by Aisling McMahon
Knowing and not knowing in a complex field of practice
I started studying psychology when I was 17 years old, and began training in clinical psychology when I was 21. I emerged as a bona fide, fresh-faced clinical psychologist at 25 years old. I had eight years of study and training behind me but what did I really know about life, growth, trauma and resilience at that stage in my life? Looking back, I think very little. And yet I had my own life experience, a willingness to explore and learn, and an open heart – it was a good enough start. I also remember having a strong but simple belief in the value of someone’s experience being met in a caring, thoughtful relationship – that still seems to me to be the core of therapeutic practice. I later went on to do further training as a humanistic and integrative psychotherapist and have become involved in teaching on therapeutic theory and practice with clinical psychology trainees. I also now supervise the therapeutic work of psychology and psychotherapy practitioners, both individually and in groups. I’m 20 years older, have more life and therapeutic experience, and yet I can still wonder what do I know about life, growth, trauma and resilience at this stage in my life?
While staying with uncertainty can be uncomfortable, I believe remaining open to such questions keeps me tuned in to the quintessential complexity of humanity and of psychotherapy work. This matters for my own therapeutic practice, but also when holding the role of supervisor or trainer for other practitioners. It is inherently engaging and meaningful to work with human problems and some sophisticated maps for this work have been developed over the last century, with new therapeutic models regularly being developed. As Clarkson (1994) asserted in relation to psychotherapy work: “The natural learning cycle never ends, for everything is constantly evolving” (18). Our maps and ongoing learning are essential for our work as therapists. However, we can still be brought face-to-face with ambiguity, uncertainty and an intimate awareness of our own limits when dealing with problems of living (Skovholt & Starkey, 2010). In addition, therapeutic work is often emotionally intense and involves engaging closely with the harder, more traumatic edges of life. It is also normally carried out in privacy with clients, meaning that we have no natural opportunities for debriefing, support or feedback in relation to our work. Given these realities, engagement in regular career-long supervision, where we can be supported to open up and explore the complexities of our work, provides an essential “professional watering hole” for therapists (Grant & Schofield, 2007: 11). I greatly value such ongoing support from my own supervisor and I am glad to offer this professional resource to others.
Offering supervision for other therapists
While it is rewarding, meaningful work, being a supervisor also brings its own challenges. Hawkins and Shohet (2012) argue that supervisory work requires a “more complex ethical sensitivity” than therapeutic work (58). For instance, in addition to the supervisory dyad or group, various stakeholders are involved, such as clients, employers and professional bodies. With the exception of peer supervision, supervision also involves an imbalanced relationship between professional colleagues, given the focus on exploring the supervisee’s work and needs. This inevitably carries a dynamic of power and vulnerability, the extent of which depends on the degree of difference in professional status or experience between supervisor and supervisee, and whether there is a managerial or reporting relationship between them.
Most practitioners agree that creating a safe, trusted relationship is central in facilitating effective, satisfying supervision (e.g., Proctor, 2008; Scaife, 2009). From my experience as both supervisee and supervisor, I believe that offering some key elements as a supervisor helps to develop and maintain a safe supervisory relationship – for instance, the supervisor offering emotional presence and sensitivity, offering knowledge with humility, and valuing vulnerability as well as competence (McMahon, in press). Consistently offering these elements in a one-to-one supervisory relationship can be challenging, but offering these when supervising a group of therapists adds in further dynamics
and complexities. In this article, I would like to share some of my reading and observations in this area of work.
Supervision in a group context
Group supervision is clearly a more complex craft than individual supervision, placing demands on the supervisor to manage multiple processes at once. However, it can also offer greater accountability than individual supervision. Proctor (2008) evocatively described how group supervision “can be more rounded, lets in more light and air, and is less at the mercy of powerful, unquestioned influences and narrowness of focus” (xvi). Advantages of group supervision include the opportunity for feedback, support, validation and challenge from a number of peers; exposure to a broader range of clients, ideas and life experience; greater opportunities to use active, creative techniques; and the opportunity for group members to develop their own supervisory skills (Carroll, 1996; Hawkins & Shohet, 2012; Steen, 2012). Group supervision can also dilute the supervisor’s power and enhance supervisee openness (Akhurst & Kelly, 2006). With many psychotherapists in private practice, group supervision can also provide a “restorative opportunity in a pressured, often lonely working life – for supervisor and supervisees” (Proctor & Inskipp, 2009: 137). In practical and economic terms, it also offers an efficient way of using supervisory resources.
