A question-based approach to supervision
One of the aims of clinical supervision is to help people to find new versions of a clinical situation or work-related scenario that has become stuck. This may be achieved by asking questions that invite change. The following approach seems to produce the most helpful outcomes.
- Do not give advice unless absolutely necessary.
- Do not offer solutions until absolutely necessary.
- Do not make interpretations of people’s behaviour or motives.
Educational supervision may sometimes require a more directive and guidance-based approach than this open approach. Tomm (1988) suggests asking different kinds of question which can help people think from new angles. These techniques and ways of asking questions have been formulated into some core concepts, the seven Cs (adapted from Launer, 2006b), which illustrate how to put supervision into practice. These are summarised below with reference to both educational and clinical supervision.
The seven Cs
1. Conversations – This implies that the conversation itself is the working tool. Effective conversations don’t just describe people’s view of reality, they create new understanding of it through the opportunity for people to rethink and reconstruct their stories.
2. Curiosity – This is the factor that changes chat into a more substantial conversation. It is used to develop the story about patients, colleagues and oneself. It involves paying close attention to both verbal and non-verbal language. It includes curiosity about the supervisor’s own responses; feeling of criticism, boredom, anxiety, etc. An important feature linked to curiosity is taking a position of neutrality. This concept is similar to that of being non-judgemental, but taking a neutral stance allows us to acknowledge our own position as well as becoming curious about the different positions others might take, including the position of no change.
3. Contexts – This develops an understanding of the person’s networks, their sense of culture, faith, beliefs, community, values, history and geography, and how these may impinge on the case presented. An important context is that of how power is understood (see below). Who holds the power and how is this seen by others? Who is asking for supervision and for what purpose? Understanding the different contexts of all the people or organisations involved is key to developing effective clinical supervision conversations and making them come alive.
4. Complexity – This involves thinking about things in a non-linear fashion, getting away from fixed ideas of cause and effect. It is a way of becoming more interested in interactions between people and the kind of patterns that develop between people and events over time to produce a richer description of the story.
5. Creativity – This means finding a way to create a story or account of reality that makes better sense for people than the one they are going through. To do this involves using oneself, intuition and sensitivity to fine-tune the conversation. It also implies the creative process of jointly constructing a new version of the story through the process of supervision.
6. Caution – This consists of looking for cues from the client to monitor their responses. It involves working on the cusp between affirmation and perturbation in order to get an appropriate level of challenge without being confrontational and without being too bland. Sometimes it may be appropriate to give straightforward advice (although you need to be aware of its limitations).
7. Care – This encompasses being respectful, considerate and attentive to patients, supervisee and yourself. It means ensuring that the work is carried out within an ethical framework.