According to Yalom (2016), clinical experience under supervision is a necessary condition for preparing a professional who works with clients. In practice, an endless number of varied situations arise, and each may require a resourceful and imaginative approach. It is precisely in such situations that the supervisor contributes to the employee’s learning in a unique and valuable way. Mátel (2013) states that supervision belongs among the most effective tools of support. It helps social consultants, social workers, and through them clients as well. In Slovakia, supervision is part of the key quality standards in social services. In this contribution we introduce the objective of supervision and its estimated effectiveness at the theoretical level. We also discuss how the supervisor understands the current state of social services, the barriers encountered during supervision, and the reasons for these barriers. We identify the topics that arise most frequently in supervision (and are therefore resolved in practice), and we provide a perspective that should clarify their causes and possible ways to find effective solutions through supervision.

For supervision to be effective, a supervisory alliance is necessary. Supervision does not only transfer expertise and theoretical knowledge, but also models professional values and ethics. Therefore, supervisors must strive to achieve congruence, which allows them to interact with a supervisee with the same respect and care that supervisees should provide to clients. If we want our supervisees to work with clients in an attitude of respect, compassion, and dignity, then we, as supervisors, must behave in the same way toward them. The supervisor should focus on the supervisee’s professional and clinical development and pay attention to any blocks that may arise from either ignorance or countertransference. It is recommended that the supervisor listens like a therapist and speaks like a mentor. The supervisory relationship is most effective when supervisor and supervisee are on the same wavelength. The supervisor should follow the supervisee’s narrative, help them overcome clinical dilemmas, and demonstrate genuine interest and support. Supervision that is overly critical, shaming, or that does not address the supervisee’s central concerns fails in educational terms and may also discourage the supervisee. (Yalom, 2016)

Reaching such a state can be achieved by building mutual trust between supervisor and supervisee, therapist and client, teacher and pupil, or doctor and patient—as many authors in psychotherapy, psychology, social work, and psychiatry suggest. It is possible when there is a shared task of solving fundamental life issues (to which professional life inevitably belongs). Relationships in professional life should be based on mutual understanding, help, support, empathy, and mutual investment in a good-quality relationship. However, this is only possible through trust-building, which depends on one’s ability to work with oneself, to perceive, understand, and accept another person. Working with oneself means engaging in self-assessment and self-knowledge, and examining what happens to oneself in interactions with others and how one is affected by those interactions. The supervisor should provide supervisees with a supervised perspective on themselves and help them work with it so they can understand their personality effects in a complex way—both in relation to clients and to colleagues. Here we are speaking of the basic competencies acquired by those who have completed higher education in the helping professions (or at least basic socio-psychological training). Acquiring this knowledge can be painful for many and is often met with resistance. Every educator, therapist, or supervisor knows that without working through personal gratification or the pain of self-knowledge, it is impossible to work with clients on a professional level. It is also not possible to teach techniques to an employee if they have not personally experienced and internalized how those techniques feel from the client’s position.

There are now many educational institutions offering diverse training modules that require experiential completion. However, their quality differs fundamentally, depending on whether the educational goal is true quality achieved through compliance with established procedures and standards, where intrapsychic work is the beginning of future competencies, or whether the focus is primarily on avoiding risks that can arise when working with oneself. In group work, a group member may experience insight and may also feel threatened. Even here, Yalom’s words (2016) are relevant. He argues that there is convincing evidence that even in primitive cultures and among primates, and still today, people have always lived in groups characterized by strong and enduring relationships among members. The need to belong to someone represents a powerful, basic, and widespread motivation. Interpersonal bonds have long been adaptive in developmental terms. Without deep, positive, mutual interpersonal relationships, individuals and the species could not have survived.

If we want to build an effective and efficient supervisory group, we must remember that without establishing group coherence in a logical sequence, this will not happen. We can appear as pseudo-professionals and perform an awkward performance for others and for ourselves. Yet, as practitioners working with clients, we must assume that clients are sensitive human beings with a high level of perception; they can reveal this false and incongruent performance and may undermine our goals—namely the client’s interests.

