Clinical Supervision Activities for Increasing Competence and Self-Awareness

Roy A. Bean, Sean D. Davis, Maureen P. Davey, Roy A. Bean, Sean D. Davis, Maureen P. Davey

• Publisher: Wiley
• Year: 2014
• Print ISBN: 9781118637524
• eBook ISBN: 9781118827918
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Cultivate self-awareness, empathy, and clinical competence in the mental health professionals you supervise

Providing tested guidance for clinical supervisors of mental health professionals, editors Roy A. Bean, Sean D. Davis, and Maureen P. Davey draw from their own backgrounds in training, private practice, and academe, as well as from an international panel of experts representing various mental health fields to provide activities and best practices that allow therapists to better serve an increasingly diverse set of clients and issues.

While clinical skills are easily observed, the more subtle areas of self-awareness, or exploring unexamined judgments are more difficult to spot and to provide supervision and guidance for. The numerous experiential activities included will help supervisors and the mental health professional they supervise develop their skills and techniques around:

• Intuition
• Empathy
• Self-awareness
• Mindfulness
• Multicultural awareness
• Perspective taking

The book covers both clinical as well as diversity-focused competence and awareness, and suggests various forms of activities, including research exercises, reflection, journaling, and more. Each activity includes measurement metrics as well as additional resources that help clinicians identify the best activity for a given situation. Appropriate for clinicians at every level and from a multitude of backgrounds, these tried and tested best practices can be used in clinical supervision, as a class assignment, or to facilitate professional growth.

Part 1

Core Clinical Competence and Self-Awareness

Chapter 1
Facilitating Clinician Development Using Themes of Personal Issues

Karni Kissil, Alba Niño, and Harry J. Aponte

Introduction

The quality of the therapeutic relationship has been presented in the literature as a pivotal factor linked to better therapeutic outcomes (Grencravage & Norcross, 1990; Sprenkle, Davis, & Lebow, 2009). This chapter draws from the Person-of-the-Therapist Training model (POTT; Aponte & Winter, 2000) and demonstrates the use of an instrument with the goal of increasing clinicians' awareness and acceptance of their personal issues as a way of facilitating deeper connections with their clients. The richer the relationship is with the client, the greater the clinician's capacity is to effectively assess and intervene. This chapter is the first of two and introduces the reader to the concept of the signature theme. In the subsequent chapter, the application of signature themes to clinical work is discussed (see “Exploring the Person-of-the-Therapist for Better Joining, Assessment, and Intervention” in this volume).

Rationale

Most self-of-the-therapist approaches to training clinicians view resolution of personal issues as a necessary means of change and growth that frees clinicians to become more effective professionals (e.g., Bowen, 1972; Kerr, 1981; Satir, 2000). Although the goal of reaching resolution seems appropriate, it can be a lifelong endeavor, and possibly even an unachievable goal, as we might never fully resolve all of our emotional and relational issues. Our clients get who we are as people and clinicians in the present, not who we would like to be. Because of this, the POTT approach emphasizes learning the intentional use of self as-is. We all carry our personal struggles into our therapeutic encounters, and they color our thinking, emotional reactions, and behavior with our clients. However, our personal issues and our struggles can be used to relate to our clients and their issues. The POTT model adopts the concept of the “wounded healer” (Nouwen, 1972), stating that we can empathize with and relate to the woundedness of others through our own woundedness. Thus, our wounds can be powerful tools allowing us to feel our clients' pain, understand their life struggles, and speak to their will to change. In order to be able to intentionally use our brokenness to connect with our clients, we must be able to consciously reach into our own wounded places and use what we find to understand and intuit where our clients may be.

POTT pivots on the concept of clinicians' signature themes—the lifelong, ongoing issues that run through the struggles of their personal journeys. Increased awareness and acceptance of the signature themes and continuous reflection on how they manifest themselves in therapeutic encounters translate into a clinician being able to take conscious responsibility for what he or she brings to the therapeutic engagement with a client, and result in an enhanced ability to connect purposefully and effectively with clients around therapeutic tasks.

