Solution Focused Supervision
This article was first published in the Healthcare Counselling and Psychotherapy Journal (HCPJ Vol 6, No 1), the quarterly healthcare journal of the British Association for Counselling and Psychotherapy.
The pluses of solution-focused supervision
A solution-focused approach to supervision may be particularly suited to counsellors and others working in healthcare settings. Carole Martin outlines the reasons…
Solution-focused brief therapy grew from the work of Steve de Shazer and Insoo Kim Berg in Milwaukee4, and is constantly being developed and applied in a wide variety of settings — including that of counselling supervision. There have been some excellent articles on solution-focused supervision in recent years1-3, in which practitioners describe the approach in all its spacious simplicity - a simplicity which springs from a basic attitude of respect.
Solution-focused supervision, in parallel with therapeutic practice, is about collaborating in a partnership which pays attention to, and develops, the supervisee's interests, best intentions, and goals for their work (Table 1). It is restfully clear about the relative areas of knowledge and responsibility of the client, therapist and supervisor. Just as in solution-focused therapy, the supervisor works with the unique person beside them, using the solution-focused tools of:
- eliciting strengths and resources
- developing the supervisee's preferred future or outcome
- taking a ‘not-knowing’ position and asking appropriate questions
- using scales to measure and develop progress
- remembering to notice positive movement in small practical steps
- offering appropriate, evidenced compliments
- staying curious, respectful and adapting to the other's pace.
|Solution-focused therapy||Solution-focused supervision|
|Seeks to be helpful to the client in their agenda for therapy.||Seeks to be helpful to the supervisee in their agenda for their work.|
|Focuses on history of resources and strengths and the ‘solution story’ rather than the ‘problem story’.||Focuses on abilities, learning, and strengths that the therapist already has.|
|Pragmatic — helps the client notice what works — their good qualities, abilities in the face of difficulties, etc.||Pragmatic - helps the therapist notice what works — their skills, abilities, creative ideas, etc. in the service of the client/patient.|
|Collaborates with the client on their agenda.||Collaborates with the therapist on their agenda for their work with clients/patients.|
|Listens constructively for client's unique strengths and resources.||Listens constructively for the therapist's unique strengths and resources in order to aid clients and their practice generally.|
|Invites client to talk about and develop details of their ideas of their preferred future.||Invites and develops therapist's preferred future in terms of being as good a therapist as they can possibly be for this client, or all clients/patients, and in their working context.|
|Uses scales and circular questioning to note and measure progress towards client's preferred future and goals||Uses scales and circular questioning to note and measure progress towards the therapist's best practice|
|Maintains professional boundaries of time, place, confidentiality and ethical practice. Strives for best therapeutic practice.||Maintains professional, ethical boundaries of time, place etc. as well as appropriate accountability and care for clients/patients. Strives for best practice in supervision.|
My colleagues and I in the UK Association for Solution Focused Practice have been using this approach routinely in supervision for many years. Many of us work in different areas of the health service, in substance misuse, Child and Adolescent Mental Health (CAMHS) or other mental health areas, as well as the more general areas of physical health (see below). The model is particularly valuable in the modern, patient-centred health service, as it helps practitioners to work with the client's (or patient's) agenda, elicit the client's goals, and help therapists and their clients to prioritise what they need to do given the usually restricted time available. A beneficial side-effect is the focus on the supervisee's strengths; a morale-boosting change from the NHS tendency to ferret after problems and deficiencies.
Like all other supervisors, solution focused supervisors aim to practice ethically and professionally, maintaining an awareness of appropriate boundaries, and mindful of our responsibility to the supervisee, their clients, and where appropriate their employer or course. We assume that the supervisee is on a journey of exploration and improvement in the exciting wild woods of human interactions; occasionally we have the privilege of joining them to discuss their latest adventures.
Solution-focused supervision allows a neat match between what therapists want from supervision and what a supervisor can helpfully assume about his or her supervisees. Thomas1 quotes four relevant themes extracted from some quoted research by Heath and Tharp (1991). In this research, supervisee therapists said about supervisors:
- We want relationships based on mutual respect.
- You don't have to be a guru.
- Supervise us or evaluate us: not both.
- Assume we're competent. We're hard enough on ourselves already.
On the other side of the coin, Wheeler3 suggests four helpful ‘supervisor assumptions’:
- Supervisees want the best for their clients.
- Supervisees are likely to be already doing something that clients find valuable.
