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Example of Reflective Supervision
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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 today?

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 feelings)

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 process)

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 space.

Collaboration: A mutual evaluation, decision-making process supported by shared discovery

• Evaluation: What was good and challenging about the experience?

• Acknowledgement of the complexity and the difficulty of working with vulnerable families

• Analysis: What sense can you make of the situation?

• Conclusion: What could you have done differently?

• Action 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.

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