Supervision Groups in Private Practice
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Supervision groups in private practice – an integrative approach – Vivian Baruch B.A., M. Couns, Grad. Cert. Professional Supervision, CMCAPA, RMPACFA.
Abstract: Effectively leading and evaluating a supervision group in private practice requires attending to leadership style, intended group composition, theoretical approaches of members and what a leader needs to provide. A combination of generic models of led group supervision for consultative use in private practice is described, with the aim of providing post-training, practicing counsellors with effective group supervision. Well run group supervision appears to be an attractive option for some supervisees as it potentially provides a rich resource if carried out within a trusting and well-managed context.
Group supervision literature reveals several models which map the process of supervision in its broadest sense. These are Bernard’s (1997) Discrimination Model cited in Bernard and Goodyear, 2009, Bernard and Goodyear’s Three Dimensional Conceptual Model (2009), Carroll’s (2001) Integrative Generic Model, Hawkins and Shohet’s (2007) CLEAR Model of Supervision, Holloway’s (1995) Systems Approach to Supervision, Inskipp and Proctor’s (1995) Group Supervision Alliance Model (GSAM) and Page and Wosket’s (2001) Cyclical Model of Supervision (CMS). The author is using the word “model” to describe a comprehensive map of group supervision or to denote a “mental map for ordering complex data and experience” (Proctor, 2004, p.12). This article presents a combination of Proctor’s (2004) GSAM and Page and Wosket’s (2001) CMS models with the aim of providing one possible integrative model for use in group supervision. In describing the necessary components for conducting well-run consultancy group supervision with counsellors who have a minimum of two years experience, this article provides one viable approach for supervisors and supervisees to further develop and to integrate group supervision models for private practice.
Just as one-to-one clinical supervision is an intervention in its own right (Bernard and Goodyear, 2009, p.2) and requires specific training (Hawkins and Shohet 2007; Carroll 2001), additional specific skills are demanded for effective conceptualisation and conduct of supervision in groups (Proctor 2004; Page and Wosket 2001; Cohen 2004). Group supervision can be described as: “…the regular meeting of a group of supervisees (a) with a designated supervisor or supervisors, (b) to monitor the quality of their work, and (c) to further their understanding of themselves as clinicians, of the clients with whom they work, and of service delivery in general. These supervisees are aided in achieving these goals by their supervisor(s) and by their feedback from and interactions with each other.” (Bernard and Goodyear 2009, p.244).
The GSAM and CMS models are selected due to their combined potential for enhancing understanding of the clinical skills required, for their attention to the development of counsellors in a group context, for comprehensive application of monitoring and support, and for the room they allow for flexibility and creativity in group supervision. Cohen’s (2004) suggestions on supervisors’ preparations for group supervision are also included to assist the supervisor in clarifying the context of each group to be supervised.
Proctor’s GSAM arose from her collaborative efforts with Inskipp in identifying and spelling out the skills of supervisors and supervisees who worked well in groups. Both of these women are acknowledged as being among the first generation of supervision educators and trainers in Great Britain. This model encapsulates their experience of over 25 years within the historical context of group theory and supervision in counselling in Britain and the United States (Carroll, in Proctor, 2004, p.vii).
Page and Wosket’s revised 2001 CMS model incorporates the subsequent research and thinking about supervision since their 1994 work, and also includes the feedback they received from those in the field since their first publication. In addition, they explore how practitioners deal with the darker aspects of themselves and their role, Jung’s concept of “shadow” (Page, 1999a in Page and Wosket, 2001), as well as research about the “therapeutic use of self” in counselling, supervision and research (Wosket, 1999, ibid). They inform readers about the use of these insights in “…supervising in groups: working with difference and diversity in supervision, and the supervision of experienced practitioners.” (Page and Wosket, 2001, p.x). It is a product of their combined applied knowledge in counselling training, supervision and consultancy in Great Britain for over twenty years.
Before implementing group supervision the supervisor needs to consider methods for ensuring effective group process and management, capacities for balancing group and individual needs within the group as a developing system, awareness of how to address “hot” issues and difficult dynamics in groups (Proctor 2004, pp.93-131). The literature argues that supervisors of groups need to be aware of and work with stages of group development and group dynamics Comparative models of group stages and research on group dynamics are discussed by Hawkins and Shohet (2007, p.170-173). Training in group leadership and dynamics and knowing when and how to effectively intervene are required here (Bernard & Goodyear, 2009; Campbell, 2000; Cohen, 2004; Feasey, 2002; Ögren, Jonsson & Sundin 2005; McMahon & Patton, 2002; Riva & Erickson Cornish, 2008; Rutter, 2007).
