Current topics of supervision in practice
Introduction
According to Yalom (2016), clinical experience in supervision is an indispensable condition for the education of a worker who works with clients. In practice, an endless number of different situations arise, and each may require a fruitful and inventive approach. It is precisely at these points that the supervisor contributes to the worker’s education in a valuable and unique way. Mátel (2013) states that supervision is among the most effective instruments of support and help for social counselors, social workers, and through them for clients themselves. In Slovakia it is among the key quality standards of social services. In this paper, we will present what the aim of supervision is and what its expected effectiveness is at the theoretical level, how the supervisor moves within the current state of social services, with what barriers they encounter in the practice of supervision, and what causes these barriers. We identify the most frequently appearing topics in supervision that are handled in practice and offer a perspective intended to show their reasons and possible ways of finding effective solutions through supervision.
For supervision to be effective, it necessarily needs a supervisory alliance. Supervision not only transmits professional skills and theoretical knowledge; it is also a model of professional values and ethics. Therefore, supervisors must strive for alignment that would result in the ability to act in mutual interaction with the supervisee with respectful conduct and care similar to what should be offered to clients by the supervisees. If we want our supervisees to act with respect, empathy, and dignity toward clients, we as supervisors must treat them in the same way. The supervisor should focus on the supervisee’s professional and clinical development and notice any blocks that may arise from ignorance or countertransference that the supervisee encounters. Supervisors are advised to listen like therapists and speak like teachers. The most effective is when the supervisor can attune to the supervisee, follow their narration, guide them through clinical dilemmas, and show personal interest and support. Supervision that is overly critical, shaming, or closed to the supervisee’s main concerns not only fails in education but also discourages the supervisee. (Yalom, 2016)
We can reach such a state, as many authors in psychotherapy, psychology, social work, and psychiatry claim, by building mutual trust between supervisor and supervisee, therapist and client, teacher and student, or doctor and patient. Where it is necessary to jointly solve major personal issues of life, among which working life is essential, where relationships are created that should be based on mutual understanding, help, support, empathy, and mutual investment in a shared high-quality relationship. Without building trust through the ability to work with oneself, perceive, understand, and accept the other, to unconditionally accept them, and to know through self-evaluation and self-awareness how to work with what happens with me in interactions with others and how this influences others, this is impossible. Therefore, the supervisor should provide supervisees through supervision with this self-insight and teach them to work with it so they can perceive their influence, as a personality, toward the client and toward colleagues. We are speaking about basic competencies of those who have graduated, for example, from higher education in helping professions or at least from basic socio-psychological trainings. Gaining this knowledge can be painful for many and naturally resisted by them. Any educator, therapist, or supervisor knows that without overcoming this possible joy at one’s own expense or pain of self-discovery, it is impossible to work with clients at a professional level, and it is also not possible to offer such workers techniques to apply to clients unless they have personally experienced and internally assessed how they themselves feel when they are on the receiving end of a technique. At present, there are many educational institutions offering various training modules, which need to be conducted through experiential learning. Their quality differs fundamentally depending on whether the purpose of education is to develop competencies in a recommended sequence, where work with intrapsychic processes begins, or whether they are meant to avoid risks that can naturally arise in work solely with oneself. In group forms of work, a group member can feel exposed and threatened. Even here, Yalom’s (2016) words apply: there is convincing evidence that from the beginning, primitive cultures, primates, and modern humans have lived in groups characterized by strong and enduring relationships among members. The need to belong is a powerful, basic, and dominant motivation. In evolutionary terms, interpersonal bonding has been clearly adaptive. No individual or species could have survived without deep, positive, reciprocal interpersonal bonds.
If we therefore want to build an effective and efficient supervision group, we must keep in mind that without group cohesion and its logical developmental sequence, we cannot achieve this. We can at best pretend, as pseudo-professionals, and perform bad theater for ourselves and others. As experts in client work, however, we must consider that the client is a sensitive being with heightened awareness, and they can detect us in this split, incongruent performance, which can negate the goal of the work—the primacy of the client’s interest.