For example, catharsis and universality are not separate processes. Simply venting emotions is not central, and neither is the discovery that others have similar problems. Even saying “I am not the only castaway in the world” is not the essence. The most important element is emotional sharing of our inner world and subsequent acceptance of that sharing by others. (Yalom, 2016) He further explains that when a person is accepted, they can begin to revise the old conviction that they are essentially unacceptable, unloved, and loathsome. The need to belong to someone is inborn. Group and organizational relationships evoke this need. The group generates a positive, self-reinforcing cycle: trust — openness — empathy — acceptance — trust. The group can accept a member regardless of past and social failures if the member respects group standards. The person’s impaired interpersonal abilities limit the possibility of sharing and, consequently, acceptance within group relationships.

Havrdová, Hajný et al. (2008) discuss basic topics in supervision, including the building of mutual relationships based on the individual’s, group’s, and whole team’s self-concept as one of the core themes. They also emphasize trust and self-work in building the supervisory relationship among supervisor, supervisee, and client. They state that topics in supervision can be acute or chronic and are often unclear. If supervisees are prepared for change and genuinely care about it, supervision can illuminate a topic from multiple perspectives and offer clearer understanding of intertwined causes and consequences and relational processes; then we can actively seek a sensitive path forward together. This approach is beneficial and can help resolve unclear topics by clarifying the origins of problems, one’s own role, and one’s commitment to change. It can lead to concrete steps for addressing themes, and to openly identifying what others involved should contribute to solutions. However, this is possible only when supervisees are stabilized within the team and within relationships, and can communicate with one another effectively and openly, without defensiveness becoming an obstacle to teamwork quality.

However, as Hawkins and Shohet (2004) note, the helper role carries certain expectations. Identifying strongly with this role can sometimes hinder clear recognition of clients’ strengths, one’s own vulnerability as a helper, and one’s own interdependence. As Dass and Gormen state (1985, p. 28), as quoted in Hawkins and Shohet (2004): “The more you regard yourself as a therapist, the higher the pressure on someone else to become a patient.” Choosing to begin again and to explore our motives—even the “good and bad” ones and often others—is a required precondition for effective help. To become sufficiently aware of what Jung’s followers call the shadow side, one assumes a significant premise: we will be less likely to project onto others what we cannot accept in ourselves. A psychotic patient should not be forced to carry our own madness while we pretend to be perfectly sane. For example, when working with patients with cancer who cannot face approaching death, we may encounter our own fear of dying. If we focus on our shadows, we are less likely to become consumed by fantasies of omnipotence and the illusion that we can change the world when we cannot even change ourselves. One possible shadow position is the need for appreciation and admiration. We should consider how often we place ourselves on the shadowy side of helping. When we allow ourselves—and others—to see us as exceptional, we create illusions, followed by inevitable disillusionment when others try to “bring us down” one or two levels. Our own belief that we are the embodiment of help, rather than facilitators toward help, is dangerous. We want recognition for success but avoid blame for failure. It is difficult to accept that we are merely instruments of help. On the other hand, accepting this is the only way to step out of dependence on recognition and fear of blame, and to stop oscillating between feelings of helplessness and omnipotence. Non-attribution of feelings does not mean lack of care. On the contrary, it can enable genuine care because we do not live only for our clients, and our self-esteem does not depend on their success. (Hawkins, Shohet, 2004)

With this theoretical introduction, we emphasize the supervisee’s need to learn to work on themselves rather than expecting to resolve individual themes in supervision. This means that if supervisees have not gone through such a process during training, especially when developing competencies, it is unrealistic to expect them to participate effectively in supervision topics. Supervisees may still appear sufficiently capable of discussing topics in group supervision, but this does not necessarily mean that the participation is truly effective. The fact that supervisees do not fully realize this does not mean it is absent; unresolved content often appears in topic analysis and can be experienced as friction in their professional work quality—not only toward clients but also toward themselves and team members. This means that although supervisees may not overtly resist, they communicate this friction in subtle ways during well-guided supervision, even if they cannot name it directly. It is up to the supervisor to determine how and when these hidden contents will be addressed, in relation to the supervisees’ readiness. The supervisor must decide sensitively whether there is sufficient time and space to guide supervisees in making hidden content explicit. If the supervisor pushes supervisees to name this content before they are ready, conflict that has been suppressed and unnamed can surface and remain unresolved. Through this seemingly difficult discussion of current supervisory topics in practice, we highlight a central fact of effective supervision: in the first phases of supervision and in the supervisor’s work of creating a space in which supervisees develop the ability to work on themselves. This is the first and necessary condition for eventually changing the topics opened in supervision. This means that the first current topic of supervision in practice is both the supervisee and the process of building mutual trust between supervisor and supervisee, and among supervisees together.