Activity Instructions

The exercise described as follows is intended to be the starting point of a journey of self-discovery and learning. It can be used in the context of a clinician's supervision or training, or as part of an informal mentoring/supervision group. The POTT initial exercise has three steps:

1. Writing a reflection paper addressing the topics described in the guide (see below)
2. Meeting with a mentor for personal support and to discuss the topics addressed in the reflection paper
3. Rewriting of the reflection paper, incorporating the insights gained during the discussion with the mentor

Unlike the more reflective activities in this book, it would be difficult to conduct this activity on a self-assigned basis; this journey requires the support and guidance of a seasoned clinician who serves as a mentor for the new clinician, as well as a safe and caring environment where the clinician can openly talk about his or her own family history, experiences of hurt, shortcomings, and struggles. Therefore, the instructions are written specifically for the mentors or supervisors conducting the activity.

It is important for mentors to note that the essential element in any context for this POTT exercise is that they provide the safety and support of a relationship with the student or supervisee that allows for follow-up with personal issues of the clinician that require special attention. Attending to personal issues usually brings to the surface painful memories and uncomfortable thoughts and feelings for the clinician. Thus, the environment in which the exercises are done has to be continuously supportive and stable, where the clinician knows that he or she will not be left alone to deal with the emotional aftermath of the POTT experience.

Consistent with the POTT approach, the initial reflection paper should deal with several key points. Detailed instructions for writing each part are included here:

• Your Signature Theme. Describe what you believe to be the personal issue that has been most dominant in your life. This is the hang-up of yours that has vexed and continues to vex you, affecting many or all areas of your life.
• Your Genogram. Attach a three-generational genogram of your family, with comments that may help your mentor understand who the characters are and their relationships to one another.
• Your Family History. Provide a history of your family as you believe it relates to your signature theme. This is your hypothesis about the contributions your family members and their relationships may have made to the origin and perpetuation of your signature theme.
• Your Struggle With Your Signature Theme. Speak to how you deal with your signature theme. Describe where you handle it poorly and where you deal with it most effectively. Identify who in your life is most helpful in wrestling with it and how you make good use of this person's help.
• Your Clinical Work. Add your thoughts regarding how you believe your signature theme has affected or may affect your relationship with clients and your work with their issues—negatively and positively.

The clinician's openness and willingness to be vulnerable are necessary when writing the refection paper. Once the paper is finished, it is shared with the mentor prior to and in preparation for the face-to-face discussion. The meeting with the mentor serves as an opportunity to explore the thoughts addressed in the written exercise, illuminate blind spots, and carry the introspection to a deeper level. Also, the mentor is expected to assist the clinician in connecting the personal and professional realms by helping the clinician see how the signature theme might manifest itself in the clinician's work. Because the discussion of the reflection paper with the mentor can be an emotionally charged experience where the clinician might feel overwhelmed, it is important for the mentor to maintain a supportive relationship with the clinician throughout this process.

After the discussion, the clinician-in-training should write a new and updated version of the reflection paper. This updated reflection should distill the insights derived from the discussion with the mentor into a coherent narrative, allowing the clinician to give closure to this stage in the POTT journey and return to it as a point of reference as needed. It is highly recommended that the discussion with the mentor be recorded either in audio or video format, as many important issues can be discussed in a short and emotionally charged period of time, and the student may not be able to remember them completely or accurately. Students who have viewed the videotapes of this experience have frequently reported that they either missed or forgot parts of the discussion with the mentor. Students also found it very helpful when the trainer provided them with specific written feedback on their initial papers that they could refer to in the writing of the second version.

Example

A. K. was a first-year master's-level student who attended a POTT class as part of her training as a marriage and family therapist. Each student was required to complete the initial reflection paper, e-mail it to the POTT trainers and classmates before class, and then discuss it in class with the trainers while the other students observed and provided feedback at the end. In her paper, A. K. wrote about the process of defining her signature theme:

I didn't think it would be possible for me to group all the painful events in my life into jus...

Table of contents

• Cover
• Title Page
• Copyright
• Preface
• Acknowledgments
• Part 1: Core Clinical Competence and Self-Awareness
• Part 2: Diversity-Focused Competence and Self-Awareness
• About the Editors
• About the Contributors
• Author Index
• Subject Index
• End User License Agreement