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Multidisciplinary team supervision in forensic psychiatry, an absolute necessity!

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Lettie Theunissen-Schuiten is passionate about clinical supervision in teams, and this stimulated her to study teams in depth at doctoral level…

I am Dutch and in Holland, team supervision is seen as a method of enabling employees to work with complex patients in a complex closed environment and is usually offered every five to six weeks.

In Germany, where I now live, and many other countries team supervision is also offered to employees as a form of professional support, mostly guided by an external professional.

Individual supervision is offered as well for employees with specific needs, but as far as l know, almost all multidisciplinary teams in forensic psychiatry have team supervision on a regular basis and employees are obliged to attend.

“From day one, I needed the safe haven of my multidisciplinary team to help me deal with all kinds of themes.”

I believe that regular team supervision is necessary for all multidisciplinary teams in forensic care and from my experience l would recommend that you consider it a requirement when you are looking for a job!

As l started working as a member of a multidisciplinary team in 1995, l quickly discovered, that being responsible for the treatment of people with complex and sometimes very emotionally disturbing psychiatric and criminal backgrounds in a closed and restricted environment, affected me.

From day one, I needed the safe haven of my multidisciplinary team to help me deal with all kinds of themes, like handling my own fear, learn about relationships to others and simply because of all the knowledge that comes together.

“In forensic hospitals, beside all the ‘normal’ issues you have in psychiatric hospitals, there is an extreme issue of power involved.”

I learned, that - having a culture of giving and receiving feedback on my work and that of others, and - becoming reflexive myself in my team, were the most important professional methods used to create safety for patients and staff.

Although I had just finished my Masters and thought l had a lot of knowledge, l found out how important it is to be able to answer reflexive questions like; - why do you react the way you do towards this patient? Are you too close or too far away in the relationship? What happened in the days before an incident, did we miss something?

In forensic hospitals, beside all the ‘normal’ issues you have in psychiatric hospitals, there is an extreme issue of power involved.

The staff is in charge off almost everything, for example all doors are locked and only staff members have keys, every personal belonging is checked, cell phones are not allowed, staff decides when the lights are turned off, patients with severe problems have to live with 10 to 20 other patients with severe problems on one ward for a long time, the whole daily routine is planned and patients only have contact with life behind the 5.5 meters high fence or wall when staff decides he or she is allowed to go on leave or to have visitors.

Discussing the issues of personal and team resilience, discussing and reflecting on all treatment decisions, reviewing incidents and learn from them, talking about the closed, restricted environment and the implications this has for everybody, is needed to keep the team and the environment healthy.

I believe multidisciplinary teams need team clinical supervision, to build team and individual knowledge and to create an open-minded culture in restricted and powerful environment, so a team can stay creative and healthy to serve patients, their families and society the best they can.

 

Lettie Theunissen-Schuiten is a part-time PhD Student at the University of Chester and owner of her own company, specialised in guiding people in (multidisciplinary) teams and Management from the philosophy of empowerment. 

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