Considerations for Improving Supervision of Clinical Practice From an Exploratory Case Study

8/4/2019 Considerations for Improving Supervision of Clinical Practice From an Exploratory Case Study

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Clinical Psychology Supervision Observations Report Dianne Allen p.1

Considerations for Improving Supervision of Clinical Practice from an Exploratory Case Study

Considerations for Improving Supervision of ClinicalPractice from an Exploratory Case Study: Group Supervisionfor Supervisor and Trainee

Dianne Allen, 2006

Contents

Considerations for Improving Supervision of Clinical Practice from an Exploratory Case Study: Group Supervisionfor Supervisor and Trainee ...................................................................................................................................... 1

Abstract: ................................................................................................................................................................. 2Context and Purpose of this Exploratory Case Study ............................................................................................... 2

Method of Inquiry and Consideration ...................................................................................................................... 2

Definitions and key assumptions made in this study ............................................................................................ 3

Report of Observations............................................................................................................................................ 3

Broader Context of the Group Supervision sessions ........ ......... ........ ......... ........ ......... ......... ........ ......... ........ ........ 3The Group Observed ........................................................................................................................................... 4A Broad Brush view of the observed Group Supervision session ......................................................................... 4

Particular Implications of Group Supervision for a Fresher Group ....................................................................... 4

Analysis of Content and Processes .......................................................................................................................... 5

Content Components of a Group Supervision Session ......................................................................................... 5

Overview of Supervisors Practice in Formal Group Supervision Program .......................................................... 6The First Session ................................................................................................................................................. 6

The Experienced-Based Learning Components ....................................................................................................... 7Video: working with video records of practice .................................................................................................... 7

Role play: working with role playing the practice ................................................................................................ 8

Case Material: working with trainee case material ............................................................................................... 9

This analysis compared with the OBAS analysis ................................................................................................. 9

Reflective work when interacting with the literature .............................................................................................. 11The First Session ............................................................................................................................................... 12The Experiential Components ........................................................................................................................... 13

Figure 1 Various ways of recognising reflection in a particular learning context for psychology studies BobDick .............................................................................................................................................................. 17

The Reflexivity Issue ............................................................................................................................................ 17

Recommendations for Making the Most of Learning from Experience in the Practice Setting ............................... 19

Other Specific Recommendations for Group Supervision in the Practice Setting ............................................... 20Other Specific Recommendations for Individual Supervision in the Practice Setting ......................................... 20

Acknowledgements: .......................................................................................................................................... 21Bibliography: ........................................................................................................................................................ 22


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Abstract:A progressive reflective structure, of description, analysis, and attending to

critical/significant findings, is used to investigate and report on the relevance of particular

pedagogic features of a semester of formal group supervision for training in clinical

psychology. The emphasis on experience-based learning for clinical training is explored,and ways to help trainees make the most of the learning available from learning-by-doing

are enunciated.

Keywords: reflective work, Clinical Psychology, training, case study, supervision, pedagogy

Context and Purpose of this Exploratory Case Study

During the Autumn semester of 2006, an observer, from the field of studies in reflective research of

practice, attended the group supervision sessions of the clinical supervision component for six beginning students of

masters or doctoral studies in clinical psychology at the University of Wollongong. The observers purpose was to

find out if, and how, recent work done on reflective research of practice might be incorporated into the group

supervision process, to enhance current levels of learning from the supervision processes utilised in these sessions

(Allen, 2005). The group supervision supervisor (P-Supervisor) was intent on also checking out concurrent moves

towards integration and empirical evaluation of an objectives approach to clinical supervision (OBAS), where a

pilot study of objectives and methods had been reported to the field (Gonsalvez, 2002). The observer met with the

P-Supervisor at the end of most sessions to share feedback from the observers educative frame, and from the

observers work with engaging in reflective work to make the most of experience-based learning. On some

occasions the exchange of views in that debrief helped sharpen the P-Supervisors thinking about the experience-based tools and their use in group supervision sessions, and the nature and role of reflective work in helping draw

learning from experience.

Method of Inquiry and Consideration

Contemporary notes were taken of observations made during the session. The observations were

analysed, via a variety of lenses, for: their pedagogic contents and processes; their adherence, or otherwise, to adult

and/or higher and professional learning principles; the level and effectiveness of the experiential components; and

the way the whole might be reflexive of the principles of cognitive behaviour therapy. The analysis was then

compared with the objectives approach to supervision (OBAS) currently subject to broad evaluation by the present

faculty staff, and tested against current trends in clinical training for psychology. The purpose of this analysis was

to expose and consider ways supervisors might develop their supervisory practice to contribute to the learning of

the trainee in such a practice-focused context.

The observer took into the sessions the following hypothesis concerning reflexivity in developing practice

skills where the person is one of the tools of the practice: That clinical psychologists, to improve their practice,

need to work on a second-order process, and that work will be most effective, but also subject to difficulty and

confusion, when that second-order process matches their practice theory-in-use. The observer went into the


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Considerations for Improving Supervision of Clinical Practice from an Exploratory Case Studyobservation with no prior awareness of the P-Supervisors commitment to and engagement with the OBAS frame

for undertaking and evaluating supervision of clinical training.

Definitions and key assumptions made in this studyBy way of clarification for thinking about the following material, the observer, as a novice in clinical

psychology, has developed the following working definitions:Clinical = assessment and treatment; diagnosis and therapy; the interaction of assessment in response tothe effects of treatment (ie tentative hypothesis forming and experimental testing of the hypothesis,

including how testing the capacity of the client to take action in response to the therapists treatment

suggestions provides more data to take into the hypothesis testing and adjustment, leading to progressively

better formulations of the case and its appropriate treatment)

Supervision = combination of educative and clinical work to contribute to the formation of the trainee as a

competent psychologist-in-practice. P-Supervisor (abbreviating the idea of practice supervision) in thisreport refers to the supervisor acting to contribute to the trainees learning about practice issues:

knowledge, skills, attitudes and relational aspects of the profession of psychology (OBAS analysis,Gonsalvez, 2002)

Practice = what the therapist (practitioner) does, in the clinical or simulated clinical context, to express

their professional capacity to deal with the presenting problem, and help the client deal with the life issues

involved for them (a combination of mobilisable knowledge (including theoretical understanding of thefield) and mobilisable skills in dealing with the presenting case at hand, with all its recognisable or

discoverable contextual cues and constraints)Therapist= the experienced clinical psychologist or the clinical psychologist trainee, exercising their

current mobilisable knowledge and skills in a practice context

Reflective work= the use of remembering and other tools (Dick, 1998) for capturing data on thinking

(cognitions), feelings (affect) and actions (behaviour) experienced and undertaken by the therapist in

therapy, with a view to working with that data and examining the effectiveness of the practitioners theory-

in-use, and the congruence of their thinking-action in the application of diagnostic and therapeutic movesto help the client to learn to change. (That is to say, the Deweyan view of reflection (Dewey, 1933);

elucidated by recent scholarship about the relationship of cognition-affect-behaviour in reflection andlearning from experience (Boud, 1985; Heron, 1999); and applied with a view to developing action

conclusions (Argyris, 1985, 2004). Because the therapist is working with a client to learn to change,

reflective work on their own practice (ie the therapist is also working on learning to change for themselves,in their practice, to become a more effective practitioner) is a second-order activity for the therapist, and is

reflexive in relation to the activity of therapy). The assumption is that such reflective work is needed to

make the most of the learning available from experience, by helping the trainee recognise what has been

learned by doing the practice. Further, that being conscious about doing this kind of work, in a systematic

manner, will yield higher quality learningmore depth (Entwistle, 1997 #730), as well as some awarenessof that increased depth, richness and complexity.1

Report of Observations

Broader Context of the Group Supervision sessions

The students of Clinical Psychology (CP) have a total of 200 hours of CP supervision, over two years.