However, if not run well, group supervision has the potential to be an aversive experience, where learning may be inhibited (Steen, 2012). Groups can be anxiety-provoking, with a general tendency for people to feel less safe in groups than in one-to-one settings (Steen, 2012). In group supervision, group dynamics can become a preoccupation, personal growth needs can take over from client work, there can be pressure to conform to group norms, there may be too much happening for an individual supervisee to process, and supervisees have less individual time to present work (Carroll, 1996; Hawkins & Shohet, 2012). In my experience, supervising a group is complex, emotionally demanding work, while also being highly rewarding and energising. Compared to therapeutic work, supervising can seem deceptively easy at times – supervisees are less likely than therapy clients to bring chronic concerns or urgent crises, so the sense of holding is usually less charged. However, over time I have become more aware of the underlying interpersonal dynamics, needs and sensitivities in supervisory relationships. I believe that this contrast between overt simplicity and covert complexity is particularly marked with a supervision group. At times, I have found that a supervision group session nearly runs itself. However, I believe that the initial contracting work done to establish our working agreements and preferences, as well as the ongoing physical and emotional structuring and containing I do, as the group supervisor, strongly underpins a group session that runs well. In line with my experience, the literature suggests that there are some key issues that benefit from attention when aiming to establish and run a well-functioning supervisory group.
1. Carefully establishing a supervision group. There is a strong consensus that initial contracting is particularly important in group supervision, given the complex nature of groups (Carroll, 1996; Proctor, 2008; Steen, 2012). Such contracting may include the purpose, focus and key tasks of the group, the group size and membership, group boundaries (e.g., open or closed), the nature of the supervisor’s role and authority, and the group’s ground rules and methods of working (Steen, 2012). Proctor (2008) creatively depicts the levels of contracts or agreements that need discussion as a set of nesting Russian dolls:
(i) the professional contract (non-negotiable parameters such as codes of ethics, confidentiality, record-keeping and lines of accountability: the largest doll);
(ii) the group working agreement (e.g., type of group, ground rules for interacting with each other, time allocation for presenting);
(iii) the agenda for a particular group session;
(iv) the uncontracted space(the supervisor’s responsibility to decide
how to use group resources at any one time: depicted as a shadow doll);
(v) the mini-contract for a particular piece of supervision (the reflective space for each individual practitioner and their work: the smallest doll – described as “the heart of the matter”, Proctor, 2008: 66).
Taking time to establish contracts and working agreements fosters understanding, safety and trust for group members. However, some flexibility is needed too, so that goals and working arrangements can be adjusted and developed over time (Proctor, 2008).
When establishing a supervision group, it is also important to consider what type of group is both wanted and needed. Proctor (2008) describes four main group types – authoritative, participative, co-operative, and peer groups. She suggests that the type of group established may depend on the experience of the supervisor (for instance, an authoritative group, where the supervisor essentially does individual supervision in a group context, is easier for an inexperienced group supervisor as it leaves less room for group dynamics to be expressed); the supervisor’s preference and suitability for different types of leadership (such as their comfort with certainty versus creative chaos, with self-managed learning versus passing-on of expertise); the level of experience of the supervisees (for example, a co-operative group may be best for experienced practitioners, where there is a group supervisor but group members are very active co-supervisors), and the context or working culture (for instance, a peer group, where there is no group leader, may be preferred by a multidisciplinary team). I have found that it has been valuable to reflect on and respect my own preferences and needs when taking on the role of group supervisor so that I can offer a grounded and secure space for others to work and explore. I personally find an authoritative group limiting, as opening up the space for supervisees to co-supervise brings a rich dynamic to the supervisory process. However, I enjoy taking responsibility for providing a restorative space for other practitioners, so I am most comfortable as a participative group leader (where the group supervisor takes main responsibility but also supports and invites co-supervising). I find that the psychologists and therapists in my supervision groups are glad of the opportunity to hand over some responsibility, appreciating being looked after for a couple of hours.
Other practical issues, such as group membership and size, benefit from consideration when establishing a group. Optimum group size depends on a number of factors, such as the purpose of supervision and whether the group is the participants’ only source of supervision (Scaife, 2009). Generally, the larger the group, the greater the likelihood is that some supervisees will feel inhibited about being open, while a smaller group can find it difficult to sustain attendance in times of sickness or leave. Numbers of four to six have been named as optimal, allowing enough variety and enough intimacy (Proctor, 2008; Scaife, 2009). I have found the ideal group size to be five to six participants as this is still intimate enough for safe sharing, while a group of four or less can lead to cancelled meetings.
