Abstract
‘Home is where we start from’ was coined by Winnicot (1990). What child doesn’t need a safe home base from which to explore and experience the world fully? What professional doesn’t need a safe base from which to explore a child’s and family’s difficulties fully when things go wrong? The range of articles in this special section serve to highlight how important an understanding of history, context, clinical model, and client group is in order for consultation and supervision to promote a full and safe professional engagement with our clients.
Consultation and supervision have long been part of service delivery in children’s services in the UK. Robin Skynner highlighted the importance of consultancy in his address to the London Child Guidance inter-clinic conference in 1967: ‘through consultation – we increase the capacity of others to carry a share of the treatment load … and to … illuminate the social, psychological, and psychiatric aspects of the problems they (front line staff) meet in the course of their own work.’ (Skynner, 1967, p. 50). Similarly, clinical supervision has a long tradition in psychotherapy practices and in social work. This rich and diverse history is evident in the writings of our contributors.
Consultation and supervision, despite their commonalities, are distinct activities which Southhall (2005) suggests are distinguished by differences in focus and responsibility. Most commonly in consultation, the consultee remains clinically responsible for any clinical decisions and the focus is on practice or on working with the organisation. On the other hand, in clinical supervision, the supervisor maintains a focus on the supervisee and is more often clinically responsible, if not wholly, at least jointly.
One of the privileges of editing a special section is the contact with authors and their writing which is often outside one’s usual reference points. Another privilege is to write an editorial. We would like to use this opportunity to reflect on some of the issues that emerged for us in reading and editing the material.
Political and social contexts
Risk
Some areas of our practice can readily become headline news, especially when outcomes are unexpected or mistakes are made. In these contexts it is a particular challenge to promote safe spaces for living, working and supervising. Several of the articles show how clearly articulated, theoretical and ethical frames provide important containment for practitioners and practice. It is in these contexts that the balance between ensuring and enabling has to be most carefully managed. In their paper about Multisystemic Therapy (MST), Ramón Karamat Ali and Daniel Bachicha show, by detailed clinical example, how in a risky setting, strong adherence to an explicit and clearly defined way of working keeps things safe. In their example a challenge to the worker in supervision enables a clearer boundary to be set for both worker and family. In this case the clarity of the task makes it easier to highlight when something has not been achieved thus rendering it available for challenge and fresh consideration. The illustration shows how the fresh consideration is made available through personal reflection by the worker: this brings the worker (and, therefore, the family) back on task to safety. Making safety matter by always asking about it is also highlighted in Arlene Vetere’s paper. She presents a way of making safety questions routine that increases containment and safety in a setting which requires flexibility, creativity and a keen attention to risk. Lynette Hughes in her ‘Test of time’ highlights the importance of a rigorous attention to emotional processing to avoid the danger of interprofessional conflict and collusion in safeguarding work.
Change
As professionals we inhabit rapidly changing work contexts. As you read the following quote you may be as surprised as we were when we noticed that it had been written over a decade ago. To us, it has a very contemporary feel:
‘It is difficult to identify any profession or occupation which is not heir to the knowledge explosion or indeed to the obsolescence of some forms of knowledge within it, to the technological revolution and to the modification of both values and practices.’
Clearly changing political priorities and approaches to service delivery were and are constantly impacting on provision. As policies, practices and organisations change we can feel in danger of losing our professional homes: the places we started from. New ideas and practices may be exciting and offer new possibilities. However, in amongst the debates about service funding the value of indirect working and the need for safe spaces to reflect on clinical work is not always recognised and sometimes has to be fought for.
Practice as art?