That consists of four, 13 week, 1.5hr sessions of group work with about 5-7 peers, usually with four different

university staff, ie 78 hours group supervision, and about 100-120 hours of individual supervision sessions, either

with the clinician supervisor during their practicums, or with one of the university staff for individual and

confidential support of practice etc emergencies. The CP supervision in groups is not assessed. Supervision

during the practicum is assessed. (See current studies for findings of work-in-progress here (Gonsalvez, 2007).

The group forms by allocation: the students are allocated to groups by staff, taking into account when it is

held, and by whom it is conducted. The groups can be relatively homogeneous, or more diverse. Students can


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Considerations for Improving Supervision of Clinical Practice from an Exploratory Case Studytravel through the group supervision sessions as a cohort, or be associated with different peers for each or most

groups. Their exposure to a maximum of four university staff practitioners provides access to different therapy

approaches and/or different personal styles of supervision over the four years. The supervisors, from the university

campus and from the clinical practicum sites, meet twice a year, for professional inputs, and for workshopping

current issues of clinical supervision, and the development and assessment of clinical skills in new and developing

professionals.

The Group Observed

The group observed was a group of freshers: students with limited or no practice experience, and/or just

beginning formal postgraduate studies. They began the semester by negotiating learning objectives for the time

together. Typically, the groups negotiate the development of skills for Cognitive Behaviour Therapy (the P-

Supervisors area of clinical expertise), or other therapy approaches.

A Broad Brush view of the observed Group Supervision session

In the group observed, the P-Supervisor opens the session by negotiating the focus for the session, and

secures commitments from the group for material to be available for the next session. The specific therapy

practice skill focus component, approximately half of the time each session, can be joint viewing of a video of a

student-therapists practice, or as students become more involved in dealing with clients, can explore current issues

involved in providing therapy in a client-based case. The remainder of the time can be spent exploring therapy

practice issues, including self-care for the therapist.

With the fresher group in first semester 2006, one of the clinical experts foci was on using reflection to

enhance practice learning. In previous years, with fresher groups, the foci have been elsewhere. These foci

develop in response to the negotiation of the initial overall learning objectives with the group, the developing group

dynamics, the staff members agenda for clinical skill development and current trends.

Particular Implications of Group Supervision for a Fresher Group

As a fresher group, the first semester of CP supervision is in effect preparing them for making the most of

the remaining three supervision group sessions: getting used to having, bringing, and sharing practice issues and

insights from their own therapy practice, amongst a group of peers. The primary device for doing that is the joint

viewing of a short video tape, of either a peer pair simulated session, or of a therapist with a client, where the video

recording has been agreed to, to be a tool and provide vivo data for clinical practice analysis purposes. The group

is involved, as individuals, in seeing their own practice open to the supportive scrutiny of peer practitioners. This

experience is reciprocal: they see everyone elses practice for the same sort ofpractice-related scrutiny. For the

first exposure to this kind of examination of their practice, this can be a personally threatening event. In the

fresher round, the task of the P-Supervisor is then (1) helping the individual navigate this personally vulnerable

event, at a level that equips them to continue to use this form of practice learning effectively, (2) helping them

1 This can possibly be appended at the end, as an endnote


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Considerations for Improving Supervision of Clinical Practice from an Exploratory Case Studyacclimatise to this form of practice learning, (3) helping them identify, and appropriately evaluate, their own and

others execution of the practice skills involved in the intended therapy approach, (4) helping them think clinically

about the problems arising in practice and thinking therapeutically about strategies of therapy relevant to presenting

problems, in either their own case or in the cases of their peers. There is both learning directed by the P-

Supervisor, and learning from peer inputs.

The learning-by-doing aspect of the clinical supervision sessions is set within a wider frame where there

are (1) demonstrations and descriptions of the micro-skills associated with the therapies being examined and

developed in the clinician-in-training, (2) demonstrations and descriptions of the suite of actions that constitutes

effective practice of a particular therapeutic approach, (3) regular faculty-wide case conference sessions for current

hard cases for current students. These processes are consistent with Donald Schons observations of, and

discussion about the way to educate the reflective practitioner, in psychotherapy and in other professional areas

(Schon, 1987, especially p.303-343).

Analysis of Content and Processes

Content Components of a Group Supervision Session

From the observations of the ten sessions attended by the observer, the following eight aspects of an

individual session were identified:

1. Opening worknegotiating objectives

1.1 Foreshadowing coming sessionspecific goals

1.2 Capturing anything from previous session, from homework between sessions

2. Closing workstructuring objectives for future meetings

2.1 Setting particular targets for homework for next session

2.2 Recapitulation of session material and/or immediate reflections on that

3. De-stressing component of session workexplanation; implementation of function

4. Skills workRole plays

(There were six instances spread over the semester. Progressive development of the level of

CBT assessment and therapy approach was observed in the inputs and engagements of the

students over the period.)

5. Skills workVideos

(There were six instances spread over the semester. Each student was observed in the therapist

role. P-Supervisor inputs included: normalisation for expectations of self in learning the

practice, an aspect of de-stressing; technique identification; therapeutical model identification;

matching steps to structures for assessment BASIC-P, ABC, etc; assistance with self-assessment.

Peer learning and engagement included: observation and identification of specific process steps;

giving peer feedback; getting peer feedback; getting P-Supervisor feedback; examining and

reporting on their own practice; observing others/peer practice)

6. Skills and knowledge work in practiceCase work7. Knowledge content contributions


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Considerations for Improving Supervision of Clinical Practice from an Exploratory Case Study8. Post session debrief for Supervisor with observer (unique to this round of group supervision)

Overview of Supervisors Practice in Formal Group SupervisionProgram

For an overview synthesis of the content and processes, the observer evaluated the P-Supervisors practice

to appear to be a seamless display of the way in which practice intentions developed during a typical case

timeframe, and achieved similar outcomes to the claims of the therapeutic approachie supervision can be

perceived as CBT for novice therapists, not yet dealing competently/effectively with tasks in therapy (assessment

and treatment/ intervention).