Identification and analysis of topics in supervision.

In this section we present the sequence of steps and what the practical opening of current topics in supervision looks like in real practice. By “supervisees” we mean employees in roles such as caretaker, healthcare assistant, nurse, social worker, physiotherapist, social rehabilitation worker, cleaner, and other staff in regular contact with clients in different types of social service facilities. One option is to ask supervisees what, in their opinion, works and what does not work in the current state of the organization. It is also about whether supervisees can begin to acknowledge their own achievements among one another, and how they can gain the ability to identify shortcomings in the organization through a critical lens. In these phases, supervisees usually reflect deeply on what these questions actually mean to them. Depending on team functioning, the quality of interpersonal relationships among supervisees, and the degree of preparation for open communication, the quality of responses to these questions will vary accordingly. If trust among supervisees is low, they will, over a relatively long period, selectively focus on what does not work. Conversely, questions that invite responses about what works tend to be generalized under mutual distrust and remain unnamed or vague.

An important determinant is the level of trust supervisees place in the supervisor. If they feel they can communicate openly, the number of responses about what does not work is usually greater than responses about what works. This means that in the phase of low trust toward the supervisor, supervisees may present what works in a positively colored way, trying to appear in the best possible light. However, the difficulty arises when what works is too general and the supervisor reasonably asks for clarification. Then there may be a situation in which supervisees cannot describe those “working” contents in concrete terms. For example, if supervisees say cooperation works well, when the supervisor asks how this is reflected in everyday practice, supervisees may be unable to answer and even be surprised by the question. The reason is that cooperation has been stated without real evidence, and in reality it is not of such quality that supervisees would identify it as high quality in a safe and trusting environment. Similar patterns are confirmed when explore what does not work. On one hand, supervisees identify that cooperation works; on the other hand, they report that mutual communication does not work well because interpersonal relationship quality among staff is low. This allows for relatively quick and effective identification that the actual quality of interpersonal relations is not as high as supervisees initially present it to the supervisor. In this process, the supervisor should also attend to supervisees’ nonverbal communication. This often provides clearer evidence of team functioning and mutual relationships than verbal responses alone.

To illustrate this, we show responses to questions about levels of trust among staff. Staff identified openness, ability to keep confidentiality, mutual interest in communication, and personal responsibility as positive features. In contrast, openness in trust was also identified as a negative feature, while on the other hand it was also seen as positive. At the same time, slander, mutual envy, and humiliation among staff were identified as negative features. The use of control over staff was also perceived as a negative feature, and these contents are communicated inconsistently because the same content can be identified in both positive and negative terms. Thus, we cannot treat openness as a positive feature if it is simultaneously defined as negative, and we cannot treat secrecy as positive if slander is also present. Likewise, mutual interest cannot be considered positive if mutual humiliation is also identified, and if taking personal responsibility for performance is positive, then checking performance cannot simultaneously be treated as negative.

When asked what works well, supervisees primarily mention direct service tasks, such as work with seniors—the practical activities with them. A brief list of “what works” often includes, for example, staff members’ ability to motivate clients to activity (without specifying methods), prevent pressure sores, improve clients’ hygiene, carry out group activities with clients (again without indicating effectiveness or importance), quality of nursing care, physiotherapy, and mutual cooperation among personnel (usually without explaining how this cooperation actually functions), and, for example, implementation of quality standards without clearly naming specific indicators.

In response to “what does not work,” the most frequent content concerns the quality of mutual communication among staff, management style, inadequate working conditions, and staff shortages, which are considered urgent issues across facilities. These conditions lead to chronic fatigue, very low remuneration and motivation, and misunderstandings among colleagues. In many responses, having enough time for clients is mentioned last. From these results, it is clear that personnel tend to focus on service delivery tasks and view those as central to their role. The human dimension of understanding client needs, meeting emotional needs, and attending to social needs is not recognized as part of their role description. We assume that genuine professional interest in the client at a high-quality level may be hidden in what staff identify as “what does not work.” If the organization does not communicate with personnel as necessary participants, no holistic approach to client care is applied. If personnel feel that management does not sufficiently involve them in organizational operations as individual and team actors, their natural response is to focus on service and routine tasks, while activities that would support a comprehensive fulfillment of client needs are neglected. Yet staff often believe they are doing their best.

