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									                                                              Psychology




Clinical Psychology Specialist
Supervision Module for New
          Supervisors



                 Quality Education for a Healthier Scotland
Clinical Psychology Specialist Supervision
                                                                       Psychology
       Module For New Supervisors

 Duration :
 • Two days; 9.30am-4.30pm
 Activities:
 • Small group discussion
 • Plenary discussion
 • Behavioural rehearsal




                          Quality Education for a Healthier Scotland
Clinical Psychology Specialist Supervision
                                                                                Psychology
       Module For New Supervisors

 Day 1
    9.30am
      Introductions
      Expectations


    11.00am
      Setting up the placement
      Thinking about competences

              Lunch


                                   Quality Education for a Healthier Scotland
Clinical Psychology Specialist Supervision
                                                                               Psychology
       Module For New Supervisors

 Day 1
    1.45pm
      What does the trainee know, what do they need to know?
      How do we help them get there?
      Contracting


    3.30pm
      Supervision has its ups and downs!
      Review



                                  Quality Education for a Healthier Scotland
         Would I lie to you?                                             Psychology




Tell the group two things about yourself:
  – One true
  – One a lie



• Not work related (unless its funny)

• We need to guess the lie
  – If you can con us more than we can guess the
    lies, we supply biscuits for break
                            Quality Education for a Healthier Scotland
            Introduction                                             Psychology




Where are we now?
 Minimum 3 years experience of being a
 trainee and receiving supervision
 Attended the 3 day GSC course
     models
     practicalities
     processes


                        Quality Education for a Healthier Scotland
                   Introduction                                                   Psychology




This framework conceives supervision as a formal but
collaborative relationship which takes place in an organizational
context, which is part of the overall training of practitioners and
which is guided by some form of contract between a supervisor
and a supervisee… The expectation is that the supervisee offers
an honest and open account of their work and that the supervisor
offers feedback and guidance which has the primary aim of
facilitating the development of the supervisee’s therapeutic
competencies but also ensures that they practice in a manner
which conforms to current ethical and professional standards.

        (Roth and Pilling 2008)


                                     Quality Education for a Healthier Scotland
                Introduction                                                 Psychology




 An intervention that is provided by a senior member
  of a profession to a junior member.... this relationship
  is evaluative, extends over time and has the
  simultaneous purposes of enhancing the professional
  functioning..., monitoring the quality of the
  professional services offered…., and serving as a
  gatekeeper for those who are to enter the particular
  profession.
                          (Bernard & Goodyear, 1998).




                                Quality Education for a Healthier Scotland
            Introduction                                             Psychology




Where are we now?
 Minimum 3 years experience of being a
 trainee and receiving supervision
 Attended the 3 day GSC course
     models
     practicalities
     processes
 May have delivered some supervision already

                        Quality Education for a Healthier Scotland
               Introduction                                                Psychology




Where are we now?
• Making a significant transition
   – Confidence in therapeutic skills growing
   – New roles and responsibilities
   – Shift in perspective (“gatekeeper”)




                              Quality Education for a Healthier Scotland
                 Introduction                                                    Psychology




Aims of the course:
  – Apply understanding of the models to supervision of Clinical
    Psychology Trainee

  – Reflect on impact of role transition and individual difference
    on practice of supervision

  – Apply understanding of learning theories to develop a
    positive learning environment

  – Reflect on and practice some of the skills required in the
    process

                                    Quality Education for a Healthier Scotland
               Introduction                                                Psychology




Our methods:
• Activity based
  –   Discussion (small group & plenary)
  –   Reflection
  –   Rehearsal
  –   …and a bit of fun!




                              Quality Education for a Healthier Scotland
                Introduction                                                    Psychology




Resources
  – Shared space
    •   Guidelines
    •   Key chapters
    •   Journal Articles
    •   Evaluation tools
  – Handouts
    • Workbook
        – Record key learning points
        – Reflections
        – Record of learning experience and learning needs

                                   Quality Education for a Healthier Scotland
               Introduction                                                 Psychology




Why do we need a Specialist
Supervision Module in Clinical
Psychology?
– What are the particular challenges?
– What characteristics are unique?
– Are there professional/cultural issues that are
different?



                               Quality Education for a Healthier Scotland
               Expectations                                                  Psychology




Small group discussion

• In light of the previous discussion, discuss your
  expectations for the next few days

• How will we know if we have achieved it?