Supervision is the exercise of cognitive therapy on practitioners who are using cognitive therapy to helpothers become more effective in their life. For the cognitive therapists working with dysfunctional clients,

the help is at a primary level: out-there, on anothers problem, within a structured frame (of DSM IV, andof recommended therapeutic optionsthose being learned as part of the course). For the supervisor

working with the neophyte practitioners, or experienced practitioners working with current problems, the

supervisor, or the peer group, is working to help the practitioner see their own current ineffective

thinking, operating in the exercise of their practice of helping others see their ineffective thinking. This is

the second-order level operation that is spoken of in Batesons work and Argyris and Schons work. The

neophyte practitioner, or the experienced practitioner with a perplexity (Dewey and Schon), however, is

not (yet) operating at a pathological level. There is no DSM IV for the faulty or incomplete thinking

during diagnosis, or for faulty thinking in designing therapeutic approaches. In Schons terms, theprocess needed is, for the practitioner, one of learning how to reflect-in-action, and involves mental or

actual experimenting with a tentative hypothesis, and being prepared to drop one hypothesis and reframethe problem in another way, and test that, mentally or actually. [Observers post observations reflections

and meaning-making notes 30/5/2006]

The following particular aspects of micro-skills were evident in the P-Supervisors practice and noticed by

the observer, as having relevance to the nature of the practice, and skill advancement in the practice: Significant use of effective metaphors: helping a client to distance/ dissociate from a personal to a more

generalised situation which allows them to begin to think about the problem a bit more dispassionately/

disinterestedly, and recognise possible alternatives to lead to a possible solution (cf Stewart Hase and use

of irony, and childrens stories, personal communication)

Use of language: gives other options to students; especially once students were aware that they were stuck

for variety of terms to express emotions, in exploring emotional component of a clients experience

Multiple choice/ multi-pronged questions: giving a client a variety of options to choose from which best

expressed /captured where they were at

The First Session

At the first session the group developed objectives for the semester that included knowledge and skills.

The P-Supervisor indicated that to focus on skills would involve working with case material, undertaking role

plays, observing and providing feedback to video records of the students operating as therapists. Arrangements

were made for one of the students to bring a video of their therapy practice to the next session. By way of

example, in the second half of that session, one of the students case concerns was used as an opportunity for a role

play. The P-Supervisor undertook the role of therapist, the student with the case concern played the role of the

client, the remainder of the class observed. The role play was broken into two parts, the first stage some diagnostic

work, and the second stage some therapeutic work. In the break in the middle, the P-Supervisor dismissed the


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Considerations for Improving Supervision of Clinical Practice from an Exploratory Case Studyclient from the room and engaged with the observers about diagnosis, and about possible therapy. The P-

Supervisor also indicated some of his own practice thinkingwhat was the possible diagnosis and why, and what

would be his next step confirming the diagnosis and in the development of an appropriate therapy activity. At the

end of the role play there was debriefing, at a number of levels. The observers were asked for their responses to

what they had observed. The student in the client role was asked for their response to the experience from the

other side. The P-Supervisor reiterated for the observers, and disclosed for the client role player, what he was

doing before the break and after the break, and linked it back to the material of the course: lectures on techniques,

on theory; the prospective practice work with clients and video records for learning about practice, from the clinical

psychologists point of view; discussions associated with case conferences, etc.

The Experienced-Based Learning Components

Three major experiential or experience-based learning components were identified in the group sessions:

video work, role play and workwith the trainees current case material. As noted above, there were six instancesof video work, six instances of role play work, and eleven clear instances of working with case material. In terms

of time spent on these experience-based components, each session was split in two, where the video work or a role

play, and the discussion arising, constituted the second half of the time for all but one session when the second half

was devoted to working with a trainees current case material. Frequently, discussion of trainees case-related

questions, and identification of learning needs, led to an informally generated role play, which was conducted in the

time slot allocated for other learning modes (3 of the 10 sessions had both role play and the video work).

Video: working with video records of practice

From the analysis of the video work accomplished in the sessions the following common processes were identified:

P-Supervisor asks student to identify what they want to learn from the video and the class feedback and

discussion

There is stopping of the video at key points

o When the P-Supervisor intervenes it is to identify a particular aspect of therapy worth noting

o When the trainee stops it is to get feedback about the problem as they were experiencing it at the

time

P-Supervisor invitespeers to provide input about what has happened; whats the diagnosis at this point;

whats the next step

P-Supervisor asks student to report on self-assessment

P-Supervisor and peers give positive feedback about trainee performance

P-Supervisor provides normalising feedback to ameliorate the unrealistic expectations of the trainees

P-Supervisor gives specific feedback to address demonstrated practice inadequacy, usually by means of a

corrective exercise, generalised to all trainees, and gathering answers from more than one trainee

Over the six instances of the video work (sessions 2, 3, 4, 5, 6 and 7), two were of trainees with clients (the

first one and the last one); four were of simulations with peers playing the client role (this was because of the nature

of the fresher group, and the staging of their first exposure to clients in a university-based clinical facility). In all


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Considerations for Improving Supervision of Clinical Practice from an Exploratory Case Studycases but one the trainee initiated stopping the video. In the instance when the P-Supervisor initiated the stop it

was to raise the question about Whose Agenda? and as a significant aspect of professional practice.

The P-Supervisor inputs included: clarification of assessment steps, treatment steps; prospective questioning of

the observer trainees: what would you do next? (ie priming the observers to focus the learning); permission to

cruise while checking out blind alleys; therapy options; Cognitive Behaviour Therapy (CBT) process details;

linkages back to other course inputs, especially if recent, eg discussions in Case Conference sessions; knowledge

content about the particular case issue (eg the relevance and possible efficacy of CBT in the situation where there is

a development disabilitywhat can be reasonably attempted, and how, and where other strategies are necessary).

The trainee initiatives for stopping occurred to seek advice about: what to do when the client becomes

defensive; being uncertain about whats the next step; thinking that progress is faltering; recognising being stuck;

how to balance questioning with rapport building; trainees practice thinking as the client session unfolded.

Role play: working with role playing the practice

From the analysis of the role play work, conducted in sessions 1, 2, 6, 7, 8, 9, the following overview emerged:

All role plays had some experience-based salience or context. Four of the six role plays developed out of

trainees case material. One drew on the recent Case Conference observations of the trainees. One had a

prospective component, demonstrating how the P-Supervisor would deal with a client presenting for anger

management, and exhibiting anger behaviour, so that the trainee anticipating this as needed for a session

with a client could observe the P-Supervisors approach.

P-Supervisor played role of therapist (session 1, 6, 7 and 8) demonstrating skills

Trainees played role of therapist (sessions 2 and 9), each taking turns to progress the process

P-Supervisor initiated intentional time-outs to explain the process

P-Supervisor intervened to clarify the process, and to clarify moving the process through its stages

P-Supervisor froze his demonstration to check progress with diagnosis, to enunciate process, to offer the

role of therapist to the trainees to take the process to the next step (no trainee took up this offer)

No trainee initiated a time-out or an intervention to ask for clarification

Issues dealt with in the role plays included: obsessive disorder? watching self; processes: assessment andtreatment phases; anger management, especially the therapist managing the angry client; General Anxiety Disorder;

extending understanding of the BASIC-P procedure; shifting models; questioning the barriers; Socratic questioning

to challenge intermediate beliefs.

