The Evaluation of the experience of reflective practice for a social work intensive support team

Introduction

As a therapist working within a social work context, I gathered together a cohort of supervisees as part of my learning experience to bring to an APPCIOS webinar group as this is how we learn, through experience.  As my employers funded the training, I have evaluated it for them and am now sharing it with you and colleagues.

 

This paper is the evaluation of the experience of therapeutic supervision offered to family support workers in an intensive support service for primary age children and their families in South Lanarkshire, social work services. South Lanarkshire Council is a county, south of Glasgow. A large local authority with approximately 320,000 people, the social work department has four local offices, and the children and families department include three intensive support services.

The intensive services offer a high level of contact with children and young people who are at risk.  They aim to keep all children and young people at home and in their communities, and they can help those who have been accommodated return to family or carers.  They focus on each child`s and young person's unique needs and views, providing an intense tailored support programme.

The social work department also has a trauma recovery service (TRS) staffed by a team of therapists from various modalities providing counselling and therapy to children and families across South Lanarkshire.  This team also offer consultations and support to the social work staff and other organisations supporting children and families. 

As a member of the TRS, and as part of a programme of continuing professional development I made a request to undertake training in therapeutic supervision with The Association for Psychodynamic Practice and Counselling in Organisational Settings, APPCIOS.  South Lanarkshire Council agreed to fund the training if the cohort of supervisees to receive therapeutic supervision came from within the group of social work staff. 

FAS (meaning Grow in Gaelic) was a relatively new intensive service at this time in early 2019, that provided support to families with a child between 5-11 on the child protection register.  The staff team of nine worked both with the children and parents to promote emotional wellbeing and affect change.  The new team was ideally placed to trial the provision of therapeutic supervision support. 

Reflective Practice

APPCIOS was formed in 2011, providing information, advice, training and accreditation to individuals and organisations interested in enhancing the capacity to work interpersonally, empathically and self reflectively within a psychodynamic framework.  They specialise in the development of reflective practice within organisations and especially frontline services as they recognise how frontline staff can stagger under the emotional weight of the work. 

“The helping professions are made up of people who want to make a difference to those in pain, physical or psychological, or whose lives have been difficult and stressful. The desire to work with vulnerable clients is a profound aspiration for many people and they enter their various professions with high ideals. The reality is often very challenging: they can find themselves in the grip of strong emotions that make them feel strangers to themselves and the unremitting nature of the work can leave them feeling exhausted and unappreciated. Helping workers make sense of these experiences is at the heart of reflective practice, as is understanding the dynamics of teams and organisations.”

The therapeutic supervision training that APPCIOS offer is underpinned by systems-psychodynamic theory that evolved from the Tavistock framework of work with organisations. The model refers to the application and integration of two distinct areas of thinking and research, which together offer a comprehensive approach to understanding organisations and the behaviour of those who work within them. 

• Psychoanalytic ideas, to develop awareness of emotions, conflicts and blind spots, in order to support and manage better the emotional experience of work and relationships within work.  And the development of understanding the unconscious and its impact on behaviour.

 

• Systemic thinking, which allows for consideration of the child, family, team and organisation in context and to understand the interplay between all these aspects and the wider organisation. 

Reflective practice can take many forms from individual therapeutic supervision, process groups and work or case discussion groups.  Although prioritising space for reflection is still in development in social work services, it is considered ethical and increasingly important for frontline social work staff and other helping professions. 

 

The FAS experience

Due to therapeutic commitments in the trauma recovery service, I could only offer individual therapeutic supervision sessions to three FAS members every three weeks, for approximately a year. I then started a new three, and another, until nine staff members had had the experience.

I wrote an explanation of therapeutic supervision which described the process and introduced the idea of reflective space.  I emphasised how it differed from line management or consultation.  These therapeutic supervision sessions over time form part of a trusted relationship we develop together, and this forms a containing framework which can potentially impact both personally and professionally. It is an open, confidential space whereby the practitioner could discuss anything that they felt was impacting on themselves at work.

