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 Clinical Practice from an Exploratory Case Study: Group Supervision for Supervisor and Trainee
Dianne Allen, 2006

Contents
Considerations for Improving Supervision of Clinical Practice from an Exploratory Case Study: Group Supervision for Supervisor and Trainee ...................................................................................................................................... 1 Abstract: ................................................................................................................................................................. 2 Context 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 ............................................................................................. 3 The Group Observed ........................................................................................................................................... 4 A 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 .......................................................... 6 The First Session ................................................................................................................................................. 6 The Experienced-Based Learning Components ....................................................................................................... 7 Video: 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 .............................................................................................. 11 The First Session ............................................................................................................................................... 12 The Experiential Components ........................................................................................................................... 13 Figure 1 Various ways of recognising reflection in a particular learning context for psychology studies Bob Dick .............................................................................................................................................................. 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 ............................................... 20 Other Specific Recommendations for Individual Supervision in the Practice Setting ......................................... 20 Acknowledgements: .......................................................................................................................................... 21 Bibliography: ........................................................................................................................................................ 22

Clinical Psychology Supervision Observations Report Dianne Allen p.2 Considerations for Improving Supervision of Clinical Practice from an Exploratory Case Study

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 experiencebased 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

Clinical Psychology Supervision Observations Report Dianne Allen p.3 Considerations for Improving Supervision of Clinical Practice from an Exploratory Case Study observation 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 study

By 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 to the 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 this report 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 the field) 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 theoryin-use, and the congruence of their thinking-action in the application of diagnostic and therapeutic moves to 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 and learning 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 learning more depth (Entwistle, 1997 #730), as well as some awareness of 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

Clinical Psychology Supervision Observations Report Dianne Allen p.4 Considerations for Improving Supervision of Clinical Practice from an Exploratory Case Study travel 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 PSupervisors 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 of practice-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

Clinical Psychology Supervision Observations Report Dianne Allen p.5 Considerations for Improving Supervision of Clinical Practice from an Exploratory Case Study acclimatise 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 PSupervisor, 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 work negotiating objectives 1.1 Foreshadowing coming session specific goals 1.2 Capturing anything from previous session, from homework between sessions 2. Closing work structuring 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 work explanation; implementation of function 4. Skills work Role 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 work Videos (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 practice Case work 7. Knowledge content contributions

Clinical Psychology Supervision Observations Report Dianne Allen p.6 Considerations for Improving Supervision of Clinical Practice from an Exploratory Case Study 8. Post session debrief for Supervisor with observer (unique to this round of group supervision)

Overview of Supervisors Practice in Formal Group Supervision Program

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 approach ie 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 help others 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, and of recommended therapeutic options those 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, the process 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 reframe the 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

Clinical Psychology Supervision Observations Report Dianne Allen p.7 Considerations for Improving Supervision of Clinical Practice from an Exploratory Case Study client from the room and engaged with the observers about diagnosis, and about possible therapy. The PSupervisor also indicated some of his own practice thinking what 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 work with the trainees current case material. As noted above, there were six instances of 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 o When the P-Supervisor intervenes it is to identify a particular aspect of therapy worth noting When the trainee stops it is to get feedback about the problem as they were experiencing it at the time P-Supervisor invites peers 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

Clinical Psychology Supervision Observations Report Dianne Allen p.8 Considerations for Improving Supervision of Clinical Practice from an Exploratory Case Study cases 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 disability what 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 and treatment 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

Clinical Psychology Supervision Observations Report Dianne Allen p.9 Considerations for Improving Supervision of Clinical Practice from an Exploratory Case Study declaration 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 test 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-buts personal 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 material personal barriers to thinkingaction 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 activity going 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 this report. 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.

Clinical Psychology Supervision Observations Report Dianne Allen p.10 Considerations for Improving Supervision of Clinical Practice from an Exploratory Case Study nature 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

Clinical Psychology Supervision Observations Report Dianne Allen p.11 Considerations for Improving Supervision of Clinical Practice from an Exploratory Case Study questioning, 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 selfassessment 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

Clinical Psychology Supervision Observations Report Dianne Allen p.12 Considerations for Improving Supervision of Clinical Practice from an Exploratory Case Study the 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.

Clinical Psychology Supervision Observations Report Dianne Allen p.13 Considerations for Improving Supervision of Clinical Practice from an Exploratory Case Study

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 be taught? 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 PSupervisor to review their own practice performance, and observing how peers learn from peers can help the PSupervisor 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 critical examination of the thinking-doing, theory-practice nexus. Clearly, experience without directed, and conscious

Clinical Psychology Supervision Observations Report Dianne Allen p.14 Considerations for Improving Supervision of Clinical Practice from an Exploratory Case Study learning 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 own increasing 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 data items that demonstrate video recordings and 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.

