GROUP SUPERVISION: SUPPORTING STAFF
ON COMPLEX ISSUES IN ADDICTION WORK
One of the biggest resources and strengths of working in the field of addiction recovery is highly dedicated, motivated and skilled staff. These staff must be valued and supported through good management structures and supervision. Divine Charura and Lee Wallace explain the benefits and offer a model.
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Working in the field of addictions requires specialist knowledge, skills and dedication to help people whose lives have been permeated by addiction in many aspects. If such work is to continue to progress to the highest standard, the staff who work in such settings must be valued, and supported through appropriate and effective management structures and supervision. This will ensure that they are supported through work which is often complex and can impact on them both physically and psychologically, often resulting in stress, impasse and burnout.
It is important to focus on practice which empowers both managers and staff in avoiding such experiences. This article looks at group supervision practice developed through our experience.
Group supervision offers a facilitative space for therapists to share their practices, their difficulties and to experience the support and feedback of peers to enhance and inform that practice. While this is a well-established phenomenon in therapy and used by many therapeutic modalities, the benefits of group supervision have not migrated so readily across the field of addictions work.
There is ample literature on managing staff and individual staff supervision, but little has been written on the efficacy and importance of offering group supervision in addiction settings. In this article, we consider the need for group supervision and benefits for practitioners. We also offer a simple model of group supervision which we hope will provide significant benefits to participants.
BENEFITS OF GROUP SUPERVISION
Staff in the addictions field work in stressful and emotive environments. The work requires high levels of motivation and emotional resilience. This work often includes hearing or seeing issues about abuse, imprisonment, multiple levels of loss, trauma, physical and mental ill-health initiated or linked with the addiction. Our work can also involve working with death and bereavement.
As a result of working with such complex matters, space for reflection and support is a requisite. The nature of addiction work means that often staff work shifts or alone or in small teams. Group supervision offers possibilities of meeting staff in a supportive environment and improves social cohesion – making connections, building a greater sense of team identity – or reduces the sense of isolation. It is an effective way of sharing ideas about practice in an immediate, person-to-person manner, which is ideally collaborative and engaging and offers a person the potential input of several practitioners in a short space of time.
For this reason, it also a cost-effective way of learning and developing, for a minimal commitment of time in comparison to individual supervision sessions. This is useful in view of the economic restraints facing many organisations.
WHAT GROUP SUPERVISION IS NOT
Supervision is a collaborative endeavour with a focus on professional and personal development. This can be easily be de-railed where an element of performance management, or case management or blame appears in sessions. Participants will very quickly come to dread sessions called group supervision which turn out to be a forum in which other staff or practitioners focus on “naming clients as difficult” or a forum in which staff are openly disciplined for malpractice or performance issues. If this happens, the likely effect is a closing-down and the adoption of a heavily-defended position in which the only position becomes a blaming culture. This is damaging and does not foster cohesion in an organisation, or celebration and learning from practice.
So managerial/performance supervision, team meetings and disciplinary meetings for malpractice are best separated from group supervision.
HOW DOES IT WORK?
If this is a first session, it is important that ground rules are set which encapsulate ethical practice. This includes principles like confidentiality, respect for each other and of the clients whose cases are brought for supervision. Group supervision should be bounded in ethical practice, with a commitment to beneficence, for the good of all involved and non-maleficence: to not cause harm, and the principles of justice which is about ensuring fairness.
It is important to state that group supervision is a process in which the practitioner/team focus on themselves and their interactions with a client, or family, and explore the difficulty they might be experiencing with that client/family in relation to addiction. When this is shared with the other people in the supervision group, a way to work more effectively is explored. This is a more therapeutic and developmental position than seeing the client/family as the difficult problem who are presenting as complexities which cannot be dealt with.
SIMPLE FIVE-STEP GUIDE
We propose the following steps as a simple guide of going through the group supervision process. This guide has been formulated from different theoretical perspectives, through learning in different teams and facilitating many group supervision sessions which have been successful in helping both staff and clients in their recovery journey.
1. The named group supervision facilitator starts the group. This involves stating the time boundaries, reiterating the boundaries of the group and its purpose, and ensuring that the supervision is about complex cases and about celebrating and learning from good practice.
2. Individuals [group supervisees] begin the check-in process and those who want to present/share their work/cases state so. When everyone has checked in, the facilitator and group work out in what order the supervision will go: who will start and how much time each case will be given.
3. The supervisee/practitioner who has agreed to start to present his/her case then shares their case or is helped (by facilitator and group) to be able to articulate their difficulty if it is confusing or unclear to them.
It is important that people in the group are encouraged to reflect on their practice and to ask themselves questions before coming to the group supervision session. These questions could include the following.
a) What exactly is the issue I am bringing?
b) What is my role in this difficulty/complex case?
c) How did things get to that?
d) How can I best work with this client or family to enable recovery/abstinence/harm reduction?
e) What have I done or tried to help things get better so far?
f) What is going well in this case with the individual or family I am working with?
At times, however, particularly where people might feel overwhelmed or stuck, s/he may not be able to answer these questions about their case. Having the supervision space to just explore and for the other group members to ask questions can enable him/her to articulate what they want from the group supervision session.
4. Once a practitioner has presented his/her case, the facilitator then asks the group for their input on helpful thoughts and ideas on what the person who has presented could do.