I encouraged the supervisees to tell me about themselves, share the feelings they had in relation to their roles, their colleagues, the team and the children and families that they worked with.  They were also encouraged to come along for sessions and to see what emerged in the space, to allow thoughts and feelings about a stuck case, or an issue to arise, as this allowed for unconscious material to be expressed.  I encouraged them to share any difficult or conflicting feelings too, as left unexpressed these may be experienced in other ways, perhaps somatically in the body- or as stress and anxiety. 

I met with nine FAS staff over the two and a half years and developed relationships with them within our regular therapeutic supervision sessions. Concurrently I attended the APPCIOS three-weekly training group to explore themes and experiences emerging in the sessions for reflection.  The training group consisted of myself and the facilitator, a psychoanalytic psychotherapist and, for a time, a colleague working in a children’s hospital setting offering reflective practice groups and individual sessions to staff.  This training group considered the material derived from our supervision practices from a psychoanalytic frame and explored unconscious processes and theories which helped to deepen understanding of the impact of the work and contained the experience, both for myself and for the FAS staff.    Themes emerged and the space enabled a further layer of reflection, that then informed my work with staff in the sessions themselves. 

 Feedback

FAS staff were asked to complete a questionnaire to give feedback on their experience of therapeutic supervision. These are some of their, verbatim, responses.

1. Initially they were asked if they found it useful

I found it helpful.

It helped me to see the children and parents views in a different way.

I have found the sessions extremely useful!

It helps me in my work and in my home life.

The various supervisions I have access to have been beneficial and have positively impacted on my ability to be reflective in my work and life.

2. If so, in what way

The therapeutic process gave me the opportunity to reflect on my practice and express difficult and confused personal and professional feelings, in a safe environment.

It was useful in helping me understand how childhood issues still play a role in my life and the lives of the families we work in partnership with.

I realise that the past affects the present so much more now, both my own and the families we work with.

My initial understanding of what the sessions may look like was that I may be given guidance on possible strategies / resources to use with families; however, the sessions have been more about being able to have a space to reflect upon and consider my own way of working with families and to challenge my own approach when met with resistance.

I think having the chance to have therapeutic supervision has changed my practice permanently, for the better!  I am more confident in my abilities, and I don’t fret like I have to fix everything anymore.  As that is not realistic and not what they need from me. 

I have learned to just listen and provide a safe space for families to talk, without my brain scrambling in the background trying to think of a solution for them.

I now understand how important relationships are in the work.  Both with my team and the families.  Especially if we are to be trauma informed and respond safely to families. 

I think differently now about success too.  I went to a family 50 times and only got in 10 or 12 times. The child was removed, and it seemed like a failure.  I then met the mother on a bus and she talked to me about when I used to visit.  She said that I helped her to understand why her son was going to be accommodated, she said she hadn’t really grasped what she was doing wrong.  She seemed sad about it, but grateful that I had helped in her understanding.  I think that helped her emotionally to accept the outcome. 

I think the sessions helped me to respect different experiences and cultures too.  To be a better listener and not judge so much. 

3. Did you experience any limitations with it?

The hour seems to go so quickly.

Initially I was a bit unsure if I would benefit from it as I did not feel like I had anything I really wanted to talk about it is also the first time I have had any form of therapeutic input so was a bit unsure if I would feel comfortable with it, however I very quickly realised that I would greatly benefit from the sessions. 

It never seems quite long enough!

I thought the supervision would be awkward and I wouldn’t know what to talk about… but every session we ran out of time.  I think it should be more widely available especially to any workers who support families with attachment disorders or trauma. 

4. Please share any further thoughts

It also helped me personally as I got an injury through stress, and I reflected in the space on my earlier life and how I like to be busy all the time.  It has helped me a lot when trying to relax, in terms of my self-care in and out of work.

I’ve also learned that endings are ok!  They don’t have to cause more trauma, and they can be positive, just with a bit of planning. 