• Individually write one Intended Learning Outcome for
  you (space in workbook)

• Feedback TWO expectations from the group

                                Quality Education for a Healthier Scotland
Anxieties                                            Psychology




        Quality Education for a Healthier Scotland
                Expectations                                                  Psychology




Take some time                 •How would you
individually to consider 3     behave/think/feel about the
future selves                  trainee?
                               •What would be the impart on
   –The supervisor you         the trainee?
   MIGHT become
                               •How would you know which
                               one you were becoming?
   –The supervisor you would
   LIKE to be come             •What would it feel like?
                               •What would it look like to
   –The supervisor you are     others?
   AFRAID you might become


                                 Quality Education for a Healthier Scotland
                                             Psychology




Quality Education for a Healthier Scotland
    Setting up the placement                                                     Psychology




Looking back on better days (!?!?)
• What are your recollections on the first day of placements?
• What made things less anxiety provoking?
• What made you think “this is going to be good!”?
• How quickly did you make a conclusion about the nature of the
  placement?
• What prompted that conclusion?
• How much did this influence the way placement panned out?
• Did it impact on the way you approached supervision;
    – what you brought;
    – what you discussed;
    – what you disclosed


                                    Quality Education for a Healthier Scotland
     Considering Competence                                                 Psychology




Competence Framework
• Core Competencies – Clinical Psychology – A Guide
  (BPS 2006)
• Division of Clinical Psychology - Professional
  Practice Guidelines (BPS 1995)
• Standards of Proficiency – Practitioner Psychologists
  (HPC 2009)
• Competency Framework (Roth and Pilling 2008)



                               Quality Education for a Healthier Scotland
     Considering Competence                                                 Psychology




BPS domains of Competence
• 3.1 Transferable skills
• 3.2 Psychological Assessment
• 3.3 Psychological Formulation
• 3.4 Psychological Intervention
• 3.5 Evaluation
• 3.6 Research
• 3.7 Personal and professional skills
• 3.8 Communication and teaching
• 3.9 Service delivery

                               Quality Education for a Healthier Scotland
      Considering Competence                                                   Psychology




3.1 Transferable skills
●Deciding, using a broad evidence and knowledge
   base, how to assess, formulate and intervene
   psychologically, from a range of possible models and
   modes of intervention with clients, carers and service
   systems.
● Generalising and synthesising prior knowledge and
   experience in order to apply them in different settings
   and novel situations.
● Demonstrating self-awareness and working as a
   reflective practitioner.
● Ability to think critically, reflectively and evaluatively.


                                  Quality Education for a Healthier Scotland
    Considering Competence                                             Psychology




“Accreditation standards tend to increase in
  number over time…however even when
  criteria are specified, expected competence
  levels often remain elusive to both
  supervisors and supervisees”
                      (Bernard & Goodyear 2009)




                          Quality Education for a Healthier Scotland
                                                                                      Psychology




            Becoming a Clinical Psychologist




   Adult        Child        L.D         Older
                                          Adult            Specialist          Specialist
placement    placement    placement                        placement           placement
                                       Placement




                                        Quality Education for a Healthier Scotland
         The complexity of the trainee experience

Public                                                                                  Psychology




                   NHS      LAT                   University
             Supervisor‟s
             supervisor                                     Academics



              Supervisor          Trainee              Clinical Tutor




                                  Client



                                           Quality Education for a Healthier Scotland
Understanding the trainee‟s context                                     Psychology




 A model by Michael Carroll of:

   Survival mode

               Versus


                   Competency mode


                           Quality Education for a Healthier Scotland
     Frontal cortex thinking                                           Psychology




•Plans for the future   •Creativity and change
•Imagination and        •Speaking
prediction              •Writing
•Self development       •Reasoning
•Ability to reflect     •Abstracting
•Introspection          •Problem solving
•Ethical decisions      (Carroll, Centre for Supervision
                        Training, 2009)
•Managing emotions

                          Quality Education for a Healthier Scotland
           Survival Mode                                          Psychology




• Fight

• Flight

• Fragment

• Freeze
                     Quality Education for a Healthier Scotland
          Competency Mode                                                   Psychology




“Learning is risky and occasionally dangerous, and
creating reflective environments engenders
disagreement and debate.”
“We do create environments and relationships where
power over is so dominant that it puts people into
„„survival mode‟‟ (rather than competency mode), which
means they can only learn in certain restricted ways.”
“It means further that we look carefully at how power is
used in learning situations to ensure that power over
doesn‟t negatively affect learning.”
                                         Carroll 2009


                               Quality Education for a Healthier Scotland
            Observation Task                                                     Psychology




Clip 1
Pick out areas of competence that could be considered:
   – Areas of particular strength
   – Areas for development

Into groups of three and discuss your observations
   – The experience of observing and picking out
     strengths/weakness
   – What did it feel like?
   – Did you know what you were looking for?
   – What level were you expecting?


                                    Quality Education for a Healthier Scotland
    Considering Competences                                                        Psychology




Clip 1
• First year trainee working with a woman experiencing
   low mood and relationship difficulties.
• Observe with checklist
   – Strengths
   – Areas for development
• Small group discussion
   – Your observations
   – The experience of observing and picking out
     strengths/weakness
      •   What did it feel like?
      •   Did you know what you were looking for?
      •   What level were you expecting?


