and behaviour(s) (both conscious
  and unconscious) and how they relate to my sense
  of well-being and fulfilment in life. E.g.

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• Modes of supervision (and their
  appropriateness to different developmental
  stages/levels in the supervisory relationship-
  adapted from Hawkins and Shohet Supervision in
  the Helping Professions OUP 1989)
• 1. Concentrating on the then and there of the
  pastoral situation/piece of work that is brought
  to supervision
• Diagnosis looking for expert answers/help
  (can be reassuring, but can also be an abdication
  of/undermine responsibility on part of
  supervisee) emphasis on What happened.
  Paint me a pictureso the supervisor can
  diagnose and then prescribe.
• Intervention aiming to increase
  practitioners pastoral skills through evaluating
  and exploring what worked/didnt, together with
  other options/possibilities (e.g. through
  verbatim)
• Process Exploring the processes at work and
  aiming to deepen the practitioner's insight re
  what is happening in their work. Tell me about
  the relationship/encounter? How did it make you
  feel?

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• 2. The here and now mode is about the
  supervisory relationship in the room (whereas
  the then and there approach is limited through
  only ever getting/having a presentation of the
  supervisees work)
• Supervisee-focussed concentration is on what the
  practitioner is bringing and carrying (both
  consciously and unconsciously) E.g.
• Parallel Process looking at how the here and
  now might be mirroring the then and there of
  the pastoral situation/encounter in some way.
• Supervisor focussed using the counter
  transference (how the client and supervisee
  enters into the internal experience of the
  supervisor) to inform the presenting
  situation/pastoral

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• Developmental Stages in Supervision and in the
  Supervisory relationship/process (reflected in
  the metaphors we choose)
• When they had finished eating, Jesus said to
  Simon Peter
• Feed my lambs. Take care of my sheep. Feed my
  sheep
• 
  (John 21)
• Apprentice
• Journeying craftsman
• Independent craftsman
• Master craftsman
• Specialist craftsman - E.g.s
• NB they are not linear stages we may move
  back and forth between all of these depending on
  what we are bringing to supervision and what else
  is going on for us, and it may be necessary to
  have different supervisors for different
  types/areas of work and specialty.
• (It is also interesting to think about these
  different types and stages of relationship how
  they correlate to the different modes of
  supervision and which might be appropriate when.)

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• Having supervision is one of the most creative
  and nurturing things I do and the more so as I
  go deeper into it and we grow together level
  after level. The more trust grows, the more open
  I (and we) are to different ways of working and
  exploring things together more attuned and open
  to improvisation to the prompting of the
  Spirit more open to the resonances and deep
  resources within faith and other traditions and
  Wisdom herself.

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• Issues pertinent to supervision in the specific
  context of Health Care Chaplaincy
• (speaking out of experience in acute physical
  and forensic mental health settings)
• Generally
• Pressures and ethos of medial management model
  (busy-ness task-oriented functional
  reductionist competency issues emphasis on
  the material urgency culture of suspicion and
  blame)
• i.e. Little time/space to think, reflect and be
  creative

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• Acute Physical Setting
• Physical nature of dis-ease (possible
  somatisation)
• Intensity/Pressure of work
• Demands on colleagues/team members (often already
  full of own needs)
• High frequency of trauma
• Levels emotional/spiritual distress
• No time/information with which to prepare
  (especially when called out-of-hours/sleep)
• Life-changing moments/events
• Difficulties in communication
• Caring for relatives as well as patient
• E.g.s
• Others?

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• What do we do with the depth of pain and
  suffering we meet and the ways it impacts on us?
  How do we hold it and hold hope? How do we seek
  healing for the wounds we carry so that we can
  keep being there to serve others? Who and what
  holds and heals us? If we're called to hold, our
  calling is also to be held.
• Sometimes just talking and telling someone who
  hears, understands and holds the pain, anxiety
  and cost of it all with me is enough to have it
  known and accepted and to then be able to take
  them with me after the session has ended back
  into the situations I have to face. There is a
  new sense of solidarity and togetherness I dont
  have to do it all on my own and I know that
  if/when something difficult comes up, I can hold
  it and put it to one side for my next
  supervision.

