Current topics of supervision in practice

máj 15 2019

Abstract: Current topics of supervision in practice Supervision in Slovakia has reached a solid position and its practice is considered an effective tool to search for and utilize potential and innovation for a high quality of work with clients. Supervision has legislative support in social services and has been carried out for a few years. The current state of social services creates space for resolving topical issues of supervision in practice for workers and organizations providing this type of service. These issues serve as a mirror reflecting what it is like to work in social services, how the management functions and what the position of social services in the society is. There are many legal conditions that organizations providing social services must follow and accept so that the quality of the service is in accordance with European standards which are implemented also in recent legislation. Current topics, which are communicated by supervisees, indicate that the conditions required for meeting the quality standards are not equal and they do not reflect the actual state within organizations (especially in public services). We will introduce some issues which are frequently discussed and analysed in order to outline the actual state of social services from the perspective of supervisors, supervision and supervisees.
Key words: Supervision. Supervisor. Supervisee. Social Services. Quality

Introduction

According to Yalom (2016), clinical experience under supervision is a necessary condition for the education of an employee who works with a client. In practice, an endless number of various situations emerge and each situation may require a prolific and imaginative approach. Just in these situations the supervisor contributes to the education of the employee in a unique and valuable way. Mátel (2013) says that supervision belongs among the most effective tools of support. It helps social consultants, social workers, and through them the clients, too. In Slovakia, supervision belongs to the important quality standards of social services. In this contribution we will introduce the objective of the supervision and its estimated effectivity on the theoretical level. Furthermore, we will introduce how the supervisor understands the current state of social services, the barriers the supervisor meets during supervision and what the reasons for these barriers are. We will identify the most frequently arising topics of supervision (which are resolved in practice) and we will offer a view that should prove their reasons and possible ways of searching for effective solutions through supervision.

Supervision and its efficiency from the theoretical point of view.

For supervision to be effective, a supervising alliance is necessary. Supervision does not only transfer expertise and theoretical knowledge, but it is also a model of professional values and ethics. Therefore, supervisors must strive to achieve compliance, which would result in the ability to interact with a supervisee with the same respect and care as supervisees should provide to clients. If we want our supervisees to deal with the client with respect, compassion and dignity, we, as supervisors, have to behave in the same way with them. The supervisor should focus on the professional and clinical development of the supervisee and pay attention to any blocks that may be caused by either ignorance or counter-transference, which the supervisee comes across. It is recommended that the supervisor listens as a therapist and speaks as a mentor. The relationship is most effective when the supervisor and supervisee are on the same wavelength. The supervisor should follow the supervisee’s story, help him to get over clinical dilemmas and demonstrate personal interest and support. Supervision that is overly critical, embarrassing or does not deal with the main worries of the supervisee, not only fails in terms of education, but also discourages the supervisee. (Yalom, 2016)

Reaching such a state can be achieved by building mutual trust between the supervisor and the supervisee, between the therapist and the client, between the teacher and the pupil, or between the doctor and the patient (as many authors from the areas of psychotherapy and psychology, social work or psychiatry say). It is possible to achieve it where it is necessary to solve collectively the principal issues of life (which the professional life inevitably belongs to). Relations created in professional life should be based on mutual understanding, help, support, empathy and mutual investment into creating a mutual and good-quality relationship. However, this is not possible without building trust through the ability to work with oneself, to perceive, understand and accept the second person. Work with oneself through self-assessment and self-knowledge and work with the fact of what happens to oneself in interactions with others and how others are affected. The supervisor should provide a view of supervisees through supervision, and teach them to work with it so that they can perceive their effect of personality in a complex way, i.e. towards the client and towards their colleagues. Here, we speak about the basal capabilities of those who have gone through higher education in the service professions (or at least through basic social-psychological trainings). To acquire this knowledge can be painful for many and they may naturally resist it. Every educator, therapist or supervisor knows that without overcoming possible happiness of himself or pain from self-knowledge, it is not possible to work with the client on a professional level. Also, it is not possible to offer techniques to such an employee which might be applied on the client without experiencing them personally and judging them internally in terms of how they themselves feel in the situation of the recipient of the technique. Currently, there are many educational institutions which offer various modules of education which need to be completed in an experiential manner. However, their quality fundamentally differs according to whether the objective of education is quality which was achieved in compliance with set procedures and requirements, where the process of work with intrapsychic is the beginning of acquisition of future competencies, or whether to avoid risks which can occur during the work with oneself. In group work, a member of the group may feel a sense of revelation and feel threatened. However, even here Yalom’s words (2016) can be applied. He claims that there is convincing evidence that primitive cultures and primates as well as people of the modern era have lived from the beginning in groups (which were characterized by strong and lasting relationships among their members). The need to belong to someone represents a powerful, basic and prevalent motivation. The interpersonal link was clearly adaptive in its developmental sense. Without deep, positive and mutual interpersonal relationships the individual and species was not able to survive.

