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Ongoing Clinical Supervision Yalom’s therapeutic factors and group supervision • Yalom’s therapeutic factors are listed below and described in relation to the experience of being a member of a supervision group: • Instillation of hope: Within the context of group supervision, clinicians get a sense that there is light at the end of the tunnel when working with challenging clients. Hearing the experiences of others can highlight progress that the presenting clinician might have lost sight of because he or she has lost some objectivity. • Universality: A sense that clinicians are not alone in the work they are doing and how they are feeling. Feeling validated from other clinicians who discuss similar experiences with clients. • Imparting of information: Providing information to others about the client, how to work with them or the process of self-reflection. • Altruism: Having the opportunity to help other staff. • The corrective recapitulation of the primary family group: Traumatic re-enactments play out in the team based on the clients projected experiences, power differentials within the team and how these are processed, parallel process and how conflicts are managed within the team. • Development of socializing techniques: Learning how to communicate with one another within the team using interpersonal feedback and constructive feedback without judgment. • Imitative behaviour: Learning how other team members work with clients and each other by observing what they say and do in supervision. • Catharsis: An opportunity to vent and label feelings. • Existential factors: Issues that come from the person’s confrontation with the “ultimate concerns of existence”: death, freedom, isolation and meaninglessness. In working with clients, a significant existential issue that clinicians encounter over and over again is human suffering. Having an opportunity to process these issues is helpful to clinicians who may otherwise feel overwhelmed. • Cohesiveness: The sense of belonging and value within the team. • Interpersonal learning: How the team interacts with one another in the here and now while discussing a client can be a reflection of the client’s relationships in the world outside (e.g., staff that takes on the negative aspects of the clients, those who are the vessels of the positive) (Yalom, 1995). 51
Clinical Supervision Handbook An example of group clinical supervision We find that the clinicians’ experience is most helpful and safe when it is structured in such a way that the expectations of all participants and what is expected of the participants are clear. This allows them to come to the sessions prepared, understanding their roles in the context of the person requesting assistance and giving constructive feedback to others. CASE EXAMPLE: GROUP CLINICIAN SUPERVISION The clinician begins by presenting a clinical dilemma in the form of a question so the group has a frame of reference before hearing about the client. An example of this would be, “I would like your help with the client I am going to present. I am feeling stuck and would welcome your ideas about how to help the client consider some other alternatives.” Another example might be, “This client is feeling overwhelmed with many stressors in her life. She isn’t working. Her kids are a handful for her. She does not feel safe where she is living. She continues to have flashbacks and nightmares. When I listen to her, I don’t know where to start. I feel overwhelmed myself. I would welcome your ideas.” The purpose of introducing this question is to keep the feedback focused, diminishing the possibility of a “free-for-all.” Other clinicians might ask several questions that do not address the needs of the clinician and assume the clinician has not already covered or considered what is being asked. After the question / dilemma is put forward, the clinician presents some background on the client (e.g., major concerns, history of her or his work with the client, attempted solutions—material that directly relates to the question). As the clinician receives feedback from the group, he or she takes notes and then shares what most stands out and what specifically was gleaned from the consultation. The clinician then discusses what she or he would like to try and how it might be helpful. The clinician will then make a note of this recommendation in the progress note or on the Interdisciplinary Plan of Client Care. In a round table format, each person is invited to ask one question of the clinician once he or she is finished providing the overview. 52
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A Pan American Health Organization
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