In the final role play the P-Supervisor, as therapist, used role-play as a therapeutic device. In the first role

play, the P-Supervisor took the therapist role, and was introducing the whole process, and enunciating its steps. In

the fourth role play the P-Supervisor again took the therapist role and demonstrated the fluid practice of the

experienced practitioner working with General Anxiety Disorder. In the third role play the P-Supervisor took the

therapist role, and the trainees expressed surprise at the content of the anger management moves: the apology, the


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Considerations for Improving Supervision of Clinical Practice from an Exploratory Case Studydeclaration of support of and obligation to the client. The trainees also appreciated the metaphor of the puppet on

a string for addressing the clients feelings.

Case Material: working with trainee case material

In the work with case material, occurring in sessions 1, 4, 6, 8 (3 case instances), 9 (3 case instances) and

10 (2 case instances), the analysis shows that in four instances (instances in sessions 1, 6, 8 and 9) the learning

needs were dealt with by conducting role plays. On one occasion, a foreshadowed case discussion was not

proceeded with when the trainee indicated that inputs from the recent Case Conference, the video, and the other

session discussions had provided enough to allow the trainee to take the next moves with the client2. Two case

material instances involved using external case presentation material to provide for an opportunity to t est progress

with diagnosing.

Prior to the discussion of case material the following occurred: The trainee with the case concern identified their specific learning need (skill or knowledge)

The trainee presented a summary of the case situation data

The trainee identified their practice problem (assessment or treatment or a particular aspect of process)

During the discussion of case material the following occurred:

Peer and P-Supervisor questioning extracted additional situational/contextual knowledge from the trainee

A key input from the P-Supervisor was the testing of any practitioner yes-butspersonal barriers in the

presenting case

Issues raised in the discussion of case material included: exposure therapy; reframing or shifting on models;

dilemmas on boundaries of professional practice; gender differences and boundaries; therapist disclosure; religious

thinking and pathology; General Anxiety Disorder; difficulty of the therapist in standing ground while challenging

and the fear of loss of rapport; any yes-buts in the trainee with their case materialpersonal barriers to thinking-

action in the exercise of their practice.

This analysis compared with the OBAS analysis

The analysis of supervisor objectives and trainee objectives3, identified and compared in the 2002 pilot

study, made a split between skill advancement methods and knowledge advancement methods. Further, it

identified case presentation and discussion within the knowledge advancement category, and separated out

demonstration of clinical skills by supervisor from observation of trainee performance followed by feedback and

role play (Gonsalvez, 2002). In this more qualitative analysis, greater acknowledgement is given to the holistic

2 Possible note for end: This reminds the observer that this report does not/ cannot record all the learning activitygoing on, only that which is open. Also, note, what is reported only represents that which is meaningful to the

observer, given the observers perceptive frame, and that which has been selected as salient for the purposes of thisreport.

3 Trainee objectives: A dilemma arises here about what the trainee knows about what they do not know, about

being able to articulate tangible objectives, about not knowing what they do not know and how practice and the

practicum experience helps identify that.


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Considerations for Improving Supervision of Clinical Practice from an Exploratory Case Studynature of practice and looks to recognise a more holistic process as being needed for training for practice, since this

is as a matter of congruence for practice and training for practice.

The video work conducted in these sessions included demonstration and observation. In video work the

trainee is in the role of the therapist, with either a real client or a peer playing the role of a client, so there is

demonstration of trainee skills in action. Having the video record of a more experienced practitioner operating

with a client demonstrates an experienced practitioner in action (not used during the semester sessions observed,

but available had time permitted). Likewise, the video record is open to the observation by trainees of peer

performance as well as allowing the observation by trainees of an experienced practitioners performance (if used),

and the observation by P-Supervisor of trainee in action. The video record captures vivo material and is then

available for slower and interrupted re-view, providing time and space for closer examination of therapy moves.

Furthermore, the trainee has the opportunity to undertake self-assessment post-event, before sharing with the group.

After the sharing of the video in the group session the trainee still has the video record for reviewing as often as

they like, for as long as they are still learning something from each view. This is the value of repetition in learning

in developing deeper knowledge about complex activities or concepts (Dall'Alba, 1996; Marton, 1993, 1997).

Similarly, role play work includes demonstration and observation. In a role play the trainee may act as a

therapist or a client. When acting in the role play of therapist, trainee skills-in-action are demonstrated. Such skill

demonstration is observable by both the other peer trainees and the experienced practitioner. When the

experienced practitioner plays the role of therapist, skill modelling occurs by way of demonstration, and is open to

observation by the non-role-playing trainees. The trainee taking the role of the client experiences some of the

affective as well as cognitive impact of the therapists approach, both of the assessment process and the

development of an appropriate treatment, when the role-play proceeds to that point. This other side of the

interaction, in the class context can be both a safe, and a powerful way of learning about that aspect of clinical

practice. Indeed, the playing of the role of client asks a trainee to identify some of the generalisable aspects of a

presenting problem, as the therapist questions seek to explore articulatable cognitions and affects observed almost

implicitly by the trainee, and can bring to their attention the nature of their awareness of the symptoms of the

presenting problem being studied. In the role play as an educative device in group supervision, the context of class

also allows for time-outs, for examining and giving immediate feedback on actions, cognitions, and practice

principles worthy of examination, and at the experienced practitioners or the trainees initiative.

As demonstrated in the semester of group sessions observed, work with the trainees case material can

become a role play opportunity (as was the situation in at least four of the eleven case instances), particularly when

the trainee identifies their learning need as skill-related, and when the experienced practitioner employs the role

play as the way of examining the case issue and/or the learning task to develop the required skill. In the observed

semester of group supervision, discussion of case material almost invariably involved the asking of clarifying

questions of the trainee about the case. These questions, more often than not, came from the peer trainees, and the

observer noticed that this engagement with and facility in information gathering, by the trainees, increased over the

course of the semester. Both the peer trainee questions and the experienced practitioner questions extracted

information that the initial case description did not provide, but which the trainee with the problem was able to

bring forward from their memory of their clinical work with the client. The different material drawn forth by such


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Considerations for Improving Supervision of Clinical Practice from an Exploratory Case Studyquestioning, and the nature of the questions asked that extracted that information, were open to both peers and

experienced practitioner to both demonstrate and observe. If the trainee was not overburdened with the

remembering task to answer the question, then they were also able to observe the nature of the questions asked, and

to sometimes recognise what were good questions, where if they had asked that of their client they might have

better information to work with.

Furthermore, case work in the group session provided the opportunity for the P-Supervisor to observe the

trainees skills in action in the same context (same access to information, same rights of questioning for

clarification) as the exercise of their own experienced skills. The experienced practitioner could then evaluate to

what extent the trainees were responding to different cues, and absence of cues or relevant information for forming

tentative hypotheses. The trainee with the case material brought forward for discussion was engaged in self-

assessment and case assessment, to the point of identifying their own stuckness, before sharing with the group. In

some instances the trainee was able to articulate the nature of the stuckness while identifying their learning needs.

So while the OBAS analysis categorised working with case material within the knowledge-advancement methods,

it is probably better to consider case material, when dealt with in this non-didactic way, as a combination of skill

advancement and knowledge advancement. The skill advancement occurs by demonstration and observation (by

peer and P-Supervisor), by taking on and owning the clinical professional role by the trainees, and by knowledge

advancement of the skill. The knowledge advancement develops of the differentiating symptoms of a

psychological pathology.

