Clinical supervision in systemic practice

Drawing from her experiences as a female consultant clinical psychologist and systemic family psychotherapist working within the National Health Service (NHS) and private practice, Dr Cristina López-Chertudi aims to explore the various dimensions of supervision, highlighting its context, purpose, and significance through the lens of systemic practice.

Understanding supervision

Supervision is aptly defined as “a formal process of professional support and learning which enables individual practitioners to develop knowledge and competence, assume responsibility for their own practice and enhance consumer protection and safety of care in complex clinical situations” (Department of Health, 1996). This multifaceted process can be categorised into three primary aspects: administration (normative), education (formative), and support (restorative) (Kadushin, 1992). By meeting the broader needs of clinical governance and continuing professional development (British Psychological Society, 2003), supervision ensures that practitioners can reflect upon their practice, conceptualise their experiences, and improve clinical practice and patient outcomes. Additionally, it promotes both personal and professional development (Carroll & Holloway, 1999), a sentiment widely supported among practitioners (Spence et al., 2002).

Systemic supervision and live supervision

One unique aspect of systemic therapy is the incorporation of live supervision. This method involves an outsider’s voice, often through a reflecting team, which fosters reflection and facilitates the creation of new meanings and understandings (White, 1995). Live supervision offers several beneficial dimensions, such as presenting different perspectives, ensuring transparency, and promoting thoughtfulness, respect, and mindfulness about language. It also empowers practitioners, brings freshness and flexibility to the practice, and supports and models various aspects of relating to others. However, it can have drawbacks, such as intruding into private experiences, leading to lengthy team discussions, and the challenge of managing multiple voices.

Non-live supervision: Depth and reflection

In contrast, non-live supervision allows for more profound reflection on personal values, family scripts, prejudices, and the therapist’s position within the therapeutic relationship. This form of supervision facilitates a shared, thoughtful, and deeper understanding of the family's experience, linking theoretical models with clinical presentations. Nonetheless, it can become detached, speculative, and potentially biased towards a single ideology, thereby deviating from the spontaneous shifts that families experience in therapy.

The developmental process model

The developmental process model of supervision proposed by Hawkins & Shohet (1989) is instrumental in exploring the session content, strategies, interventions employed, the therapist’s emotions, and the supervisor’s countertransference. This model acknowledges the power differentials inherent in supervision, allowing hierarchy and collaboration to coexist creatively and dynamically. For effective collaboration, it is essential to negotiate approaches, validate skills, engage in respectful dialogue, recognise differences in personal, professional, and cultural backgrounds, and access various expertise.

Balancing empowerment and restriction

Supervision can be both empowering and restrictive. When focused solely on meeting professional requirements and organisational standards, it can feel limiting and disempowering, offering little opportunity for collaboration and the joint creation of shared understandings. Therefore, the aim should be to create a safe, truthful, respectful, and honest space for sharing, moving away from discourses of pathology, and allowing flexibility and creativity to emerge in sessions with clients and within supervision itself.

Dr Cristina López-Chertudi is an esteemed consultant clinical health psychologist and systemic family psychotherapist. You can schedule an appointment with Dr Lopez-Chertudi on her Top Doctors profile.

References

British Psychological Society, (2003). Policy guidelines on supervision in the practice of clinical psychology. Leicester: The British Psychological Society.

Carroll, M. & Holloway, E. (1999). Counselling supervision in context. CA: Sage Publications Ltd.

Department of Health. (1996). Clinical supervision: a resource pack for practice nurses. Department of Health, NHS Executive.

Hawkins, P. & Shohet, R. (1989). Supervision in the helping professions. Milton Keynes: Open University Press.

Kadushin, A. (1992). Supervision in social work (3rd. ed.). New York: Columbia University Press.

Spence, C., Cantrell, J., Christie, I. & Sameti, W. (2002). A collaborative approach to implementing clinical supervision. Journal of Nursing Management, 10(2), 65-74.

White, M. (1995). Reflecting teamwork as definitional ceremony. In White, M. (ed), Re-authoring lives: interviews and essays, pp 172-198. Adelaide: Dulwich Centre Publications.