If we want to build an effective and efficient supervising group, we must keep in mind that without building group coherence in its logical sequence, we will never be able to do so. We can look like pseudo-professionals and play out an ugly theatre in front of others and ourselves. However, as experts working with clients, we must assume the clients are sensitive human beings who have an increased level of perception and they can reveal us in that bad and incongruent theatre and they can negate goals of our work – client’s interests.

For example, catharsis or universality are not separate processes. The simple process of venting emotions is not what is important, nor is the finding that others have similar problems to my own and not even that I am not the only castaway in the world. The most important thing is the emotional sharing of our inner world and its subsequent acceptance by others. (Yalom, 2016). As he further explains, the man is accepted, he begins to consider the original conviction that he is basically unacceptable, unloved and loathsome. The need to belong to someone is inborn. Relationships in the group and in the individual organization evoke this need. The group creates a positive and self-evolving cycle: trust - openness - empathy - acceptance - trust. The group will accept their member regardless of his past and social failures if he will keep to group standards. His disturbed interpersonal abilities limit the possibilities of sharing and further acceptance in relationships in the group.

Havrdová, Hajný et al. (2008) speak about basic topics in supervision. They also rank building mutual relationships on the principle of the self-concept of the individual, group or the entire team, among the basic themes. They also emphasize the importance of trust and working with oneself in building the supervising relationship in the group of the supervisor, supervisee and the client. They state that topics in supervision may be acute or chronic and mostly seem to be unclear. If the supervisees are well prepared for the change and they really care for it, the supervision may cast light on the topic from more sides - and offer a view of clarification of the interwoven causes and consequences or various relations in the topic - and then together we can actively look for a sensitive way out. This approach is beneficial and can help to resolve unclear topics on the level of understanding of the causes of their origin, own roles and commitment to it. This can lead to the realization of concrete steps to help to tackle themes, or openly say how others, involved in the topic, should contribute to the solution. However, such a situation can only be achieved when the supervisees are stabilized in the team and in their relationships, and they are able to communicate together effectively and openly without openness being an obstacle in the quality of team cooperation.

