Developing and implementing ‘meta-supervision’ for mental health nursing staff supervisees: opportunities and challenges

Abstract

This paper reports from a study of an intervention aimed at strengthening mental health nursing staff supervision. We developed and tested a short-term group-based meta-supervision intervention as a supplement to usual supervision. The intervention drew on action learning principles to activate and inspire supervisees to develop strategies for influencing their own supervision practices. The core ‘meta-supervisory’ process was organized round participants’ reflections on the possible benefits of supervision, their perceived barriers to realizing the benefits, and the articulation of concrete actions to overcome the barriers. In this paper, we introduce previously reported findings from the study and present two novel supplementary analyses of data from the meta-supervision process. First, we analyse a transcript of an audio recording made during the intervention, which illustrates how supervisees generate empowering psychosocial resources through the group processes. Second, we analyse supervisees’ paraphrased accounts of barriers to effective supervision and their accounts of personal projects to overcome the barriers. Barriers ‘outside’ the supervision setting primarily inspired projects aimed at creating structural change, whereas barriers ‘inside’ the supervision setting inspired projects aimed at creating individual change. The meta-supervision intervention was effective in increasing participation in supervision, but it shared the same problems of resistance and reluctance as often observed in supervision in general. In the discussion, we compare our ‘bottom-up’ approach to activating supervisees and implementing supervision practices with ‘top-down’ approaches. The meta-supervision intervention illustrated the importance of engaging supervisees in their own supervision and suggested how it can have both individual and organizational benefits.

Supporting our supervisors: a Summary and Discussion of the Special Issue on CBT supervision

“…These include a systemic failure to prioritize supervision, anxieties about exposing work-related concerns in supervision groups, and difficulty transferring material from supervision to everyday practice. To address these challenges, Buus et al (2016) examine a group-based, ‘meta-supervision’ intervention, led by an external ‘meta-supervisor’. Meta-supervision is designed to promote ownership, morale, self-reflection, and individual problem-solving on the personal and organizational barriers to engaging in supervision.…”

“…Paper 5: Organizing professional development to enhance practice. Like Buus et al (2016), Corrie & Lane (2016) recognize that supervisor development should not be viewed solely as a personal learning process that is left to individuals, but in order to succeed needs to contextualize supervision within the organizational environment. At the same time, Corrie & Lane's four-step PURE model ( P reparing, U ndertaking, R efining and E nhancing supervision) provides well-structured guidance to anyone who wishes to conduct individual or group CBT supervision, or to train supervisors.…”

“…The authors recognize that today's supervisors face daunting tasks, such as needing to be conversant with a wide range of problem-specific treatment protocols, and having to operate within economically mandated (rather than research-informed) time limits. Supporting our supervisors means that we must recognize and address such work challenges, or further problems may arise within the clinical service, such as those noted above in the Buus et al (2016) study. Other likely consequences are avoidance of supervision, and fatigue that can lead to ‘drifting’ from established procedures (Waller, 2009).…”

“…Consultation may also involve supervision-of-supervision, also known as ‘meta-supervision’, in which an experienced clinical supervisor observes, evaluates, and gives feedback plus guidance to a colleague on his or her supervisory work with a trainee (Newman, 2013). As noted by Buus et al (2016), meta-supervision can be done in a group format, helping clinical staff to experience a sense of institutional support for their work (see paper 4, below).…”

“…The target group for the Buus et al . (2016) study was comprised of nurses working in residential practice. Thus, the meta-supervision described in their paper contrasts with meta-supervision as described in outpatient CBT in the clinical psychology literature (e.g.…”