In addition, working with a trainees current case material is an opportunity to identify aspects of context

that need to be attended to in practice. Practice competence is more than knowledge (content) and skill (process).

Practice competence is content and process exercised in context. Context, what Bateson calls pattern through

time, is an essential component of what we also call meaning (Bateson, 1979, pp.14-15).

Reflective work when interacting with the literature

The above report, of the practice of group supervision, at the University of Wollongong, by this particular

staff member, constitutes some of the storying available from the observations. The series of sessions in this

instance provide an opportunity for an exploratory case study (Yin, 1984, 1993). As Schon and others note,

undertaking reflective work on practice (or any other activity) involves case study, and the usual way of reporting

the qualitative engagement in a case study investigation amounts to a story, where coherence becomes one of the

evaluative criteria by which practitioners, particularly, judge its usefulness (Kressel, 1997; Schon, 1991). As

Bateson points out, the development of a story is the identification of a knot of relevance, is the activity of a mind

(Bateson, 1979), and includes chunking of a host of data (Argyris, 1993), and,by arbitrarily punctuating a stream

of experience to develop abstractions, it allows an educator to present a complex phenomenon in a form that

another mind may recognise and relate meaningfully with (Bateson, 1972).

More significantly, Mezirow notes that the practice story or anecdote, like the metaphor, becomes a site

for abductive reasoning: where another practitioner is able to compare and contrast this report with their own

awareness of elements of their own practice (Mezirow, 1991). The reading practitioner is involved in (1) testing


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Considerations for Improving Supervision of Clinical Practice from an Exploratory Case Studythe reported practices relatability (Bassey, 1981 in Bell 1989) and (2) identifying any significant differences

between the report and their own practice, and which might constitute points of learning, since the difference

represents variance, an important pre-condition of perception (Marton, 2000) as a preliminary step of any

learning. {Abductive reasoning: where one person draws on their experience to explain anothers experience it is

a feature of interpersonal communication when one person is trying to understand what another means (Mezirow,

1991, p.84-5))

The continuation of the stories associated with the analysis of this case study now seeks to draw in and

draw on the considered views of other experienced practitioners, as reported in the literature, to provide a third

point (the practitioner writer is point one, the reader practitioner is point two and the practitioners reporting in the

literature become the third point) in the triangulation needed to test and confirm the merits of these findings,

especially in regard to their implementable validity (Argyris, 2004).

The First Session

There is an aphorism about starting the way you intend to go. More importantly, in educative processes,

Russell points out that the first session is a significant one for instituting any major change in pedagogic approach

(Russell, 2006). Russell draws on Nuthalls work(Nuthall, 2005) which concludes that teaching in class depends

on ritualized routines. The implication and application for Russell is that if a teacher wants to use new and

different approaches to learning, then the teacher needs to take the risk and present a new and different approach as

a significant and perhaps the major part of the first session of a class. Otherwise, the present level of acculturation,

in the ways of teachers and teaching, that the student brings to the class, after something like 15 years of

experience, will mean that the status quo of teaching methods will prevail, and any change of approach, tried later,

will be both harder to introduce, and to sustain, than might otherwise be hoped for by the initiating teacher.

The role play, as a novel and less-expected approach to skill learning in the group supervision component

of clinical training, by appearing in that first session, becomes the new default for learning in this course4. What

approaches to thinking about, examining, and learning from this instance, that the supervisor wishes to introduce as

a different but general approach to the learning required to become a scientist-practitioner will be engaged or not,

demonstrated or not, and valued or not, depending on what has happened and has been encouraged to happen, no

matter how tentatively or haltingly, especially for the students, in that first session.

If more focus on reflective work with experience, as part of the process of learning-by-doing (Boud, 1985,

1993, 1996, 1998), is to be introduced to budding psychologists to prepare them for clinical practice (American

Psychological Association, 2006; Hoshmand, 1994; Kressel, 1997; Power, 1992), then building that more

consciously, and explicitly, into the first session, will also be important.

4 And also for any future work undertaken with this P-Supervisor. His personal style, and his capacity to not hog

the floor, provided space for more and more trainee engagement and interaction. But it was also a skilled

performance: fluid, and appearing natural.


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The Experiential Components

It is clear from the records of the observed group supervision program that the focus on three modes of

experience-based learning, viewing videos of trainee practice, role plays, and work with case material, was high on

the agenda. That evoked the questioning of the efficacy, in terms of time spent on this form, of learning in this

way, and expressed by at least one of the trainees. Compared to other modes of learning, the role play, or the

examination of a video record for debriefing, takes time, and does not necessarily or easily yield material for

propositional reporting. This is, in part, because much of the activity involves embedded communication skills and

interpersonal skills, elements of competent practice in everyday living, and taken for granted. Being able to attend

to the embedded, and to learn to change any routinised response that is embedded, becomes a second-order process

for the student, where learning to attend to the self, and examine ones own activity, while engaging in that activity,

is called for. It is here where reflective work with experience, is required, in order to develop the data that allows a

person to learn from experience (Mason, 1993). As Russell comments, the question Can reflective practice betaught? is not a trivial question when exploring how to make more of the learning available in experience-based

instances (Russell, 2005).

The access to skill-in-action of both peers and experienced practitioner, in demonstration and observation

modes, provides for the trainee to recognise variances: between their own performance and their peer performance,

and between their own performance, their peers best performance and the experienced practitioners performance

(Bowden, 1998; Marton, 1997, 2000). The comparison of peer performance can sometimes be more informative,

since peers are likely to be operating within what Vygotsky has called the Zone of Proximal Development

(O'Byrne, 1998). When one of the peers is more advanced in one area of practice than the remainder, the others

learn from the more advanced performance. Though one trainee might be more advanced on one area that the

others, that same trainee might be less advanced in areas where another is more advanced. There is reciprocity in

peer learning. The value of access to P-Supervisor advanced performance is the recognition of the advanced

standard, especially in having it all together, in a fluid performance. It is even possible for the P-Supervisor to

learn from the more novice practitioners: what the novice practitioners do can often provide a perspective for the P-

Supervisor to review their own practice performance, and observing how peers learn from peers can help the P-

Supervisor identify relevant break points and foci for attending to significant differences, or developmental stages,

in performance when moving from novice to competence (Kressel, 1997).

Current concerns about the quality and nature of training for clinical practice in psychology tend to

challenge the efficacy of hours spent in supervision and in practicum, and calling for a redirection of effort on

building research skills (McFall, 2006), especially for students proceeding to doctoral qualifications (see also

Bickman, 1999). What needs to be noted here is that McFall and Bickman are speaking about US conditions,

where clinical studies class sizes reach as high as a mean of 48 (McFall, 2006). The University of Wollongong

model is closer to the mentoring spoken of by McFall as the preferred model that has come out of the researcher

development field. The use of role play and video work, in the one-to-one supervision and in the small group

supervision sessions, invokes the apprenticeship model, but with the added potential to undertake criticalexamination of the thinking-doing, theory-practice nexus. Clearly, experience without directed, and conscious


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Considerations for Improving Supervision of Clinical Practice from an Exploratory Case Studylearning from it, is wasted (Mason, 1993; Power, 1992). Similarly, the apprenticeship model, without appropriate

examination of another practitioners practice actions, rules of thumb, and concordance between practice and

theory, is fraught with developing embedded and unexamined practices (Power, 1992).