However, as Hawkins and Shohet (2004) say, the role of a helper comes with certain expectations. Falling in with this role sometimes hinders the ability to clearly see clients’ strong points, to realize one’s own vulnerability as the helper and one’s own mutual dependence. As Dass and Gormen state (1985, p.28) in Hawkins and Shohet (2004): "The more you regard yourself as a therapist, the higher the pressure on someone else to become a patient." Such a decision to start again and to willingly explore our own motives ("good and bad" and often even other ones) are regarded as a necessary precondition for effective help. If we are going to be sufficiently aware of what Jung’s followers call the dark sides, there is a big assumption - we will have a much lower need to attribute to others what we cannot accept in ourselves. A mad psychiatric patient will not have to bear our insanity while we pretend to be absolutely mentally healthy. For example, in patients who are ill with cancer and who cannot face up to the approaching death, we can see our own fear of dying. If we focus on our own shadows, we can assume that we will be much less prone to fantasies about our own omnipotence and about being able to change the world - when we are not able to change ourselves. One possible position of our own shadow is the desire for appreciation and admiration. We should think how often we find ourselves on the shadowy side of helping. When we allow others, and often ourselves, to think how exceptional we are, we create illusions, and subsequently we experience disillusionment, with people wanting to degrade us by taking us down one or two levels. Our own notion that we are the embodiment of help and not only mediators on the way towards help is dangerous. We want to hear the recognition for success, but we do not want to be blamed for failures. We find it very difficult to accept the possibility that we are just a tool for help. However, on the other hand, the acceptance of this fact is the only way to jump away from addiction on recognition and fear of blaming and, at the same time, to be able to stop thrashing between the feelings of powerlessness and omnipotence. The non-attribution of feelings does not mean a lack of interest. On the contrary, it can bring us closer to an interest in 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 above-mentioned theoretical introduction into the topic, we are trying to emphasize the need of the supervisee to learn to work on himself, rather than to start to resolve particular topics in supervision. This means that if the supervisee has not gone through such a process during his education (during the acquisition of his competencies), it is not possible to expect his active involvement in the topics of the group supervision to be sufficiently effective. And the supervisee will prove to have sufficient ability to openly resolve topics that are needed for the supervisees at the time when they have not yet realized them. However, the fact is that the supervisees do not realize this situation, does not mean that it is not indicated in uncovered contents during the topics’ analysis, which the supervisees may regard as friction in their qualitative professional approach towards the clients, but also towards themselves and other team members. This means that although the supervisees look as though there was no friction, they communicate them in hidden ways during the properly guided supervision even if they do not name them exactly. It is up to the ability of the supervisor to determine how these hidden facts will be handled in time and in terms of the preparedness of supervisees. The supervisor must consider very sensitively whether there is sufficient time and space to lead the supervisees in order to specify hidden contents. If the supervisor leads the supervisees to specify earlier than they are ready, instead of understanding and gaining the ability to find a solution, a conflict, which was supressed and unnamed, may arise and this conflict will remain due to its inability to be resolved with the supervisee. By this seemingly difficult introduction into the issues of the current topics of supervision in practice, we draw attention to the most important fact of effective supervision. This lies in the first phases of supervision and in the supervisor’s work to create a space for acquiring the ability of the supervisee to work on himself as the first and necessary requirement which will lead to a change in topics which are opened for supervision. This means that the first current topic of supervision in practice is both the supervisee and the process of gaining mutual trust between the supervisor and the supervisee and among the superviseestogether.

Identification and analysis of topics in supervision.