In topics focused on checking and reflection, their method again appears to be oriented toward service activities, not toward a holistic client approach. Low salaries are also a serious issue, as are the relatively high migration (turnover) of staff, demotivation, and resignation, as employees see no short-term solution to the current situation.

When supervisees see such content written on a whiteboard, there is space and time to ask what they think as they see it presented. In these stages, supervisees usually realize what is before them. This allows them to see and acknowledge that client-centered interest may not be as high a priority as they believed—unless their mutual relations function well and management has created a supportive atmosphere. We can thus observe a process through which supervisees recognize previously resisted realities. If they do not begin looking for solutions and developing solutions themselves, they will not resolve workplace relationships, and without that resolution they will not be able to attend effectively to clients on a professional level, even if they previously believed they could. A key factor in supervision is that supervisees identify topics they need to express and trust that they can express them in the process. They expect the supervisor to demonstrate a sense of belonging and understanding. They should be able to distinguish which topics can be resolved through supervision and those for which they must find solutions themselves, and those that cannot be resolved in either way. They can then direct their energy where change is possible and effective.

Conclusion

The topics we have analyzed and explained occur in supervision in almost all facilities where social services are provided, regardless of who founded them. These topics reflect the current state of social services and their place in society. We argue that if society refuses to understand the complexity and demanding nature of personnel work in social service facilities, and does not create economic, social, and rehabilitation conditions commensurate with the difficulty of that work, there is a high likelihood that service quality in Slovakia will inevitably decline, resulting in lower quality care for clients. If one of the core topics among supervisees is staff shortages and fatigue resulting from this, we can infer a risk factor for reduced client care quality. If employees are exhausted, they cannot focus on the level of performance clients are entitled to expect. The evidence is that fatigued staff spend more time on routine service tasks and less on the human approach to clients. On the other hand, clients expect staff to communicate with them and address their problems, regardless of severity, and to provide the time needed.

Another important issue is the relatively frequent turnover of staff, which lowers service quality because most clients in social service facilities become attached to known personnel and do not respond well to frequent changes. Staff who come and go also need time to adapt to new workplaces. Relationships among staff require stability, openness, trust, and high-quality interpersonal communication. We consider this a central and key determinant of service quality because the way personnel communicate shapes the quality of the environment in which clients live.

From the above-mentioned findings, we can see that all analysed topics influence one another and are interconnected. These topics are crucial for supervision concerning both method and periodicity. In the best cases, supervision is conducted quarterly, but in some places only annually, and some facilities have not yet begun supervision at all. Because supervision often identifies poor communication habits and unprofessional stereotypes, the supervisor must recognize this and expect to spend a relatively long time working through it. If personnel cannot communicate effectively and professionally with each other and with clients, the effectiveness of supervision is substantially reduced. As a solution, we see planning life-long education that reflects current personnel competence and legislative quality requirements. At present, only a small number of facilities have a seriously developed and implemented personnel training plan. Personnel are more likely to be educated depending on how actively facility management invests in staff training, how needs are identified, but primarily according to available educational funding. As a result, staff often participate in formal, short-term training modules with no lasting effect. Our practical experience indicates that supervision is a necessary component of social service facilities and can help improve personnel professional level, contributing to fulfillment of individual quality indicators. However, this is not a short-term process. Therefore, it is necessary that both supervision frequency and supervision quality correspond to the real needs of the organization, not merely to formal compliance. To ensure this, the organization must support supervision so that supervisees’ activity is strengthened and the supervisor can demonstrate professional competencies. This will help realize the facts discussed above.

Authors: doc. PhDr. Tibor Roman, PhD. Mgr. Bibiana Ondrejková,PhD. List of used literature

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HAWKINS, P., SHOHET, R. 2004. Supervision in the Helping Professions. Praha: Portál. 2004. 208 s. ISBN 80-7178-715-9

HAVRDOVÁ, Z., HAJNÝ, M. et al. 2008. Practical Supervision, a Guide to Supervision for Beginning Supervisors, Managers and Recipients of Supervision. Praha: Galén, 2008. 213 s. ISBN 978-80-7262-532-1

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YALOM, I., LESZCZ, M. 2007. Theory and Practice of Group Psychotherapy. Praha: Portál. 2007. 648 s. ISBN 978-80-262-1073-3