A review of the literature of the past twenty years or so indicates that the use of video, role play, or case

material in clinical training is either taken for granted, unchallenged, or ignored (Gonsalvez, 2002). The review

showed that both video recordings and engaging in role plays are used as assessment tools in clinical training, since

they expose the trainees skills to observation and assessment5. There is no mention of how to move from

assessment to giving meaningful feedback that might be part of focusing learning effort. That is to say, it is

assessment for quantification for research, or accreditation, and not formative assessment as part of an

intentional learning process. The educational value of the video-recording is taken for granted in its use in therapy

strategies6. The therapeutic value of the role play is likewise unchallenged7. What is challenged is the

unexamined nature of any or all clinical training (American Psychological Association, 2006; Bickman, 1999;

Gonsalvez, 2002; McFall, 2006), and relying on untested or under-researched beliefs about how professional

competence is formed or developed (Bickman, 1999).

A rationale for video work, as an educative tool in skill learning, supported by a broader literature base,

includes

Video work captures the complex of audio (text/conversation content, intonation for emphasis, pace for

reading comfort/ discomfort, fluency/ hesitancy) and video (gesture, body language) of therapists move,

clients response, therapists response or move, in the systemic and dynamic interaction

Once recorded it can be replayed, stopped, and slowed down, to allow the self-analysis and awareness of

what has happened develop (Schon, 1987, p.332)

The slow-down, the capacity to stop and segment interactions, allows a Supervisor to name processes, to

help students recognise steps and movements (Bateson, 1972, p.163, for supervisor as educator operating

in this way in the punctuating and abstraction process)

After-the-event, and after the emotional desensitisation, the material provides more access to what has

happened in a real therapy interaction, for the therapists to continue to learn from, demonstrating the value

of repetition in learning at this level (Marton, 2000, for repetition, and variation in repetition when the

understanding generates or allows for a change of perception)

The record, a form of documentation, over time, can allow a neophyte therapist to observe their ownincreasing competency, particularly important when trying to recognise learning of a complex process or

of subtleties of non-tangible activity, eg the thinking-affect-action complex, spiritual development

(Walker, 1985)

In the group context, it provides peers with evidence of alternative approaches and their effectiveness

(Bowden, 1998; Marton, 2000) for peers as a source of variation to learn from

5 I can cite some items here, mostly dissertations, but it is negative dataitems that demonstrate video recordingsand role plays are used as assessment tools. The referencing does nothing to contribute to the argument, or

provide useful resources for another to check for further useful information.

6 Again, I can cite some items here, again mostly dissertations, with the same caveat as in the previous note.

7 Again, I can cite some items here, again mostly dissertations, with the same caveat as in the previous notes.


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Observing peers work, with the intent of giving feedback, allows peers to recognise aspects of success, as

well as difficulties for other practitioners operating at a similar level, and provides for normalisation of

being able to make mistakes, of not having it all in place yet

Similarly, a rationale for role play work, as an educative tool in skill learning, includes

Role play draws on students experiential knowledge of a particular behaviour/ condition(van Ments,

1989)

Peers are able to observe and check their own thinking and projected action against the exemplar of the

experienced practitioner(Power, 1992; van Ments, 1989)

Pauses and debriefing clarify educative content, and educative perceptions: matching vocabulary with

chunks of interaction (Bateson, 1972, p.163)

Students are able to test their thinking with peers, with the experienced practitioner. Testing thinking can

be part of learning about reflective practice especially if the experienced practitioner is aware of what and

how they reflect-on-action and as and when they reflect-in-action, and can coach within such a frame

(Schon, 1987). (Reflective practice, as defined in Schons terms, involves the invoking of evaluation

against multiple criteria, and in a sequential hierarchy of relative values. The aspect of designing the

solution to a problem in reflective practice involves the choice of the hierarchy of relative values that

determines the sequence of multiple evaluations. Changing from one choice of hierarchy, because it does

not appear to be working, to an alternative choice of hierarchy is what Schon calls reframing, and

constitutes a perceptive shift about the possibilities of solving the problem. (Schon, 1983))

Live participants, with a capacity, because a learning context, to freeze a particular interchange for

explication of learning availableslowing down (Schon, 1987)

Also, a rationale for working with the trainees current case material, as an educative tool in skill learning, includes

The learner, when involved in identifying specific learning needs, summarising situation data and

identifying their practice problem, is operating out of key aspects of adult learning, timeliness, and

relevance, and are prepared for learning because they know what they want to learn (Abadzi, 1990; Burns,

1995; Power, 1992)

Peer and Supervisor questioning extracts additional situational/contextual knowledge from the learner-

practitioner, indicates others views of what information is significant, and which was not covered in the

summary, and involves the comparison between the learners frame and others frames, generating

variation that allows for learning, and particularly for an awareness that a different construction on the data

is possible (Marton, 1997; Schon, 1983)

Recognition of the level of the contextual that informs content and possible diagnosis/assessment and

possible therapy (Bateson, 1979)

Questioning to uncover any practitioner Yerbuttspersonal barriers to thinking-action (Boud, 1993c;

Charlton, 1995)

Schon indicates that the use of the case study is an important aspect of educating the reflective practitioner.

"All these things [putting students into a mode of operative attention; using cases as a way of

helping students learn an art of applying known principles; demonstrating, and helping students


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Considerations for Improving Supervision of Clinical Practice from an Exploratory Case Studytry out for themselves, kinds of reasoning by which to determine what issues and principles aremost usefully taken as central to the analysis of a given case; helping students make sense of a

problematic case situation where no known principles are involved - where a student is helped toperform a kind of frame experiment] some very good case teachers already know how to do, and

such case teaching deserves to be called a reflective practicum. In addition, however, student-practitioners might also be encouraged to see the case situation as one in which they try to make

explicit the underlying, tacit theories they bring to problem setting and problem solving. A case

teacher might involve them in such a process, first, by asking them, as usual, "What would youdo?" Then he might collect and compare a number of proposed courses of action and invite

students to try and construct the values, strategies of action, and underlying models of phenomena

that make such proposals seem plausible to their proponents. When practicing managers areinvolved in this sort of task, their exposure to multiple theories of action often makes them aware

of the extent to which their own practice is theory-laden; it suggests the surprising possibility of

theories of action alternative to their own; and it creates interest in the problem of testing,

synthesizing, or choosing among equally plausible theoretical options." (Schon, 1987, pp.323-4)

and Schon further remarks:

"There is, in the field of philosophy of science and in various social sciences, a palpablemovement towards new ways of thinking about research and practice - ways that emphasise the

merits of full, qualitative description of phenomena and the utility of well-worked-out cases of

intervention, even when their translation into general rules is problematic. And there is evidence

that a large and perhaps increasing number of students are attempting to create their own versions

of the reflective practicum that the schools have so far failed to offer (Schon, 1973)." (Schon,

1987, pp.313)

Hoshmand draws her analysis of inquiry in professional psychology to a close with reasons why to use case study

as an educative tool.