In this part we will introduce the sequence of steps and what the practical opening of current topics in supervision looks like in practice. Under the term of supervisees we have in mind employees in positions of a caretaker, healthcare assistant, nurse, social worker, physiotherapist, social rehabilitation worker, cleaner, and others who are in regular contact with clients in social services facilities of various type. One option is to ask supervisees what, in their opinion, works and does not work in the current state of the organization. It is also about the possibility of the supervisees beginning to boast about their achievements among themselves – and how they can gain the ability to see shortcomings within the organization through critical eyes. During these phases, the supervisees usually think long and hard about what these questions really mean to them. Depending on how good the level of their team work is, how the relationships among the supervisees in terms of team work, and which process of preparation for the capability of open communication the supervisees have gone through, the process of answers to the questions posed will follow accordingly. If there is no sufficient trust among the supervisees, they will selectively and for a relatively long time consider the contents that lead to what does not work. On the other hand, questions leading to responses to questions related to what works, will be generalized in the case of mutual distrust and will not be clearly named. An important determinant is the level of trust supervisees have in the supervisor. If they have the feeling that they can communicate openly, it is assumed that the number of reactions leading to responses to question what works will be quantitatively lower than the amount of responses leading to responses to that which does not work. This means that in the phase of ‘no-confidence’ towards the supervisor, the supervisees will try to name what works in order to be seen by the supervisor in the best possible light. However, the problem comes when the contents leading to what works is too general and the supervisor rightfully requires to better understand the contents offered. Then, there may be a situation in which the supervisees will not be able to describe the contents which they identified as the working contents. For example, if the supervisees say that the cooperation works well, then when the supervisor asks how this good cooperation is reflected in practical activities, the supervisees are not able to answer this question and they may be surprised by it. The reason for this is that cooperation is offered for verification, which in reality is not of such a good-quality that the supervisees would identify of a high quality if the supervisees were in safe and trustworthy environment. . These statements are mostly confirmed in the search for the contents to questions what does not work. On one hand, the supervisees will identify that the cooperation works well and, on the other hand, they will identify that the mutual communication does not work as well because the quality of relationships among the personnel is low. This way you can relatively quickly and effectively identify that the level of mutual relationships among the personnel is at a high quality level as the supervisees try to present it to the supervisor. In this process, it is necessary for the supervisor to work and manage to reflect also on the nonverbal communication of the supervisees in these questions. This often provides much clearer responses regarding the quality of team work and mutual relationships of the personnel than their verbal expressions. To illustrate this, we show responses to questions focusing on the level of trust among the personnel. The personnel regard the degree of openness, ability to maintain secrecy, mutual interest in communication and personal responsibility as the positive features. Compared to this, openness in trust is regarded as a negative feature, but on the other side, they regard openness as a positive feature. Simultaneously they regard slander, mutual envy and humiliation among the staff as negative features. As a negative feature they also regard the way of exercising control over the personnel, these contents are communicated incongruently, because the identical contents are identified as negative features. This means that we cannot speak about openness as a positive feature if it is simultaneously identified as a negative feature. In the case of secrecy, we cannot speak about a positive feature if slandering is identified as a negative feature. Equally, mutual interest as a positive feature is questioned if mutual humiliation among the personnel is identified as a negative feature. If the personal responsibility for the performance of activities is a positive feature, the checking of the performance of activity cannot be regarded as a negative feature.

To questions related to what works well, the supervisees respond mostly by the provision of social services such as their work with seniors, i. e. practical activities with them. A short outline of what works contains for example: the ability of the personnel to motivate clients to activity (without specifying how it is done), to prevent the bed sores of clients, improve the quality of hygiene of clients, performance of group activities with clients (without an ability to specify efficiency or their importance), and also issues of quality of nursing care, physiotherapy and mutual cooperation among the personnel (again without the ability of specifying how this cooperation works) and, for example, the implementation of quality standards without the ability of clearly naming their individual indicators. In response to the question of what does not work, the most frequent content is firstly communicated as a quality of mutual communication among the personnel, the way the management handles the personnel, the creation of sufficient working conditions, and the lack of staff which is identified by the personnel as urgent in all facilities. This results in chronic tiredness of personnel, very low remuneration and motivation, and mutual misunderstandings. In many responses, having time for the client is mentioned in the last place. From the above-mentioned results we can see that the personnel is focused on the performance of service activities in the long term and they are regarded as key in the job. The human factor leading to the understanding of the client, fulfilment of the client’s emotional needs, or the saturation of the client’s social needs is not identified by the personnel as part of the job description. We assume that the reason for the real interest in the client on a high professional and qualitative level can be hidden in responses of the personnel to questions about what does not work. If the organization does not communicate with the personnel then no holistic approach to the fulfilment of needs of care for the client is applied. If the personnel feel that the management does not sufficiently involve them in the operations of the organization, as a necessary individual and simultaneously team element, the natural reaction of the personnel is to focus on service and mindless activities at work, while other activities which would lead to the comprehensive fulfilment of a client’s needs are neglected. But the personnel think that they are doing their best. In topics related and leading to checking, we can again speak about their method, which is oriented on service activities and not on a holistic approach to the client. Also, low salaries must be regarded as a serious topic, and the relatively high migration of personnel, demotivation of personnel, resignation of personnel, because they see no solution to the current state in the short term.