- Supervisees are likely to have hidden talents.
- Most supervisees underestimate the value of their work.
These two boxes dovetail neatly together. Thus the supervisor is more likely to be helpful to supervisees by being respectful, collaborative and pragmatic, while making the assumption that the supervisee is competent and has hidden strengths of which she or he may not yet be aware. Solution-focused thinking keeps us oriented in this direction.
Let's take an example. Patricia, a skilled and conscientious primary care counsellor, comes for supervision. We ask ‘What are your best hopes for today's meeting?’, and we hear about a client who is depressed. The client's goal seems to be ‘to find new meaning in her life’. Patricia says that she and her client just seem to talk ‘round and round’ the distressing events that led to the depression. Supervisor and supervisee know that the number of client sessions has to be limited to eight because of managing the waiting list, and already the client has had four.
We might have the following conversation with Patricia:
- ‘When the client does find ‘new meaning’ in her life, what will she be doing differently? What does that phrase mean to her? How will she know she's moving towards that state?’
- Patricia: ‘She might be talking about doing some work in her beloved garden, or putting up the photo of her daughter in the living-room again.’
- Supervisor: ‘If we look back to your first session together, and call that 0, how far up the scale towards 10 has she come, if 10 is that she's got all the help she can from counselling?’
- Patricia: ‘Four or five?’
- Supervisor: ‘What do you think she'd say if she were here?’
- Patricia: ‘About the same, I think.’
- Supervisor: ‘So it sounds as if you're tuning in well to her, and that she has already come some way. What might she say about how she's moved from zero to four or five; what has been helpful in her work with you, and what strengths has she used to keep moving?’
- (Patricia answers thoughtfully)
- ‘And suppose you both got to the very last session (session 8) and your client was telling you that although life wasn't perfect, it was a good deal better — what do you think she might be saying? And what would you be telling me after your last session, when you felt that you had done a good job together?’
In this way we begin to fine-tune, together, an understanding of the tiny steps that Patricia's client is already making towards health. Rather than ‘going round and round’, we are now focusing on helping the client (and therapist) to shape goals for their work. We are amplifying Patricia's skills and knowledge of her client; and what we focus on will blossom.
Some of the questions asked could be adapted by Patricia for use in her sessions with her client if she felt comfortable with this, though there is no suggestion that she should adopt this approach. Patricia is an independent counsellor and her work with her client is her own. The supervisor's job is to assist, respond, ask helpful questions, and recognise Patricia's therapeutic abilities — ‘coaxing expertise’, in Thomas's1 lovely phrase.
Solution-focused supervision for a variety of professionals?
Solution-focused practice sprang from a psychotherapy background, but it is now used in a wide variety of settings in which people talk together professionally, including nursing, the probation service, teaching, mental health services, and allied health professions such as occupational therapy, as well as counselling in primary and secondary care. Indeed, Hawkins and Shohet5 write of harnessing supervision to help develop a culture of new thinking and learning across a wide range of helping professionals.
A solution-focused approach can be used in any of the above contexts, because of its focus on the practitioner's direction and aims for their work. For the supervisor, it can be refreshing and interesting to go with the practitioner along new paths and into different settings. Superior clinical knowledge is not necessarily useful or even helpful in solution-focused supervision, where the spotlight falls clearly on the practitioner's abilities, and their quest for knowledge and improvement, rather than on the supervisor as the fount of all knowledge.
How can the solution-focused supervisor best work with a practitioner outside their field? Somebody once likened solution-focused work to that of a taxi-driver; the client or supervisee in the back is the boss, tells the driver where she wants to go, has a purpose for the journey, and pays the fare. The driver's job is to drive safely, keep a well-maintained cab, have the Knowledge, and be available for hire. Different areas of expertise combine to achieve a result.
In a typical physiotherapy department, for example, professional clinical knowledge is abundantly available, everyone is line managed, and there is usually a strong culture of sharing learning and information. So, faced with a clinical query, the non-physiotherapist solution-focused supervisor might respond honestly: ‘I don't know, I'm afraid. How else might you find that out?’, in the knowledge that the practitioner has many ways to discover practical answers. The supervisor's expertise is in discovering and amplifying the physiotherapist's abilities, views, and creative ideas about how to do their job as well as they can. The conversation will range over both the larger issues — managing systemic difficulties, for example, or considering the practitioner's unfolding career choices — right down to tiny steps such as encouraging a recalcitrant patient to do an exercise.