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• Particular issues in relation to Trauma
• Tendency to over-identify
• Replays of own traumas
• No warning/preparation sense of urgency
• Intensity of emotions
• Holding/staying with uncertainty/not knowing
• Complexity of family dynamics/stages
• Extreme anxiety danger of premature resolution
  rather than staying with patient/relative/member
  of staff where theyre at
• Psychologically primitive and fluctuating
  nature of emotions
• Numbness, shock, confusion, grief, despair
  (anger, guilt, denial, blame etc)
• Holding hope without raising false hope
• Difficulties in/of communicating with patient
  (levels consciousness etc)
• Others? E.g.s

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• What about the actual practice of supervision?
• (you cant really learn what supervision means
  until you are in it!)
• What tools and methods do you use/need in
  supervising and being supervised?
• E.g. More word and thought centred - such as
  verbatim theology as attention journaling
  etc.
• Or other? Images drawing story-telling
  play drama, free association, dreams etc...
  more focus on symbolic levels of meaning.
  Mutative/transformative capacity of metaphor.
• Is your supervision peer (post
  training/qualification)?
• What are the pros and cons of individual and/or
  group supervision?
• Which might be particularly helpful for you and
  why? (personality, experience, context,
  strengths/weaknesses etc)
• If there is no-one in your area, might you
  consider supervision by phone? (periodic face to
  face meetings too!)

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• Arranging for Supervision who, how, what, where,
  when?
• Some things to consider
• Who?
• APSE the Association of Pastoral Supervisors
  and Educators has recently been launched in the
  UK and will soon have a list of registered
  (and those working towards registration) pastoral
  supervisors available. Google Pastoral
  Supervisors (Home) for their website.
• What? Individual or group?
• How much do you want/need 11space/attention?
  How able/prepared are you to share the space?
  (given that we all learn about ourselves/our own
  work participating in anothers supervision)
• It is harder to find group supervision, but
  there are real advantages to this way of working
  and you might find colleagues and/ or peers
  enough to start a group (and arrange for a
  facilitator if appropriate)
• What methods and styles of working would you
  like to explore/incorporate?
• Arrange an initial interview/meeting to explore
  what you might want need/want from supervision
  and how/whether this person/group might be able
  to meet this. Remember the relationship is key
  so it needs to be someone you feel you can trust
  and is your match or fit.
• Most supervisors will suggest a trial period (3-6
  months) with a review to see how its going ( a
  2-way let out clause!)

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• Personal Supervision /or Supervision as
  Supervisor? Do you need to differentiate?
• Do you need specialist supervision for parts of
  your work? E.g.
• Cost most supervisors operate a sliding fee
  scale prices will vary depending on the region
  and the experience of the supervisor
• (20-45 ish)
• Where? In house or out?
• Setting the frame time, place, frequency of
  sessions
• length of sessions cancellations holiday
  arrangements etc.
• When? Time, frequency, length of sessions (50
  mins 60 mins more? E.g.)
• Who/What Deciding/exploring what style and
  method of supervision might be best for you
• What else?
• Look out for forthcoming edition of Practical
  Theology on Supervision (Autumn 09)

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• More information about training in supervision
  /being a supervisor
• See the APSE website (google Pastoral
  Supervision Home).
• Contact Wesley House Theological College
  (Cambridge) for details of their 3-day (?annual)
  training course entitled Empowering Ministry
  through Supervision
• N.B. .The best training for being a supervisor is
  to be in good supervision gaining experience
  (over time) of working with a number of different
  supervisors/styles in order to develop a
  portfolio of experience in order to develop
  your own self, gifts and style as a supervisor.

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• Think about it finding a wise supervisor to
  accompany you and teach you in your ministry
  you wont regret it!

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• Live Supervision?
• (Confidentiality)
• Sculpting
• In pairs
• One person to be the clay and the other to
  sculpt them into an emotion they want to
  express.
• This is then presented to the rest of the
  group, who are invited to say how this makes them
  feel.
• They are then invited to actively respond by
  changing the sculpt.
• Present and original participants (i.e. the
  sculptors and the sculpted then have the
  chance to be the clay and experience/feel the
  effects of the re-sculpting
• Being invited to tell the group how it now feels.