Proctor (2004, p.37-39) and Page and Wosket (2001, p160-162), each identify four different types of group supervision, none of which are hierarchical or preferential:
Proctor – GSAM Page and Wosket – CMS Type 1- Authoritative group Supervision Individual supervision in a group (1) Type 2- Participative group Supervision Supervisor-led group (2) Type 3- Co-operative group Supervision Facilitated group (3) Type 4- Peer group Supervision Peer Group (4)
There is a common agreement between their first and last definitions which are respectively: one-to-one supervision taking place in a group, where the supervisor manages the group and the other supervisees are observers; and a peer group with shared responsibility for facilitation, supervising and being supervised. Inskipp and Proctor’s “Co-operative group” (3) is supervision by the group, whose members actively contract to co-supervise, and where supervisors take turns to be group facilitators and supervision monitors. Page and Wosket’s “Supervisor-led group” (2) is defined as one in which the participants are involved in discussing the material presented, yet the supervisor leads the group and its process, and has both the implicit and explicit experiential seniority and responsibility for the group.
Both the GSAM and CMS models are similar in that they describe a typology of groups; emphasise the importance of group contracts with respect to ground rules, boundaries, accountability of members, expectations of the group and of each other; explore group dynamics. They both also outline procedures to effectively enhance the conduct of group supervision so as to maximise the benefits for each member. The differences are that Proctor addresses the meta-tasks of supervision (described later in the article), takes system dynamics into account to give a greater amount of detail about methods for ensuring effective group process and management, and also provides more comprehensive advice on how to address difficult dynamics in groups.
In a post-training supervision group, the facilitated group format is ideal. The rationale for preferring this format for experienced counsellors is that running supervision groups is an enterprise requiring management, leadership and administrative qualities, and needs to be acknowledged as such. Covert management is detrimental to establishing clear foci in supervision, and person-centred, psychodynamic and action-oriented traditions can endorse this lack of clarity (Proctor, 2004).
Inskipp and Proctor’s “Participative group” (2) and Page and Wosket’s “Facilitated group” (3) share commonalities and the facilitated group format utilizes a combination of factors found in both. These factors entail the supervisor taking prime responsibility for supervising each supervisee, while also inducing and facilitating members to co-supervise each other. This requires the supervisor to encourage, assist and challenge group members to actively respond to each other to enact the potential of co-supervision.
In preparing for, conducting and evaluating a group supervision of counsellors, the group format requires that the supervisor embodies a presence similar to that of an educator. To provide a structured approach to this endeavour, Cohen (2004) suggests attending to the five questions below while strategically preparing for group supervision. It is similar to the way that an educator develops a strategic and tactical plan for each lesson within the overall programme of their course. The questions are: what is the type of group and population; what are the reasons for the group; what are the supervisor’s goals and criteria for success; what are the practical, practice and process questions to be borne in mind; and how will the evaluation be conducted? Elaborations on these are given in the following paragraphs.
In considering the type of group and population, Proctor (2004) and Page & Wosket (2001) suggest optimum numbers are three to six in each type of group so as to create sufficient safety for honest presentation and feedback. Safety is enhanced by making it a closed group, with a specific meeting time, for example two hours once monthly for six months. This is negotiated with the group and the supervisor advises the group that any agreements made together are to be reviewed at the end of the six months. One means of addressing the issue of group population is to seek, through professional networks, a self-selected, mixed gender group of practicing counsellors with a minimum of two years post-training experience, stipulating that the theoretical approaches appropriate for this group are limited to, for example, the psychodynamic/humanistic/existential spectrum, so as to give reasonable homogeneity (Bernard & Goodyear, 2009, p.252).
Reasons for the group might include such aims as providing a forum to explore integrative and eclectic models of working, offering practitioners from different traditions the opportunity to open their work to each other, and/or for all to gain from each other’s varied training, expertise and modes of practice (Proctor, 2004). In personal preparation for group supervision, the supervisor clarifies her or his personal goals, examples of which may be to provide a forum for shared learning to “stretch, support and challenge ourselves…around our work” (Clarkson, 1998, in Proctor, 2004, p.21), and to apply “…careful forethought, initiation and building of a group working alliance {which} are essential foundations for a good working group” (ibid, p.24). The supervisor must also make her/his intentions transparent to the group, expressing the desire to meet the learning needs of the group members by addressing their individual learning styles, and to facilitate the group doing informed co-supervision. The last point is explained to mean encouraging members to give each other respectful, clear feedback, whilst enjoying the group development process. Explicit clarification is also given that evaluation of these criteria will be made after each supervision session and will be complemented by a more formal six monthly review, using methods explained below.
A supervision session in Page and Wosket’s five stage CMS has the following components – contract, focus, space, bridge and review, whereas Proctor’s options for creating session agreements in her GSAM are – overall contract, group working agreement, session agenda, minute to minute response management and the reflective space. Both models begin with contracting, although Page and Wosket’s CMS refers more specifically to contracts made at the start of each session. Good practice at the first meeting of the group entails a written contract given to each member, which covers the broader context of limitations and accountability pertaining to the agencies, organizations and professional bodies to which all are beholden. A necessary component of a group contract is the group working agreement, which describes the roles and responsibilities that the group members and the supervisor take. These are crafted by the group and include the non-negotiable responsibilities such as confidentiality, preparation, monitoring, assessing and reviewing as well as negotiable ones such as accountability to the group, note-taking, record keeping, methods of presentation, group manners and individual needs. For Proctor (2004), establishing these norms is important in a group context because each supervisee’s reaction to them has an effect on the dynamics of the group and will become a matter for group exploration in the event of non-compliance.