If the supervisees see such content written in front of them on the whiteboard, there is space and time for questions related to what the supervisees think when they see it written in front of them. In these stages, supervisees mostly realize the fact in front of them. This means that they have a possibility to see and realize that the interest in the client is not such a priority for them as they have been saying it is, unless their mutual relations work, and if for example the management has not created a good working atmosphere. So, we can talk about the process which leads the supervisees to realize the fact they may have resisted. The fact is that if they do not start looking for a solution and they do not find a solution for themselves, they will not be able to resolve mutual relationships in the workplace, and, if this process does not take place, they will not be able to pay attention to the client effectively and on a professional level (even though they thought that they were able to do so). As an important factor in the supervision we regard the fact that the supervisees realize topics which need to be expressed and where they expect to find the space for expressing them. And they hope that the supervisor will show a sense of belonging and understanding. They should be able to distinguish which topics can be resolved through the supervision and those that they can find a solution to, and they should be able to distinguish which topics they cannot resolve both through the supervision and by themselves. They could then direct the energy where it is effective and where a certain change can be expected.

Conclusion

The topics which we have analysed and explained occur in supervision in almost all facilities where social services are provided, regardless of who their founder is. These topics correspond to the current state of social services provided and their position in the society. We state that if the society refuses to understand the complexity and demanding character of the work of personnel in facilities providing social services, and will not create economic, social, but also rehabilitation conditions that correspond to the difficulty of the work, there is a high probability that the quality of services provided in Slovakia will be inevitably affected by a lower quality of care for patients. If one of the central topics of the supervisees is the lack of personnel and tiredness resulting from this, it is one of the factors in which we can assume a lower quality of care for the patient. Undoubtedly, if the employees are tired, they cannot focus on the type of performance which the client has a right to expect. The proof of this is the fact that tired employees spend more time on service and mindless activities and less on the human approach towards clients. On the other hand, the clients will expect the personnel to communicate with them and resolve their problems, regardless of how serious they are, and will find the time for them that they need. We regard another important issue to be the relatively frequent migration of the personnel, which leads to a decrease in the quality of the service provided, because the majority of clients in social services facilities like the personnel which they have got used to - and they do not like too frequent changes. On the other hand, the frequently changing personnel need time, so that, they can adapt to the new working environment. Relationships among the personnel need stability, openness, and trust and high-quality interpersonal communication. We regard this as a topical and key preference in the quality of services provided, because the way the personnel communicate creates the quality of environment in which the clients live.

From the above-mentioned results, we can see that all of the topics we have analysed mutually influence one another and are connected. These topics are crucial for supervision with respect to the method and the periodicity of supervision. Supervision is in the best cases done on a quarterly basis, but in some places it is done only on an annual basis - and there are some facilities where supervision has not started yet. Due to the fact that supervision identifies a number of bad communication habits and unprofessional stereotypes, the supervisor must reflect this fact and must expect to take a relatively long time to deal with this. If the personnel cannot effectively (and on a professional level) communicate together, with their colleagues and with clients, the level of effectivity of supervision is substantially reduced. As a solution, we see the planning of life-long education which will reflect the current state of the personnel’s professional level and the legislative requirements for its quality. At present there is a minimum number of facilities where a personnel training plan has been seriously elaborated and performed. The personnel are more likely to be educated according to how active the management of the facility is in educating their personnel, how they have identified the training needs, but primarily according to the finances allocated for education. The result is that the personnel often take part in educational modules, which are formal, short-term and without final effect. Our practical experience indicates that supervision is a necessary factor for social services facilities, and it can help to improve the professional level of the personnel and contribute to the ability of the facility to fulfil individual quality indicators. However, this is not a short-term process. Therefore it is necessary that both periodicity and quality of supervision is on the level of real needs of the organization and not just there for formal performance. In order to ensure this, it is necessary for the organization to support the supervision, which can serve to increase the activity of supervisees so that the supervisor can demonstrate his abilities. This will lead to the fulfilment of the above-mentioned facts.

Authors:
doc. PhDr. Tibor Roman, PhD.
Mgr. Bibiana Ondrejková,PhD.

List of used literature

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