The aim of incorporating solution-focused techniques into clinical supervision is to enhance the supervisor’s range…
VOL: 103, ISSUE: 22, PAGE NO: 30
John Fowler, PhD, MA, BA, DipN, CertEd, RGN, RMN, RCNT, RNT, is principal lecturer, School of Nursing, De Montfort University, and education consultant, Leicester City PCT
Gaynor Fenton, MSc, DipHE, DipCounselling, RSCN, RGN, is lecturer, School of Nursing, University of Salford; Jacqueline Riley, MSc, BACP, is palliative care counsellor and clinical supervisor facilitator, Salford PCT
The aim of incorporating solution-focused techniques into clinical supervision is to enhance the supervisor’s range of options when helping supervisees move forward positively. ‘Solution focus’ is about looking for solutions not dwelling on problems (Iveson, 2002). At the heart of solution-focused work is what Waskett (2006) calls ‘spacious simplicity’ - a simplicity derived from mutual respect combined with the intention of moving forward positively (Fowler, 2005).
A number of ideas and techniques in solution-based therapies apply to the supervisory relationship. These include:
- The use of scales;
- Focused questions;
- Looking for exceptions;
- Constructive feedback;
- Follow-up tasks.
These techniques assist the clinical supervisor to engage collaboratively with supervisees, encouraging reflection on practice and a focus on solutions. The supervision relationship is based on mutual respect and equality that encourage openness and honesty, and an opportunity to reflect on work-related issues in a safe and non-judgemental environment.
Models of clinical supervision
In the early 1990s a number of accounts described how clinical supervision could work, or was working, in a variety of clinical settings. Different models of clinical supervision began to emerge. At the more humanistic end of the spectrum, a growth and support model of the supervisory relationship was described. This focuses first on the relationship between the individuals then looks at the role of the supervisor to facilitate both educational and personal growth for the supervisee.
From a more behaviourist perspective, Nicklin (1997) argued that clinical supervision would become rhetoric, promoting the illusion of innovation without actually producing change. He proposed that clinical supervision be used to analyse issues and problems, clarify goals and identify ‘strategies for goal attainment and establish an appropriate plan of action’. Nicklin (1997) developed these ideas into a six-stage process of supervision.
Solution-focused clinical supervision identifies with both the humanistic and behavioural models. It values the enriching humanistic relationship that enhances growth and development, using that relationship to help the supervisee to move forward in a positive, step-by-step way.
Solution-focused brief therapy
Solution-focused brief therapy was developed as a therapeutic technique in the 1980s, under the umbrella of ‘talking therapies’. As the name suggests, the approach is about being brief and focusing on solutions with a minimal emphasis on problems. Attention is devoted to developing the person’s idea of:
- A preferred future or goal;
- Discovering the resources needed in order to achieve this.
As a talking therapy, a solution-focused approach can be effective for a range of problems in a variety of contexts (Iveson, 2002). It consists of several techniques that a helper can use to assist people identify skills, strengths, resources and goals. These techniques include the use of scales, the miracle question, searching for exceptions, constructive feedback and follow-up tasks.
The techniques, if used within clinical supervision, help the supervisor to engage collaboratively with supervisees, encouraging reflection on practice and a focus on achievable, positive solutions.
Framework for clinical supervision
The following questions encourage the supervisee to give self-affirmative, constructive feedback, such as:
- What did it take to do that?
- What helped you to achieve that?
- How did you do that?
- How did you get through that time/experience or deal with that difficulty?
- What did you learn about yourself managing to do that?
- What do you think that might have taught others about you?
The supervisor adopts the stance of a curious inquirer. Their being interested in how the supervisee managed a situation enables the supervisee to acknowledge their ability to identify the skills used.
Solution-focused clinical supervision is not a collection of techniques used in a routine, dehumanised way but within a mutually respectful relationship. The role of the supervisor is to help the supervisee realise her or his strengths and build upon them.
A number of techniques can help the supervisee focus on the positive. One is the 0-10 scale, where 10 represents the best achievement of the supervisee’s goals and zero is the worst-case scenario. The person uses the scale to assess her or his position. Their satisfaction with this position can be determined and they are also able to identify their preferred position.
The ‘miracle question’ can determine preferred futures or goals. Focusing on an aspect of the supervisee’s work, the supervisor asks: ‘If you went to sleep tonight and a miracle occurred, what would be the first thing you would notice?’ Asking ‘What else?’ several times elicits the finer detail of the person’s preferred future (see www.northwestsolutions.co.uk/questions-res.html for a full example).
The supervisee is encouraged to consider if there are times when some of the miracle is already happening (exceptions). Those ‘differences’ can be key to developing actions and behaviours for future action and enable the preferred future to be identified.
This can help them to realise that there are times when a problem does not occur and to identify what is different then and what is already working.
Subsequent sessions focus on solutions rather than problems. Asking ‘What is better?’ at the beginning of a session, as opposed to ‘How are things?’ encourages the person to focus on positive aspects. At the end of each session, the supervisor provides a summary of the supervisee’s strengths, skills and resources, based on what they have heard. Good communication cannot be overemphasised. The following are important:
- Listening with a constructive ear for evidence of resources, for example skills, strengths, supportive relationships;
- Acknowledgement of the issue or difficulty being discussed;
- Encouragement - actively showing interest and encouraging the supervisee to continue;
- Noticing and naming - involves feeding back the skills, strengths and abilities that emerge during the session;
- Scaling - using scales from 0-10.
Appropriate use of questions can aid communication and exploration, enabling the supervisee to be specific:
- Questions that are likely to draw out resourceful answers;
- Questions that lead to exploration;
- Questions of who, where, what, when, how;
- Questions that focus on one point at a time;
- Questions that encourage imagination of new behaviour and new self-image.
Solution-focused clinical supervision provides a structured framework that can be used by a range of practitioners to help colleagues reflect on practice and enhance their skills, moving forward in a positive way.
Some people work more towards one end of a spectrum than the other. Solution-based clinical supervision suggests that these models are not mutually exclusive.
Implications for practice
- Solution-focused clinical supervision can be used to help supervisees move forward positively by helping the person find solutions rather than dwelling on problems.
- Supervisors can use techniques from solution-focused brief therapy, such as the use of scales, the miracle question, searching for exceptions and constructive feedback, within the clinical supervision context.
- A range of questions can be used to encourage supervisees to give self-affirmative, constructive feedback.
- The supervisors must use the tools within a mutually respectful relationship.
- Subsequent sessions should focus on solutions rather than problems; at the end of each session the supervisor provides a summary of the supervisee’s strengths, skills and resources.
The NMC has recently updated the original (UKCC, 1995) guidance, which identifies the aims of clinical supervision to be (NMC, 2006):
- Identifying solutions to problems;
- Increasing understanding of professional issues;
- Improving standards of patient care;
- Further developing skills and knowledge;
- Enhancing the person’s understanding of her or his own practice.
A generally accepted umbrella definition of clinical supervision is that given by Butterworth et al (1998), as ‘a process that promotes personal and professional development within a supportive relationship’.
This article has been double-blind peer-reviewed