                                      Quality Education for a Healthier Scotland
             Observation Task                                                      Psychology




Clip 2
As before, however the trainee is more experienced

In your groups discuss:
   –   What was it like this time?
   –   How confident did you feel?
   –   How difficult was it to find areas for improvement?
   –   How close to your level do you think they were?
        •   How does that impact on you and the decisions you make?




                                      Quality Education for a Healthier Scotland
       Considering Competences                                                  Psychology




Clip 2
• Third year trainee working with a woman
   experiencing low mood and relationship difficulties.
• Observe with checklist
   – Strengths
   – Areas for development
• Small group discussion
   –   What was it like this time?
   –   How confident did you feel?
   –   How difficult was it to find areas for improvement?
   –   How close to your level do you think they were?
   –   How does that impact on you and the decisions you make?


                                   Quality Education for a Healthier Scotland
   Kolb‟s Experiential Learning Cycle                                          Psychology




Adapted from Milne & Jones 2002   Quality Education for a Healthier Scotland
Kolb‟s Experiential Learning Cycle                                Psychology




                     Quality Education for a Healthier Scotland
           Experiential Learning                                                         Psychology




Observation is the key
    By supervisor
        Anxiety provoking but does convey interest
        Can be supportive
        Nature will change through placement
        Maintains Quality Assurance
        Provides evidence for both formative and summative evaluation
    Of Supervisor
        Provides model
        Is experienced differently through placement
        Promotes reflection (through modelling)
        Reiterates “competence” (and therefore confidence in trainee)




                                            Quality Education for a Healthier Scotland
           Demonstrating                                               Psychology




What are people‟s recollection of observing
their supervisors?
   – When?
   – How often?
   – What kind of activity?

Why is this the pattern?
  – What are the struggles for supervisors?
  – What is your experience of demonstrating
    (ie observed but not evaluated)
                          Quality Education for a Healthier Scotland
   Experiential Learning                                                  Psychology




Observations of supervisor

Observations by supervisor




                             Quality Education for a Healthier Scotland
   Experiential Learning                                                  Psychology




Observations of supervisor

Observations by supervisor




                             Quality Education for a Healthier Scotland
                                             Psychology




Quality Education for a Healthier Scotland
Setting Learning Objectives with Trainee                              Psychology




 SMART objectives are:
    Specific
    Measurable
    Achievable
    Realistic
    Timely




                         Quality Education for a Healthier Scotland
                Setting ILO‟s                                                   Psychology




Split into groups of similar type (e.g. adult, learning
  disability etc) if possible
• Think about developing some SMART ILOs for the
  placement you offer.
    – What would be the specific competences they would expect
      to see developing within their placement?
    – What methods do they use to nurture these competences
      in the trainee?
    – What experiences doo they offer which directly contribute
      to the development of the competences?
    – How do they know if the competences have been
      achieved?
    – How do they review them.


                                   Quality Education for a Healthier Scotland
                 Contracting                                                        Psychology




• What are your recollections of the supervision
  contract?
  How is it generally used?
  As trainee, how did it feel?
  Was it ever revisited?
  How were boundaries set?
     Were they explicit or implicit?




                                       Quality Education for a Healthier Scotland
         Beginning Contracting
                                                                            Psychology


        Wish List                      Making concrete


What is important for you in
supervision?                   Which of these could you
                                contract for?
„My image of successful        What would it look like?
supervision is…..‟
„What I fear happening in      What would be the
supervision is….‟               challenges
                               What might the impact on
Write down some                 the relationship be?
responses to these
questions
   As a supervisee
   As a supervisor
                               Quality Education for a Healthier Scotland
           Why Contract?
                                                                            Psychology




Scaife (2001/2009) gives a number of
 reasons to contract including the
 following:
  • To clarify the expectations of both parties
  • To set a context of openness and negotiation
  • To set a context of shared responsibility
  • To encourage supervisees to think about the
    conditions that help them learn
  • To model exploring process and content
  • To clarify the evaluative role
  • The identify the context (e.g. training) within which
    the supervision will occur
                               Quality Education for a Healthier Scotland
                     Contracting                                                Psychology




•In contracting a new              Individual session
supervision relationship you         contracting
may want to consider the           – responsibility, number of
following:                           clients/issues to be discussed,
 –The developmental stage of         etc.
 the Supervisee
                                   – Clarity about the reduction of
 –The interpersonal style of the     harm as paramount and my
 Supervisee
                                     need to act if necessary
 –The Supervisee‟s needs within
 supervision                       – Ways of developing mutual trust
                                     (e.g., „My image of successful
 –The Supervisee‟s previous
 experience of supervision           supervision is…..‟, „What I fear
                                     happening in supervision is….‟)