Contracting is followed by combining the CMS focus and the GSAM session agenda. Here the specific session priorities are jointly negotiated: the number, order and content of presenters, as well as timings. This includes the agreement with each supervisee about the management of their presentation and the amount of time available for reflective space which are dependent on the number of presenters per session. An agreed agenda at the start of the session allows time to “check in”, for each person to “arrive” and be present, for left-over issues from the previous session to be revisited as well as for a shared commitment to time management (Page & Wosket, 2001; Proctor, 2004).
The supervisor now facilitates moving the group into the CMS space, known as reflective space in GSAM. Each presentation of client work or professional issue provides the central task for the group at this point. During each presentation, feeling and behavioural responses occur within the group from which emerge the important benefits of group work. These felt responses may include countertransference, shadow material, parallel process and group energy level fluctuations (Page & Wosket, 2001), and it is here that Proctor’s minute to minute response management task is most required. This potentially creative segment encourages supervisees to be accountable for the reason they are prioritising their issue by openly acknowledging their felt responses. The supervisor utilizes this segment to decide how to help the group respond in the most useful way in service of the supervision work, in the development of each group member and of the group as a whole (Proctor, 2004).
The next part of the group comprises the CMS bridge. In this portion of the group process, the presenter is given time to think through understandings resulting from exploring their issue and the emotional experience in the group so it can be applied to the counselling situation (Page & Wosket, 2001, p.174). Proctor (2004, p.72) refers to this as the debriefing portion for each presenter and the group after each presentation. This is followed by the next supervisee presenting in the order established in the session agenda.
The final segment is called review, both in CMS and GSAM. It is a “check-out” time in which the supervisor leads an exploration of the effectiveness of meeting each individual’s learning needs, as well as attending to any group maintenance and group function issues. A review of the session as a whole and the supervisor’s performance is undertaken in this last part of the group, both in verbal then written format. The written feedback form may be modelled on the one Carroll (2006) gives to individual supervisees and can be submitted after the session to allow time for further reflection on the group experience as well as to appropriately phrase the feedback. Written evaluations are used in the contracted group review time, notionally after six months of meeting, and in the supervisor’s own supervision as material to present to their supervisor when discussing the group work.
It is helpful to remember that each group develops a unique culture which needs to be accounted for in conceptualising how group supervision works or fails to work. Some skills used in individual supervision are transferable to a group supervision context and others can only develop through the process of leading supervision groups. Carroll’s (2001, p.27) quip provides a unique point of focus: “It sounds a terrible choice, but given the option between a good counsellor who was a poor educator, or a poor counsellor who was a good educator, I would choose the latter as a supervisor.” A competent group supervisor has the ability “…to offer a range of educational methods and to be aware of which learning processes suit which individuals…” (ibid, p.28), and increasingly polishes her/his capacities as a teacher and counsellor who focuses supervisees’ learning and attention to the welfare of their clients. Rutter’s (2007) research on effective group supervision revealed that experienced counsellors placed great value on three main factors: a group’s climate of trust and safety, the relationships among group members, and the many opportunities to learn from the supervisor and one another. Members perceived that the group contributed significantly to their knowledge and skills, their self-awareness, and to their professional identities. An overall impression based on anecdotal evidence from the literature supports the view that when groups are well run, they are helpful for supervisees and clients (Proctor, 2004).
In summary, a judicious combination of the CSM and GSAM helps the supervisor conduct the task of group supervision with the aim of facilitating the normative, formative and restorative tasks of supervision (Proctor, 2004, p.75), which are the previously-mentioned meta-tasks. Proctor (ibid) asserts that the normative task comprises group negotiations highlighting the shared responsibility for ethical practice. The formative task is fulfilled by pinpointing and addressing individual learning needs. Finally, “[t]he respect, empathic engagement, honesty and purposefulness called for provide…[a] culture and environment [which] is an optimal atmosphere for learning and development” (ibid, p.75). Group supervision, if managed well, can enable “…a safe …place for shedding old habits and trying new ways of being in… the world of counselling and supervision. It is restorative and often therapeutic” (ibid, p.75).
This article explores one integrative method for understanding and conducting effective group supervision. It addresses the agreement in the literature that well managed groups can contribute significantly to supervisees’ knowledge, skills, self-awareness, and professional identities. Although further writing and research on group supervision is recommended, the literature suggests that practicing, post-training counsellors may reap significant personal and professional rewards from involvement in generic forms of group supervision.
References:
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