For example, catharsis and universality are not separate processes. A simple process of emotional ventilation is not what is important, just as finding that others have problems like mine is not the most important, nor that I am not the only one lost in the world. What is most important is “sharing one’s own inner world emotionally and then having that accepted by others.” (Yalom, 2016) As further noted, when a person is accepted, they begin to question original beliefs that they are fundamentally unacceptable, unloved, and repulsive. The need to belong is innate. Group and individual relational arrangements respond to this need. A group creates a positive and self-developing cycle: trust – openness – empathy – acceptance – trust. A group accepts its member regardless of their past or social failure, as long as group norms are maintained. Disturbed interpersonal skills limit possibilities for sharing and acceptance in relationships.
Havrdová, Hajný et al. (2008) also speak about core topics in supervision and list among them building mutual relationships on the principle of self-understanding of the individual, the group, and even the whole team. They also emphasize the importance of trust and working with oneself in building the supervisory relationship in the interweaving of supervisor, supervisee, and client. They further note that topics in supervision can be acute or chronic and are usually ambiguous. If supervisees are well prepared for change and truly committed to it, supervision can illuminate the topic from multiple angles and offer a view to clarify entanglements of causes and consequences, or different relationships within the topic, and then together actively search sensitively for an exit. This is beneficial and can move unclear topics to a level of understanding of their origin, one’s own role, and one’s own contribution to them, and can lead to adopting concrete personal steps to contribute to resolution, including openly naming how others involved in the topic should contribute. Such a state, however, is possible only when supervisees are team-stabilized and relationship-stabilized and can communicate effectively and openly with one another without openness becoming a barrier to team collaboration quality.
As Hawkins and Shohet (2004) state, the helping role is accompanied by certain expectations. Identifying too strongly with this role sometimes prevents one from clearly seeing clients’ strengths, acknowledging one’s own vulnerability as a helper, and one’s own mutual dependency. As Dass and Gormen (1985, p. 28) note in Hawkins and Shohet (2004): “The more you see yourself as a therapist, the more pressure there is that someone else should be a patient.” By choosing to begin exactly here again, we say that the willingness to begin exploring one’s own motives—good and bad, including those hidden ones— is considered an essential prerequisite for our effective help. If we are sufficiently aware of what Jungians call the shadow aspects, there is a high chance we will have much less need to project onto others what we cannot accept in ourselves. A psychotic psychiatric patient need not simultaneously carry our own madness while we pretend to be absolutely mentally healthy. For example, in cancer patients who can no longer face approaching death, we may see our own fear of dying. If we focus on our own shadows, it is likely that we will be much less prone to fantasies of omnipotence, that we can change the world while unable to change ourselves. One possible aspect of one’s own shadow is the desire for recognition and praise. We should consider how often we are caught on the shadow side of helping when we allow others—and often ourselves—to think we are exceptional, creating an illusion and then experiencing disillusionment when people bring us down even one or two degrees. Our own belief that we are embodied help, and not merely conduits on the path to help, is dangerous. We crave hearing recognition for success, but not blame for failure. We find it very difficult to accept that we are merely instruments of help. On the other hand, accepting this reality is the only way to step out of the carousel of dependency on recognition and fear of blame, and at the same time to stop oscillating between feelings of helplessness and omnipotence. Non-possessiveness does not mean disinterest; on the contrary, it can bring us closest to genuine care, because we do not live for our clients and our self-worth should not depend on their successes. (Hawkins, Shohet, 2004)
With this theoretical framing, we seek to emphasize the need for the supervisee to learn to work on themselves first, before beginning to address specific supervision topics. That means that if a supervisee has not gone through such a process during their training while acquiring their competencies, it is not possible to expect that active participation in themes raised in group supervision will be sufficiently effective and that the supervisee will show enough capacity to openly address topics needed for supervisees at a time when they may not yet even realize that this is needed. The fact that they do not realize this does not mean that the hidden content in the analysis of topics may, in their minds, indicate potential weak spots in their high-quality professional functioning toward clients, themselves, and other team members. In other words, although they may present as if such weak spots were absent, in hidden content they communicate them during properly guided supervision, even if not named precisely. It is up to the supervisor to decide, both from a temporal perspective and in regard to supervisee readiness, how to work with these hidden contents. The supervisor must very sensitively weigh whether there is sufficient time and space for supervisees to concretize these hidden contents. It may happen that if the supervisor leads supervisees to concretization before they are ready, conflict will be evoked instead of understanding and acquiring problem-solving capacity; it may remain a conflict in an unprocessed and unnamed state and remain so. With this seemingly complicated introduction to the issue of current supervision topics in practice, we highlight the most important condition for effective supervision: in the early phases, the supervisor’s work must focus on creating space for the supervisee to acquire the ability to work on themselves as the first and indispensable prerequisite for any change in any topic opened in supervision. This means that the first current topic of supervision in practice is the supervisee themself and the process of building mutual trust between supervisor and supervisee and among supervisees themselves.
