This page presents an example of Reflective Supervision relevant to an integrated care setting.
Please see the blog post from Natalie Levkovich that introduces this topic.
Reflective supervision is "the discipline of regularly "stepping
back” to consider the meaning of what has transpired in relationships
and to examine one’s professional and personal responses to this
interactions for the purpose of determining future actions.” Minnesota
Family Home Visiting, 2009
Carmen is BHC. She just met with a patient who reported being
physically abused by her partner, the father of her five children. The patient
came to the health center to seek care for her bruises and "to talk with
someone about what to do.” The patient had with her three of her five
children. In spite of Carmen’s best
efforts, at the end of the visit, the patient reported that she was going to "try
to work it out with her partner.”
Carmen left the encounter feeling scared for the safety of
the patient and her children as well as frustrated, angry and helpless because she
had hoped for a different outcome. Carmen could not stop thinking about her own
sister’s physically and emotionally abusive husband. That night Carmen had
difficulty sleeping and felt very anxious.
Regularity: Committing to
protected, consistent, regularly scheduled meeting time.
The next day, Carmen had her scheduled weekly supervision
meeting with her supervisor. Carmen’s
supervisor greeted her, closed the door to her office and turned-off her phone.
(Supervisor’s role: Development of an atmosphere of safety, trust and consistency)
Reflection: Stepping back from
the experience to sort through feelings and thoughts about what one is
observing and doing.
Supervisor: How are you feeling
Carmen: I’m exhausted, barely
slept last night … I finally got up at 4:00 AM. I’m very worried about a
patient I saw yesterday.
Supervisor: What happened? (Supervisor’s
role: Encourage supervisee to describe in detail the situation: Who, What,
When, Where, Why?)
Carmen described her intervention with the patient.
Supervisor: What were you
thinking while in the room with the patient?
Carmen: I thought that the
partner was going to kill her if she went back… I did what I could to help her
move forward with a plan to leave…The whole time, I could not stop thinking
about my sister and the situation with her husband. It’s just so sad. It was
all I could do to not just tell her to "snap out of it and leave!”…
Supervisor: What were other
feelings you had at the time? (Attend to
Carmen: I felt helpless… frustrated and angry when she
told me she was going back home. I felt sad and scared for them. I looked at
the kids and just wanted to take them home with me. As a clinician, I know it
takes time for people to change … "this one just got to me”.
Supervisor: Why do you think
working with this patient was so difficult for you? (Attend to parallel
Carmen: I could not stop thinking
about my sister and my frustration that she won’t leave and that I have not
been able to do anything about that situation either.
Supervisor continued to listen to Carmen and encouraged
self-reflection without jumping into "making it better” or
becoming very directive. (Greater emphasis on the supervisor's ability
to listen and wait)
The supervisor attended to the emotional content of the
work and how reactions to the content might affect the work by creating a safe
A mutual evaluation, decision-making process supported by
Evaluation: What was good and challenging about the experience?
of the complexity and the difficulty of working with vulnerable families
Analysis: What sense can you make of the
What could you have done differently?
Steps: What will you do next time?
Adopted from "Gibbs
Reflective Cycle", created by Graham Gibbs;
Interest in "Structured Debriefing” as a way to promote reflection for
practitioners to connect direct practice and continued professional learning
and development; Gibbs
cycle is frequently used by healthcare practitioners.