                                   Quality Education for a Healthier Scotland
           Contracting                                             Psychology




–Ways of constructively challenging when
 appropriate
–Transference and countertransference
 issues- how we can deal with personal
 issues that arise (for both of us)
–Confidentiality boundaries
–Working with difference
–System for review and feedback
–Negotiation regarding the use of the
 parallel process practicalities
                      Quality Education for a Healthier Scotland
                      Helpful events
‘Factors which might contribute to effective supervision’                        Psychology
   Hirons and Velleman (1993) Clinical Psychology Forum 57:11-13


• Joint problem solving
• Guidance on clinical work (including observation of
  supervisor and guided discovery)
• Theory/practice linking
• Reassurance
• Soliciting views from the trainee
• Reflection on parallel process between therapy and
  supervision
• Being available and reactive to trainee needs
• Sensitivity to impact of personal issues on ability to
  carry out certain types of clinical work
• Discussion of feelings
                                    Quality Education for a Healthier Scotland
              Unhelpful events
                                                                          Psychology

•   Lack of direction in therapy
•   Trainee being talked to like a client
•   Non-genuine reassurance
•   Lack of direct guidance when needed
•   Supervisor telling the trainee what to do
•   Anxious supervisor-unclear advice
•   Unreliable supervisor
•   Global, unclear criticism
•   Lack of balance between +ve and -ve feedback
•   Expected to ‘know what to do’




                             Quality Education for a Healthier Scotland
    Cushway & Knibbs (2004)                                                       Psychology




Helpful Aspects                    Unhelpful Aspects
Rapport & Safety                   •Unbalanced
      e.g. affirming & safe,       •Developmentally
      emotional support,
      supervisor qualities,        inappropriate
      supervisor self-disclosure   •Intolerant of differences
Client Focus and Challenge         •Poor model of
      e.g. challenge and           personal/professional
      direction, introducing new   attributes
      ideas, reflection, direct
                                   •Professionally apathetic
      learning


                                     Quality Education for a Healthier Scotland
             Role model                                                Psychology




Supervisor perceived as
•   Skilled and knowledgeable
•   Respectful of clients
•   Respectful of colleagues
•   Respectful of trainee
•   Viewed as possessing special knowledge,
    credibility and integrity


                          Quality Education for a Healthier Scotland
The supervisory relationship over
        time (Frost, K. 2004)                                               Psychology




IPA study of 4 supervisory dyads over 3 time points

Beginning: Supervisee: adjusting, seeking guidance,
  striving for acceptance. Supervisor: influence and
  guidance , nurturance and commitment.
Middle: Supervisee: expanding learning and
  understanding. Supervisor: exploring ideas, settling
  into a sense of security, trusting the trainee.
End: Supervisee: resolution and empowerment.
  Supervisor: satisfaction and collaboration, evaluation
  and endings.
                               Quality Education for a Healthier Scotland
               Contracting                                                Psychology




Behavioural Rehearsal
• Trainee
• Supervisor
• Observer
  – Observe and feedback, commenting on issues of
     • Power
     • Modelling
     • Negotiation
  – In “washup” connect with trainee/supervisors
    reflective experience

                             Quality Education for a Healthier Scotland
                                             Psychology




Quality Education for a Healthier Scotland
    The Supervisory Alliance                                       Psychology




„The content of supervision is not
explored by two impartial objective
observers looking at various areas of
the supervisee‟s working life, it is in
the context of the live and changing
interaction of the supervisory
relationship.‟
Hawkins (1982)
                      Quality Education for a Healthier Scotland
      The Supervisory Alliance                                                  Psychology




You and the trainee are approaching a lift on the way to
a meeting. Consider what happens next:
   – Who presses the lift button when outside the lift?
      • How would you feel if the trainee pressed the button?
   – Who goes in the lift first?
   – Where do you stand?
   – Who presses button inside?
   – How was it being in the lift?
      • What did you discuss (if anything!)?

How would it look for each of your “future selves”
   – How might you be?
   – How would you like to be?
   – How are you afraid you could be?
                                   Quality Education for a Healthier Scotland
        The Supervisory Alliance                                                Psychology




One floor later someone else gets on. It turns out its …
 –   Your supervisor
 –   The trainee‟s line manger
 –   The clinical tutor
 –   A client!


How does this impact on the activity on the lift?
 – How does the relationship between you and the trainee
   change?
 – Who presses the button now!



                                   Quality Education for a Healthier Scotland
                Context for the Relationship

Public                                                                          Psychology




               NHS                        University
         Supervisor‟s
         supervisor                                 Academics



          Supervisor      Trainee              Clinical Tutor




                          Client



                                   Quality Education for a Healthier Scotland

								
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