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Ongoing Clinical Supervision group. The clinical supervisor uses these questions to shape the learning experience for all supervisees. The questions are: 1. What is different and similar about this group and other groups you have observed or participated in? 2. How is gender playing itself out in this group? What themes do you notice? 3. How are diversity issues experienced in this group (i.e., class, culture, sexuality)? 4. What questions do you have about the choices that the co-facilitators made in terms of facilitation during this session? General comments and debriefing A range of questions can be used depending on what the supervisor intends observers to learn from the observation experience. For example, MacKenzie (1990) developed a Group Climate Questionnaire that asks observers (and group members and facilitators) to rate the group as a whole along various dimensions that break into three subscales: engaged (a positive working environment), conflict (a negative atmosphere with anger and distrust) and avoiding (of personal responsibility for group work). Using a tool like this increases observers’ awareness of the interaction between members and between members and facilitators. The tool reinforces the differences between working with clients individually and within a group, highlighting areas to explore further in future sessions when gaps are noticed. After the group, the co-facilitators debrief with the observers, discussing their responses to the questions as well as processing their observations of group member interactions and what they observed the co-facilitators do. This provides an excellent learning opportunity for all involved since there are often a variety of strategies that can be used at any given time. Co-therapy Co-therapy is the joint facilitation of a client group by two clinicians—in this case, the clinician and the clinical supervisor. This allows the clinician to observe the strategies used by his or her clinical supervisor, and it enables the clinical supervisor to observe the clinician’s interventions and to provide immediate feedback. 39
Clinical Supervision Handbook CASE EXAMPLE: CO-THERAPY The clinical supervisor meets with the staff member before he or she begins co-facilitating in order to provide some background / history of the group, its goals, co-facilitators’ roles, what the clinician can expect to occur, and to explore what the clinician feels comfortable doing. The clinical supervisor continually evaluates the clinician’s involvement and interventions over time and monitors the clinician’s desire to take more risks within the group. Prior to each session, the clinical supervisor and staff member (co-facilitators) meet briefly to discuss the plan for that day. For the Enhancing Women’s Well Being Group, which is a 14-session, closed outpatient group, there is greater opportunity for continuity since the same people facilitate for the whole cycle. The cofacilitators can review previous sessions and decide what needs to be followed up on and what roles they might each take for the particular meeting. After the session, the clinical supervisor takes some time to debrief. During this time, the co-facilitators reflect on what occurred with respect to the clients—themes, participation level, critical issues—and what they noticed each other do and the response from clients. This provides them with the opportunity to notice how their skills are developing and the impact their strategies are having on the group. The clinical supervisor shares what she was thinking during the group that influenced what she said or did not say. After the clinical supervisor has modelled this process, the staff member does the same, which expands the opportunity to discuss what he or she did and did not do and the reasons underlying interventions. The co-facilitators discuss what their follow-up will be in the next session and the cycle continues. The clinical supervisor invites her co-facilitator to risk trying a strategy that the clinician had thought about, but had not done. Within the Keeping Safe Group, staff members learn that even though it theoretically makes sense for the program’s clients to have safety plans, the process goes beyond ensuring that clients have completed these plans. Staff members need to be open to 40
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A Pan American Health Organization
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