Practitioners can often be heard to rail against tick box cultures and bureaucratic or overly procedural responses to clinical challenges. Defensive organisational responses to anxiety can be all too common; however, we know that these responses can risk losing the potential for new resources and new vitality to emerge from more process-orientated responses. It is the possibility of something becoming known in a new way that we as clinicians value when we seek supervision or consultation. It is what keeps us on track to serve the needs of our clients. It is what excites us when we support others to engage in new understandings with us in supervision or consultation. As supervisors or consultants we might be reluctant to describe this as art although Shaw and D’Angour (2001) in their book about swimming and the Alexander Technique suggest that ‘Doing something with art means discovering the peculiar excellence appropriate to the activity’. We liked the idea of artistry being a discovery and a kind of peculiar excellence, and we thought it captured the many and different elements that can make up the supervisory experience for the provider and/or the recipient. Their descriptions of our potential relationship with the water also capture important ideas pertaining to positioning and being alongside and with clients, supervisees and organisations. Shaw and D’Angour suggest that swimming is not just about manoeuvring oneself through the water. It is also about being in water and with water. They add ‘There is an art just to being in the water’. There are resonances here with John Burnham’s paper about training supervisors. He provides us with some insight into how exercises worked through playfully can help trainee supervisors think about how they are in the water, and how different it might to be to swim as an experienced therapist or a novice supervisor.
The potential tensions that can arise from exploring these processes from different standpoints are well discussed by Joyce Scaife in her Soap Box. She asks us to think about the extra something that can be lost if our analysis is too simple or too concrete, as if in thinking about swimming we had forgotten what it can be like to be in the water.
In my reading for this special section, I came across Ruth Padel’s writing about poetry and thought she had something to say that had resonance for us in understanding supervisory processes. It seems that thinking about swimming, journeying and reading poetry can all show us ways to find something new or different in our understanding.
Padel (2008) suggests that to read a poem is to journey and that poems and journeys go together: her reflections on the way they go together sound like a reflection on a supervisory process:
‘Both move. Both take a bit of time and effort. Both let you reflect on other things as you go. Both can upset and surprise you. There may be boring moments; or moments that seem boring at the time though afterwards they were crucial. Both give you new windows on the world, take you out of yourself but let you more deeply into yourself at the same time. They get you to new places.’
This idea that supervision and consultation can take our work to a new place is central in all the papers. What other central ideas emerge across the different models and contexts?
New things made familiar and familiar things made new
It seems to us that the key personal and private processes discussed so far have been connection, being known in a relationship and reflection. We have also been reminded, especially when considering issues of risk and deprivation, that our thinking also needs to be rooted in public and political processes, and that there are important links between these wider social contexts, changing service values and the everyday experiences of clients and workers.
In addition practice context, theoretical models and professional discipline will all have an impact on how supervision and consultation contracts are drawn up and attended to. Clearly many distinctions can be made between different types of consultation and supervision. However, it seems to us that all of these activities will have at their heart a commitment to reflection in and on action (Schön, 1983) in the service of our practice and our clients. Whether it is within one’s agency (effectively with one’s colleagues) or an inter-agency conversation, and whether the context is one of exploration or more specific and outcome-focused, a secure base (Byng-Hall, 1995) is required to be able to engage in this way. It is this kind of reflective practice which enables professionals to work safely and creatively in the service of others.
In order for practitioners to be able to look at their practice critically and ethically, it is vital that a context of safety is established.
One aspect of safety is a clear understanding of accountability. Once this has been clearly established it helps the consultee or supervisee to trust the process. Importantly with a clear understanding (or contract) in place, the consultant or supervisor can be more effective and emotionally available. The relationships are clear: a mandate for supervision or consultation can be established.
The personal, professional and contextual factors that can impact on securing this safe enough space were raised by almost all our contributors. So too was the challenge of arguing for effective supervision and consulting forums within modernising working environments.
The rich selection of papers in this special section deal with a variety of supervisory and consultative relationships, from single encounters to the more ongoing relationships. We hope that they will remind you of certain familiar aspects of supervision and consultation processes and that as a reader you will also be introduced to new and less familiar issues. We trust that the novice supervisor or consultant as well as the seasoned will find something of interest and direct relevance to their practice in this collection.