In terms of group membership, both homogeneity and diversity are valuable. While group diversity can encourage participants to think flexibly about their work, some similarity in theoretical orientation, type of client work or professional culture does foster understanding and a sense of shared goals (Steen, 2012). In even quite homogenous professional groups, there will still normally be some diversity in age, gender, class, competence, experience, and emotionality. In my experience, the potential this diversity offers to facilitate greater awareness, understanding and tolerance is a powerful feature of a supervisory group.
2. Forewarned is forearmed – understanding the dynamics of groups. Groups generally elicit stronger feelings than one-to-one sessions. Managing this emotional energy is an important part of group supervision so that it becomes a resource rather than “an unruly animal that has to be tamed and controlled” (Hawkins & Shohet, 2012: 180). The importance of managing, and the potential dangers of ignoring, the emotions and dynamics of groups are frequent themes in the literature (Steen, 2012). Rosenthal (2005) offers a daunting description of the primitive nature of group processes:
Therapists in supervisory and training groups have no immunity to the whole range of resistances encountered in therapeutic groups. They monopolise; are silent; neglect silent members, seek to defeat the group leader or attempt to become his or her favourite; discuss sexual material for the purposes of titillation; seek to expel new members; form subgroups; come late or have unexplained absences, and breach confidentiality (177).
Most groups, however carefully set up, wittingly or unwittingly expose such primitive behaviour and people tend to approach new groups with a mixture of anxiety and anticipation (Proctor, 2008). As groups tend to be re-stimulating for most people, bringing us back to early family or school experiences, Proctor (2008) suggests that the supervisor works to make an alliance with the adult in each group member, while being sensitive and respectful to the more primitive child. Various needs will get triggered for group members, such as the need for protection, challenge and stimulation, risk-taking, safety, closeness, separateness, and so on. Proctor (2008) wisely suggests that if the supervisor refrains from getting too caught up in tackling these underlying needs, he or she can help the group acknowledge the primitive forces at work with some acceptance and humour, encouraging group energy to be consciously redirected to the supervisory work. In contrast, if the supervisor gets too involved in pointing out primitive processes and individual needs, both individual and group energy may get lost in self- protection. I think most group supervisors would agree that finding the right balance here is one of the most challenging aspects of this work.
Developing a good understanding of group dynamics helps – maps and frameworks can then be drawn on as possibilities to explain and normalise group experiences and interactions. For instance, Tuckman’s (1965) early framework is still widely used, identifying group stages of forming, storming, norming, performing and mourning. Offering another map, Steen (2012) advocates that the group supervisor works to keep three main group needs in balance – task needs (the supervisory work), maintenance needs (good working relationships and group climate), and individual needs (for instance, to be recognised, to belong, to exercise power and influence; Adair, 1983: in Steen, 2012).
Another framework draws from Bion’s (1961, 1974: in Proctor & Inskipp, 2009) model of unconscious processes, naming four categories of group climate – insecure and task oriented (angry group), insecure and relationship oriented (disappointed group), secure and task oriented (sensible group), and secure and relationship oriented (solidarity group; Ogren et al., 2001: in Proctor & Inskipp, 2009). Proctor and Inskipp (2009) argue that when a group engages in dysfunctional ‘Bion groups’ their task is not clear, is too difficult, or there are underlying agendas that are not voiced. They suggest that the best strategy is to bring the process into consciousness and help the group discuss unrecognised difficulties. Revisiting the professional contract and working agreement may also be necessary to check if there is enough shared desire to come back to the group’s initial intention to do supervisory work.
3. Engaging fluidly with multiple roles. The group supervisor needs to be a master multi-tasker, managing a number of simultaneous processes – facilitating a space for individuals’ reflective supervision, facilitating group responses, attending to group dynamics and development, and managing group boundaries, time and task (Hawkins & Shohet, 2012). In a single session, the group supervisor may find him or herself taking on the role of “negotiator, teacher, trainer, model, conciliator, umpire, director” (Proctor, 2008: 71) – moving flexibly and appropriately between these roles involves considerable skill and presence of mind. In addition, Proctor (2008) asserts that the group supervisor needs to learn how and when to move between “active leadership, engaged receptivity and calm assertiveness” (73).