Identification and analysis of topics in supervision
In this section, we will present the sequence of steps that constitute the practical opening of current topics in supervision in practice. By the term supervisees in this contribution, we mean workers in functional positions such as caregiver, health care assistant, nursing attendant, social worker, physiotherapist, social rehabilitation worker, cleaner, and others who have regular client contact in social service facilities of various kinds. One option is to ask supervisees what, in their view, is working and what is not working in the current state of organizational functioning. This is also a way for supervisees to begin praising their own successes and to develop the ability, through a critical lens, to see shortcomings within the organization. In these phases, supervisees usually think for a longer time about what these questions actually mean to them. Depending on the state of team functioning and how relational bonds among supervisees operate, and possibly on the preparatory process they have gone through for open communication, their process of offering answers to the questions will proceed accordingly. If there is insufficient trust among supervisees, they will consider selectively and for a long time the contents that will lead to what is not working. Questions aimed at answers about what works tend, in conditions of mutual mistrust, to be generalized and not clearly named. An important determinant is also the degree of trust supervisees have in the supervisor. If they develop the feeling that they can communicate openly, it is expected that the number of responses about what works will be lower than responses about what does not work. That means that in the mistrust phase toward the supervisor, supervisees will try to identify what works in a way that presents them in the best possible light. A problem arises, however, if the contents of what works are too general and the supervisor rightly asks for clearer understanding of the proposed content. Then it may happen that supervisees cannot describe in detail the content they have marked as working. For example, if supervisees say that cooperation works well, when asked how good cooperation appears in practical activities they cannot answer, and may be surprised by such a question. The reason is that they present cooperation as working even though, in reality, its quality is not at the level they could identify as truly high in a safe and trustworthy environment. These statements are usually confirmed when searching for content in response to questions about what does not work. On the one hand supervisees indicate that cooperation works well, and on the other they indicate that mutual communication and the quality of relationships among staff do not work. In this way it is possible to identify fairly quickly and effectively that the quality of interpersonal relations among staff is not as high as supervisees try to present to the supervisor as fact.
In this process it is necessary for the supervisor to work with and reflect, in relation to these questions, on the supervisees’ nonverbal communication as well. This often gives far clearer and more distinct answers about team collaboration and mutual staff relationships than verbal expressions do. By way of illustration, we present responses to questions directed at the level of trust between staff. As positives, staff identify openness, capacity for discretion, mutual interest in communication, and personal responsibility. As negatives in trust they similarly identify openness, but also negative phenomena such as gossip, mutual envy, humiliation among staff, and they view the way of exercising control over staff as a negative communication pattern. From this it is entirely clear that in the early phases, where positives in trust-building are named, these contents are communicated incongruently, because identical content appears as negatives. It is therefore not possible to speak of openness as a positive if openness is also marked as a negative, just as it is not possible to speak of “positive silence” if gossip is marked as a negative. Mutual interest as a positive is equally called into question if mutual humiliation is marked negatively among staff. If personal responsibility for task performance is considered a plus, performance control cannot then be simultaneously treated as a minus.
Questions about what works lead supervisees to answers that, in social service provision—for example, in work with older adults—usually point to service tasks of a caregiving, practical nature. A short recap of what works often includes the staff’s ability to motivate clients to activity without clarifying how this is done, prevention of pressure ulcers in clients, hygiene quality, conducting group activities with clients without specifying effectiveness or meaning, the quality of nursing care, physiotherapy, and mutual collaboration among staff, again without clarifying how that collaboration works; and even implementation of quality standards without being able to clearly define individual indicators. In answers to the question of what does not work, the most common content is usually first and foremost the quality of mutual communication among staff, the way leadership handles staff, creation of adequate working conditions for staff, personnel shortages—which staff in all facilities identify as an acute issue—resulting chronic fatigue of staff, very low remuneration, staff motivation, mutual understanding, and in most responses, time for the client is usually mentioned only last. From this it follows that staff are consistently focused on performing practical tasks and consider this the key in their work. The human factor aimed at understanding the client, meeting their emotional needs, or meeting their social needs is not identified among staff as part of their work activity. We assume that genuine client-centered interest at a high professional and quality level may depend precisely on identifying these contents in the part of staff responses to what does not work. If the organization communicates toward staff a holistic approach to fulfilling care needs in a way that is sufficiently understandable, or if staff, based on communication from leadership, feel that they are not sufficiently involved in organizational functioning as an essential individual and also team component, the natural reaction is to orient themselves to caregiving and mechanical tasks in routine work and to neglect other activities that support the comprehensive fulfillment of client needs, believing they are doing as best as they can. Regarding contents about control, we can again speak of a control style oriented to caregiving actions rather than a holistic approach to the client. We also consider low wages, fairly frequent staff migration, staff demotivation, and resignation as serious issues, because the current state offers no visible solution.