"Professional inquiry involves an ability to assess the requirements of a problem context, tojudiciously select models and methods to generate information, and to integrate the findings from

diverse sources into a pattern of understanding that will lead to useful action. As indicated by the

research reviewed in the previous chapter, this requires the development of well-connected andgeneralizable knowledge structures in specific domains. It is not sufficient to learn isolatedcomponents of knowledge and skills or to engage in solitary practice of their application. One

needs to have the opportunity to apply them in meaningful problem solving with supervision and

feedback. For the student who is learning about the various conceptual models in our field and

the diverse methods of inquiry and their possible applications, an integrative learning experiencecan be found in case studies. " (Hoshmand, 1994, pp.155-178)

Hoshmand's focus on the case study includes how to go about it in a reflective and reflexive way.

Given the amount of time devoted to these experience-based modes of learning, helping the trainees to get

the most value from that time, by developing their practice-related reflective work, will be important. Dick reports

that there are a variety of ways that can be recognised as using reflection to enhance learning, at the individual and

group level (Dick, 1998) as shown in Figure 1. Kressel nominates three key areas that might be productive foci for

reflective work for trainee psychologists, as it has been found that they are productive for mediators working on

their practice theories-in-use and by working with their competency building interactions in a peer support group

(Kressel, 1997): (1) negative surprises; (2) recurrent moments; (3) departures from routine. Knights suggestion

about co-counselling, as a mechanism for undertaking reflective debriefing has an added attraction in its

reflexiveness: the skills used and developed in co-counselling amongst peers are part of the skill set used to engage

in clinical psychology practice (Knights, 1985).


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Figure 1 Various ways of recognising reflection in a particular learningcontext for psychology studies Bob Dick

Mechanisms which were designed to increase

reflection by class members

Mechanisms which, although not specifically

intended for the purpose, were identified by classmembers as aids to reflection

Diary Home groups

Walk-talk pairs

Graded assessment

Self evaluation of all they do

Daily debriefing

Personal development plans

Course evaluations

Mentors

Meeting previous students

Process observers Coordinating the day's activities

Informal discussions (in class and out)

Field trips

Mini-lectures

Talking to staff members

Reviewing notes

Critical incidents

Diary and other feedback

Combination of mechanisms

The Reflexivity Issue

The above focus on reflective work to enhance learning from experience to develop communication skills

and interpersonal skills as part and parcel of the tools of trade of the practising psychologist, raises a number of

important issues: When, in the development of the practitioner is the demand for more reflective work most

appropriate? What are the implications for the supervisor-trainee relationship for mutual working with personal

reflections on cognitions, affect, and behaviour, when the practice of (especially) cognitive behaviour therapy is in

fact the exploration of a clients cognitions, affect and behaviours, with a view to bringing change that delivers on

greater personal efficacy. When does that relationship move the supervisor from educator to therapist and the

trainee from student to client? And what are the implications of that change of relationship, if it occurs? This is

not the place to discuss these issues in detail, but to flag one way in which reflective work, to improve practice, has

its own limitations: the implications of reflexivity, for the practice where the person is a significant tool in the

practice.

As noted at the beginning, the observer of the group supervision sessions came to those sessions with an

ear more attentively tuned to the paradox of meta-processes. The paradox of meta-process involves a reflexive

aspect of professional practice and professional practice improvement by self-study, where the subject is the object

and vice versa. The paradox comes from individuals not being able to operate at a certain level of perception to

discern the contraries that generate the paradox and bind the actor from effective action within their own too well-

known practice frame (Bateson, 1972). It is where practitioners lose sight of the elements of their own specific

practice, and are unable to use those elements on their own practice to improve it. The process seems to threaten

the capacity of self-study by reflective inquiry to produce practice improvement and to hint at some of the

unintentional contradictions that arise for practitioners as competence builds. The observers alertness to such a

phenomenon had developed from work with reflective research of practice, and self-study while studying others

responses to a professional development activity design which was based on increasing self- and other-awareness as

a pre-cursor to being able to engage more effectively in practice investigation within a peer support group (Allen,

2005).


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Considerations for Improving Supervision of Clinical Practice from an Exploratory Case StudyThe overview analysis of the group supervision program demonstrates elements of the practice of group

supervision that mirror the practice of cognitive behaviour therapy. The mirroring extended to the sessions having

a form reminiscent of the usual routine of a therapy session (opening and closing formalities; moves to de-stress

and make the client emotionally comfortable; moves to analyse the clients presenting problem; moves testing

hypotheses of condition assessment; moves to treat condition while continuously attending to responses that might

challenge tentative hypotheses; the role play that is used therapeutically to help a client see another persons view

of their own problem; the psychological education information input).

Responses in class also indicated that the students were aware of similar mirroring effects. In learning

how to act therapeutically, they were experiencing some of the processes they might take a client through. One

such observation was that over the time, the trainee had got more used to the video and video workits like our

own exposure therapy. Another shared the experience of seeing solutions and suggestions for how to handle her

own current dilemmas as she questioned and tested potential solutions with a client. One particularly poignant

reflexive moment, arose when the trainees experience of the P-Supervisors practice, as demonstrated in the group

supervision sessions and programs, mirrored that of a client in therapy. In the penultimate session they suddenly

realised they were coming to the end of the program and to the end of the trainee-supervisor relationship established

over the semester. The plaintive you didnt prepare us for termination! and the group-wide laugh, including the

P-Supervisor, said it all.

The issue for the reflexive nature of reflecting on practice to learn, and to improve performance, appears to

derive from what Bateson calls levels of learning, levels of communication, levels of attention, or levels of

cognition (Bateson, 1972). We can learn and we can learn to learn, a second-order process. We can think and we

can think about thinking, a second-order process which is called meta-cognition. To do any of these things, we

need to be operating at another level: the process under observation is an internal one and is observed, internally,

from another level. But we can also muddle levels and get confused about which level we are operating at, and

when that happens internal contradictions, or paradoxes, or incongruences of theory and practice, develop. There

appears to be a point, in practice, and the development of competence in practice, where the practitioner loses sight

of the process of that practice, and how it applies to the self as the practitioner endeavours to problem solve in the

area that is self-development and of improving practice. The point where this occurs appears to arise on the cusp

of competence and expertise, and may well be inherent in the point of moving from learner to competent

practitioner. We know what we are doing and are comfortable with its basic efficacy, and the ways of doing most

aspects of the practice have become (or are beginning to become) routinised, a patterned approach. Whether the

practitioner stays on that cusp and eventually falls into competence, or is prepared to stay a learner and move into

expertise, depends on whether they are able to mobilise the usefulness of reflexivity in reflective work, or whether

they have and need the assistance of some external agent to assist them move beyond that point. Where the power

of reflexivity breaks down for the individual, the role of the external agent, either the supervisor in clinical practice,

or the peer support group, enabled to engage in critically examining their current practices in a valid inquiry

process, becomes an important factor in any further practice improvement (Allen, 2005).