I use boundaries in my time with families now as well, which I previously thought would feel restrictive, but I now know it models containment and I’ve found it particularly effective with children in insecure attachments.

I feel in this role my psychological wellbeing is so important if I am to continue helping children and families to understand their actions and how to control them.  Feeling safe and supported in my job has contributed massively in ensuring I am much more aware of my own needs and limitations.

After a therapeutic supervision session I would feel as though I had been recharged.

It is actually a privilege to be trusted with people’s stories, there is so much pain and trauma.  We need to safely think through how to work with them.

Other questions asked about frequency and whether they would like to remain working individually or also as a group experience.

Evaluating the feedback

Seven questionnaires were returned out of a possible nine and one member gave verbal feedback.  Therefore, eight staff experiences were captured.

The experience of the therapeutic supervision was reported as being overwhelmingly positive.  Everyone could identify changes it made to their practice and all wanted to continue.  Some identified a benefit both personally and professionally.  Several were unsure initially how it would help and what they would talk about, then found it useful in ways they didn’t imagine.  Many reported a shift in their thinking about the children and families they work with.  Specifically, there was a sense of increased self-awareness and confidence in themselves and in their role.  Areas such as ending with a family were identified as now being easier and positive rather than negative, and boundaries were understood to feel containing rather than punitive.  There was also the mention of feeling safe and supported to do the job.  The issue of trauma came up and a sense of respect for families affected by trauma emerged.  The idea of needing to think through was expressed, in order to work safely both for ourselves and for families. 

The material I now have as a result of the feedback, can be used for future good practice.

Policy and priorities

In February 2020 Scotland’s Independent Care Review published ‘The Promise’.  The Promise reflected what over 5,500 care experienced children and adults, families and the paid and unpaid workforce told the Care Review in the hope that Scotland was listening.  The report set out changes that it recommends for the ongoing care of children and families in the care system and for the staff that support them.   The report noted that they found “a frustrated anxious and overwhelmed workforce” and that a “new way of thinking about our workforce” was required to overcome this.  A key objective was outlined: the workforce must be supported to develop relationship-based practices, to “bring their whole selves to their work, and to act in what feels natural and is not impeded by a professional construct.”  In particular, the Promise calls for “adequate time for effective, flexible, day-to-day and more regular structured support, supervision and reflective practice”.

This is clear recognition that relationship-based work and reflective practice is vital for healthy social work practice.   The workforce “must be supported to listen”. 

The review also highlighted the commitment local authorities need to have for trauma- informed practice with responsibility toward children and families, as they found that many organisations acknowledged that they were uncertain about how to embed it as an approach.  This is particularly the case where there are stresses in supporting and maintaining a stable children’s workforce.  Local authorities need to prioritise training and supervision and commit to supporting trauma-informed understanding across the workforce, as well as throughout management. 

 

Good Practice

South Lanarkshire Council has had a commitment to trauma-informed practice for many years.  The in-house Trauma Recovery Service was established in 2000 and has provided support and consultation to social work staff as well as therapeutic services to children and families.  This service is a specialist trauma team that sits within social work and liaises with education and health to provide a comprehensive systemic approach to the treatment and care of children and families in South Lanarkshire.  In line with the recommendations of the care review the therapeutic supervision has been developed and is now available to all FAS staff and to the staff team of a second intense family support service for adolescents and their families.  Discussions continue about the development of reflective practice in the form of groups for both the intense support services and for other teams, and about the continued development of the provision throughout the service. 

 

The closer that therapy and Social Work tasks align the greater the chance for positive and lasting change for a child and family.  South Lanarkshire Council’s continued use of child and family Trauma Counsellors to work within Social Work Care plans remains a forward thinking and progressive initiative, which keeps reflective practice at the centre of Social Work interventions and which aligns perfectly with The Promise’s commitment to rights-based working practices.

Relational-based practice in social work services for vulnerable children and families is now recognised as central and the provision of reflective practice as safe and ethical when supporting staff to work with children and families affected by trauma is indisputable.