The supervisee has the answers and talents within him or herself, so the supervisor must aim to ask open and helpful questions to elicit that fresh thinking and those new answers. While our responsibility remains to ensure ethical practice as far as possible — for example in being clear and if necessary directive about such matters as child protection — in general we are working from a position of curious and respectful not-knowing. We will make some assumptions about the capability and responsibility of both our supervisee and their client. At the least, we will not assume that we know more than either of them about their respective therapeutic work. The client's (patient's) work is to run their own life as they see fit, and use the relationship with their therapist as productively as they can; the supervisee's, to do their work professionally and assist the client/patient as well as they possibly can.
We try not to hear too much of the client's story. Often new supervisees think they have to tell every little detail about the client so that the ‘cleverer or wiser’ supervisor can diagnose ‘the problem’ and tell the supervisee what to do. But we know we are not ‘wiser’ than the supervisee, in the same way as the therapist is not ‘wiser’ than the client. Each has their own job to do. And solution-focused supervisors are not looking for ‘the problem’. In the main, we are treasure-hunting — seeking the skills, abilities, creative ideas and strengths of the supervisee and supporting those qualities in the service of the client or patient. This is thrilling and totally engaging work.
How do we manage feedback? By giving the supervisee a chance to coach us to do our best work, and in the process to get more of what they want from supervision. Unless the supervisor knows if, and how, they are being helpful, it is hard to improve. One way of getting feedback is to use a ‘usefulness scale’. We might ask the therapist:
“Where 10 means ‘today's session was as useful as it could possibly be to me and my clients’, and 0 means ‘it was useless’, where are we on that scale after today's meeting?”
This is a calm and depersonalised feedback tool which allows for appreciation as well as improvement. Whatever number on the scale is chosen, we can discover:
- What went well, or what was most useful in our conversation that made the supervisee choose that number?
- What would have to be different next time (what would each of us need to do differently) to move us up just one step from there?
- If we were working at optimum level — the best supervision ever — what would that look like?
This kind of scale can be used at the end of every session, or just now and again at regular reviews. Obviously if the numbers on the scale remain very low, we might gently enquire whether the supervision was helpful enough for the supervisee to want to continue with it. Occasionally these relationships just do not work, and an alternative has to be sought. But normally, we might hear supervisees making such comments as:
- ‘Your questions are useful, but I'd like you to slow down a bit and give me more time to think’
- ‘I found it very useful to talk about the bigger, systemic picture; it made a difference to the way I run my practice, and I'd like to do more of that’
- ‘Are you really serious when you're so appreciative of this professional ability in me? I can't see it myself, but I'd love to develop it — can we talk about that some more?’
- ‘Could we do some more work on the way I say goodbye to clients?’
- ‘Can we spend some time describing the perfect supervision relationship?’
All of these comments are valid and (of course) immensely helpful to the supervisor, who gains a valuable steer on how the supervisee needs the conversation to be both the same and different, and better.
The practice of solution-focused clinical supervision is the practice of treasure hunting. We are constantly listening and watching for signs of the overflowing cornucopia hidden in the cave, in the treasure chest behind the arras, or buried deep in the earth. The light glancing off precious jewels in clients and supervisees can only be reflected in our faces.
Carole Martin is a senior accredited member of BACP, who trained in solution-focused therapy, supervision and coaching at BRIEF in London. She teaches, coaches and supervises in the NHS, in universities and privately, and is a founder member and executive secretary of the UK Association for Solution-focused Practitioners. She has spent 17 years counselling in primary care, as well as running a private practice. More information is on her website at www.northwestsolutions.co.uk
- De Shazer S. Clues: investigating solutions in brief therapy. WW Norton and Company, New York/London; 1988.
- Thomas, F. Solution-focused supervision: the coaxing of expertise. In: Miller SD, Hubble MA, Duncan BL. Handbook of solution-focused brief therapy. Jossey-Bass-Wiley, San Francisco; 1996.
- O'Connell B, Jones C. Solution-focused supervision. Counselling, November 1997 pp 289-292.
- Wheeler J. Solution-focused supervision, in Clinical Applications of Solution Focused Brief Therapy; in press. C NelsonT, Thomas F (eds). Likely publication 20072005.
- Hawkins P, Shohet R. Supervision in the helping professions (2nd ed). Buckingham: Open University Press; 2003.