Learning, in clinical training, that focuses on learning available from experience, and does so by relying on

inputs from supervision, either from another experienced practitioner or from a group of peers conducting


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Considerations for Improving Supervision of Clinical Practice from an Exploratory Case Studycollaborative inquiry into their practice, can only go as far as the time permits to undertake the requisite work of

learning from the experience, and as the supervisors and/or peers are able to be aware of this capacity of reflexivity

to work for or against the learning required at the time.

Recommendations for Making the Most of Learning fromExperience in the Practice Setting

The main theme of this consideration is the question: How might trainees be encouraged to work at the reflectivework needed to make the most of learning-by-doing, to move toward the reflective practitioner model within the

spectrum of scientist-practitioner?

(1) Encourage the development of post-practice reflective work, descriptive, analytical, critical; workingwithin the categories, say, as enunciated by Tripp and Boud

Tripps Dimensions(Tripp, 1993)

Bouds distinctions

PracticalHow you respond in

practice, at the time,

the tacit response

DiagnosticTo identify by

careful observation;categorising

(categories available

from ontology; from

theoretical

understandings);

looking at possiblereasons

ReflectiveHow you feel about

the incident;

practitioners values

and values

immanent critique

capacities;

What should I do

and why ought I doit?

Socially criticalExploring the

ideology for socialjusticepower,

gender, race, etc

Cognitions

(Negatives surprises;

recurrent moments;departures from

routine Kressel,

1997)

Know what

(content)Know how (process)

Know what of how(content about

process)

Know how of how

(process of process)Know when

(context, timing)Know why (theory-

practice nexus)

Cognitive theory

match

Thinking about

thinking(epistemology)

Thinking aboutaffect

Thinking about

behaviour

Thinking aboutvalues: priorities in

actionsSelf-awareness

about practitionervalues

Smyths list here

(Smyth, 1996)

Affect Emotion and

motivation

Emotion and

barriers

Emotional hot

buttons pushed

Emotional

intelligence match

Emotion and

motivation

Emotion and

barriers

Emotional hot

buttons pushedThinking about

affect issues

Smyths list here

Socially permissible

expression of affect

Impact of repression

of affect

Behaviour (Actions)

(Negatives surprises;

recurrent moments;

departures from

routine Kressel,

1997)

What can I do?How can I best do

it?

What did I do in

practice?

How do I understand

what I did inpractice?

Cognition-Behaviour

relationship

Affect-Behaviour

relationship

Cognition-Affect

relationshipCognition-Affect-

Behaviourrelationship

Ethical dimension ofpractice

Thinking about

theory-in-use; ie

actions/behaviour

that demonstrates

theory-in-use held,compared to

espoused theory

Smyths list hereExtent to which

cognitions and

acceptance of

dominant

sociocultural frame

limits what can bedone; what should

be done

Practice Notes: It can be reasonably anticipated that the early emphasis, of observation and analysis, within this

grid, for the trainee, will be on the practical and the diagnostic.


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A supervisor cannot demonstrate what they do not do; and a supervisor trying to work with such agrid will themselves have experiential knowledge of how workable such a grid is

One key to making the most of this grid is to not try and do it all at once: that generates overload,discourages and demotivates; step the foci: 1. practical; 2. diagnostic; 3. reflective; 4. socially

critical (ie. Working with this grid represents a lifelong developmental program)

Alternate modes of observation and analysis between divergent (broad) and convergent (focused)and divergent again for thin description, then rich description, then selective focus and startingagain divergent, followed by convergent (Heron, 2001)

Remember the capacity of analysis to overwhelm, and the way we use heuristics to manage insuch complexity

(2) Make more use of the post-practice reflective work to enhance practice-related tasks; not assessment, butfor use in preparing case presentation material; for preparing reports about self-assessed and self-directed

learning(3) Help trainees to begin to share reflective work (thinking, and thinking-action connections) in group

supervision instances, preparing session minutes and with reflective content about evaluation of session forknowledge components; skills components; attitudinal components; relational components (OBAS

structure)

(4) Do work on case presentation (initial report; class inputs; developed report; preparations for next session;

post-session review of actions undertaken in relation to preparation intentions)(5) Do work on video, for self, for one-on-one supervision, for group supervision, and post supervisory inputs;of first re-view, of a later review, of a comparison with other videos of own practice

Other Specific Recommendations for Group Supervision in thePractice Setting

In the group setting one ofthe powerful sources of learning is from peers. Wengers concept of

community of practice is an example of the potential of learning from peers, by mutual supervision (Wenger,

1998).

In the group setting, moving to a collaborative inquiry mode, about the practice, by (1) rotating minuting

and structured reflecting on the session amongst the group, (2) working at a joint report supervisor and trainees

on what has been learned through the session, (3) allocating some time credits for the work involved, might make

more of what is being done presently

Other Specific Recommendations for Individual Supervision in thePractice Setting

At the individual level, starting the trainee off on their own practice reflective inquiry/ self-study as a part

of the negotiated relationship between supervisor and trainee, and part of the assessment process, might make more

of what is being done at present

Extending such an inquiry process to a collaboration between supervisor and trainee, about an aspect of

practice for both supervisor and trainee, and developing a report for internal consumption, as part of the

assessment process, might make more of what is being done at present


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Considerations for Improving Supervision of Clinical Practice from an Exploratory Case StudySmyths Lists

Smyth, John, (1996). Developing socially critical educators. p.41-57 in Boud, David & Nod Miller, eds Working

with experience: animating learning. London: Routledge, 1996

1 Describe what do I do?

2 Inform what does this mean?

3 Confront how did I come to be like this?

4 Reconstruct how might I do things differently?

p.53 questions to aid the process of confronting:

What do my practices say about my assumptions, values and beliefs about teaching?

Where did these ideas come from?

What social practices are expressed in these ideas?

What is it that causes me to maintain my theories?

What views of power do they embody?

Whose interests seemed to be served by my practices?

What is it that acts to constrain my views of what is possible in teaching?

p.49 questions to help teachers frame their thinking and actions:

1. Am I prepared to endure discomfort?2. Am I willing to challenge taken-for-granted (even cherished) assumptions and beliefs?3. Am I willing to begin to describe and theorise about what is going on here? 4. What, then, is actually going on here?5. How do I know whats happening here?6. What else do I need to know about what is going on?7. Who says this is the way things should happen?8. How did these things come to be the way they are?9. Whose interests are served by having things this way?10. Why do I teach this way?11. Whose interests are served in these circumstances?

12. Whose interests are silenced or denied?13. What are the impediments to change?14. How might I work differently?15. What kind of resistance might I expect?16. How do I intend to tackle that?17. How can I create different social relationships in my classroom and in the school at large?18. What hierarchies (authority, gender, race, class, etc) exist around me?19. Schools are never neutral value-free siteswhose politics are served?20. Whats educationally worthwhile fighting for here?

Acknowledgements:

I wish to acknowledge and thank Dr Craig Gonsalvez, and the students of his Group Supervision for Clinical

Psychology practice classes in 2006, at University of Wollongong masters classes, for access to the sessionsobserved, for sharing in thinking about reflective practice, in practice, and for post-session professional discussions

and analysis review.


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Considerations for Improving Supervision of Clinical Practice From an Exploratory Case Study

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