Catching the essence of the group supervisor’s responsibility, Proctor and Inskipp (2009) note that “the conscious and unconscious making of choices among a welter of possibilities is at the heart of the job” (141). Group supervisors need to be able to prioritise but also be flexible, be able to work in an intuitive way, getting a ‘feel’ for what is happening, and to have a trust in their own spontaneity (Proctor, 2008). In tune with this, I have found that making more instinctive than thought-out decisions has often been necessary – if I wait to think about it, the opportunity to catch something important often passes. As Proctor (2008) suggests, the supervisor can (and should) reflect later on intentions, meanings and consequences in order to get a deeper understanding of the group work and their own responses. Having a good understanding of group processes, and maintaining clarity about the intentions, needs and working preferences of the particular supervision group can offer a grounding for making good intuitive choices as a supervisor.
4. Having clear roles and a shared sense of purpose. Hawkins and Shohet (2012) observe that the effective working of any group is dependent on goodwill and having a shared sense of purpose, a “collective endeavour” (184). In a supervision group, this normally includes an intention to sustain or improve the quality of supervisees’ work, through offering reflective, discursive space, support and opportunities for continued learning. Revisiting the ground of this shared purpose can be worthwhile at times, to consider how well the group is meeting its needs.
Enabling supervisees to develop clarity and comfort in their roles while engaging in this shared endeavour is another key aspect of managing an effective supervision group. Group supervisees can have four identified professional roles in the group – that of supervisee (needing skills in presenting one’s work in an accessible and economic way), practitioner (being able to identify one’s own personal and professional development needs), group member (needing to have good group manners) and co-supervisor (needing skills in offering clear, sensitive and constructive feedback: Proctor & Inskipp, 2009). Clarity about what is expected can avoid problems due to a lack of understanding about roles, priorities and preferred means of engagement or feedback (Proctor & Inskipp, 2009). While these issues need to be discussed during contracting, it remains the case that actions speak louder than words, the group supervisor having a powerful modelling role. For instance, group supervision has been described as being prey to “competitive attempts to come up with clever or insightful case formulations” (Safran & Muran, 2000: 216). To counteract this, the supervisor needs to help create an environment where ‘not knowing’ is valued as much as knowing, so that creativity and hidden meanings can emerge (Noack, 2009). This means the supervisor has to consciously work on letting go of his or her own needs to be knowledgeable or infallible (Safran & Muran, 2000). I have had moments as a group supervisor where I have been confused, have overlooked needs or have become stuck when acting as therapist in a role play. In those moments, I have felt the vulnerability of ‘getting it wrong’ or ‘not knowing’ in the public space of a group, but I have also trusted the potential in these experiences for learning about myself, about the group members or about the dynamics of the clients being discussed – I have found that my own willingness to trust the journey through ‘not knowing’ helps to create greater safety and freedom for supervisees to do so too.
5. Enjoying the creativity and life of groups. Finally, I want to name and celebrate the vitality of groups, there being great emotional and creative energy available in a group context. Working with drawing, concrete materials and guided imagery opens up intuitive knowing and capability in group members. As Carroll (2011) has asserted, supervision and therapy involve both art and science. Engaging in creative exercises recognises the artistic side of our work and can refresh our spirits. Holding our clients’ traumas and needs is serious work but counterbalancing this with a lighter energy helps to maintain resilience and vitality for our practice. There is great potential to play in a group, once enough safety is established to do so. Learning in a spontaneous, creative and playful way with our peers can greatly enhance our enjoyment, competence and effectiveness (Carroll & Gilbert, 2011).
I find working as a supervisor to be deeply satisfying and rewarding. In line with others, I appreciate how supervision sustains resilience and supports therapists to continue to learn and flourish so they spend more time working at their best (Hawkins & Shohet, 2012). In the last few years I have started working as a group supervisor and have experienced the greater complexity and challenge in working with groups. Compared to individual supervision sessions, I find that I need to spend more time grounding and preparing myself emotionally before a group arrives, so that I am ready and balanced to meet the various emotional energies and needs that will arrive into the room. However, I am glad to do so – the vitality in this more complex living system also feeds energy back into my own practice. Working with this vitality requires flexibility, creativity, balanced attention and communication skills, a good awareness of group dynamics, and a willingness and ability to make intuitive decisions; a tall order, but one that can most usefully be met with some humility and a lightness of touch. As in all my work with the complexity of people’s needs, I again feel that quintessential mix of knowing and not knowing, ability and vulnerability, as I inhabit and hold the role of group supervisor. I have much to learn, and yet I offer supervision with a belief in its value, bringing my own life experience, a willingness to learn and explore, and, most importantly, an open heart – and I trust that is a good enough start.
Aisling McMahon is a Humanistic and Integrative Psychotherapist and Clinical Psychologist in private practice in Lucan, Co. Dublin. Contact details can be found at www.aislingmcmahon.com
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