Clinical Psychology Supervision Observations Report Dianne Allen p.15 Considerations for Improving Supervision of Clinical Practice from an Exploratory Case Study 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 available slowing 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 learnerpractitioner, 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 Yerbutts personal 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

Clinical Psychology Supervision Observations Report Dianne Allen p.16 Considerations for Improving Supervision of Clinical Practice from an Exploratory Case Study try out for themselves, kinds of reasoning by which to determine what issues and principles are most 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 to perform 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, studentpractitioners 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 you do?" 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 are involved 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 palpable movement 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, to judiciously 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 and generalizable knowledge structures in specific domains. It is not sufficient to learn isolated components 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 experience can 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).

Clinical Psychology Supervision Observations Report Dianne Allen p.17 Considerations for Improving Supervision of Clinical Practice from an Exploratory Case Study

Figure 1 Various ways of recognising reflection in a particular learning context for psychology studies Bob Dick
Mechanisms which were designed to increase reflection by class members 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 Mechanisms which, although not specifically intended for the purpose, were identified by class members as aids to reflection 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 wellknown 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).

Clinical Psychology Supervision Observations Report Dianne Allen p.18 Considerations for Improving Supervision of Clinical Practice from an Exploratory Case Study The 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 work its 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

Clinical Psychology Supervision Observations Report Dianne Allen p.19 Considerations for Improving Supervision of Clinical Practice from an Exploratory Case Study collaborative 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 from Experience in the Practice Setting
The main theme of this consideration is the question: How might trainees be encouraged to work at the reflective work 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; working within the categories, say, as enunciated by Tripp and Boud Tripps Dimensions (Tripp, 1993) Practical How you respond in practice, at the time, the tacit response Diagnostic To identify by careful observation; categorising (categories available from ontology; from theoretical understandings); looking at possible reasons Cognitive theory match Reflective How you feel about the incident; practitioners values and values immanent critique capacities; What should I do and why ought I do it? Thinking about thinking (epistemology) Thinking about affect Thinking about behaviour Thinking about values: priorities in actions Self-awareness about practitioner values Emotion and motivation Emotion and barriers Emotional hot buttons pushed Thinking about affect issues Ethical dimension of practice Thinking about theory-in-use; ie actions/behaviour that demonstrates theory-in-use held, compared to espoused theory Socially critical Exploring the ideology for social justice power, gender, race, etc

Bouds distinctions 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 (theorypractice nexus) Emotion and motivation Emotion and barriers Emotional hot buttons pushed

Smyths list here (Smyth, 1996)

Affect

Emotional intelligence match

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 in practice?

CognitionBehaviour relationship Affect-Behaviour relationship Cognition-Affect relationship Cognition-AffectBehaviour relationship

Smyths list here Extent to which cognitions and acceptance of dominant sociocultural frame limits what can be done; 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.

Clinical Psychology Supervision Observations Report Dianne Allen p.20 Considerations for Improving Supervision of Clinical Practice from an Exploratory Case Study A supervisor cannot demonstrate what they do not do; and a supervisor trying to work with such a grid 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 starting again divergent, followed by convergent (Heron, 2001) Remember the capacity of analysis to overwhelm, and the way we use heuristics to manage in such complexity (2) Make more use of the post-practice reflective work to enhance practice-related tasks; not assessment, but for 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 for knowledge 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 the Practice Setting

In the group setting one of the 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 the Practice 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

Clinical Psychology Supervision Observations Report Dianne Allen p.21 Considerations for Improving Supervision of Clinical Practice from an Exploratory Case Study Smyths 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. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. Am I prepared to endure discomfort? Am I willing to challenge taken-for-granted (even cherished) assumptions and beliefs? Am I willing to begin to describe and theorise about what is going on here? What, then, is actually going on here? How do I know whats happening here? What else do I need to know about what is going on? Who says this is the way things should happen? How did these things come to be the way they are? Whose interests are served by having things this way? Why do I teach this way? Whose interests are served in these circumstances? Whose interests are silenced or denied? What are the impediments to change? How might I work differently? What kind of resistance might I expect? How do I intend to tackle that? How can I create different social relationships in my classroom and in the school at large? What hierarchies (authority, gender, race, class, etc) exist around me? Schools are never neutral value-free sites whose politics are served? 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 sessions observed, for sharing in thinking about reflective practice, in practice, and for post-session professional discussions and analysis review.

Clinical Psychology Supervision Observations Report Dianne Allen p.22 Considerations for Improving Supervision of Clinical Practice from an Exploratory Case Study

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