It is often good practice that the facilitator is an experienced practitioner who can offer and respond to the individual responses of the group and ensure that the process remains focused and helpful to the group. This can include identifying points of learning or exploring areas which the group could have overlooked, or not thought of.
5. The practitioner who would have brought their case for supervision then formulates a plan of action based on the dialogue which would have emerged in the group. The facilitator can ask questions such as “Now that you have heard the group and processed what they/you said, what will you do?”.
In formulating the plan of action, it is important that the focus is on the practitioner and their responses to the client. Again, it is not useful to blame the client or label them as difficult. We recognise that often there might be complexities in working with some clients more than others, in terms of supervision, but if responsibility and blame are placed with the client then a chance to learn and explore solutions is missed.
Furthermore, this could feed into a practitioner’s sense of powerlessness and resentment. And an entrenched negative position towards the client-practitioner relationship can be adopted. The danger of group supervision being used in this way is that, if not properly facilitated, it can become an extension of the negative culture and become “a moan group” (Carroll 1996).
For our proposed model to work in practice, we envisage that supervision will offer most value to participants if it is grounded in a collaborative and supportive person-centred philosophy which will display some key features which we shall now explore (see diagram).
FEEL SAFE ENOUGH TO TAKE RISKS
A good supervision group should allow practitioners to feel safe enough to admit mistakes in their work. We acknowledge that trust is something that develops, and with time group members should be able to ‘risk’ sharing their difficult experiences as well as where they feel they might not have performed well. We suggest that it is important to value the spirit of acceptance and to avoid ‘blaming and shaming’ and instead foster an attitude focused on learning and development. The group members should all thus work together in co-creating a safe environment.
Through experience, we learned that this allows practitioners to be open and to avoid continuing in malpractice. We also acknowledge that with this comes the issue of: if malpractice does emerge, what are the group and facilitator to do?
We suggest that the group should be aware of what would happen in such a case from organisational and team policies and guidelines. The facilitator should at all times be clear that in such cases they will follow the procedures.
But we highlight that group supervision should not be the forum to deal with the investigations of such issues. It is a place where alternative and reflective practice could emerge and be explored.
BE PERSON-CENTRED RATHER THAN 'PROBLEM-CENTRED'
In supervision, it is important to emphasise exploration of the complex as well as work that is going well in the case for the supervisee. This includes exploration of feelings and experience of the client:practitioner professional relationship. The use of empathy to attempt to understand their experience and communicate that understanding to the person is a very powerful way of supporting a person and allowing them to make constructive decisions in a supportive environment (Rogers 1961).
Empathy will allow the person to feel truly heard by the group and feel safe to explore what they are experiencing. Thus the focus is on the practitioner’s process of exploration. Equally, a practitioner needs to have empathy for the clients rather than reducing them to an addiction or a collection of problems.
The way of working we propose also aims to look for solutions for what the practitioner brings to the group. This is grounded in a person-centred exploration so the person can gain a clearer understanding of what is going on for them. This might suggest, through that exploration or group-input, different ways of dealing with problems of an interpersonal nature. An example is how we communicate or respond to a client who might be perceived as a difficult or complex person.
Exploration of practical solutions could be arrived at through the feedback of group members. In either event, the group as a resource is committed to creating solutions.
The group offers a dynamic resource which can offer freedom from impasse – ‘stuckness’ – by the collective experience and exploration of knowledge and experience in the group. In seeking solutions, it is paramount also to adopt best evidence-based practice as noted in research and learned from other teams/practitioners. These solutions and the action to be taken can be recorded and followed-up and reviewed at the next group supervision session, which are good examples of evidence-based practice.
It is not all bad. As already noted, group supervision should not only be about what is not working. This model encourages the celebration of good practice and reflections on what is going well. This enables the modelling of good practice and can be informative to others in the group. This can be particularly helpful for staff new to the profession, to expose them to the collective practice experience of fellow practitioners in their supervision group.
Group supervision has been used successfully in several fields and has been particularly powerful and helpful in counselling/ psychotherapy. We have applied many aspects of our experience in this field to presenting a model for group supervision in addiction work. It is a simple model that draws on the experience and qualities of the group to help and support the individual.
We have found that there is significant power in groups, particularly when there is an underpinning of a person-centred focus and philosophy. This is a significant benefit to the practice of addiction work and a pilot of group supervision has indicated to us the value of this way of working.
Carroll M 1996 – Counselling Supervision: Theory, Skills and Practice. London, Cassell.
Rogers C 1961– On Becoming a Person. London, Constable.
Gossop M 2001 – Drug Addiction and its Treatment, New York, Oxford University Press.
Pilgrim D 2005 – Key Concepts in Mental Health, London, Sage.
Further reading: Divine Charura’s article on Group therapy in rehab.
Divine Charura is a senior lecturer at Leeds Metropolitan University in Counselling and Psychotherapy. He also works as a UKCP registered adult psychotherapist for the Leeds Partnership Mental Health Foundation Trust (NHS). He has years of experience working in diverse psychiatric/clinical and therapeutic settings including co-managing a detox and rehab centre. Among his writing, he recently wrote a chapter in the Transcultural Handbook for Counselling and Psychotherapy edited by Professor Colin Lago (2011).
Lee Wallaceis a consultant psychotherapist in private practice. He also offers both group and individual supervision. He has worked in a wide range of settings including with families on the impact of addiction, particularly on children in a school setting. His Interests are in psychotherapy research and working with dual diagnosis.