If such content is written on the board in front of supervisees, there is room for questions about what they think of it when they see it there. In these phases, supervisees usually come to awareness of the reality before them. That means they can see and realize that their client interest is not as high a priority as they claim when their mutual relationships do not function and when, for example, leadership has not created a good working atmosphere. We can therefore speak of a process that leads supervisees to awareness of a reality they may previously have resisted. This reality is that unless they start addressing and resolving themselves, they cannot adequately address and resolve their mutual workplace relationships; and if this process does not take place, they cannot effectively and professionally attend to the client, despite previously believing they could. In supervision, we also consider it important to direct supervisees to identify topics of a ventilatory character, where they expect space for emotional ventilation and where the supervisor shows belongingness and understanding. They should be able to distinguish which topics can be addressed and resolved through supervision, and which topics cannot be resolved either through supervision or by themselves, thereby potentially directing their energy toward places where it can be effective and where some concrete change can be expected.
Conclusion
The topics we analyzed and explained currently occur almost identically in supervision across almost all facilities where social services are provided, regardless of who established them. These topics also correspond to the current state of social services and their position in society. We argue that if society does not understand the complexity and difficulty of staff work in social service facilities and does not create economic, social, and rehabilitative conditions that match this complexity, there is a high likelihood that the quality of services in Slovakia will inevitably be marked by reduced levels of care quality for the client. If one of the central topics for supervisees is staff shortages and reported fatigue, this is already one factor where reduced care quality can be expected. It is undeniable that if a worker is tired, they cannot maximize concentration on the performance that clients fully and rightly expect. Evidence of this is that such fatigued workers devote themselves more to caregiving and mechanical activity and less to clients from a human perspective. Clients, on the other hand, expect staff to communicate with them, handle their problems regardless of seriousness, and make time for them that they need. We also consider the relatively frequent migration of staff an important topic, because it likewise leads to declining service quality: most clients in social service facilities are attached to staff they have become used to, and too frequent changes do not suit them. Staff who change often also need time to adapt themselves to new work environments. Relational ties among staff require stability, openness, trust, and high-quality interpersonal communication. We consider this a current key factor in service quality for clients, because the way communication occurs among staff also creates the quality of the environment in which clients live.
From this it follows that all topics we analyzed are interrelated and connected. For supervision these topics are crucial, given the way and periodicity of supervision, which in best cases is conducted quarterly, somewhere only once per year, and there are still facilities where supervision has not even begun. Given the fact that supervision identifies a large number of communication bad habits and unprofessional stereotypes, the supervisor must reflect on this and create a fairly long period to work through this state. If staff cannot effectively communicate at a professional level with themselves, with their colleagues, or with clients, the level of supervision effectiveness is substantially reduced. As a solution, we see planning lifelong education that reflects the current level of professional competencies among staff and legislative requirements for quality. In the current state, there is a minimal number of facilities where staff development plans are prepared and implemented seriously. Rather, training is determined by how actively leadership is involved in staff education, how it identifies training needs, but first and foremost by the financial resources budgeted for training. The result is that staff often attend training modules that are more formal, short-term, and with no lasting effect. Our practical experience shows that supervision is an indispensable factor for social service facilities, as it can help improve staff professionalism and thereby the facility’s ability to meet individual quality indicators. This process, however, is not short-term, so periodicity and quality of supervision must match real organizational needs and not just formal requirements. For this to happen, the organization must support supervision, thereby increasing supervisee engagement in the supervision process, and the supervisor must demonstrate their competencies in ways that address these realities.
Authors: doc. PhDr. Tibor Roman, PhD. Mgr. Bibiana Ondrejková List of referenced literature
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